Why Two Doses?

• Optimal Immune Response – A single dose of flu vaccine may not provide sufficient protection for young children, especially those receiving their first-ever flu vaccine. Two doses — spaced at least 4 weeks apart — will allow their immune systems to develop a stronger and more lasting response.
• Reduced Risk of Flu Complications – Children are particularly vulnerable to severe flu complications like ear infections and pneumonia, which can result in hospitalization. Two doses significantly reduce their risk of experiencing these complications.
• Protecting the Community – Vaccinating children helps protect not only themselves but also vulnerable individuals in their community, including infants too young to be vaccinated and those with weakened immune systems.

Research Supports Two Doses

Studies have shown that two doses of influenza vaccine in the same season may be more effective than alternative priming strategies. A study published in the Pediatric Infectious Disease Journal¹ found that children who completed the two-dose series in a previous flu season had higher vaccine effectiveness (VE) against influenza A(H3N2) and B in the current flu season compared to those who received only one dose.

Notably, children 2-8 years old who did not complete the priming two-dose series were 2.4 times more likely to become ill with influenza A(H3N2) in the current season.

Furthermore, a more recent study² found that two doses of influenza vaccine given four weeks apart were more effective in protecting influenza vaccine-naïve children aged 6 months to 2 years. This study found a VE of 53% for children who received two doses compared to a VE of 23% for one dose.

Key Points for Clinicians

• Timing Matters –The ideal time to get vaccinated is before the flu season peaks, typically in October or November, but the vaccine can be administered throughout winter and early spring.
• No Age Restrictions – Both the inactivated influenza vaccine (IIV) and the live attenuated influenza vaccine (LAIV) are available for children 6 months to 8 years old.
• Administer Dose 2 – Even if the child turns 9 years old between receipt of dose 1 and dose 2, the child should receive the second dose.
• Informed Consent – Ensure parents understand the benefits and risks of both vaccine options and make informed decisions.
• Educate Parents – Clearly communicate the benefits of two-dose vaccination to parents, emphasizing the enhanced protection and potential for long-term benefits. Discuss root causes of vaccine hesitancy and address health literacy concerns if they arise.

Resources for Parents

• www.cdc.gov/flu
• www.healthychildren.org

By embracing the 2-dose recommendations, clinicians can play a vital role in maximizing influenza protection for children and reducing the burden of influenza illness.

References

1. Thompson, M. G., Clippard, J., Petrie, J. G., Jackson, M. L., McLean, H. Q., Gaglani, M., … & Fry, A. M. (2016). Influenza vaccine effectiveness for fully and partially vaccinated children 6 months to 8 years old during 2011–2012 and 2012–2013: The importance of two priming doses. Pediatric Infectious Disease Journal, 35(3), 299–308.

2. Abraham, C., & Stockwell, M. S. (2020). The clinical importance of a second dose of influenza vaccination in young children. JAMA Pediatrics, 174(7), 643-644. https://doi.org/10.1001/jamapediatrics.2020.0377

Highmark does not recommend particular treatments or health care services. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should determine the appropriate treatment and follow-up with your patient. Coverage of services is subject to the terms of each member’s benefit plan. Additionally, state laws and regulations governing health insurance, health plans and coverage may apply and will vary from state to state.

  

Provider News, Issue 8, August 2024   |   © 2024 Highmark Blue Cross Blue Shield