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Prevention of Influenza in Children in the US
of vaccine in their first season of vaccination.
11–13
The Advisory Committee on response to an influenza vaccine. The use of antiviral agents is beneficial for
Immunization Practices (ACIP) of the Centers for Disease Control and the prevention of infection, but in most situations annual immunization
Prevention (CDC) and the Committee on Infectious Disease (COID) from the against influenza is the preferred strategy.
3,20
Two classes of antiviral
American Academy of Pediatrics (AAP) are in agreement that a child less than medications are currently available to treat and/or provide prophylaxis for
nine years of age who was administered one dose of either LAIV or TIV influenza infections: adamantanes (amantadine and rimantadine) and
vaccine in their first season of vaccination should receive two doses of neuraminidase inhibitors (oseltamivir and zanamivir).
27
They are both felt to be
vaccine in their second season to ensure a sufficient protective antibody safe and effective in children. However, over the past several years studies
response and increased vaccine effectiveness.
20
have shown a rapid increase in worldwide adamantine resistance among
circulating influenza A viruses. Until further data are available on the
The possible change in vaccine antigens from one season to the next may susceptibility of this year’s influenza isolates, neither amantadine nor
result in inadequate protection for children who received only one dose of rimantadine is recommended for treatment or chemoprophylaxis of the
vaccine in their first year of vaccination and a second dose the following influenza A strain.
20,27
season.
24,25
When vaccine strains remain unchanged, the spring–fall priming
of young children engenders a similar response compared with a regimen of Expanding outreach and infrastructure to vaccinate more children is
two doses in the fall.
13
A study conducted over two consecutive seasons important for the current paradigm toward universal annual influenza
where the vaccine strains did not change showed that spring–fall priming immunization in the US. Broader routine influenza vaccination early in life is
provided protection in preventing influenza-like illness for healthy children expected to decrease morbidity and mortality associated with the disease,
(62%), but with lower efficacy compared with two doses in the same fall and will also reduce the financial costs attributable to influenza for all ages.
(82%).
26
Another study assessed the effectiveness of developing a protective When vaccine supply is limited, vaccination efforts should focus on
antibody response after one and two doses in previously unvaccinated delivering vaccination to healthy children aged six months to 18 years, all
children, and demonstrated a greater increase in protective antibody close contacts of children less than five years of age and especially less than
response for both H1N1 and H2N3 antigens than influenza B antigen.
12
six months of age, children who require regular follow-up medical care
Notably, there has been a change in at least one antigen in the annual because of underlying medical conditions that place them at high risk for
influenza vaccine in all but two of the past 15 years. The potential risks and influenza-related complications, and pregnant females.
benefits of influenza vaccine administration should be considered for
patients with suspected immunodeficiency or risk factors that contraindicate Further developments to improve the efficacy and effectiveness of both
influenza vaccination. Children should not be vaccinated with TIV or LAIV if inactivated and live-attenuated influenza vaccines will increase the number
they have a moderate to severe febrile illness. LAIV should not be delivered of persons able to receive annual influenza immunization. It is crucial that all
if nasal congestion will impede the delivery of the vaccine to the individuals receive the correct type and number of influenza vaccine doses,
nasopharyngeal mucosa. Since both TIV and LAIV are developed with within the correct time period, for vaccination to be effective. Increased
embryonated hen eggs, vaccination should be avoided for those with known education about the importance and value of routine influenza vaccination
anaphylactic reactions to eggs or egg proteins. will greatly promote a decrease in the spread of influenza throughout
communities. It is hoped that broader routine influenza vaccination will also
Chemoprophylaxis is an alternative to vaccination for those persons with reduce the financial costs attributable to influenza among persons of all
immune deficiencies, who are more likely to have an inadequate antibody ages, while improving the health of all children and families. ■
1. Clements ML, Betts RF, Tierney EL, Murphy BR, Serum and nasal 11. Neuzil KM, Jackson L, Nelson J, et al., Immunogenicity and 20. Centers for Disease Control and Prevention, Prevention and Control
wash antibodies associated with resistance to experimental reactogenicity of one versus two doses of trivalent inactivated of Influenza: Recommendations of the Advisory Committee on
challenge with influenza A wild-type virus, J Clin Microbiol, influenza vaccine in vaccine-naïve 5–8-year-old children, J Infect Dis, Immunization Practices (ACIP), MMWR, 2007;56(No. RR-6):1–54.
