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Has child received ≥2 total doses of trivalent/quadrivalent influenza vaccine before July 1, 2024? - If yes, give 1 dose of vaccine
- If no/unknown, give 2 doses of vaccine ≥4wk apart
- Give 1st dose ASAP (i.e., July/Aug.) to allow 2nd dose before end of Oct.
Vaccinate all annually w/ any IIV3 or ccIIV3. - Ideally give in Sept. or Oct.
- Any age-appropriate formulation is acceptable regardless of egg allergy hx
- Egg allergy is not a contraindication. Regardless of allergy hx, all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and tx of acute hypersensitivity rxns are available.
- LAIV3 contraindicated in children <2 yo
Children 6-35 mo may receive any of the following IIV3 or ccIIV3 products. Preferred site is anterolateral aspect of thigh. - Afluria (IIV3) 0.25 mL IM (not available in prefilled syringes)
- Fluarix (IIV3) 0.5 mL IM
- FluLaval (IIV3) 0.5 mL IM
- Fluzone (IIV3) 0.25 mL or 0.5 mL IM (approved at either dose; 0.25 mL if multidose vial; if prefilled syringe or single-dose vial, 0.5 mL per dose)
- Flucelvax (ccIIV3) 0.5 mL IM
Contraindications: - Severe allergic rxn (e.g., anaphylaxis) to any prior flu vaccine. If giving ccIIV3, and prior rxn was to any other flu vaccine (e.g., IIV, RIV, LAIV), then considered a precaution.
- Although hx of severe allergic rxn (e.g., anaphylaxis) to egg is a labeled contraindication to egg-based IIV3s, ACIP recommends that everyone ≥6 mo w/ egg allergy should receive influenza vaccine, and any vaccine (egg-based or non–egg-based) otherwise appropriate for age and health status can be used.
- LAIV3 contraindicated in children <2 yo
Precautions: - Moderate or severe acute illness w/ or w/o fever
- GBS hx w/in 6wk of a previous influenza vaccine dose
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Has child received ≥2 total doses of trivalent/quadrivalent influenza vaccine before July 1, 2024? - If yes, give 1 dose of vaccine (prior doses don’t need to have been in same or consecutive seasons)
- If no/unknown, give 2 doses of vaccine ≥4wk apart
- Give 1st dose ASAP (i.e., July/Aug.) to allow 2nd dose before end of Oct.
Vaccinate all annually w/ IIV3, ccIIV3, or LAIV3. - Ideally give in Sept. or Oct.
- If only 1 dose required, can consider vaccination in July or Aug. Although immunity may wane over the course of the season among all age groups, evidence is scant in children. Children in this group might visit health care providers in July-Aug. for school exams, creating a vaccination opportunity.
- Any age-appropriate formulation is acceptable regardless of egg allergy hx
- Egg allergy is not a contraindication. Regardless of allergy hx, all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and tx of acute hypersensitivity rxns are available.
Children 2-8 yo may receive any of the following products: - Afluria (IIV3) 0.25 mL IM from multidose vial; if ≥3 yo, 0.5-mL prefilled syringe is alternative
- Fluarix (IIV3) 0.5 mL IM
- FluLaval (IIV3) 0.5 mL IM
- Fluzone (IIV3) 0.25 mL or 0.5 mL IM (approved at either dose; 0.25 mL if multidose vial; if prefilled syringe or single-dose vial, 0.5 mL per dose)
- Flucelvax (ccIIV3) 0.5 mL IM
- FluMist (LAIV3) 0.2 mL intranasally (0.1 mL in each nostril)
Contraindications: - Severe allergic rxn (e.g., anaphylaxis) to any prior flu vaccine. If giving ccIIV3, and prior rxn was to any other flu vaccine (e.g., IIV, RIV, LAIV), then considered a precaution.
- Although hx of severe allergic rxn (e.g., anaphylaxis) to egg is a labeled contraindication to egg-based IIV3s and LAIV3, ACIP recommends that everyone ≥6 mo w/ egg allergy should receive influenza vaccine, and any vaccine (egg-based or non–egg-based) otherwise appropriate for age and health status can be used.
