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AAP.org > Advocacy & Policy > AAP Health Initiatives > What's the Latest with the Flu?
Influenza activity remains elevated. According to the Centers for Disease Control and Prevention (CDC), influenza is widespread with influenza like illness reported in every state. The number of laboratory confirmed hospitalizations continues to increase, with high rates in adults > 65 years old and children 0-4 years of age. Most (57.5%) children hospitalized for laboratory confirmed influenza have no known underlying medical conditions. As of March 2, there have been 64 influenza-associated pediatric deaths reported this season.
The American Academy of Pediatrics (AAP) recommends continuing to vaccinate children against influenza now and throughout the season and prescribing antivirals for those with severe disease, those who are hospitalized, and those at high risk of serious flu complications. In addition, any person diagnosed with influenza can benefit from antiviral treatment if started within 48 hours of onset of symptoms. See the AAP policy "Recommendations for Prevention and Control of Influenza in Children, 2018-2019" for updated recommendations.
The CDC recently released a new Morbidity and Mortality Weekly Report that provides an update on this season's influenza activity. Based on CDC indicators of influenza like illness, hospitalization and mortality, this has been a low-severity influenza season so far. Preliminary data indicates that the predominant influenza virus strain circulating this year in the US is influenza A (98.4%), of which the majority, 64.5%, is influenza AH1N1pdm09, while 35.5% is influenza A H3N2. The latter is predominant in the southeast region of the country. Little influenza B activity has been seen so far, but the B Victoria lineage predominates this year. Preliminary estimates indicate that the effectiveness of influenza vaccination among children aged 6 months to 17years is 62% (95% CI 40-75) for influenza A H1N1 viruses this season. Overall vaccine effectiveness for A H3N2 viruses is 44% (955 CI 13-64), although specific estimates for children are not yet available. There is no vaccine effectiveness data available specific to any individual vaccine, including the live intranasal vaccine. Updated vaccine effectiveness data will be available at the end of the season.
Reach out to those who haven't been vaccinated yet this season to let them know it is not too late to get their flu vaccine.
Follow up with children who need a second dose to ensure optimal protection with two doses of vaccine.
Address parent's vaccine hesitancy and/or misconceptions about seasonal flu and flu vaccines.
Offer walk ins, after hours appointments, or Saturday flu vaccine clinic days.
See the AAP Voice Blog, "Mommy, Can Wonder Woman Give Me My Flu Shot?", for additional strategies.
Each year, prebooking of influenza vaccines (ordering doses for the next year's flu season) begins around February. Consider any changes in your order presentation if you will incorporate new dosing options for children down to 6 months of age. See the AAP Influenza Implementation Guidance 2018-2019 Web page on Prebooking for additional details. The guidance also includes information on supply, storage and handling, scheduling, administration, and payment and coding.
In February 2019, CDC conducted a webinar for clinicians providing an overview of seasonal influenza activity and recommendations for vaccination and antiviral treatment. The archived webinar, along with PowerPoint slides are available online.
See the AAP Red Book Online Influenza Resource page or CDC FluView. All "What's the Latest with the Flu" messages are archived. Also see the "What's the Latest with the Flu" messages for child care providers and a holiday flu prevention song from the CDC.
Influenza activity is increasing. According to the Centers for Disease Control and Prevention (CDC), while H1N1 viruses have been most common this season, H3N2, and B flu viruses have also been detected. Recently circulating H1N1 viruses are antigenically like the H1N1 viruses that circulated last season. The vaccine effectiveness of the flu shot against H1N1 viruses last season was more than 60 percent in the US. This season's flu vaccines contain the same H1N1 vaccine virus.
Unfortunately, there have already been 19 influenza-associated pediatric deaths reported during the 2018-2019 season. Even one death is too many. This reinforces the need for you to make sure that everyone in your care has been immunized against seasonal flu.
The American Academy of Pediatrics (AAP) is asking you to take action to ensure that all children get vaccinated against flu. See the AAP policy "Recommendations for Prevention and Control of Influenza in Children, 2018-2019" for updated recommendations on the routine use of seasonal influenza vaccines and antiviral medications for the prevention and treatment of influenza in children.
