American Academy of Pediatrics Policy Statement on Flu Vaccine (and Egg Allergy)

Influenza Vaccines and Egg Allergy

There is strong evidence that egg-allergic individuals can safely receive influenza vaccine without any additional precautions beyond those recommended for any vaccine.^1,30,31 The presence of egg allergy in an individual is not a contraindication to receive IIV [inactivated influenza vaccine] or LAIV [live attenuated influenza vaccine]. Vaccine recipients with egg allergy are at no greater risk for a systemic allergic reaction than those without egg allergy. Therefore, precautions such as choice of a particular vaccine, special observation periods, or restriction of administration to particular medical settings are not warranted and constitute an unnecessary barrier to immunization. It is not necessary to inquire about egg allergy before the administration of any influenza vaccine, including on screening forms. Routine prevaccination questions regarding anaphylaxis after receipt of any vaccine are appropriate. Standard vaccination practice for all vaccines in children should include the ability to respond to rare acute hypersensitivity reactions. Children who have had a previous allergic reaction to the influenza vaccine should be evaluated by an allergist to determine whether future receipt of the vaccine is appropriate.

Summary of Recommendations

1. The AAP recommends annual influenza vaccination for everyone 6 months and older, including children and adolescents, during the 2019–2020 influenza season.
2. For the 2019–2020 season, the AAP recommends that any licensed influenza vaccine appropriate for age and health status can be used for influenza vaccination in children. IIV and LAIV are options for children for whom these vaccines are appropriate. This recommendation is based on review of current available data on LAIV and IIV VE. The AAP will continue to review VE data as they become available and update these recommendations if necessary.
3. The AAP does not have a preference for any influenza vaccine product over another for children who have no contraindication to influenza vaccination and for whom more than one licensed product appropriate for age and health status is available. Pediatricians should administer whichever formulation is available in their communities to achieve the highest possible coverage this influenza season.
4. Children 6 through 35 months of age may receive either a 0.25- or 0.5-mL dose of the licensed, age-appropriate IIVs available this season. No product or formulation is preferred over another for this age group. Children 36 months (3 years) and older should receive a 0.5-mL dose of any available, licensed, age-appropriate inactivated vaccine.
5. The number of seasonal influenza vaccine doses recommended to be administered to children in the 2019–2020 influenza season remains unchanged and depends on the child’s age at the time of the first administered dose and vaccine history (Fig 1).
6. Children 6 months through 8 years of age who are receiving an influenza vaccine for the first time or who have received only 1 dose before July 1, 2019, should receive 2 doses of influenza vaccine ideally by the end of October, and vaccines should be offered as soon as they become available. Children needing only 1 dose of influenza vaccine, regardless of age, should also receive vaccination ideally by the end of October.
7. Efforts should be made to ensure vaccination for children in high-risk groups [See Table 1 below] and their contacts, unless contraindicated.
8. Product-specific contraindications must be considered when selecting the type of vaccine to administer. Children who have had an allergic reaction after a previous dose of any influenza vaccine should be evaluated by an allergist to determine whether future receipt of the vaccine is appropriate.
9. Children with egg allergy can receive influenza vaccine without any additional precautions beyond those recommended for all vaccines.
10. Pregnant women may receive an IIV at any time during pregnancy to protect themselves and their infants who benefit from the transplacental transfer of antibodies. Postpartum women who did not receive vaccination during pregnancy should be encouraged to receive an influenza vaccine before discharge from the hospital. Influenza vaccination during breastfeeding is safe for mothers and their infants.
11. The AAP supports mandatory vaccination of HCP as a crucial element in preventing influenza and reducing health care–associated influenza infections because HCP often care for individuals at high risk for influenza-related complications.
12. Antiviral medications are important in the control of influenza but are not a substitute for influenza vaccination. Pediatricians should promptly identify their patients suspected of having influenza infection for timely initiation of antiviral treatment, when indicated and based on shared decision-making between the pediatrician and child’s caregiver, to reduce morbidity and mortality. Although the best results are observed when the child is treated within 48 hours of symptom onset, antiviral therapy should still be considered beyond 48 hours of symptom onset in children with severe disease or those at high risk of complications.
13. Antiviral treatment should be offered as early as possible to the following individuals, regardless of influenza vaccination status:
    • any hospitalized child with suspected or confirmed influenza disease, regardless of the duration of symptoms;
    • any child, inpatient or outpatient, with severe, complicated, or progressive illness attributable to influenza, regardless of the duration of symptoms; and
    • children with influenza infection of any severity who are at high risk of complications of influenza infection [See Table 1 below], regardless of the duration of symptoms.
14. Treatment may be considered for the following individuals:
    • any previously healthy, symptomatic outpatient not at high risk for influenza complications who is diagnosed with confirmed or suspected influenza, on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset; and
    • children with suspected or confirmed influenza disease whose siblings or household contacts either are younger than 6 months or have a high-risk condition that predisposes them to complications of influenza [See Table 1 below].
15. Antiviral chemoprophylaxis is recommended in the following situations:
    • for children at high risk of complications from influenza for whom influenza vaccine is contraindicated.
    • for children at high risk during the 2 weeks after influenza vaccination, before optimal immunity is achieved.
    • for family members or HCP who are unvaccinated and are likely to have ongoing, close exposure to the following:
      • unvaccinated children at high risk; or
      • unvaccinated infants and toddlers who are younger than 24 months.
    • for the control of influenza outbreaks for unvaccinated staff and children in a closed institutional setting with children at high risk (eg, extended-care facilities);
    • as a supplement to vaccination among children at high risk, including children who are immunocompromised and may not respond with sufficient protective immune responses after influenza vaccination;
    • as postexposure antiviral chemoprophylaxis for family members and close contacts of an infected person if those people are at high risk of complications from influenza; and
    • for children at high risk of complications and their family members and close contacts, as well as HCP, when circulating strains of influenza virus in the community are not well matched by seasonal influenza vaccine virus strains on the basis of current data from the CDC and state or local health departments.