AAP Now Endorses Influenza Vaccine Shot and Nasal Spray

Troy Brown, RN

March 15, 2019

The American Academy of Pediatrics (AAP) has updated its influenza vaccination recommendations, saying both the injectable vaccine (inactivated vaccine; IIV) and the nasal spray vaccine (quadrivalent live attenuated influenza vaccine; LAIV4) are acceptable for the 2019-2020 season.

The decision is being announced now to allow healthcare providers time to place vaccine orders, AAP says.

"The current year data regarding LAIV vaccine effectiveness against all influenza strains was used to make the decision," Bonnie Maldonado, MD, FAAP, chair of the AAP Committee on Infectious Diseases, told Medscape Medical News.

Last season, the AAP recommended children receive the injectable vaccine and only get the nasal spray in situations when they might not otherwise get vaccinated — for example, during vaccine shortages or when a child refuses the shot.

"This year the AAP is comfortable with recommending the use of either LAIV or IIV, with no preference, based on the data available at this time. It is important for all individuals 6 months of age and older to receive an influenza vaccine every year in order to prevent infection and possible complications," Maldonado explained.

The US Centers for Disease Control and Prevention (CDC) recommended either the injectable or nasal spray vaccines during the 2018-2019 season. The AAP's updated influenza vaccine recommendation is now consistent with CDC's.

“Every year we are never sure if the vaccine strains are going to be perfectly matched up with incoming flu strains, but based on the information that we have now, we believe the nasal spray is an acceptable option," Maldonado said in an AAP news release.

The AAP Board of Directors reviewed the latest data on the IIV and LAIV4 vaccines and approved both on March 14, 2019. The nasal spray is indicated for healthy individuals aged 2 through 49 years, the AAP explained in the news release.

The AAP will release a formal policy statement on prevention and treatment of influenza later in the year.

In the 2013-2014 and 2015-2016 influenza seasons, the LAIV4 formulation was not as effective against the A/H1N1 strain as the IIV formulation; therefore, the AAP did not recommend it during the 2016-2017 and 2017-2018 seasons.

The manufacturer of the LAIV4 changed the formulation to include a new A/H1N1 strain in 2017, and new data from Great Britain, based "on a limited number of cases in other countries," support the effectiveness of the nasal spray vaccine against some influenza strains, according to the news release.

"There may not be sufficient data regarding LAIV from this year's US influenza season because of low usage to determine its effectiveness. There may be data from other countries but if so not until later this year," Maldonado told Medscape Medical News.

More children were vaccinated against influenza during the fall of 2018 than the year before; however, there is still room for improvement. By November 2018, approximately 45% had been vaccinated, up from 38% in November 2017, the AAP noted in the news release.

Parents should talk with their child's pediatrician if they have questions about immunizations.

"The flu virus is unpredictable and can cause serious complications even in healthy children," Flor M. Munoz, MD, FAAP, a member of the AAP Committee on Infectious Diseases, said in the news release. "Children who have been immunized are less likely be hospitalized due to flu."

Maldonado has disclosed no relevant financial relationships.

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