- LAIV3 additional contraindications:
◦ Concomitant aspirin- or salicylate-containing tx in children and adolescents
◦ Children 2-4 yo w/ asthma dx, whose parents/caregivers report a clinician telling them in the past 12mo that their child had wheezing/asthma, or whose medical record indicates a wheezing episode in the past 12mo
◦ Immunocompromised due to any cause, including but not limited to immunosuppression caused by meds, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia, or functional asplenia (e.g., due to sickle cell anemia)
◦ Close contacts/caregivers of severely immunosuppressed individuals who require a protected environment
◦ Pregnancy
◦ Pts w/ active communication between the CSF and the oropharynx, nasopharynx, nose, or ear or any other cranial CSF leak
◦ Individuals w/ cochlear implants. Discuss w/ specialist if age-appropriate inactivated or recombinant vaccine can’t be used.
◦ Receipt of influenza antiviral medication w/in the past 48h (oseltamivir and zanamivir), 5 days (peramivir), or 17 days (baloxavir)
Precautions: - Moderate or severe acute illness w/ or w/o fever
- GBS hx w/in 6wk of a previous influenza vaccine dose
- LAIV3 additional precautions:
◦ Influenza antivirals might interfere w/ LAIV3 if initiated ≤2wk after vaccination. Pts who receive antivirals w/in a specified time frame before receipt of LAIV3 (48h for oseltamivir and zanamivir, 5 days for peramivir, and 17 days for baloxavir) through 2wk after receipt of LAIV3 should be revaccinated w/ an age-appropriate IIV3 or RIV3.
◦ Asthma in individuals ≥5 yo
◦ Other underlying medical conditions that might predispose to complications after wild-type influenza infection (e.g., chronic pulmonary, CV [except isolated HTN], renal, hepatic, neurologic, hematologic, or metabolic diseases [including DM])
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Vaccinate all annually w/ IIV3, ccIIV3, or LAIV3. - Only 1 dose needed, regardless of prior vaccine status
- Ideally give in Sept. or Oct. Can consider vaccination in July or Aug. Although immunity may wane over the course of the season among all age groups, evidence is scant in children. Children in this group might visit health care providers in July-Aug. for school exams, creating a vaccination opportunity.
- Any age-appropriate formulation is acceptable regardless of egg allergy hx
- Egg allergy is not a contraindication. Regardless of allergy hx, all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and tx of acute hypersensitivity rxns are available.
Children 9-17 yo may receive any of the following products: - Afluria (IIV3) 0.5 mL IM
- Fluarix (IIV3) 0.5 mL IM
- FluLaval (IIV3) 0.5 mL IM
- Fluzone (IIV3) 0.5 mL IM
- Flucelvax (ccIIV3) 0.5 mL IM
- FluMist (LAIV3) 0.2 mL intranasally (0.1 mL in each nostril)
Contraindications: - Severe allergic rxn (e.g., anaphylaxis) to any prior flu vaccine. If giving ccIIV3, and prior rxn was to any other flu vaccine (e.g., IIV, RIV, LAIV), then considered a precaution.
- Although hx of severe allergic rxn (e.g., anaphylaxis) to egg is a labeled contraindication to egg-based IIV3s and LAIV3, ACIP recommends that everyone ≥6 mo w/ egg allergy should receive influenza vaccine, and any vaccine (egg-based or non–egg-based) otherwise appropriate for age and health status can be used.
- LAIV3 additional contraindications:
◦ Concomitant aspirin- or salicylate-containing tx in children and adolescents
◦ Immunocompromised due to any cause, including but not limited to immunosuppression caused by meds, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia, or functional asplenia (e.g., due to sickle cell anemia)
◦ Close contacts/caregivers of severely immunosuppressed individuals who require a protected environment
◦ Pregnancy
◦ Pts w/ active communication between the CSF and the oropharynx, nasopharynx, nose, or ear or any other cranial CSF leak
◦ Individuals w/ cochlear implants. Discuss w/ specialist if age-appropriate inactivated or recombinant vaccine can’t be used.
◦ Receipt of influenza antiviral medication w/in the past 48h (oseltamivir and zanamivir), 5 days (peramivir), or 17 days (baloxavir)
Precautions: - Moderate or severe acute illness w/ or w/o fever
- GBS hx w/in 6wk of a previous influenza vaccine dose
- LAIV3 additional precautions:
◦ Influenza antivirals might interfere w/ LAIV3 if initiated ≤2wk after vaccination. Pts who receive antivirals w/in a specified time frame before receipt of LAIV3 (48h for oseltamivir and zanamivir, 5 days for peramivir, and 17 days for baloxavir) through 2wk after receipt of LAIV3 should be revaccinated w/ an age-appropriate IIV3 or RIV3.
