Written by Kimiko Dunbar
Spoon Feed
Influenza prevention guidelines have been updated by the AAP for the 2025–2026 season. Highlights include all vaccines being trivalent and simplification of treatment and chemoprophylaxis recommendations.
Oseltamivir for (mostly)everyone!
Children with medical complexity are at high risk for complications secondary to influenza infection. Further, children play a large role in household and community spread. Despite vaccine effectiveness, coverage remains suboptimal (49.2% in 2024–2025). This updated policy statement from the AAP addresses the question of optimal influenza prevention and treatment strategies for children in the 2025–2026 season. Updates for this year are summarized below:
- All licensed vaccines this year are trivalent, so kids should get whatever licensed product is available, with no preference for one over the other. Kids who need two doses can mix and match.
- At-home vaccines are available for individuals older than 2; caregivers can request a vaccine from their pharmacy without a prescription (details are a little unclear on the logistics of this).
- Treatment recommendations have been simplified.
- The following individuals should definitely be treated, regardless of symptom duration (meaning, even outside 48 hours): Any hospitalized child, anyone with severe, complicated, or progressive disease (inpatient or outpatient), any child < 5 or at high risk regardless of severity.
- Consider treatment in any lower-risk child presenting within 48 hours of symptom onset, or who has a household contact less than 6 months or at high risk.
- Post-exposure prophylaxis (if within 48 hours of exposure) is recommended for the following individuals:
- High-risk kids who can’t get vaccinated, who haven’t received the flu shot yet, or who had the flu shot within the past two weeks.
- An unvaccinated child with a close household contact who is at high risk of the flu and cannot be protected from the flu.
- Unvaccinated adults in close contact with unvaccinated kids who are at high risk, especially those < 2.
How does this change my practice?
The potential for at-home vaccines is cool, although I’m not sure how much that will boost vaccination rates. I’m a hospitalist, so I just treat everyone (hammer meet nail), but I’m glad to see that recommendations regarding post-exposure prophylaxis have been simplified.
Source
Committee on Infectious Diseases. Recommendations for Prevention and Control of Influenza in Children, 2025-2026: Policy Statement. Pediatrics. 2025 Jul 28. doi: 10.1542/peds.2025-073620. Epub ahead of print. PMID: 40717223.