Also see the AAP Influenza Implementation Guidance 2018-2019, which is designed to help you and your staff prevent influenza. The guidance has information about vaccine hesitancy, including sample responses to some questions parents/guardians may ask. Do you have ideas about how to help your colleagues reach parents who are hesitant to get their child vaccinated? If so, please email here. The AAP is collecting suggestions and stories about improving influenza vaccine recommendations (or access to recommendations) when it comes to parents.
There are steps that you should take to store influenza vaccines properly according to the guidance of the manufacturer and the CDC. Temperature changes have the potential to destroy the potency of vaccine stock (especially if vaccines get too cold).
Sufficient storage space also is needed for vaccines. If a vaccine refrigerator is packed too tightly, temperature fluctuations can occur and potentially make flu vaccines and other vaccine stock unusable. Some practices may want to consider a separate flu vaccine refrigerator, for use to store those vaccines during flu vaccination season. All influenza vaccines should be stored between 2°C and 8°C (36°F and 46°F) and should not be frozen. Influenza vaccine exposed to freezing temperature should not be used.
Unfortunately, natural disasters are becoming more frequent, and these situations result in power outages, so it's wise to plan ahead. If you ever experience a loss of power, do not open freezers or refrigerators containing vaccines, except to transport them to an alternative storage location. Always continue to monitor the temperatures of your vaccines. After the event, do not discard vaccines. If vaccines were lost or damaged, contact the manufacturers for their replacement/refund policies. The AAP summarized the policies and processes of vaccine manufacturers and the CDC Vaccine for Children Program related to vaccine loss due to a natural disaster after Hurricane Michael.
For additional information, see the CDC Vaccine Storage and Handling Toolkit and the AAP Storage and Handling Web page.
Informing families about the importance of influenza prevention and control through various messaging strategies can make a real difference. The CDC Public Health Matters Blog outlines how to talk to friends, family, and patients about flu vaccines. Pediatricians can share a link to this blog with families and encourage them to take important steps to protect themselves from influenza.
Also consider sharing the Vaccine Locator. This tool helps identify the locations where influenza vaccine is available in a particular area.
Does your practice have a Web site or a social media outlet? If not, consider creating one to easily share updates and reminders with families throughout flu season. See the AAP Marketing the Practice and the Immunization Social Media Toolkit Web pages for ideas.
Consider sharing the following video in your waiting room or with families after routine visits. The AAP National Center on Early Childhood Health and Wellnessdeveloped a new 1 minute animated video that emphasizes the importance of everyone receiving a flu vaccination every year, focusing on child care professionals and the children in their care. The video also is available in Spanish.
A new AAP Voices Blog highlighted some ways that pediatricians are making it more convenient – and fun – for children to get vaccinated.
Activity 6: Immunizations for all Health Care Personnel.
Influenza activity has been low in the United States, but localized outbreaks have been reported to the Centers for Disease Control and Prevention (CDC). Two influenza-associated pediatric deaths have already been reported during the 2018-2019 season. Even one death is too many. This reinforces the need for clinicians to be vigilant in their flu immunization efforts. With family and friends gathering for the holidays, now is an ideal time to make sure that everyone is vaccinated for seasonal flu.
As with each influenza season, the American Academy of Pediatrics (AAP) urges all clinicians to take action to ensure that all children get vaccinated against flu. The CDC estimates that there were more than 960,000 hospitalizations and nearly 80,000 deaths from flu last season. 183 pediatric deaths were reported, many of these deaths were in previously healthy children but who were unvaccinated. This emphasizes just how important influenza prevention and control activities are each year.
See the AAP policy "Recommendations for Prevention and Control of Influenza in Children, 2018-2019" for updated recommendations on the routine use of seasonal influenza vaccines and antiviral medications for the prevention and treatment of influenza in children. Also see the AAP Influenza Implementation Guidance 2018-2019, which is designed to help practitioners and pediatric office staff prevent influenza. The guidance has information about vaccine hesitancy, including sample responses to some questions parents/guardians may ask.
