ACIP recommends live attenuated influenza vaccine for healthy children

Issue: July 2014

The CDC’s Advisory Committee on Immunization Practices voted unanimously, 14-0, to recommend preferred use of live attenuated intranasal influenza vaccine for healthy children 2 to 8 years of age who have no contraindications or precautions.

Perspective from Mary C. Dundon, MD

This is the first time a recommendation has been made for a specific influenza vaccine.

In addition, revisions to recommendations regarding influenza vaccination for children with egg allergies and the pediatric dosing algorithm were discussed.

For the 2014-2015 influenza season, the ACIP recommended , the following:

All individuals aged older than 6 months should receive influenza vaccine. Influenza vaccination should not be delayed to procure a specific vaccine preparation if an appropriate one is already available;
When available, LAIV should be used for healthy children aged 2 to 8 years who have no contraindications or precautions. LAIV is not indicated for patients aged younger than 2 years or older than 49 years;
If LAIV is not immediately available, inactivated influenza vaccine should be used. Vaccination should not be delayed in order to procure LAIV.

Regarding dosage, the ACIP recommends children aged 6 months through 8 years receive two doses when receiving influenza vaccine for the first time. Further, physicians should consider the number of doses of pandemic 2009 H1N1 vaccine the patient has received. Children who received at least one dose of 2013 seasonal vaccine need only one dose in 2014.

Jeffrey S. Duchin

Children with an egg allergy should not receive LAIV and should maintain a 30-minute wait period after receiving inactivated influenza vaccine in case of a negative reaction.

“The ACIP has formally acknowledged evidence for the superior effectiveness of LAIV in young children by incorporating a preference for LAIV use into their 2014-15 influenza vaccine recommendations. Both LAIV and inactivated injectable influenza vaccines are safe and effective vaccines. When LAIV is available, it should be used in healthy children 2 years through 8 years of age. Vaccination should not be postponed if LAIV is not available — inactivated influenza vaccine should be used,” ACIP member Jeffrey S. Duchin, MD, professor in medicine at the University of Washington, told Infectious Diseases in Children. — by Amanda Oldt

Perspective

Mary C. Dundon, MD

With the universal recommendation to vaccinate all individuals age 6 months and older every year against flu, FluMist Quadrivalent (MedImmune) has been a savior at my practice. Our seven doctor practice has 17,000 patients. Trying to stick a needle in every one of them every year is a nightmare. FluMist Quadrivalent can be given faster and without tears and fears. Previously when a family of five children came in for flu vaccine, the family dreaded it, the nurses dreaded it. And now, ask the children who wants to go first and you get, "Me, me!" The parents would ask me which one is best and are surprised when I said FluMist Quadrivalent has been shown to be more effective in children compared to the flu shot.

Other physicians have asked me about the cost of FluMist Quadrivalent. It is well covered by all our insurance plans and I get the same profit per dose that I can with the flu shot. I get more children vaccinated, faster and with fewer tears. We have also used FluMist Quadrivalent in school vaccination programs for years – it is always quick and easy among students.

Now that the ACIP recommended preferential use of LAIV among children 2 to 8 years old, this will help protect more families and communities. Of course the bottom line is for all children to receive a flu vaccine yearly. And not every child is eligible to receive FluMist Quadrivalent. But my nurses are very grateful, my patients are grateful and I am glad the ACIP has officially stated it is the preferred vaccine option for children 2 to 8 years of age. Having choices and options with vaccines only improves vaccination rates.

Mary C. Dundon, MD

Vanderbilt Children's Hospital

Disclosures: Dundon reports no relevant financial disclosures.