The American Academy of Pediatrics reaffirmed its recommendation for annual influenza vaccination for all children aged 6 months and older in their updated 2025–2026 policy statement.

The update simplifies antiviral treatment guidance and expanded eligibility for the recombinant influenza vaccine (RIV3), now approved for children 9 years and older. However, "influenza vaccination should not be delayed to obtain a specific product, including a thimerosal-free product," noted the AAP.

As of April 26, 2025, only 49% of U.S. children aged 6 months to 17 years had received an influenza vaccine, which is 14.5% lower than at the end of the 2020 season. Coverage gaps were especially pronounced by age, race, ethnicity, poverty status, and maternal immunization. Vaccination should ideally be completed by the end of October.

Key Updates

All influenza vaccines available in the U.S. for this season are trivalent and contain updated strains for the A(H3N2) component. The A(H1N1) and B/Victoria components remain unchanged. The AAP does not express a preference for any particular vaccine formulation and recommends administration as soon as the vaccine becomes available.

Live attenuated influenza vaccine is now available for caregiver-administered, at-home use in eligible children aged 2 years and older. The policy also confirms that RIV3 is now licensed for individuals as young as 9 years.

High-Risk Populations

Children under age 5—particularly those under age 2—and those with chronic medical conditions remain at increased risk of hospitalization and complications. In-hospital influenza-related deaths were reported to be 3- to 4-fold higher among Black, Hispanic, and Asian/Pacific Islander children than among White children.

In its policy, the AAP emphasized efforts to reduce racial and ethnic disparities and remove barriers to vaccine access.

Antiviral Treatment and Prophylaxis Guidance

Oseltamivir remains the AAP’s preferred antiviral for both treatment and chemoprophylaxis of influenza A and B. Treatment is recommended for:

• All hospitalized children with suspected or confirmed influenza

• Children with severe, progressive, or complicated illness

• Children under 5 years or with conditions increasing risk of complications

Treatment is also an option for outpatient children not at high risk if started within 48 hours of symptom onset. “Provision of antiviral therapy does not require a positive test for influenza when influenza is circulating in the community,” the AAP noted.

Additional Recommendations

Influenza vaccination is recommended for pregnant and breastfeeding individuals at any time during pregnancy or postpartum. Pediatricians are urged to vaccinate household contacts and caregivers of immunocompromised children. The AAP supports mandatory influenza vaccination for health care personnel as a condition of employment. Vaccination should be documented in medical records and immunization registries, especially when administered in pharmacies or community sites.

Source: Pediatrics