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As the 2020/21 flu season is about to collide with a sudden increase in COVID-19 transmission in cold weather, the American Academy of Pediatrics (AAP) strongly recommends that all eligible 6-month-old children or more receive their flu shots at the end of October.
Immunization with any approved age-appropriate influenza vaccine (intranasal or injectable) is acceptable, states the AAP Committee on Infectious Diseases in updated recommendations. The policy statement is posted online today at Pediatrics.
“We are concerned that children will have their protection before the flu season begins, which usually happens after Halloween, especially as we need to be prepared for some challenges in accessing doctor’s offices and hospital beds this year. common sense of what will happen in communities or what winter will look like in terms of other seasonal viruses, “said lead author Flor Munoz, MD, associate professor of pediatrics (infectious diseases) at Baylor College of Medicine in Houston, Texas . Medscape Medical News.
“This year’s recommendations are in line with those of the Centers for Disease Control and Prevention and are very similar to last year, but the vaccines themselves have changed,” Muñoz said.
Among the changes for the 2020-2021 season:
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All pediatric vaccines are now quadrivalent.
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Three of the strains are new, including the recommended influenza A (H1N1) pdm09 and A (H3N2) components and the influenza B / Victoria component. Component B / Yamagata is unchanged from 2019-2020.
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The formulas available for children 6 to 35 months have been updated. Afluria Quadrivalent will be the only vaccine for children in that age range, with a dose volume of 0.25 mL. Fluzone Quadrivalent, licensed for 0.25 mL and 0.5 mL dosing volumes, will likely only be available in a 0.5 mL dosing volume for this age group. The dosage volume for Fluarix and FluLaval, the other two vaccines available for this age group, is 0.5 ml.
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The AAP does not recommend one product over another, but advises pediatricians to administer whatever formulation is available in their communities to ensure the greatest possible coverage for the flu season.
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Children 6 months to 8 years old receiving the flu vaccine for the first time, who received only one dose before July 1, 2020, or whose vaccination status is unknown, should be vaccinated as soon as vaccines are available. They should receive two doses, ideally at the end of October. Regardless of age, those who need a single dose should also get vaccinated at the end of October.
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The contraindications for the live attenuated influenza vaccine (LAIV) have been updated to align with the recommendations of the CDC Advisory Committee on Immunization Practices. Although no additional safety risks have been reported with LAIV among children with immunodeficiencies, anatomic or functional asplenia (absence of spleen), cochlear implants, or active cerebrospinal fluid leaks, LAIV is not recommended for these groups.
According to the CDC, 188 children and adolescents under the age of 19 died from flu complications during last year’s flu season. In general, about 80% of children who die from influenza were not vaccinated.
Muñoz notes that, as with other infections, once a child has recovered from COVID-19, there would be no contraindications to receiving the flu vaccine.
But the two infections may initially be indistinguishable based solely on clinical symptoms. “In fact, this is why influenza testing and treatment are important as soon as symptoms begin, and this is why preventing influenza through vaccination is also so important,” Muñoz said. .
In the unfortunate event that a child contracts both viruses at the same time, he added: “A lot can happen, but none of them is good. Having them at the same time or one after the other is potentially seriously damaging to the lungs.”
On a positive note, Muñoz said, the masking, distancing and disinfecting precautions taken to protect against COVID-19 can reduce the incidence of other winter infections, such as the flu, colds and gastroenteritis. “Countries in the southern hemisphere, such as Argentina, Chile, South Africa and also Australia and New Zealand, which have already had their winter season, have noticed a very substantial decrease in infections compared to last year,” he said.
However, Muñoz says he is less optimistic about the ability of such infection control measures to curb infection rates in the United States due to its geographic size and diverse population.
This policy statement did not receive specific funding. Muñoz has reported on a royalty relationship with Up to Date, Pfizer, and Moderna, as well as links with Biocyst, the European Society for Pediatric Infectious Diseases, and the International Symposium on Maternal and Neonatal Immunization.
Pediatrics. Published online September 8, 2020. Full text
Diana Swift is a medical journalist living in Toronto, Canada. [email protected]
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