The intranasal live attenuated influenza vaccine (LAIV/FluMist) returns as an option for children in the 2019 Childhood and Adolescent Immunization Schedules, published online today in Pediatrics and on the Centers for Disease Control and Prevention (CDC) website.
The 2019 schedule was approved by the CDC’s Advisory Committee on Immunization Practices (ACIP), as well as by the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.
In the past two schedules, the ACIP did not recommend LAIV “because it really didn’t work for the preceding three influenza seasons,” Cody Meissner, MD, director of pediatric infectious disease at Tufts Medical Center in Boston, Massachusetts, told Medscape Medical News. Meissner is a consultant to the American Academy of Pediatrics (AAP) and liaison between the AAP and the CDC.
The manufacturer has since modified the vaccine by introducing a new H1N1 strain, and the CDC again included it as an option. However, the AAP has reservations.
“The AAP still does not identify FluMist as a first-line vaccine and says it should be reserved for children who refuse to get the shot,” Meissner said. “The AAP took that position because we don’t know if H1N1 will in fact be protective. We know this new strain does make more antibodies against H1N1 than the older vaccine, but there are no efficacy data. There is no evidence yet available that it will protect as well as IIV [inactivated influenza vaccine].”
Meissner added, “The AAP felt that since we have a vaccine that definitely works — it’s not optimal, but it definitely works — we would prefer children to receive IIV rather than LAIV until we know if it works.”
However, he added, “LAIV is better than nothing.”
The most important thing is to get as many people immunized as possible, he added.
A section has been added for guidance on vaccinating people with a history of egg allergies and when not to give LAIV.
Updates to Hepatitis A Vaccine
Also new in this year’s schedule, homelessness has been added as an indication for vaccinating children and adults against hepatitis A.
The ACIP decided to include it because there were several outbreaks of hepatitis among homeless people last year, Meissner noted.
Another recommendation regarding hepatitis A states that children aged 6 months through 11 months, as well as unvaccinated people aged 12 months or older, should receive the vaccine before traveling internationally.
“We don’t have a whole lot of hepatitis A in the United States,” Meissner noted, “but in other parts of the world it’s much more common.”
Often children who become infected during the first 3 years of life are asymptomatic, and parents don’t know that their child is infected, but infected children pass the virus in their stools and can be infecting others, Meissner said.
Clarification About Hepatitis B
A change in wording was made in the section on hepatitis B to emphasize the importance that the first dose of the vaccine should be administered to every medically stable infant who weighs 2000 grams or more who is born to a mother who is hepatitis B surface antigen negative, Meissner said.
“The reason this was added is because there are still about a thousand babies a year who are born with hepatitis B because they contract it from their mother at the time of delivery, primarily. The previous recommendation gave more latitude, so that the first dose could be given up to 2 or 3 or 4 weeks of age in a pediatrician’s office. The problem was some children were slipping through the net and did not get a dose of the vaccine early on if they were born to a mother who is known to be positive. This way, every infant gets the vaccine, even if there is a misinterpretation of the blood result’s serology or the testing done on the mother.”
The AAP has posted parent-friendly versions of the immunization schedules on HealthyChildren.org.
The authors have disclosed no relevant financial relationships.
Pediatrics. Published online February 5, 2019.