This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Definitions for the grades of evidence (A-D) and guideline definitions for evidence-based statements can be found at the end of the "Major Recommendations" field.

Recommendations

Influenza immunization is recommended for the following groups:

• Healthy children 6 through 59 months of age (recommendation; evidence Grade B).
• Children at high risk and adolescents with underlying medical conditions, including: asthma or other chronic pulmonary diseases, such as cystic fibrosis (recommendation; evidence grade B).
• Hemodynamically significant cardiac disease.
• Immunosuppressive disorders or therapy.
• Human immunodeficiency virus (HIV) infection.
• Sickle cell anemia and other hemoglobinopathies.
• Diseases requiring long-term aspirin therapy, such as juvenile idiopathic arthritis or Kawasaki disease (trivalent inactivated vaccine [TIV] only).
• Chronic renal dysfunction.
• Chronic metabolic disease, such as diabetes mellitus.
• Any condition that can compromise respiratory function or handling of secretions or can increase the risk of aspiration, such as cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders.
• Household contacts and out-of-home caregivers of children younger than 5 years and children who are at risk of all ages. Immunization of close contacts of children younger than 6 months may be particularly important, because these infants cannot be immunized (recommendation; evidence grade B).
• Children who required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases, such as diabetes mellitus; renal dysfunction; hemoglobinopathies; or immunodeficiency caused by medication or by HIV infection.
• Any female who will be pregnant during influenza season (TIV only).

In addition, immunization with either TIV or live-attenuated influenza vaccine (LAIV) is recommended for the following individuals to prevent transmission of influenza to those at risk, unless contraindicated:

• Individuals 5 years and older.
• Healthy contacts and caregivers of other children or adults at high risk of developing complications from influenza infection (recommendation; evidence grade B).
• Close contacts of immunosuppressed individuals (TIV only if severely immunosuppressed).
• Health care workers or volunteers.

Information about influenza surveillance is available through the Centers for Disease Control and Prevention Voice Information System (influenza update, 888-232-3228) or at www.cdc.gov/flu.influenza infection.

Definitions

Definitions Grades of Evidence

1. Well-designed randomized, controlled trials or diagnostic studies performed on a population similar to the guideline's target population
2. Randomized, controlled trials or diagnostic studies with minor limitations; overwhelmingly consistent evidence from observational studies
3. Observational studies (case-control and cohort design)
4. Expert opinion, case reports, or reasoning from first principles (bench research or animal studies)

Guideline Definitions for Evidence-Based Statements

A clinical algorithm, "Algorithm for determining recommended influenza immunization actions for children," is provided in the original guideline document.

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Not applicable: The guideline was not adapted from another source.

2007 Apr (revised 2008 Apr 1)

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Infectious Diseases

Committee on Infectious Diseases, 2007-2008: Joseph A. Bocchini, Jr, MD, Chairperson; Henry H. Bernstein, DO; John S. Bradley, MD; Michael T. Brady, MD; Carrie L. Byington, MD; Penelope H. Dennehy, MD; Robert W. Frenck, Jr, MD; Mary P. Glode, MD; Harry L. Keyserling, MD; David W. Kimberlin, MD; Sarah S. Long, MD; Lorry G. Rubin, MD

Liaisons: Robert Bortolussi, MD, Canadian Paediatric Society; Richard D. Clover, MD, American Academy of Family Physicians; Marc A. Fischer, MD, Centers for Disease Control and Prevention; Richard L. Gorman, MD, National Institutes of Health; R. Douglas Pratt, MD, Food and Drug Administration; Anne Schuchat, MD, Centers for Disease Control and Prevention; Benjamin Schwartz, MD, National Vaccine Program Office; Jeffrey R. Starke, MD, American Thoracic Society

Ex Officio: Carol J. Baker, MD, Red Book Associate Editor; Larry K. Pickering, MD, Red Book Editor

Consultants: Edgar O. Ledbetter, MD; H. Cody Meissner, MD

Staff: Alison Siwek, MPH

Not stated

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

None available

None available

This NGC summary was completed by ECRI Institute on May 15, 2007. The information was verified by the guideline developer on May 23, 2007. This summary was updated by ECRI Institute on March 10, 2008 following the U.S. Food and Drug Administration (FDA) advisory on Tamiflu (oseltamivir phosphate). This summary was updated by ECRI Institute on April 9, 2008 following the U.S. Food and Drug Administration (FDA) advisory on Relenza (zanamivir). This summary was updated by ECRI Institute on May 16, 2008. The updated information was verified by the guideline developer on May 20, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.