AAP Policy Update: Recommendations for Prevention and Control of Influenza in Children, 2018-2019

Policy Update: Recommendations for Prevention and Control of Influenza in Children, 2018-2019

Red Book Online Special Alert – September 6, 2018

The AAP has updated recommendations for the routine use of seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children.

Details appear in the policy statement, Recommendations for Prevention and Control of Influenza in Children, 2018-2019, which will be published in the October issue of Pediatrics, and have been released early online.


Highlights of these updated recommendations include:

  • AAP recommends inactivated influenza vaccine (trivalent IIV3 or quadrivalent IIV4) as the primary choice for children. This recommendation was made because quadrivalent live attenuated influenza vaccine (LAIV4) showed inferior effectiveness during previous flu seasons, and its effectiveness against A/H1N1 is unknown.
  • LAIV4 may be used for children who would not otherwise receive an influenza vaccine, if the child is at least 2 years old and healthy with no underlying chronic medical conditions.
  • All 2018-19 seasonal influenza vaccines contain a similar influenza A (H1N1) vaccine strain compared with the one that included in the 2017-18 seasonal vaccines. The influenza A (H3N2) and influenza B (Victoria lineage) differ in these vaccines from last year. The quadrivalent vaccines contain the same influenza B (Yamagata lineage) included in last year's vaccine.
  • Children should receive the flu vaccine as soon as possible after it is available in their community, preferably by the end of October.
  • All children with egg allergy of any severity can receive influenza vaccine without any additional precautions beyond those recommended for any vaccine. Egg allergy is not a contraindication for influenza vaccination, nor does it require special consideration.
  • Pregnant women may receive IIV at any time during pregnancy, and infants of vaccinated mothers receive protection against influenza and its complications.
  • Antiviral medications are important in the treatment and control of influenza, but are not a substitute for influenza vaccination

This policy statement expands the recommendations in the Influenza chapter in the current edition of Red Book (p 476–490).


Also refer to the updated Vaccine Status Table and Influenza Resource pages on Red Book Online.


Please also see the two recent AAP News articles at www.aappublications.org/news/2018/09/03/flu090318 and www.aappublications.org/news/2018/06/07/influenza060718 for an overview of these latest recommendations.