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Pediatricians say children may not have a strong immunity to influenza right now due to last year’s relatively light flu season. Fat Camera/Getty Images
  • Pediatricians are urging parents to get their children vaccinated against the flu as soon as possible.
  • They say this is particularly true since flu cases were down significantly last year, and children may not have built up much immunity to influenza.
  • They also note that the recent surge in COVID-19 cases is straining healthcare services that normally would be reserved for children seriously ill with the flu.

Health authorities are urging parents and caregivers to vaccinate their children against influenza amid fears of a “twindemic” of COVID-19 and the flu.

Today, the American Academy of Pediatrics (AAP) released a policy statement advising that all children ages 6 months and older get vaccinated against flu this fall.

“During the COVID-19 pandemic, it’s important to remember that influenza is also a highly contagious respiratory virus that can cause severe illness and even death in children,” Dr. Flor Munoz, an associate professor of medicine at the Baylor College of Medicine in Texas and the lead author of the policy statement, said in a press release.

“The flu vaccine is safe, effective, and can be given alongside other routine immunizations and the COVID-19 vaccine,” Munoz added.

The AAP guidelines say children can be given the flu vaccination via either an intramuscular injection or a nasal spray.

Dr. Dean A. Blumberg, chief of pediatric infectious diseases at the UC Davis Health in California, said both options are effective at preventing severe illness from influenza.

“The flu vaccine contains certain parts of the flu virus. The immune system reacts to the inactivated virus by forming an immune response, an antibody response, and a cellular immune response so that when challenged with the actual virus, the immune system is primed to fight it off and either totally prevent infection, or if there is breakthrough infection, then it is milder than what would occur otherwise,” he told Healthline.

“The nasal spray works similarly. It’s a weakened form of the influenza virus and sprayed into the nose where the immune system recognizes it and gets primed so that if challenged in the future, it can fight off infection.

“Some people may prefer the nasal spray because it’s not an injection, so there’s advantages to that. On the other hand, some people don’t like the nasal spray because they don’t like things stuck up their nose,” Blumberg said.

Since 2004, the number of flu deaths among children has ranged from 37 to 199 deaths per flu season.

In the 2017-18 flu season, 188 children died from flu. In the 2018-19 season, 144 children died, and in the 2019-20 season, 199 children died.

Research suggests the majority of deaths related to flu are in children who are not vaccinated against influenza.

“Of those flu deaths, if you look at them over the years, over 80 percent of them were unvaccinated and half of them were normal healthy children. The other half, of course, were children with underlying illnesses who were more susceptible to the virus,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, told Healthline.

Children younger than age 5 are at particular risk of flu complications. These include pneumonia, sinus problems, brain dysfunction, dehydration, and a worsening of conditions such as asthma.

Blumberg said children could be at particular risk this year due to the low circulation of influenza in the community last flu season.

“Children may be more vulnerable to influenza this year just because they didn’t get it last year. With less influenza circulating last year due to pandemic restrictions, I think they didn’t have a chance to… develop any immunity to influenza,” he explained.

AAP officials also recommend children between ages 12 and 17 get vaccinated against COVID-19.

Children who have COVID-19 that is acute, moderate, or severe should wait until they have recovered to receive the influenza vaccine, while those with only mild COVID-19 can still be vaccinated against flu.

Blumberg argues at this stage of the year, the COVID-19 shot should be prioritized.

“Right now, there’s very little influenza activity, and we know there’s relatively high rate of transmission of COVID-19. COVID-19 is also more severe than influenza, and so I certainly would prioritize getting a COVID-19 vaccine for children for which the vaccine is eligible,” he said.

“That being said, there’s no reason not to get both. You can get both at the same time and just get it over with,” Blumberg added.

AAP officials say it will be especially important this year to protect children against influenza as emergency services and hospital beds are at capacity in many parts of the country.

Schaffner said if COVID-19 and influenza collide this fall, it could be problematic.

“Everyone I know who runs hospitals and is part of both the pediatric and adult infectious diseases community is very worried that the predicted twindemic that did not happen last year could very well happen this coming season,” he said, “and that we would have both influenza and the COVID-19 virus, the Delta variant in particular, both spreading in our communities, really straining healthcare facilities.”

Schaffner said Tennessee is already seeing a strain on healthcare facilities due to the pandemic.

“There are children’s hospitals in my state. Every one of them has seen a surge of admissions from the COVID-19 virus,” Schaffner said.

“Children are being affected with that virus already and it’s anticipated that in states such as mine where the vaccination rate continues to be really quite low, COVID-19 is going to continue to be a problem through the fall and into the winter, and then comes flu on top of that.

“For hospital facilities and the people who work in them, caring for the patients could be very strained indeed,” he said.