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All children ages 6 months and older should receive the flu shot to protect against influenza, the American Academy of Pediatrics (AAP) said.

The inactivated influenza vaccine (IIV), trivalent or quadrivalent, should be the "primary choice" for children receiving the influenza vaccine during the 2018-2019 influenza season, reported the AAP Committee on Infectious Diseases, writing in .

In a policy statement, the authors stated that "although the AAP and CDC each support the use of [live attenuated influenza vaccine] LAIV4 ... with the aim of achieving adequate vaccination coverage and optimal protection in children of all ages," the AAP recommends the inactivated influenza vaccine "for all children."

The noted that "vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4)," and that "LAIV4 is an option for those for whom it is appropriate."

But here, the AAP authors stated that the effectiveness of live attenuated influenza vaccine against influenza A(H1N1) was "inferior," and "unknown for this upcoming season."

They said this vaccine "may be used" for children who would not otherwise receive an influenza vaccine and for whom it is appropriate because of age and health status (children ≥age 2, who are healthy and without any underlying chronic medical condition).

Back at the June meeting of the CDC's Advisory Committee on Immunization Practices (ACIP), when the committee voted to re-add live attenuated influenza vaccine "as an option for influenza vaccination for persons for whom it is appropriate," the AAP raised concerns about the meta-analysis conducted by the CDC.

In the report, the authors stated that the data in a CDC systematic review found that "the effectiveness of LAIV3 or LAIV4 for influenza strain A (H1N1) was lower than that of an IIV in children 2 to 17 years of age."

David Kimberlin, MD, editor of the AAP Red Book and an AAP liaison to the CDC, said in June that "if we have an H1N1 year, and [the live attenuated influenza vaccine] doesn't work, that's a sobering sentence for me."

Kimberlin added that shedding data for the influenza vaccine that was presented by the manufacturer does not correlate with effectiveness, which was reiterated in the AAP recommendations here.

"Shedding and replicative fitness are not known to be correlated with efficacy, and no published effectiveness estimates for this formulation of the vaccine against influenza A(H1N1)pdm09 viruses are available, because influenza A(H3N2) and influenza B viruses predominated during the 2017–2018 Northern Hemisphere season," the authors wrote.

Henry Bernstein, DO, an ACIP member and an ex-officio member of the AAP Committee on Infectious Diseases, said in a statement that, "the effectiveness of the flu vaccine varies and is affected by factors such as the child's age, health status, vaccination history, and the strain of influenza circulating in a community." Bernstein was one of the two "no" votes to re-add live attenuated influenza vaccine as an option for influenza vaccination at the June ACIP meeting.

Additional recommendations for the 2018-2019 season include the following:

• Children ages 6 months through 8 years should receive two doses of influenza vaccine the first time they are vaccinated against influenza, but children ≥9 need only one dose, regardless of vaccination history
• Children with egg allergy can receive influenza vaccine with no additional precautions than those for any vaccine
• Pregnant women may receive influenza vaccine at any point throughout pregnancy
• All healthcare personnel should receive an influenza vaccine annually
• Antiviral medications can treat influenza, but are not a substitute for vaccination

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