What are the guidelines for flu and COVID-19 (Coronavirus Disease 2019) vaccinations in pediatric patients?

Pediatric Influenza and COVID-19 Vaccination Guidelines

The American Academy of Pediatrics (AAP) recommends annual influenza vaccination for all children 6 months and older, and COVID-19 vaccination for eligible children according to current age recommendations, with both vaccines being safely co-administered if needed. 1

Influenza Vaccination Guidelines

General Recommendations

• Annual influenza vaccination is recommended for everyone 6 months and older, including all children and adolescents 1
• Vaccination should ideally be completed by the end of October, though it can be administered throughout the influenza season 1

Vaccine Types and Selection

• Any licensed, age-appropriate influenza vaccine can be used without preference between options 1
• Both inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) are acceptable options for children without contraindications 1
• Children with history of asthma or wheezing should avoid LAIV 2

Dosing Schedule

• Children 6 months through 8 years of age:
  • Need 2 doses (given 4 weeks apart) if:
    • Receiving influenza vaccine for the first time
    • Previously received only 1 dose before July 1 of current year
    • Vaccination status is unknown 1
  • Need only 1 dose if previously received ≥2 doses of influenza vaccine at any time before July 1 of current year 1
• Children 9 years and older: Need only 1 dose regardless of vaccination history 1

Dosage by Age

• Children 6-35 months: May receive any licensed, age-appropriate IIV at the indicated dose (either 0.25 mL or 0.5 mL depending on product) 1
• Children 36 months and older: Should receive a 0.5 mL dose of any available, licensed, age-appropriate vaccine 1

COVID-19 Vaccination and Co-administration

• Influenza vaccines may be administered simultaneously with or any time before or after COVID-19 vaccines 1
• Children with acute moderate or severe COVID-19 should delay influenza vaccination until they have recovered 1
• Children with mild COVID-19 illness may be vaccinated 1

High-Risk Groups Requiring Special Attention

Priority Groups for Vaccination

• Children <5 years, especially <2 years 1
• Children with chronic medical conditions:
  • Pulmonary disorders (including asthma)
  • Cardiovascular disease
  • Immunosuppression
  • Neurologic conditions
  • Metabolic disorders (including diabetes)
  • Renal, hepatic, or hematologic disorders 1
• American Indian/Alaska Native children 1
• Children receiving long-term aspirin therapy 1
• Children with extreme obesity (BMI ≥40) 1

Special Considerations

Egg Allergy

• Children with egg allergy of any severity can receive any influenza vaccine without additional precautions beyond those recommended for all vaccines 1

Pregnancy and Postpartum

• Pregnant women should receive IIV at any time during pregnancy to protect themselves and their infants 1
• Women in the postpartum period who were not vaccinated during pregnancy should receive influenza vaccine before hospital discharge 1

Contraindications and Precautions

• Children who have had an allergic reaction after a previous dose of any influenza vaccine should be evaluated by an allergist before receiving future doses 1
• Product-specific contraindications must be considered when selecting the vaccine type 1

Antiviral Treatment and Prophylaxis

Treatment Recommendations

• Antiviral treatment should be offered as early as possible to:
  • Any hospitalized child with suspected or confirmed influenza
  • Children with severe, complicated, or progressive illness
  • Children at high risk of complications, regardless of symptom duration 1

Prophylaxis Considerations

• Antiviral chemoprophylaxis is recommended for:
  • High-risk children for whom influenza vaccine is contraindicated
  • High-risk children during the 2 weeks after vaccination, before optimal immunity
  • Unvaccinated family members or healthcare personnel in contact with high-risk individuals 1

Practical Implementation

• Pediatric offices may serve as vaccination venues for parents and caregivers of children, which can increase overall vaccination rates 1
• Children are 2.77 times more likely to be immunized if their parents are also immunized 1
• During the COVID-19 pandemic, influenza vaccination becomes even more important due to the potential for co-circulation of both viruses 3, 4
• Co-infection with influenza and COVID-19 has been associated with higher risk of poor outcomes compared to COVID-19 infection alone 5

Common Pitfalls to Avoid

• Delaying vaccination while waiting for a specific product - any age-appropriate vaccine should be used when available 1
• Assuming that COVID-19 mitigation measures will prevent influenza - vaccination remains essential 4
• Missing the opportunity to vaccinate high-risk children and their contacts 1
• Failing to recognize that children with mild COVID-19 can still receive influenza vaccination 1
• Overlooking the need for screening high-risk COVID-19 patients for influenza co-infection 5

By following these guidelines, healthcare providers can help reduce the burden of respiratory illness in children during influenza season, particularly in the context of ongoing COVID-19 circulation.