2022-2023 Flu Season Vaccination Recommendations for Children and Adolescents

With the new flu season rapidly approaching, it’s once again time to remind patients to get their seasonal vaccination. What are the recommendations and updates for children and adolescents this year?

Recommendations

In a September 6, 2022 news release, the American Academy of Pediatrics (AAP) strongly recommends flu shots for all children aged ≥6 months with no existing contraindications. Any vaccine approved for the child’s age and health status is appropriate.¹ Children may get the intranasal live attenuated influenza vaccine or the inactivated influenza vaccine via intramuscular injection according to the release. In addition, children may be vaccinated for flu and COVID-19 at the same time.¹

The AAP noted that high-risk, medically vulnerable children, their household contacts, and their caregivers especially should be high priorities for vaccination. “Increased efforts are needed to eliminate barriers to immunization in all persons experiencing higher rates of adverse outcomes from influenza,” the release said.¹

The AAP also stressed in the news release that pregnant women may get the flu shot at any time during their pregnancy to protect their infants as well as themselves. They also noted the vaccine is safe for breastfeeding mothers.^1,3

The release highlighted gaps in vaccination coverage in Black, Hispanic, American Indian, and Alaska Native populations, so pharmacists should be doing what they can to increase vaccination rates in these groups. “During the 2021-22 flu season, only 55% of children were vaccinated to protect against influenza, and coverage levels were 8.1 percentage points lower for Black children compared with White children, according to the Centers for Disease Control and Prevention,” the release said.

The recommendations are in agreement with the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) 2022-2023 flu vaccine recommendations and are similar to the 2021-2022 season.

Updates

The 2021-2022 flu season’s vaccines were not a good match for circulating virus, however, the season’s severity was low. A CDC analysis in MMWR reported that the current season’s vaccine did not reduce outpatient respiratory illness risk in 3636 children, adolescents, and adults between October 4, 2021, and February 12, 2022.² The vaccine for the 2022-2023 season has been updated with a different H3N2 strain to better match circulating illness.³ 

For pediatric vaccination timing, ACIP recommends that most children who only need a single dose receive vaccines in September or October. However, unlike most adults, children receiving a single dose may also have received the dose in the previous July or August. Children aged 9 years and older only need 1 dose of vaccine.³

The CDC reports that children between 6 months of age and 8 years may need 2 doses of flu vaccine if they have never been vaccinated, or if they have only ever received 1 flu vaccine.³ Children in this age group who need 2 doses should get their first dose right when the vaccine becomes available because the second vaccine needs to be given 4 weeks after the first.³ Children aged younger than 5 years, and especially those aged younger than 2 years, are particularly vulnerable to severe complications from flu, so this age group is especially important to vaccinate.³

Flu deaths among children declined during the COVID-19 pandemic because of mitigation measures such as masking. Before the pandemic, 199 children died from flu during the 2019-2020 season. Only 1 pediatric death from flu was reported during the 2020-2021, according to the CDC; there were 34 pediatric deaths in the 2021-2022 flu season.⁴ Vaccination is as important as ever to reduce pediatric morbidity and mortality and to reduce strain on the health care system given the uncertainty of COVID-19 this fall and winter.

Brigid Groves, PharmD, MS, senior director of practice and professional affairs at the American Pharmacists Association (APhA) in Washington, DC spoke with Drug Topics® about AAP’s recommendations. She said the most important piece of this guidance for pharmacists to consider is that all children who are eligible for the flu shot should get one and they need to get them annually. “We have misinformation circulating that kids are less impacted by flu and don’t need an annual shot. Truly all children [aged] 6 months and older need to be vaccinated against influenza,” she said. She added that pharmacists should ask parents or caregivers if their child has had their flu shot when they are in the pharmacy visiting to fill their child’s medications for things like asthma inhalers or allergy medications at the start of the school year. “Having the conversation right then and there, and making that strong recommendation for vaccination helps to increase pediatric vaccination rates,” she said. Groves concluded by saying that visit is also a good time to recommend the child or adolescent attend their well-child visit with their provider and to make sure they are up to date on all other vaccinations.

References

1. American Academy of Pediatrics Urges Families to Get Children Vaccinated for Influenza to Prevent and Control Illness in 2022-23. News release. American Academy of Pediatrics (AAP). September 6, 2022. Accessed September 6, 2022. https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy-of-pediatrics-urges-families-to-get-children-vaccinated-for-influenza-to-prevent-and-control-illness-in-2022-23/
2. Chung JR, Kim SS, Kondor RJ et al. Interim estimates of 2021–22 seasonal influenza vaccine effectiveness — United States, February 2022. MMWR 2022/71(10);365–370. Accessed September 5, 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7110a1.htm?s_cid=mm7110a1_w
3. Summary: ‘Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2022-23’. Centers for Disease Control and Prevention (CDC). August 23, 2022. Accessed August 30, 2022. https://www.cdc.gov/flu/professionals/acip/summary/summary-recommendations.htm.
4. Influenza-associated pediatric mortality. Centers for Disease Control and Prevention (CDC). September 2, 2022. Accessed September 5, 2022. https://www.cdc.gov/flu/weekly/#:~:text=Influenza%2DAssociated%20Pediatric%20Mortality&text=The%20death%20was%20associated%20with,have%20been%20reported%20to%20CDC.