Physicians should take strategic action to immunize all patients, particularly those with special health care needs. Children with chronic medical conditions, such as asthma, diabetes mellitus, hemodynamically significant cardiac disease, immunosuppression, or neurologic and neurodevelopmental disorders, are at high risk for influenza-related complications. Pediatricians, medical subspecialists, and parents can work together to make sure these children receive seasonal influenza vaccine as soon as it is available in their communities and that there is a plan in place to treat influenza early with antiviral medication.
Some medical subspecialists see a child more often than their primary-care provider. If so, the specialist can administer the flu vaccine or add a note to the letters sent to the child's primary care provider: "because of his/her neurologic (or other) condition, Name is at high risk for severe complications from the flu and therefore it is extremely important that he/she receive a flu vaccination as soon as vaccine is available."
Talk with parents about the importance of influenza immunization. Advise them to vaccinate their child as soon as vaccine is available in their community or whenever feasible, before the Holiday season begins.
Consider using a tracking mechanism or registry to flag children with certain conditions. This may be useful for identifying high risk patients and developing a plan to send vaccination reminders or schedule appointments.
Talk with parents about the importance of "cocooning" or immunizing family members and caregivers who spend time with children at high risk or too young to get vaccinated. Immunization of close contacts of children reduces their risk of contagion. Immunizing mothers and all family members is especially important to protect infants younger than 6 months because they are too young to receive an influenza vaccine.
Post bulletins or posters in the office. The CDC has free print materials available online.
Learn about recommendations specific to this year's flu season. Watch the archived AAP/CDC Clinician Outreach and Communication Activity (COCA) webinar titled, "2018-2019 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers."
Influenza vaccination rates among children went down during the 2017-2018 influenza season, so it's important for clinicians to remain vigilant in encouraging flu vaccination. Scheduling a large number of patients can be a daunting task for many physicians' offices, especially as it usually coincides with the school year and an increase in sick-child visits. The AAP Influenza Implementation Guidance offers tips regarding scheduling to get practices through the influenza season. For example, one idea is to offer after hours appointments or weekend flu shot clinic days. These practices can allow practices to vaccinate a much larger group of patients more efficiently.
See the AAP Red Book Online Influenza Resource page or CDC FluView. All What's the Latest with the Flu messages are archived. Also see the What's the Latest with the Flu messages for child care providers.
The AAP recommends inactivated influenza vaccine (trivalent IIV3 or quadrivalent IIV4) given in shot form as the primary choice for children. This recommendation was made because the quadrivalent live attenuated influenza vaccine (LAIV4) given via nasal spray showed inferior effectiveness against the A/H1N1 influenza virus strain during the 2013-14 and 2015-16 flu seasons. In addition, the effectiveness of the 2018-19 LAIV4 formulation against A/H1N1 viruses has not yet been documented in the US.
The AAP clarifies that LAIV4 may be used for children who would not otherwise receive an influenza vaccine, if the child is at least 2 years old and healthy without any underlying chronic medical conditions.
Children should receive a flu vaccine each season by the end of October.
Children who need two doses of flu vaccine should start the vaccination process early so that they can get two doses before the end of October.
All children with egg allergy of any severity can receive influenza vaccine without any additional precautions beyond those recommended for any vaccine. Egg allergy is not a contraindication for influenza vaccination, nor does it require special consideration (i.e. there is no need to ask about egg allergy to decide if a child can receive the flu vaccine).
Pregnant women may receive inactivated influenza vaccine at any time during pregnancy; children born to women vaccinated during pregnancy receive protection against influenza and its complications for the first several months after birth.
Antiviral medications are important in the treatment and control of influenza, but are not a substitute for influenza vaccination.
For additional information, refer to AAP resources, including the Vaccine Status Table and Influenza Resource Page within Red Book Online, which have been updated to reflect the 2018-2019 influenza policy statement. Also see the recent AAP News article, "AAP Policy Emphasizes Importance of Vaccination after High-severity Flu Season".
a the 2 doses need not have been received during the same season or consecutive seasons.
b Receipt of LAIV4 in the past is still expected to have primed a child's immune system despite recent evidence for poor effectiveness. There currently are no data that suggest otherwise.
