The American Academy of Pediatrics updated its influenza guidance for the 2026-27 season, adding detailed recommendations for vaccinating immunocompromised children to align with other professional societies.
The update comes as the CDC has not released flu vaccine recommendations for the coming season amid turnover among federal health officials, prompting the AAP and other medical societies to issue their own evidence-based guidance. Flu vaccines are still expected to be covered by commercial insurance and available through the Vaccines for Children program.
The organization’s policy statement and a technical report, titled “Recommendations for Prevention and Control of Influenza in Children, 2026-2027,” will appear in the November issue of Pediatrics and are posted online as prepublication versions.
Six things to know:
1. The core message did not change.
The AAP continues to recommend annual flu vaccination for all children 6 months and older, with any licensed vaccine appropriate for the child’s age and health status and no preference among products. The reminder carries weight after a severe 2025-26 season: the cumulative flu hospitalization rate for children was the second highest since 2009-10 and the highest on record for those ages 5-17. Approximately 190 pediatric deaths have been reported so far, a toll that is rising. Only 49% of children were vaccinated last season.
2. The immunocompromised guidance is now consolidated and specific.
The AAP combined and timed its recommendations for children with weakened immune systems:
- Moderately to severely immunocompromised children should get an inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) before the season starts when possible.
- Children with cancer should be vaccinated at least two weeks before cytotoxic chemotherapy; children starting immunosuppressive or anti-B-cell therapies, at least two weeks before those drugs begin.
- For hematopoietic cell transplant recipients, vaccination should start at least three months post-transplant; for solid organ transplant recipients ages 6 months to 17 years, at least one month after.
3. The nasal spray stays off the table for certain children and their close contacts.
The live attenuated influenza vaccine, given as a nasal spray, should not be used in immunocompromised children. It is also contraindicated for the close contacts and caregivers of severely immunocompromised patients.
Instead, the AAP said household members and close contacts of immunocompromised children should be up to date on their own flu shots to help shield a child who may not mount a strong response to vaccination.
4. Injectable vaccines carry a new febrile-seizure warning.
On Jan. 9, the FDA advised manufacturers to update the prescribing information for injectable flu vaccines to note an increased risk of febrile seizures in children younger than 5, based on two postmarketing studies from the 2023-24 and 2024-25 seasons. The AAP framed the added risk as small and said it does not change the vaccine’s risk-benefit calculus.
There was one febrile seizure per 47,170 quadrivalent doses in the 2023-24 season, and one febrile seizure per 22,624 trivalent doses in the 2024-25 season.
5. Every flu vaccine this season is trivalent.
All licensed U.S. flu vaccines for 2026-27 are three-strain formulations, and all three strains have been updated to better match circulating viruses. Seqirus’ Afluria is no longer available, which the AAP said should not affect overall supply.
6. Treatment guidance was refined.
The AAP recommends antiviral treatment for any child hospitalized with suspected or confirmed flu or with severe or progressive disease, and lists it as an option for other children in outpatient settings.
Oseltamivir remains the preferred antiviral. A single-dose option, Xofluza (baloxavir), is now available as a generic and can be used in non-hospitalized children 5 and older. Chemoprophylaxis is generally not indicated for infants younger than 3 months.
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