Resolution No. 10/07-1

ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES 

VACCINES FOR CHILDREN PROGRAM 

INFLUENZA 

VACCINES TO PREVENT INFLUENZA 

The purpose of this resolution is to revise the previous resolution to add the expanded age indication for the Live Attenuated Influenza Vaccine.

VFC resolution 2/07-1 is repealed and replaced by the following: 

Eligible Groups for Inactivated Influenza Vaccine (TIV)

All children aged 6 months through 18 years with priority given to those listed below if available supplies are limited: 

Children aged 6 months through 59 months. 

Children and adolescents aged 5 through 18 years with chronic disorders of the pulmonary or cardiovascular systems, including asthma. 

Children and adolescents aged 5 through 18 years who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus [HIV]). 

Children and adolescents aged 5 through 18 years who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration. 

Children and adolescents aged 5 through 18 years who are receiving long-term aspirin therapy and may therefore be at risk for developing Reye syndrome after influenza. 

Children and adolescents aged 5 through 18 years who are residents of nursing homes and other chronic-care facilities that house persons at any age who have chronic medical conditions. 

Adolescent females aged <19 years who will be pregnant during influenza season. 

Children and adolescents aged 5 through 18 years who are household contacts of persons in the following high-risk groups: 
	1.  any children less than 5 years old; 
2.  children or adolescents in any of the other groups listed above; 
3.   any person 50 years or older; 
4.  adults with chronic disorders of the pulmonary or cardiovascular systems; 
5.  adults who have required regular medical follow-up or hospitalization during the preceding year for chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus [HIV]). 

Eligible Groups for Live Attenuated Influenza Vaccine (LAIV)

All healthy children and adolescents (those who do not have underlying medical condition that predispose them to influenza complications) aged 2 years through 18 years with priority given to those listed below if available supplies are limited:

All healthy children (those who do not have underlying medical condition that predispose them to influenza complications) aged 2 years through 59 months

Household contacts of persons in the following high-risk groups provided that the contacts are not severely immunocompromised (e.g., patients with hematopoietic stem cell transplants) and requiring care in a protective environment: 

1.  any children less than 5 years old; 
2.  children or adolescents in any of the other groups listed above; 
3.   any person 50 years or older; 
4.  adults with chronic disorders of the pulmonary or cardiovascular systems; 
5.  adults who have required regular medical follow-up or hospitalization during the preceding year for chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus [HIV]). 

Recommended Influenza Vaccine Schedule 

Age group:  6 months – 8 years
Number of doses: 1 or 2*

*All children ages 6 months to <9 years who receive influenza vaccine for the first time should be given 2 doses. Children who receive only one dose in the first year of vaccination should receive two doses, rather then one, in their second year of vaccination.

Recommended Dosage Intervals 

Vaccine: Influenza, inactivated
Minimum Age*:  6 months
Minimum interval dose 1 to 2 (where applicable): 4 weeks

Vaccine: Influenza, live attenuated
Minimum Age*: 2 years
Minimum interval dose 1 to 2 (where applicable): 4 weeks

* Different influenza vaccine preparations have different age indications.  Please check the package insert for the age indication of the specific vaccine. 

Recommended Dosages 
Refer to product package inserts. 


Contraindications and Precautions 

The following conditions are contraindications to administration of influenza vaccine (TIV or LAIV): 
1. 	Allergy to vaccine components 
Anaphylactic reaction to the vaccine or a constituent of the vaccine (e.g. eggs). 

2. 	Moderate or severe illnesses with or without fever 
Persons with moderate or severe illness should be immunized as soon as they have recovered from the 
acute phase of the illness. Minor illnesses (e.g., upper respiratory tract infection, allergic rhinitis) with or without fever should not contraindicate the use of influenza vaccine (either inactivated or live, attenuated vaccine). 

The following conditions are precautions to administration of influenza virus vaccine (TIV or LAIV): 
1. History of Guillain-Barré Syndrome (GBS) following influenza vaccination. 
If GBS has occurred within 6 weeks of previous influenza vaccination, the decision to give influenza vaccine should be based on careful consideration of the potential risks and benefits.

The following conditions are contraindications to administration of LAIV: 
1. 	Concomitant aspirin therapy*
LAIV is contraindicated in children and adolescent receiving aspirin therapy or aspirin-containing therapy, because of the association of Reye’s syndrome with aspirin and wild-type influenza vaccine.
*	These persons should receive inactivated influenza vaccine if age > 6 months.

The following conditions are precautions to administration of LAIV: 
1. Risks in Children <24 Months of age*
Do not administer LAIV to children <24 months of age because of increased risk of hospitalization and wheezing observed in clinical trials.

2. Asthma/Recurrent Wheezing*
LAIV should not be administered to any individuals with asthma and children <5 years of age with recurrent wheezing because of the potential for increased risk of wheezing post vaccination.

3. Altered Immunocompetence*
Administration of LAIV, a live virus vaccine, to immunocompromised persons should be based on careful consideration of the potential benefits and risks.

4. Medical Conditions Predisposing to Influenza Complications*
Safety has not been established in individuals with underlying medical conditions predisposing them to wild-type influenza complications.

5. Pregnant Women*
Safety has not been established in individuals with underlying medical conditions predisposing them to wild-type influenza complications.

*	These persons should receive inactivated influenza vaccine if age >6 months.

Adopted and Effective: October 24, 2007



http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/1007influenza.txt