In September the AAP collaborated with the Centers for Disease Control and Prevention (CDC) to conduct a Clinician Outreach and Communication Activity (COCA) webinar titled, "2018-2019 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers." During this COCA webinar, subject matter experts from the AAP and CDC discussed strategies that primary care providers and medical subspecialists could use to improve flu prevention and control in children for the 2018-2019 season. The presenters shared AAP and CDC recommendations about influenza vaccination and antiviral treatment, including updated recommendations for the use of LAIV4 in children. The PowerPoint slides from the webinar and a recording of the presentation are posted on the webinar Web page.
In a new 30-second public service announcement, the AAP offers advice on annual influenza immunization. In the announcement, Ilan Shapiro, MD, FAAP, urges parents to make sure that all children ages 6 months and older are vaccinated for influenza. The public service announcement is part of a monthly series produced and distributed by the AAP. To see the entire series, visit the AAP YouTube channel.
The AAP has updated its Influenza Implementation Guidance for the 2018-2019 season. It is designed to help practitioners and pediatric office staff prevent influenza by delivering influenza vaccine according to the AAP policy, "Recommendations for Prevention and Control of Influenza in Children, 2018-19". The guidance includes information for physicians, nurse practitioners, physician assistants, nurses, medical assistants, office managers, and other office staff.
US influenza activity has begun to decrease, although Influenza activity is expected to continue for several more weeks. To date, state health departments have reported 119 children have died from influenza this season. See the American Academy of Pediatrics (AAP) article "Flu Activity Continues to Slow, But 5 More Children Die".
Given current high influenza activity, clinicians should consider influenza as a likely diagnosis in patients with fever, cough and other respiratory symptoms, regardless of their age and whether or not they have received a flu vaccine this season. Persons of any age who are hospitalized, particularly with severe or progressive illness, and all high-risk patients with suspected or lab-confirmed influenza should be treated as soon as possible with antiviral medications. Children younger than 5 years of age, but especially those younger than 2 years of age, adults over 65 years of age, pregnant women, and anyone with certain underlying medical conditions, are at high risk for serious influenza complications.
Note that some manufacturers are reporting delays in filling influenza antiviral medication orders. The Centers for Disease Control and Prevention (CDC) has an Antiviral Drug Supply Web page that is updated regularly. Also see the CDC Web page, Influenza Antiviral Medications: Summary for Clinicians.
Interim influenza vaccine effectiveness is estimated to be 36% overall this season with the highest effectiveness (59%) for young children 6 months through 8 years of age, according to interim estimates from a CDC Morbidity and Mortality Weekly Report (MMWR) on February 16, 2018.
It is not too late to get your flu shot. The AAP and the CDC continue to encourage everyone aged 6 months and older to be vaccinated. Vaccination will still prevent influenza illness, including hospitalizations and deaths this season. See the AAP News article, "CDC: Flu Vaccine 36% Effective, Highest for Young Children".
In February 2018, the CDC conducted a webinar titled, "Update on the 2017-2018 Influenza Season for Clinicians". During this webinar, CDC influenza experts addressed clinical issues for influenza patients, including those with severe disease, and provided the latest updates on the 2017-2018 influenza season. The archived version of the webinar and presentation materials/resources can be viewed online.
In January 2018, the CDC held a Grand Rounds session titled, "Public Health Response to Severe Influenza". This session provided key information for public health professionals on how to reduce the spread of seasonal influenza in communities and how to adjust to spot shortages of antiviral drugs in some areas because of high influenza activity. The archived version of the Grand Rounds is available online.
In November 2017, the AAP collaborated with CDC to conduct a webinar titled "What's New for the 2017-2018 Flu Season: Recommendations for Children". During this webinar, subject matter experts from the AAP and CDC highlighted valuable information about this year's influenza season and discussed strategies primary care providers and medical subspecialists could use to improve influenza prevention and control in children. The archived version of the webinar, a transcript, and presentation materials/resources can be viewed online.
