Recommendations for Prevention and Control of Influenza in Children, 2021-2022.

Abstract

This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2021–2022 influenza season. A detailed review of the evidence supporting these recommendations is published in the accompanying technical report.1 The American Academy of Pediatrics recommends annual influenza immunization of all children without medical contraindications, starting at 6 months of age. Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during circulation of severe acute respiratory syndrome coronavirus 2, which is expected to continue during the 2021–2022 influenza season. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference for one product or formulation over another. Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication is recommended for children with suspected or confirmed influenza who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza. Antiviral treatment may be considered for any previously healthy, symptomatic outpatient not at high risk for influenza complications, in whom an influenza diagnosis is confirmed or suspected, if treatment can be initiated within 48 hours of illness onset and for children whose siblings or household contacts either are younger than 6 months or have a high-risk condition that predisposes them to complications of influenza.Children consistently have the highest attack rates of influenza in the community during seasonal influenza epidemics. Children play a pivotal role in the transmission of influenza virus infection to household and other close contacts and can experience substantial morbidity, including severe or fatal complications from influenza infection.2 Children younger than 5 years, especially those younger than 2 years, and children with certain underlying medical conditions are at increased risk of hospitalization and complications attributable to influenza (Table 1).2 School-aged children bear a large influenza disease burden and are more likely to seek influenza-related medical care compared with healthy adults.2,3 Reducing influenza virus transmission among children decreases the burden of childhood influenza and transmission of influenza virus to household contacts and community members of all ages.2,3 Influenza vaccination is particularly important during the severe acute respiratory syndrome coronavirus 2 pandemic to reduce the burden of respiratory illnesses and hospitalizations and preserve the capacity of the health care infrastructure. The American Academy of Pediatrics (AAP) recommends routine influenza vaccination and antiviral agents for the prevention and treatment of influenza in children, respectively. This policy statement summarizes updates and recommendations for the 2021–2022 influenza season. An accompanying technical report provides further detail regarding recent influenza seasons, influenza vaccine effectiveness (VE), detailed updates of inactivated influenza vaccines (IIVs) and live attenuated influenza vaccines (LAIVs), influenza vaccination coverage, vaccine implementation, and timing of vaccination and duration of protection.1Children and adolescents with certain underlying medical conditions have a high risk of complications from influenza (Table 1). Although universal influenza vaccination is recommended for everyone starting at 6 months of age, emphasis should be placed in ensuring that high-risk and vulnerable children and their household contacts and caregivers receive annual influenza vaccine.The seasonal influenza vaccines licensed for children and adults for the 2021–2022 season are shown in Table 2. More than one product may be appropriate for a given patient, and vaccination should not be delayed to obtain a specific product.All 2021–2022 seasonal influenza vaccines will be quadrivalent and contain the same influenza strains as recommended by the World Health Organization and the US Food and Drug Administration Vaccines and Related Biological Products Advisory Committee for the Northern Hemisphere.4,5 Both influenza A(H1N1) and A(H3N2) components are different in this season’s vaccine. The B components are unchanged. The influenza A strains may be different for egg-based versus cell- or recombinant-based vaccines on the basis of their optimal characteristics for each platform, but all are matched to the strains expected to circulate in the 2021–2022 season.The contraindications and precautions for the use of IIV and LAIV are described in Table 3, and further details are provided in the technical report.1 Anaphylactic and severe allergic reactions to any influenza vaccine are contraindications to vaccination. The AAP recommends that children who have had an allergic reaction after a previous dose of any influenza vaccine should be evaluated by an allergist to determine if future receipt of the vaccine is appropriate.Antivirals available for the treatment and prophylaxis of influenza in children are described in Table 4.Antiviral chemoprophylaxis is recommended after known or suspected influenza exposure in the following situations: Jennifer M. Frantz, MPH