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2022-2023 Pediatric Flu Vaccine Guidelines

The flu vaccine is essential for children, but many parents and caregivers feel hesitant about vaccinations. Plus, there are many products available, each with different license requirements. How do you choose the right one? Here’s what to know.

Types of Flu Vaccines Available

Flu vaccines contain three or four strains of influenza: one influenza or H1N1, one influenza A or H3N2, and one influenza B. A three-strain vaccine is called a trivalent, and a four-strain vaccine is a quadrivalent, which has an additional influenza B strain.  The World Health Organization sets the strain recommendations for the season, and manufacturers create different types of vaccines.

Inactivated Influenza Vaccine (IIV)

An inactivated vaccine contains a nonliving influenza virus and is available in trivalent or quadrivalent form. Some have adjuvants that promote a stronger immune response, while others do not. The IIV comes in as a trivalent or quadrivalent in standard or high doses. A high dose contains four times the amount of viral antigen.

Live Attenuated Influenza Vaccine (LAIV)

A live attenuated vaccine contains a live but weakened influenza virus. The virus is grown in an egg-based solution and then developed into the final product in a trivalent or quadrivalent format. LAIV versions are available as a nasal spray and don’t contain any adjuvants.

Differences in Flu Vaccines

The main difference between flu vaccines is how they’re made. Some are for the general population, and others for older adults. However, each flu vaccine is considered based on a patient’s age, allergies, and health conditions.  In general, you can give healthy people aged 6 months and older most forms of non-adjuvanted trivalent or quadrivalent IIV, though the dose varies. However, influenza B is likely to cause severe illness in children aged six to 23 months, so a quadrivalent vaccine should be offered for better protection.

Vaccine Contraindications for Pediatrics 

Contrary to popular thought, you can give egg-based flu vaccines to a child with a known egg allergy. Evidence indicates that the risks of an adverse event associated with trace amounts of ovalbumin in vaccines are low.  However, patients can be allergic to other components. Children who have previously reacted to an influenza vaccine shouldn’t receive another one. These include:

  • Anaphylactic reactions
  • Guillain-Bare syndrome within 6 weeks of a flu vaccine

Additionally, LAIV nasal sprays are not recommended for children who have:

  • Immune-compromising conditions, except stable HIV
  • Severe asthma
  • Wheezing within seven days of vaccination

A LAIV also isn’t recommended for children:

  • Younger than 24 months of age
  • Aged two to 17 years taking aspirin
  • Taking influenza antiviral agents unless under a specific timeline

What Are Current NACI Guidelines?

The National Advisory Committee on Immunization (NACI) guidelines recommend you offer the influenza vaccine every year to anyone six months and older who doesn’t have contraindications to the vaccine. Caregivers of infants less than six months and pregnant mothers should also receive a flu vaccine to lower the likelihood of infants getting sick.  General pediatric vaccine recommendations are as follows:

  • Age six to 23 months:
    • IIV in a standard dose
    • Adjuvanted or non adjuvanted
    • Trivalent or quadrivalent
  • Age two to 17 years: 
    • IIV in a standard dose
    • Trivalent or quadrivalent
    • LAIV quadrivalent nasal spray

Can You Vaccinate a Sick Child?

Yes. Vaccinations are safe to give when a child has a mild or moderate illness. However, a nasal spray might not work well if the child has too much nasal congestion. You can wait until symptoms improve or give a different vaccine. Vaccines should only be delayed in pediatrics if a child has a severe, acute illness.

How To Explain the Importance of Vaccination to a Caregiver

The most effective way to explain the importance of vaccination in pediatrics is to openly discuss the risks of influenza and the safety, effectiveness, and potential risks of vaccines. Give caregivers accurate information and answer any questions.  Inform parents that:

  • Influenza can cause severe disease and hospitalization.
  • Vaccination is the best way to prevent influenza.
  • You don’t get the flu from the flu vaccine or pass it on to others.
  • Allergic reactions and serious injuries are possible, but these are rare.

What Patients Need To Know After Vaccination

Children might have some mild side effects from the flu vaccine. These are normal immune responses and go away within a few days. Common symptoms include:

  • Headache
  • Fever
  • Muscle aches
  • Tiredness
  • Red, swollen, sore arm where the needle was given
  • Runny nose and wheezing after a nasal spray

Pediatric influenza vaccines change every year and it is essential for physicians and pharmacists to stay up to date on current clinical guidelines. Join the MDBriefCase community for free.