The CDC issued a Health Alert Network (HAN) Health Advisory on December 27, 2017, to notify clinicians that influenza A(H3N2) viruses are predominating in the US this season and to provide guidance on treatment. Previously, influenza A(H3N2) virus-predominant influenza seasons have been associated with more hospitalizations and deaths in young children and persons aged 65 years and older compared with other influenza virus strains.
Given this widespread influenza activity, clinicians should consider influenza infection as a highly possible diagnosis in patients with fever, cough and other respiratory symptoms, regardless of age. People with severe or progressive illness, hospitalized patients, and all high-risk patients with suspected influenza should be treated as soon as possible with antiviral medications. High-risk patients, including children younger than 5 years of age, adults over 65 years of age, pregnant women, and anyone with underlying medical conditions, are predisposed to complications of influenza.
While the total reported national supply of influenza antiviral drugs should be sufficient to meet even high seasonal demand, some manufacturers are reporting delays in filling orders. The CDC is aware of spot shortages of antiviral drugs in some places experiencing high influenza activity. The CDC is working with manufacturers to address any existing gaps in the market. Clinicians can consider including mention of the potential shortages when writing a prescription so families are aware they may need to call a pharmacy in advance.
See the American Academy of Pediatrics (AAP) policy "Recommendations for Prevention and Control of Influenza in Children, 2017 - 2018" for updated recommendations on the routine use of seasonal influenza vaccines and antiviral medications for the prevention and treatment of influenza in children.
Annual Flu Vaccination Continues to be the Best Way to Prevent Influenza.
Even though we are already in the flu season, annual vaccination remains the best available preventive measure against influenza. While the effectiveness of flu vaccines can vary from season to season, recent studies show vaccine reduces the impact of flu by about 30% to 60% among the overall population during seasons when most circulating flu viruses match well with those viruses used to produce the vaccine that season. The CDC monitors circulating viruses throughout the year and provides new and updated information about their similarity with the flu vaccine viruses as it becomes available.
Influenza surveillance data is published weekly in FluView and summarized at intervals in the Morbidity and Mortality Weekly Report (MMWR). Vaccine effectiveness estimates are also provided when available. In previous seasons, vaccine effectiveness against H3N2 viruses has been around 30%, whereas effectiveness against H1N1 viruses has been about 50% and effectiveness against influenza B viruses has been around 60%. Similar vaccine effectiveness is expected this year. For more information on the effectiveness of flu vaccines, see Frequently Asked Flu Questions 2017-2018 Influenza Season on the CDC website.
The influenza epidemic is likely to continue for several more weeks. Therefore, it is important to continue to recommend annual influenza vaccination to everyone 6 months of age and older, particularly contacts of children too young to be vaccinated and of children with high-risk underlying conditions. In addition, please ensure that children 6 months through 8 years, who need 2 doses to be adequately protected, receive both doses 4 weeks apart. It is especially important to identify and vaccinate infants who turned 6 months old since the beginning of this year's flu season. See the AAP News article, "CDC urges vaccination for flu as hospitalizations rise", for additional information.
Informing families about the importance of influenza prevention and control through various messaging strategies can make a real difference. The recent CDC Public Health Matters Blog outlines how to talk to friends, family, and patients about flu vaccines. Pediatricians can share a link to this blog with families and encourage them to take important steps to protect themselves from influenza. Also consider sharing the Vaccine Locator. This tool identifies the locations where influenza vaccine is available in a particular area. Does your practice have a Web site or a social media outlet? If not, consider creating one to easily share updates and reminders with families throughout flu season.
In November 2017, the AAP collaborated with CDC to conduct a webinar titled "What's New for the 2017-2018 Flu Season: Recommendations for Children". During this webinar, subject matter experts from the AAP and CDC highlighted valuable information about this year's flu season and discussed strategies primary care providers and medical subspecialists could use to improve flu prevention and control in children. The archived version of the webinar, a transcript, and presentation materials/resources can be viewed online.
Flu activity is increasing in the US. There have already been 8 pediatric deaths from influenza reported, so it's critically important to recommend influenza vaccination to all of your patients. With family and friends gathering for the holidays, now is an ideal time to remind those not already vaccinated to get vaccinated for seasonal flu. Remind families that it takes about two weeks after vaccination for antibodies to develop in the body that protect against influenza infection. Vaccination is the most important step anyone can take to protect themselves and their loved ones against influenza and its complications.
