This documents summarize recent trends of past influenza seasons in the United States; discuss influenza morbidity and mortality in children; identify high-risk pediatric groups, which include children younger than age 5 years and especially under age 2 years, those with chronic pulmonary disease such as asthma, immunosuppressed patients, those with neurologic or neurodevelopment conditions, those with compromised respiratory function such as on a ventilator, those on long-term aspirin therapy, American Indians/Alaska Natives, and obese children.
The documents also describe the effectiveness of influenza vaccination on hospitalization and mortality, with up to 80% of pediatric deaths occurring in unvaccinated children. They identify the seasonal influenza vaccines available this year, which are all quadrivalent and vary in both strains of influenza A compared with last year, and include reviews of influenza vaccine contraindications and precautions, which include anaphylaxis and severe allergic reactions and the use of the live attenuated virus in children younger than age 2 years, in children aged 2 to 4 years who have a history of asthma or recurrent wheezing or a medically attended wheezing episode in the past 12 months, those with cochlear implants or active cerebrospinal fluid leak, those with suspected primary or acquired immunodeficiency or who are on immunosuppressives, those with asplenia (e.g., patients with sickle cell disease), those in close contact with a caregiver who is severely immunocompromised, those on aspirin or salicylate therapy, those who had received other live virus vaccines within the past 4 weeks, and those taking an influenza antiviral due to the presence of contraindications and a history of Guillain-Barre syndrome.
In addition, the recommendations advise on the use of influenza vaccine in the presence of an egg allergy; recommend the use of influenza vaccine during pregnancy and breastfeeding; provide tips on vaccine storage and administration; discuss the timing of vaccination and the duration of protection since influenza can circulate till late spring; stress the importance of vaccine coverage including reaching Healthy People 2030 goals of having 70% of people aged 6 months and older vaccinated against influenza; and evaluate the use of influenza antivirals with oral oseltamivir being the drug of choice in this population.
The AAP recommendations also describe the effectiveness of influenza treatment with oseltamivir, which is indicated from ages 0 months and older, and indicate that zanamivir is indicated in ages 7 years or older for treatment but ages 5 years or older for prevention; that peramivir is indicated for ages 2 years and older; that baloxavir is indicated only for children aged 12 years or older who weigh >40 kg; identifies problems associated with antiviral resistance; and addresses future directions, which include cocirculation with COVID-19, achieving adequate outreach, enhancing access to care, identifying new strains, and keeping current about new updates in the field.
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