1986;24:157–60. 2006;194:1032–9. 21. Centers for Disease Control and Prevention, Update: Influenza
2. Couch RB, Kasel JA, Immunity to influenza in man, Annu Rev 12. Ritzwoller DP, Bridges CB, Shetterly S, et al., Effectiveness of the Activity United States and Worldwide, 2006–07 Season, and
Microbiol, 1983;37:529–49. 2003-2004 influenza vaccine among children 6 months to 8 years Composition of the 2007–08 Influenza Vaccine, MMWR,
3. American Academy of Pediatrics, Influenza. In: Pickering LK, Baker of age, with 1 vs. 2 doses, Pediatrics, 2005;116(1):153–9. 2007;56:789–94.
CJ, Long SS, McMillan JA (eds), Red Book: 2006 Report of the 13. Mullooly, JP, Barker WH, Impact of type A influenza on children: a 22. Belshe RB, Edwards KM, Vesikari T, et al., Live attenuated versus
Committee on Infectious Diseases, 27th edn, Elk Grove Village, IL: retrospective study, Am J Public Health, 1982;72:1008–16. inactivated influenza vaccine in infants and young children, N Engl J
American Academy of Pediatrics, 2006;401–11. 14. Glezen WP, Decker M, Joseph SW, Macready RG Jr, Acute respiratory Med, 2007;356:729–31.
4. Poehling KA, Edwards KM, Weinberg GA, et al., The disease associated with influenza epidemics in Houston, 23. Ashkenazi S, Vertruyen A, Aristegui J, et al., CAIV-T Study Group.
underrecognized burden of influenza in young children, N Engl J 1981–1983, J Infect Dis, 1987;155:1119–26. Superior relative efficacy of live attenuated influenza vaccine
Med, 2006;355(1):31–40. 15. Monto AS, Kioumehr F, The Tecumseh Study of Respiratory Illness. IX. compared with inactivated influenza vaccine in young children with
5. Ryan-Poirier K, Influenza virus infection in children, Adv Pediatr Occurrence of influenza in the community, 1966–1971, Am J recurrent respiratory tract infections, Pediatr Infect Dis J,
Infect Dis, 1995;10:125–56. Epidemiol, 1975;102:553–63. 2006;25:870–79.
6. Peltola V, Ziegler T, Ruuskanen O, Influenza A and B virus infection in 16. Barker WH, Excess pneumonia and influenza associated 24. Englund JA, Walter EB, Gbadebo A, et al., Immunization with
children, Clin Infect Dis, 2003;36:299–305. hospitalization during influenza epidemics in the United States, trivalent inactivated influenza vaccine in partially immunized
7. Cox NJ, Subbarao K, Influenza, Lancet, 1999;354(9186):1277–82. 1970–78, Am J Public Health, 1986;76:761–5. toddlers, Pediatrics, 2006;118:579–85.
8. O’Brien KL, Walters MI, Sellman J, et al., Severe pneumococcal 17. Barker WH, Mullooly JP, Impact of epidemic type A influenza in a 25. Walter EB, Neuzil KM, Zhu Y, et al., Influenza vaccine
pneumonia in previously healthy children: the role of preceding defined adult population, Am J Epidemiol, 1980;112:798-811. immunogenicity in 6- to 23-month-old children: are identical
influenza infection, Clin Infect Dis, 2000;30:784–9. 18. Centers for Disease Control and Prevention, Update: influenza- antigens necessary for priming?, Pediatrics, 2006;118:e570–78.
9. Centers for Disease Control and Prevention, Highly lethal MRSA associated deaths reported among children aged <18 years-United 26. Allison MA, Daley MF, Crane LA, et al., Influenza vaccine
pneumonia associated with influenza, MMWR, 2007;56;325–9. States, 2003–04 influenza season, MMWR, 2004;52:1286–8. effectiveness in healthy 6- to 21-month-old children during the
10. Englund JA, Walter EB, Fairchok MP, et al., A comparison of 2 19. Bourgeois FT, Valim C, Wei JC, et al., Influenza and other respiratory 2003-2004 season, J Pediatr, 2006;149:755–62.
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Pediatrics, 2005;115(4):1039–47. Pediatrics, 2006;119:1–8. Prophylaxis for Influenza in Children, Pediatrics, 2007;119:852–60.
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