Pregnant women should receive the influenza vaccine at any time during pregnancy to protect themselves as well as their young infants during the first 6 months of life. Unfortunately, the CDC reports that nearly two-thirds of pregnant women have not been vaccinated against flu this season. See the American Academy of Pediatrics (AAP) AAP News article, "CDC: 64% of Pregnant Women Not Vaccinated Against Flu", for additional information.
Studies show that a confident and routine vaccine recommendation from a health care provider is influential. Pediatricians also play a crucial role in promoting vaccination to help keep women and their newborns healthy. Pediatric offices may serve as an alternate venue for providing influenza immunization for parents and other care providers of children. See the American Academy of Pediatrics (AAP) policy statement, "Recommendations for Prevention and Control of Influenza in Children, 2017 - 2018", for additional information.
In November 2017, the AAP collaborated with the CDC to conduct a webinar titled "What's New for the 2017-2018 Flu Season: Recommendations for Children". During this webinar, subject matter experts from the AAP and CDC highlighted valuable information about this year's flu season and discussed strategies primary care providers and medical subspecialists could use to improve flu prevention and control in children. The archived version of the webinar, a transcript, and presentation materials/resources can be viewed online.
The CDC created a Flu Fighter Campaign to highlight people and the work they are doing to contribute to flu prevention in the US and around the world. The AAP nominated Henry Bernstein, DO, MHCM, FAAP, to recognize him for his contributions in this area. Dr Bernstein leads the AAP influenza efforts, including the development of the annual AAP influenza policy. Dr Bernstein's Flu Fighter profile can be found here.
See the AAP Red Book Online Influenza Resource page, CDC FluView, or the CDC Digital Media Toolkit: 2017-18 Flu Season. Each "What's the Latest with the Flu" messages will be archived​.
Flu activity is still low in the US, but flu cases have now been reported in several southern states. Because flu is unpredictable, it's not possible to say when, where, or how quickly flu activity might increase, how severe it will be, or which viruses will predominate.
As with each influenza season, the American Academy of Pediatrics (AAP) urges all clinicians to take action to ensure that all children get vaccinated against flu. Clinicians should review influenza prevention and control strategies and take steps to educate others. The AAP has worked with the Centers for Disease Control and Prevention (CDC) to produce messaging and resources, including new letters and a fact sheet for health care providers. The AAP also provides a Web page for parents that explains why the nasal spray flu vaccine (live attenuated influenza vaccine or LAIV4) is not recommended for the second season in a row due to poor vaccine effectiveness the past few years.
The AAP and CDC recommend that all children 6 months and older receive a flu vaccine each year. Vaccination is especially important for children with special health care needs, such as conditions that increase the risk for complications from influenza, including children with chronic medical conditions such as pulmonary diseases like asthma, metabolic diseases like diabetes mellitus, hemoglobinopathies like sickle cell disease, hemodynamically significant cardiac disease, immunosuppression, or neurologic and neurodevelopmental disorders. Children younger than 5 years of age, but particularly children younger than 2, are also at an increased risk of hospitalization and complications attributable to influenza.
Talk with parents about the importance of influenza immunization and advise them to vaccinate their child as soon as possible.
Consider using a tracking mechanism or registry to flag children with certain conditions, as this may be useful for getting high risk patients in to be vaccinated.
Talk about the importance of "cocooning" or immunizing family members and child care providers who spend time with children who are at high risk or who cannot get vaccinated. Immunization of close contacts of children at high risk reduces their risk of contagion. Immunizing mothers and all family members is especially important to protect infants younger than 6 months, because they are too young to receive an influenza vaccine.
See the AAP policy "Recommendations for Prevention and Control of Influenza in Children, 2017 - 2018" for updated recommendations on the routine use of seasonal influenza vaccines and antiviral medications for the prevention and treatment of influenza in children. Also see the recent AAP News article noting an update to the policy to provide the latest dosage and administration information for intravenous peramivir, a neuraminidase inhibitor.
