Many thanks to my colleague Theresa Frey who helped put this together. Influenza season is coming. It might already be here… Or it might not. Either way you need to get ready. And to get ready you should think about some of the following questions, and definitely read the linked article from the AAP. In general the 2018-19 influenza season was moderately severe and lasts 21 weeks – the longest season in the past decade. From October to mid February Influenza A predominated – the A(H1N1) strains specifically. The a(H3N2) strains took over from February to mid May.

There were 116 laboratory-confirmed pediatric deaths (median age 6 years), with nearly half in previously healthy children. Most of the deaths had not been vaccinated against the flu.

AAP prevention and treatment recommendations for the 2019-20 influenza season continue to urge annual vaccination for everyone 6 months and older and include seven main updates: 

Inactivated influenza vaccine (IIV) AND live attenuated influenza vaccine (LAIV) are good options for children 6 months and older. Just pick one and go with it.

The A(H1N1) and A(H3N2) components of the 2019-20 influenza vaccines are new this season. The B strains are the same as last year.

All of the pediatric influenza vaccines this season are quadrivalent. Check with your employer to see which ones they pick, since they have different lower age limits. They are all egg-based – but absolutely positively can be given to a child with a reported history of egg allergy.

None of these formulations are any better per the AAP and FDA.

Children 6 months through 8 years of age who get the flu vaccine for the first time — or who received only one dose before July 1, 2019 — should receive two doses of influenza vaccine.

Offer influenza vaccines as soon as they are available and try to get those needing two doses done by the end of October.

The recommendations for the antivirals – neuraminidase inhibitors (NAIs) (oseltamivir, zanamivir, peramivir) and the selective inhibitor of influenza cap-dependent endonuclease (baloxavir) – are all the same. Most patients don’t need them. The best results are observed within 48 hours of symptom onset, but consider antivirals beyond that in children with severe or progressive disease, or a high risk of complications, and in all patients hospitalized for influenza.

Note the the AAP’s official recommendations regarding antiviral treatment are:

Children <5 years and especially those <2 years, regardless of the presence of underlying medical conditions
Adults ≥50 years and especially those ≥65 years
Children and adults with chronic pulmonary (including asthma and cystic fibrosis), hemodynamically significant cardiovascular disease (except hypertension alone), or renal, hepatic, hematologic (including sickle cell disease and other hemoglobinopathies), or metabolic disorders (including diabetes mellitus)
Children and adults with immunosuppression attributable to any cause, including that caused by medications or by HIV infection
Children and adults with neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability, moderate-to-severe developmental delay, muscular dystrophy, or spinal cord injury)
Children and adults with conditions that compromise respiratory function or handling of secretions (including tracheostomy and mechanical ventilation)12
Women who are pregnant or postpartum during the influenza season
Children and adolescents <19 years who are receiving long-term aspirin therapy or salicylate-containing medications (including those with Kawasaki disease and rheumatologic conditions) because of increased risk of Reye syndrome
American Indian and Alaskan native people
Children and adults with extreme obesity (ie, BMI ≥40 for adults and based on age for children)
Residents of chronic care facilities and nursing homes


From the American Academy of Pediatrics Policy Statement: Recommendations for Prevention and Control of Influenza in Children, 2019–2020, September 2019.

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