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In their recommendations for the prevention and control of influenza in children for 2018-2019 , the American Academy of Pediatrics Committee on Infectious Disease (COID) recommended “an inactivated influenza vaccine (IIV), trivalent or quadrivalent, as the primary choice for influenza vaccination in children because the effectiveness of a live attenuated influenza vaccine (LAIV) against influenza A(H1N1) was inferior during past influenza seasons and is unknown for this upcoming season.”
We would like to note that on July 18, 2018, Public Health England published a provisional end-of-season adjusted estimate of quadrivalent LAIV (LAIV4) effectiveness for children aged 2-17 years during the 2017–2018 influenza season . LAIV4 effectiveness for A(H1N1) was 90.3% (95% CI: 16.4–98.9). The A(H1N1) strain included in LAIV4 for the 2017–2018 formulation (A/Slovenia) was selected using new methodologies designed to optimize the replicative fitness of LAIV strains and to address the observed reduced effectiveness of LAIV against A(H1N1) strains in the 2013–2014 and 2015–2016 seasons.
With regards to effectiveness of other strains included in LAIV, the Centers for Disease Control and Prevention (CDC) reviewed the available data and concluded: “analyses of data from 2010–11 through 2016–17 indicate that LAIV was effective against influenza B viruses, and effectiveness against influenza A(H3N2) viruses was similar to that of inactivated influenza vaccines” . Bas...
With regards to effectiveness of other strains included in LAIV, the Centers for Disease Control and Prevention (CDC) reviewed the available data and concluded: “analyses of data from 2010–11 through 2016–17 indicate that LAIV was effective against influenza B viruses, and effectiveness against influenza A(H3N2) viruses was similar to that of inactivated influenza vaccines” . Based on these same data, the COID recommendations similarly state, “LAIV was more effective against influenza B strains and similarly effective against influenza A(H3N2) in some age groups compared with an IIV.”
Further, it is relevant that LAIV4 would be expected to provide superior protection compared to trivalent IIV against influenza B disease for influenza B strains of the lineage not included in trivalent IIV. In their recommendations, the COID notes that “trivalent vaccines offer limited immunity against circulating influenza B strains of the lineage not present in the vaccine,” and that “in a recent study of hospitalizations for influenza A versus influenza B, the odds of mortality were significantly greater with influenza B than with influenza A.”
We agree with the COID and CDC that additional options for vaccination of children may provide a means to improve influenza vaccination coverage, particularly in school-based settings. CDC FluVaxView data show that vaccination rates in children aged 5–12 years were 61.8% in 2015–2016, 59.9% in 2016–2017, and 59.5% in 2017–2018 . LAIV4 represents an important noninjectable option that providers can offer to eligible children, adults, and their families.
1. AAP Committee on Infectious Diseases. Recommendations for Prevention and Control of Influenza in Children, 2018-2019. Pediatrics. 2018;142(4):e20182367
2. Public Health England. Influenza vaccine effectiveness (VE) in adults and children in primary care in the United Kingdom (UK): provisional end-of-season results 2017-18. PHE publications gateway number 2018267. July 18, 2018.
3. Grohskopf LA, Sokolow LZ, Fry AM, Walter EB, Jernigan DB. Update: ACIP Recommendations for the Use of Quadrivalent Live Attenuated Influenza Vaccine (LAIV4) — United States, 2018–19 Influenza Season. MMWR Morb Mortal Wkly Rep 2018;67:643–645.
4. Centers for Disease Control and Prevention. Estimates of flu vaccination coverage among children – United States, 2017-2018 flu season. FluVaxView webpage report. Sept 27, 2018.
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