AAP updates recommendations for prevention, control of influenza

AAP. Pediatrics. 2010;doi:10.1542/peds.2010-2216.

All children aged older than 6 months should receive the annual trivalent seasonal influenza vaccine, and pediatricians should consider prophylaxis and treatment with antiviral medications under certain circumstances, according to the American Academy of Pediatrics.

In a policy statement, the AAP said the 2010-2011 trivalent seasonal influenza vaccine includes the pandemic strain — A/California/7/2009 (H1N1)-like virus — that caused widespread illness during 2009.

Although the pandemic has ended, the AAP said many children remain susceptible to the disease, and all children aged older than 6 months should receive the 2010-2011 seasonal influenza vaccine. In the statement, AAP researchers offer the following dosing recommendations:

Children aged 9 years and older require one dose regardless of previous vaccination.
Children aged younger than 9 years require a minimum of two doses of 2009 pandemic H1N1 vaccine strain.
Children aged younger than 9 years who are receiving the trivalent seasonal influenza vaccine for the first time should receive a second dose for the 2010-2011 season at least 4 weeks after the first dose.
Children aged younger than 9 years who received trivalent seasonal influenza vaccine before the 2009-2010 season in addition to at least one dose of the H1N1 monovalent vaccine last year require only one dose.
Children aged younger than 9 years who only received one dose of the seasonal influenza vaccine for the first time last year require two doses of the 2010-2011 seasonal influenza vaccine.
Children aged younger than 9 years who received influenza vaccine during the 2009-2010 season, but for whom it is unclear whether it was seasonal or monovalent, should receive two doses of the 2010-2011 vaccine.

The AAP said health care providers’ involvement is important in advocating immunization as soon as the vaccine is available, as well as throughout the season, noting that early intervention not only prevents disease transmission but also creates opportunity for administering a second dose of vaccine.

Health care professionals should also use resources and partnerships created during the 2009 pandemic to facilitate vaccination, according to the policy statement. Strategies include making vaccination accessible outside pediatricians’ offices through walk-in influenza clinics, schools, daycare centers and other venues. Vaccine manufacturers, distributors and payers should also become involved in the effort.

Additionally, although some doses of the 2009 H1N1 monovalent vaccine have expired, pediatricians should continue to stock doses that have not yet expired in case vaccine shortages occur during the 2010-2011 season, the AAP said.

Vaccine types

The researchers also noted that healthy children aged 2 years and older can receive either the trivalent inactivated influenza vaccine or the live-attenuated influenza vaccine. However, children with certain underlying medical conditions, such as asthma or immunosuppressive disorders, should receive the trivalent inactivated influenza vaccine.

Children with anaphylactic reactions to egg or chicken proteins and those who have experienced Guillain-Barré syndrome within 6 weeks after a previous influenza vaccination should not receive the trivalent inactivated influenza vaccine.

In addition to these groups, the AAP also recommends that children aged younger than 2 years and pregnant women should not receive the LAIV. The vaccine should also not be administered to children with certain underlying medical conditions, those who are taking certain medications and those who have received other live vaccines in the past 4 weeks. Children may, however, receive the vaccine on the same day as other live vaccines.

Antiviral treatment, prophylaxis

Oseltamivir (Tamiflu, Roche) and zanamivir (Relenza, GlaxoSmithKline) are the drugs of choice for prophylaxis and treatment of influenza during the 2010-2011 season, according to the policy statement, as amantadine and rimantadine appear ineffective against the strains expected to circulate.

The liquid formulation of oseltamivir has a concentration of 12 mg/mL, although if this form is unavailable, pharmacists may mix capsules’ contents with a sweetened liquid to a final concentration of 15 mg/mL, the AAP said.

Treatment guidelines are consistent for infants and children. Pediatricians should consider treatment for high-risk children with any level of the disease and for healthy children who require a decrease in the duration of symptoms.

“Clinical judgment is an important factor in treatment decisions for pediatric patients who present with influenza-like illness,” the researchers wrote. “Antiviral treatment should be started as soon as possible after illness onset and should not be delayed while waiting for a definitive influenza test result.”

The AAP recommends that antiviral medications also be used as prophylaxis in high-risk populations or among unimmunized children and adults who are likely to have ongoing exposure to the disease. These drugs can also be used for postexposure prophylaxis or as a supplement to vaccination in high-risk children.

Although these recommendations provide guidance, the AAP said staying up-to-date is important and can be accomplished by regularly checking the CDC’s website.

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