There are several vaccines that can be given to children. You can find information on all influenza vaccines available in the U.S. for the current season and the age groups approved by FDA by going to www.immunize.org/catg.d/p4072.pdf.

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WHICH INFLUENZA VACCINES CAN WE GIVE TO CHILDREN?

Peak influenza activity does not generally occur until February. Providers are encouraged to continue vaccinating patients throughout the influenza season, including into the spring months (e.g., through May), as long as they have vaccine in the refrigerator and unvaccinated patients in their office.

Because influenza occurs in many areas of the world during April through September, vaccine should be given to travelers who missed vaccination in the preceding fall and winter. Another late season use of vaccine is for children younger than age 9 years who were vaccinated for the first time in the current vaccination season but failed to get their second dose. For each of these situations, vaccine can be given through the month of June since injectable influenza vaccine customarily has a June 30 expiration date.

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HOW LATE IN THE SEASON CAN I VACCINATE MY PATIENTS WITH INFLUENZA VACCINE?

Protection from influenza vaccine is thought to persist for a year or less because of waning antibody and because of changes in the circulating influenza virus from year to year.

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HOW LONG DOES IMMUNITY FROM INFLUENZA (FLU) VACCINE LAST?

ACIP recommends annual influenza vaccination for all children age 6 months and older who do not have a contraindication to the vaccine.

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WHICH CHILDREN SHOULD RECEIVE INFLUENZA FLU VACCINE?

Although the strains may sometimes be the same as in the previous year's vaccine, you should NOT use the previous season's vaccine you might still have in your refrigerator. Influenza vaccine distributed in the northern hemisphere expires on June 30 after each season; expired vaccine should NEVER be administered. Secondly, antibody titers that persons might have achieved from the previous year's vaccination will have waned and need to be boosted with a dose of the current year's vaccine.

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WHY DO PEOPLE RECEIVED INFLUENZA VACCINE LAST YEAR STILL NEED TO GET VACCINATED THIS WHEN THE VIRUSES HAVEN'T CHANGED?

You can begin offering vaccine as soon as vaccine becomes available. Early vaccination of children younger than age 9 years who are first time vaccinees can be helpful in assuring routine second doses before the influenza season begins.

Additional Information:
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WHEN SHOULD INFLUENZA (THE FLU) VACCINE BE GIVEN?

Yes. It is especially important to vaccinate pregnant women because of their increased risk for influenza-related complications. An increased risk of severe influenza infection was also observed in postpartum women (those delivered within the previous 2 weeks) during the 2009–2010 H1N1 pandemic. Vaccination can occur in any trimester, including the first. Only inactivated (injectable or TIV) vaccine should be given to pregnant women.

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INFLUENZA VACCINE RECOMMENDED FOR PREGNANT WOMEN?

Vaccines can be administered at any time before or after administration of an "allergy injection."

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WHAT THE RECOMMENDED INTERVAL FOR RECEIVING INFLUENZA VACCINE AFTER AN ALLERGY INJECTION?

The child should always receive the dose appropriate for his or her age at the time of the clinic visit; at age 37 months that would be 0.5 mL.

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IF A CHILD RECEIVES INFLUENZA VACCINE AT AGE 34 OR 35 MONTHS FOR THE FIRST TIME (0.25 ML DOSE) AND THEN RETURNS SECOND DOSE 37 MONTHS, SHOULD WE GIVE ANOTHER 0.25 0.5 THAT INDICATED AGES 3 OLDER?

ACIP's influenza recommendations for children age 6 months through 8 years have changed for the 2011–12 season. According to the new algorithm, certain children need 2 doses of influenza vaccine this influenza season, separated by at least 4 weeks. Here is a summary:

• Children age 6 months through 8 years who did not receive AT LEAST 1 dose of the 2010–11 vaccine should receive 2 doses, separated by at least 4 weeks, REGARDLESS of their previous influenza vaccination history.
• Children age 6 months through 8 years whose influenza vaccination status from the previous season is not known should also receive 2 doses at least 4 weeks apart.
• Children age 6 months through 8 years who received 1 dose of seasonal influenza vaccine during the 2010–11 season need ONLY 1 dose this season. This is because the vaccine strains are the same this season as last season.

You may find this Immunization Action Coalition handout helpful: www.immunize.org/catg.d/p3093.pdf.

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WHICH OF OUR PEDIATRIC PATIENTS WILL NEED 2 DOSES INFLUENZA VACCINE FOR THE 2011–12 VACCINATION SEASON?

As of January 1, 2006, the use of a VIS for influenza vaccine given to a child or an adult became mandatory under the National Vaccine Injury Compensation Program. Two VISs are published annually, one for LAIV and one for TIV. Each can be found at www.immunize.org/vis along with many translations.