It is important for clinicians to know the specific vaccine product being administered in their office and to ensure that each patient meets the recommended age for each vaccine. See the recent AAP News article for details on code descriptors.
On November 7, 2017, the AAP collaborated with CDC to conduct a Clinician Outreach and Communication Activity (COCA) webinar titled, "What's New for the 2017-2018 Flu Season: Recommendations for Children." During this COCA webinar, subject matter experts from the AAP and CDC highlighted critical information about this flu season and discussed strategies that primary care providers and medical subspecialists could use to improve flu prevention and control in children. The PowerPoint slides from the webinar and a recording of the presentation will be posted on the webinar Web page.
The AAP developed an interactive digital map that highlights state immunization rates for vaccine-preventable diseases, as well as state laws regarding vaccine exemptions. The map, available at https://immunizations.aap.org/, includes data on how each state measures up against immunization thresholds that are important to ensure protection for all.
When a high number of people in a community are vaccinated, it is less likely that a virus will spread, lowering the risk posed by that disease for the entire community. This "community immunity" threshold varies for each vaccine-preventable disease, which is illustrated in the map.
The AAP supports increasing immunization rates by raising awareness about the protection vaccines offer not only to the public at large, but also for the most vulnerable people. These include infants younger than 6 months of age who cannot receive some vaccines themselves and children with chronic medical conditions. The map illustrates that much work remains to increase vaccination coverage rates, particularly to guard against influenza.
Children should receive their influenza vaccine by the end of October, if possible.
The number of recommended doses of influenza vaccine depends on a child's age at the time of the first administered dose and vaccine history.
All children with egg allergy of any severity can receive influenza vaccine without any additional precautions beyond those recommended for any vaccine. As such, there is no need to ask specific questions regarding history of egg allergy prior to influenza vaccination.
For additional information, refer to the updated Vaccine Status Table and Influenza Resource Page within Red Book Online, which have been updated to reflect the 2017-2018 influenza policy statement. Also see the recent AAP News article for an overview of these expanded recommendations.
Both trivalent and quadrivalent inactivated influenza vaccines are available in the United States for the 2017-2018 season. Neither inactivated vaccine formulation is preferred over the other. Although manufacturers anticipate an adequate supply of quadrivalent vaccine, pediatricians should administer whichever formulation is available in their communities in order to immunize as many people as possible this influenza season. Both inactivated vaccine formulations contain an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/HongKong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (B/Victoria lineage). Quadrivalent influenza vaccines also contain the B/Phuket/3073/2013-like virus (B/Yamagata lineage). The influenza A (H1N1) virus in both formulations differs from that contained in the 2016-2017 seasonal vaccines.
a The 2 doses need not have be​en received during the same season or consecutive seasons.
b Receipt of LAIV4 in the past is still expected to have primed a child's immune system, despite recent evidence for poor effectiveness. There currently are no data that suggest otherwise.
106 flu-associated deaths in children were reported to the CDC during the 2016-2017 influenza season. While full information on the vaccination status of these children is not yet available, in past seasons, between 80% and 85% of flu-associated pediatric deaths have occurred in children who had not gotten a flu vaccine that season. According to a recent CDC study, flu vaccination can reduce the risk of flu deaths in children.
In July 2017, a viewpoint was published in JAMA Pediatrics titled, "The Role of Patient Engagement in Addressing Parents' Perceptions About Immunizations". The article describes how physicians, nurses, and other health care professionals should increase efforts to build relationships with parents, especially when they express hesitation or have misconceptions about vaccinations.
The Vaccine Adverse Event Reporting System (VAERS) is a national early warning system to detect possible safety concerns in US-licensed vaccines. This system is co-managed by the CDC and the US Food and Drug Administration (FDA). Anyone can report an adverse event to VAERS. Health care professionals are required to report certain adverse events, and vaccine manufacturers are required to report all adverse events that come to their attention.
See the AAP Red Book Online Influenza Resource page, CDC FluView, or the CDC Digital Media Toolkit: 2017-18 Flu Season.