Common childhood respiratory illnesses such as influenza (flu), COVID-19 and respiratory syncytial virus (RSV) continue to pose significant health risks in children.

Kristina K. Bryant, M.D., epidemiologist and pediatric infectious diseases physician with Norton Children’s Infectious Diseases, affiliated with the UofL School of Medicine, outlines strategies to help prevent the most common respiratory viruses and increase immunization rates among pediatric patients.

“As health care providers, implementing evidence-based prevention measures to increase vaccine uptake can help reduce severe illness and hospitalizations,” Dr. Bryant said.

Influenza

Annual influenza vaccination is recommended for everyone ages 6 months and older. All influenza vaccines available in the U.S. currently are trivalent.

Influenza vaccination rates continue to fall among children in the U.S., according to Dr. Bryant. During the last flu season, the Centers for Disease Control and Prevention (CDC) reported 207 children died from the flu. Most children who die from influenza are unimmunized or incompletely immunized. Historically, about half of the children who die from flu in a given year are otherwise healthy (without preexisting medical conditions).

Evidence-based strategies to boost influenza immunization rates

1. Presumptive vaccine recommendation. Prepare vaccine information before entering the exam room. Avoid asking, “Would you like the flu shot today?” Instead, make eye contact and say: “Sarah is due for her flu vaccine today. We have her shot ready.” Use patient charts to check vaccine eligibility before visits to streamline discussions.
   
   Educate on risks for children. Emphasize that young children are at higher risk for severe complications. Reinforce the importance of immunization by highlighting that fewer children who get hospitalized are vaccinated.
2. Address vaccine hesitancy with motivational interviewing. The motivational interviewing technique involves a respectful dialogue to learn about parents’ concerns and collaborate with them to build motivations to protect their child’s health. Even if parents previously refused a vaccine, reintroduce the conversation about vaccination at the next visit.
3. Expanding access to vaccines. Extended clinic hours, vaccine clinics and alternative sites increase accessibility, along with hospital-based and emergency department vaccination programs. Norton Children’s successfully implemented flu vaccination initiatives by vaccinating hospitalized children before discharge to catch missed opportunities.
4. Leverage community-based immunization initiatives. While immunization in the medical home is optimal, especially for the youngest children, school-based flu immunization programs and pharmacies may improve access. Develop targeted strategies for communities impacted by health disparities to promote trust, encourage dialogue and increase access.
5. Make use of helpful resources. The American Academy of Pediatrics (AAP) influenza policy statement includes additional evidence-based recommendations (Table 3). The AAP also provides examples of scripts for addressing vaccine hesitancy.

COVID-19

Routine COVID-19 vaccination is recommended for everyone ages 6 months and older to protect against severe disease.

Most vaccinated patients ages 5 and older need one dose of the most updated vaccine formulation. Children ages 6 months to 4 years still require a vaccine series. The number of doses of the updated vaccine depends on the number of past doses. The AAP’s Pediatric COVID-19 Vaccine Dosing Quick Reference Guide serves as a simple visual reference.

RSV

The monoclonal antibody nirsevimab is now recommended for all infants under 8 months entering their first RSV season and for high-risk patients entering their second RSV season. Maternal vaccination is recommended for pregnant people (32 to 36 weeks) to provide passive immunity to newborns.

Infants and young children can be screened for RSV immunization eligibility with the AAP’s Nirsevimab Administration Visual Guide.