◦ Asthma in individuals ≥5 yo
◦ Other underlying medical conditions that might predispose to complications after wild-type influenza infection (e.g., chronic pulmonary, CV [except isolated HTN], renal, hepatic, neurologic, hematologic, or metabolic diseases [including DM])
Vaccinate all pregnant people annually w/ IIV3 or ccIIV3. Pregnant/postpartum individuals are at higher risk for severe illness and complications from influenza. - Only 1 dose needed, regardless of prior vaccine status
- May give during any trimester before and during flu season
- Ideally give in Sept. or Oct. Consider early vaccination (i.e., July or Aug.) for those in the 3rd trimester during these months, if vaccine is available; can protect infants in the 1st months of life when they’re too young to be vaccinated.
- Although immunity may wane over the course of the season among all age groups, evidence is scant in children. Children in this group might visit health care providers in July-Aug. for school exams, creating a vaccination opportunity.
- Any age-appropriate formulation is acceptable regardless of egg allergy hx
- Egg allergy is not a contraindication. Regardless of allergy hx, all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and tx of acute hypersensitivity rxns are available.
- Don’t use LAIV3 during pregnancy.
Pregnant children 9-17 yo may receive any of the following products: - Afluria (IIV3) 0.5 mL IM
- Fluarix (IIV3) 0.5 mL IM
- FluLaval (IIV3) 0.5 mL IM
- Fluzone (IIV3) 0.5 mL IM
- Flucelvax (ccIIV3) 0.5 mL IM
Contraindications: - Severe allergic rxn (e.g., anaphylaxis) to any prior flu vaccine. If giving ccIIV3, and prior rxn was to any other flu vaccine (e.g., IIV, RIV, LAIV), then considered a precaution.
- Although hx of severe allergic rxn (e.g., anaphylaxis) to egg is a labeled contraindication to egg-based IIV3s, ACIP recommends that everyone ≥6 mo w/ egg allergy should receive influenza vaccine, and any vaccine (egg-based or non–egg-based) otherwise appropriate for age and health status can be used.
- LAIV3 contraindicated in pregnancy
Precautions: - Moderate or severe acute illness w/ or w/o fever
- GBS hx w/in 6wk of a previous influenza vaccine dose
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Vaccinate all annually w/ IIV3, ccIIV3, RIV3, or LAIV3. - Only 1 dose needed, regardless of prior vaccine status
- Ideally give in Sept. or Oct.
- Any age-appropriate formulation is acceptable regardless of egg allergy hx
- Egg allergy is not a contraindication. Regardless of allergy hx, all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and tx of acute hypersensitivity rxns are available.
Adults 18-64 yo may receive any of the following products: - Afluria (IIV3) 0.5 mL IM
- Fluarix (IIV3) 0.5 mL IM
- FluLaval (IIV3) 0.5 mL IM
- Fluzone (IIV3) 0.5 mL IM
- Flucelvax (ccIIV3) 0.5 mL IM
- Flublok (RIV3) 0.5 mL IM
- If 18-49 yo, FluMist (LAIV3) 0.2 mL intranasally (0.1 mL in each nostril) (not approved for >49 yo)
Solid organ txp recipients 18-64 yo on immunosuppressive regimens may receive HD-IIV3 or aIIV3, w/ no preference over other age-appropriate IIV3s or RIV3. LAIV3 should not be used. - Fluad (aIIV3) 0.5 mL IM
- Fluzone High-Dose (HD-IIV3) 0.5 mL IM
Contraindications: - Severe allergic rxn (e.g., anaphylaxis) to any prior flu vaccine. If giving ccIIV3 or RIV3, and prior rxn was to any other flu vaccine formulation, then considered a precaution.
- Although hx of severe allergic rxn (e.g., anaphylaxis) to egg is a labeled contraindication to egg-based IIV3s and LAIV3, ACIP recommends that everyone ≥6 mo w/ egg allergy should receive influenza vaccine, and any vaccine (egg-based or non–egg-based) otherwise appropriate for age and health status can be used.