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A VACCINE INFORMATION STATEMENT (VIS) MANDATORY OR IT ONLY RECOMMENDED WHEN ADMINISTERING INFLUENZA VACCINE?

Yes. You are referring to Afluria, which is manufactured in Australia by CSL Laboratories for the U.S. market. CSL's 2010 Southern Hemisphere influenza vaccine (Fluvax and Fluvax Junior) has been associated with increased post-marketing reports of fever and febrile seizures in children predominantly younger than age 5 years as compared to previous years. For this reason, on August 5, 2010, ACIP recommended that Afluria, 0.5 mL, licensed for use in people age 36 months and older, not be used in children younger than age 9 years. ACIP further recommended that Afluria could be administered to children ages 5 through 8 years who are at high risk for influenza complications if there is no other age-appropriate TIV available, after risks and benefits of using this vaccine in this age group have been discussed with the parent or guardian. The vaccine should not be given to children younger than age 5 years. For detailed information, go to www.cdc.gov/media/pressrel/2010/s100806.htm.

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WE'VE HEARD THAT ACIP HAS LIMITED THE USE OF ONE INFLUENZA VACCINE PRODUCTS FOR CHILDREN BEGINNING WITH 2010-11 VACCINATION SEASON. TRUE?

LAIV can be administered simultaneously with another live vaccine (e.g., MMR, varicella), but if not given at the same time, ACIP recommends waiting four weeks before administering the second live vaccine.

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A FIVE-YEAR-OLD CHILD RECEIVED HER SECOND MMR WEEK AGO. HOW LONG SHOULD SHE WAIT BEFORE RECEIVING LIVE ATTENUATED INFLUENZA VACCINE (LAIV)?

There are several reasons why this misconception persists: (1) Less than 1% of people who are vaccinated with the injectable vaccine develop flu-like symptoms, such as mild fever and muscle aches, after vaccination. These side effects are not the same as having influenza, but people confuse the symptoms. (2) Protective immunity doesn't develop until 1–2 weeks after vaccination. Some people who get vaccinated later in the season (December or later) may get influenza shortly afterward. These late vaccinees develop influenza because they were exposed to someone with the virus before they became immune. It is not the result of the vaccination. (3) To many people "the flu" is any illness with fever and cold symptoms. If they get any viral illness, they may blame it on the flu shot or think they got "the flu" despite being vaccinated. Influenza vaccine only protects against certain influenza viruses, not all viruses. (4) The influenza vaccine is not 100% effective, especially in older persons. For more information on this topic, go to: www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm

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SOME OF MY PATIENTS REFUSE INFLUENZA VACCINATION BECAUSE THEY INSIST "GOT THE FLU" AFTER RECEIVING INJECTABLE VACCINE IN PAST. WHAT CAN I TELL THEM?

The most important factor in preventing outbreaks is annual vaccination of all occupants of the facility, and all persons in the facility who share the same air as the high-risk occupants. Groups that should be targeted include physicians, nurses, and other personnel in hospitals and outpatient settings who have contact with high-risk patients in all age groups, and providers of home care to high-risk persons (e.g., visiting nurses, volunteers).

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ARE THERE RECOMMENDATIONS FOR THE PREVENTION OF INSTITUTIONAL OUTBREAKS INFLUENZA?

Yes. As long as a child is eligible to receive nasal spray vaccine (i.e., is in the proper age range and health status), it is acceptable to give 1 dose of each type of influenza vaccine. The doses should be spaced at least 4 weeks apart.

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WHEN A CHILD NEEDS 2 DOSES OF INFLUENZA VACCINE, CAN I GIVE 1 DOSE EACH TYPE (INJECTABLE AND NASAL SPRAY)?

Beginning with the 2010-11 vaccination season, ACIP recommends annual vaccination for all people ages 6 months and older who do not have a contraindication to the vaccine.

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RECOMMENDED TO GET VACCINATED AGAINST INFLUENZA (THE FLU)?

Information regarding influenza surveillance is available October through May from the CDC influenza website at www.cdc.gov/flu/weekly/fluactivity.htm.

In addition, periodic updates about influenza are published in the MMWR. State and local health departments should be consulted regarding availability of influenza vaccine, access to vaccination programs, information about state or local influenza activity, and for reporting influenza outbreaks and receiving advice regarding their control.

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WHERE CAN I GET INFORMATION ON INFLUENZA (THE FLU) AND ITS SURVEILLANCE?

Yes, unless you live in a state that has enacted legislation restricting use in pregnant women. There is no scientific evidence that thimerosal in vaccines, including influenza vaccines, is a cause of adverse events, unless the patient has a systemic allergy to thimerosal.

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CAN THIMEROSAL-CONTAINING VACCINE BE GIVEN TO PREGNANT WOMEN?