The American Academy of Pediatrics (AAP) recently updated its guidelines on preventing and controlling influenza for pediatric patients. The guideline, Recommendations for Prevention and Control of Influenza in Children, 2025-2026: Policy Statement, helps arm clinicians with evidence-based recommendations for children for the 2025-2026 flu season.
Overall, the AAP recommends annual influenza vaccinations for all children without medical contraindications, beginning at six months old. The AAP also clarifies that any licensed influenza vaccine, without preference for product or formulation, can be administered as early as possible in the season.
Additionally, the AAP states that antiviral treatment of influenza is recommended for children who have suspected or confirmed influenza and who are hospitalized or have a severe or progressive disease, or who have underlying conditions that increase the risk of complications. Such antiviral treatments should be initiated as soon as possible. This treatment option is, in some circumstances, also suggested for children in the outpatient setting who have suspected or confirmed influenza. Antiviral chemoprophylaxis can be considered for asymptomatic children who are at high risk for influenza complications but who have not been immunized or for those who are believed to be unable to produce an effective immune response.
Let’s take a look at how the 2025-2026 recommendations align with the previous recommendations.
5 Key Elements of the 2025-2026 Flu Season Update:
- All licensed vaccines available in the United States this season are trivalent.
- The compositions of influenza vaccines for the 2025-2026 season have been updated.
- Recommendations for influenza treatment and prophylaxis have been simplified.
- Live attenuated influenza vaccine (LAV) is available for administration in the home by a caregiver for eligible children ≥2 years of age.
- Recombinant baculovirus-expressed hemagglutinin (HA) influenza vaccine (RIV3) is now licensed for individuals as young as 9 years of age.
Comparisons Between Current And Last Year’s Release
| Topic | 2025-2026 | 2024-2025 |
|---|---|---|
| Recombinant Influenza Vaccine | Now an option for patients ≥9 years of age. | An option for persons ≥18 years of age. |
| Thimerosal-free Products | New notes regarding not delaying vaccination to obtain a thimerosal-free product. | N/A |
| IIV/RIV | "For children who will be starting anti-B cell therapies (eg, rituximab, alemtuzumab), IIV or RIV should optimally be provided at least 2 to 4 weeks before starting these therapies." | "IIV (or RIV, if age-appropriate) may be administered simultaneously with or at any time before or after other inactivated (nonlive) or live vaccines or nirsevimab." |
| Influenza Vaccine Implementation | Additional information is provided in Recommendation 21 regarding patients and families for whom resource constraints would prevent recieving a vaccine. | N/A |
| Contraindications and Precautions | A note was added that an overlap between gelatin and alpha-gal allergy has been reported | N/A |
| Influenza Testing Recommendation 1 | Recommendation expanded to mention testing for avian influenza. Expanded recommendation includes: "Clinicians should consider asking about exposures to sick or dead animals, particularly wild birds, poultry, or dairy cows, to inform the need for testing for avian influenza." | N/A |
| Influenza Testing Recommendation 2 | "When influenza is circulating in the community, hospitalized patients with signs and symptoms of influenza should be tested with a nucleic acid amplification test with high sensitivity and specificity (eg, reverse transcriptase-polymerase chain reaction [RT-PCR])." | "When influenza is circulating in the community, hospitalized patients with signs and symptoms of influenza should be tested with a molecular assay with high sensitivity and specificity (eg, reverse transcriptase-polymerase chain reaction)." |
| Influenza Treatment Recommendations | A note was added: "The role of antivirals for the prevention and treatment of influenza in children depends on illness severity and risk considerations." | N/A |
| Antiviral Susceptibilities | New note added under treatment recommendations: "Clinicians should refer to the CDC...for the most up-to-date information on antiviral susceptibilities." | N/A |
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