Until what age should children receive annual influenza vaccination?

Annual Influenza Vaccination for Children: Age Recommendations

Children should receive annual influenza vaccination starting at 6 months of age and continuing through 18 years of age (through their 18th birthday). 1

Age Range for Annual Vaccination

The American Academy of Pediatrics (AAP) has consistently recommended since 2008 that all children from 6 months through 18 years of age receive annual influenza vaccination, regardless of underlying health conditions. 1 This represents a universal recommendation that applies to:

• Infants and toddlers: 6 months through 23 months 1
• Preschool children: 24 months through 4 years 1
• School-age children: 5 through 12 years 1
• Adolescents: 13 through 18 years 1

Why Vaccination Continues Through Age 18

The recommendation extends through adolescence because:

• School-aged children and adolescents bear the highest influenza disease burden in the community, with attack rates of 30-40% during seasonal epidemics 1, 2
• Children serve as primary vectors for transmitting influenza to household contacts and community members of all ages 1
• Adolescents have significantly higher rates of seeking influenza-related medical care compared to healthy adults 1
• Reducing transmission among school-aged populations decreases the overall community burden of influenza across all age groups 1

Critical Age Groups Requiring Special Emphasis

While vaccination is universal for ages 6 months through 18 years, special effort should be made to vaccinate:

• Children younger than 2 years, who face the highest risk of hospitalization and severe complications (41-77 hospitalizations per 100,000 children) 1
• Children with chronic medical conditions (asthma, diabetes, cardiac disease, immunosuppression, neurologic disorders) at any age from 6 months onward 1
• Infants born preterm starting at 6 months chronologic age 1

Dosing Considerations by Age

For children 6 months through 8 years:

• First-time vaccine recipients require 2 doses separated by at least 4 weeks 1, 3, 4
• Children who received only 1 dose in their first vaccination season need 2 doses in the current season 3
• Both doses should ideally be administered before the end of October 3

For children and adolescents 9 through 18 years:

• 1 dose annually is sufficient regardless of vaccination history 1

Protection for Infants Under 6 Months

Infants younger than 6 months cannot receive influenza vaccine as it is not approved for this age group. 1, 3 Therefore:

• All household contacts and caregivers of infants under 6 months must be vaccinated to provide indirect protection 1, 3
• Pregnant women should receive influenza vaccine at any time during pregnancy to protect both themselves and their newborns 1
• Postpartum women who were not vaccinated during pregnancy should receive the vaccine before hospital discharge 1

Common Pitfalls to Avoid

• Do not stop vaccinating at age 5 or any arbitrary age before 18 years - the recommendation explicitly continues through age 18 1
• Do not assume healthy adolescents don't need vaccination - they remain important disease vectors and experience significant morbidity 1
• Do not delay the second dose in young children beyond 4 weeks, as this may leave them inadequately protected during peak season 3
• Do not forget to vaccinate household contacts of high-risk children and infants under 6 months 1

Historical Context

The AAP expanded recommendations progressively: initially targeting only high-risk children, then adding healthy children 6-23 months (2004), then 24-59 months (2006), and finally all children 6 months through 18 years by 2008. 1, 5 This expansion was based on epidemiologic evidence showing that children experience the highest attack rates and play a pivotal role in community transmission. 1