- LAIV3 additional contraindications:
◦ Age >49 yo
◦ Immunocompromised due to any cause, including but not limited to immunosuppression caused by meds, congenital or acquired immunodeficiency states, HIV infection, anatomic asplenia, or functional asplenia (e.g., due to sickle cell anemia)
◦ Close contacts/caregivers of severely immunosuppressed individuals who require a protected environment
◦ Pregnancy
◦ Pts w/ active communication between the CSF and the oropharynx, nasopharynx, nose, or ear or any other cranial CSF leak
◦ Individuals w/ cochlear implants. Discuss w/ specialist if age-appropriate inactivated or recombinant vaccine can’t be used.
◦ Receipt of influenza antiviral medication w/in the past 48h (oseltamivir and zanamivir), 5 days (peramivir), or 17 days (baloxavir)
Precautions: - Moderate or severe acute illness w/ or w/o fever
- GBS hx w/in 6wk of a previous influenza vaccine dose
- LAIV3 additional precautions:
◦ Influenza antivirals might interfere w/ LAIV3 if initiated ≤2wk after vaccination. Pts who receive antivirals w/in a specified time frame before receipt of LAIV3 (48h for oseltamivir and zanamivir, 5 days for peramivir, and 17 days for baloxavir) through 2wk after receipt of LAIV3 should be revaccinated w/ an age-appropriate IIV3 or RIV3.
◦ Asthma in individuals ≥5 yo
◦ Other underlying medical conditions that might predispose to complications after wild-type influenza infection (e.g., chronic pulmonary, CV [except isolated HTN], renal, hepatic, neurologic, hematologic, or metabolic diseases [including DM])
Vaccinate all pregnant people annually w/ IIV3, ccIIV3, or RIV3. Pregnant/postpartum individuals are at higher risk for severe illness and complications from influenza. - Only 1 dose needed, regardless of prior vaccine status
- May give during any trimester before and during flu season
- Ideally give in Sept. or Oct. Consider early vaccination (i.e., July or Aug.) for those in the 3rd trimester during these months, if vaccine is available; can protect infants in the 1st months of life when they’re too young to be vaccinated.
- Any age-appropriate formulation is acceptable regardless of egg allergy hx
- Egg allergy is not a contraindication. Regardless of allergy hx, all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and tx of acute hypersensitivity rxns are available.
- Don’t use LAIV3 during pregnancy.
Pregnant adults may receive any of the following products: - Afluria (IIV3) 0.5 mL IM
- Fluarix (IIV3) 0.5 mL IM
- FluLaval (IIV3) 0.5 mL IM
- Fluzone (IIV3) 0.5 mL IM
- Flucelvax (ccIIV3) 0.5 mL IM
- Flublok (RIV3) 0.5 mL IM
Solid organ txp recipients 18-64 yo on immunosuppressive regimens may receive HD-IIV3 or aIIV3, w/ no preference over other age-appropriate IIV3s or RIV3. LAIV3 should not be used. - Fluad (aIIV3) 0.5 mL IM
- Fluzone High-Dose (HD-IIV3) 0.5 mL IM
Contraindications: - Severe allergic rxn (e.g., anaphylaxis) to any prior flu vaccine. If giving ccIIV3 or RIV3, and prior rxn was to any other flu vaccine formulation, then considered a precaution.
- Although hx of severe allergic rxn (e.g., anaphylaxis) to egg is a labeled contraindication to egg-based IIV3s, ACIP recommends that everyone ≥6 mo w/ egg allergy should receive influenza vaccine, and any vaccine (egg-based or non–egg-based) otherwise appropriate for age and health status can be used.
- LAIV3 contraindicated in pregnancy
Precautions: - Moderate or severe acute illness w/ or w/o fever
- GBS hx w/in 6wk of a previous influenza vaccine dose
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Vaccinate all annually. Older adults are at risk for severe dz, hospitalization, and death. - High-dose, recombinant, or adjuvanted vaccine (HD-IIV3, RIV3, or aIIV3) preferred for pts ≥65 yo; however, no preference given to any one formulation. If none available, then any age-appropriate formulation ok.
- Only 1 dose needed, regardless of prior vaccine status
- Ideally give in Sept. or Oct.
- Any age-appropriate formulation is acceptable regardless of egg allergy hx
- Egg allergy is not a contraindication. Regardless of allergy hx, all vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and tx of acute hypersensitivity rxns are available.
- LAIV3 not approved for pts ≥50 yo
Adults ≥65 yo may receive any of the following products: - Fluad (aIIV3) 0.5 mL IM (preferred)
- Fluzone High-Dose (HD-IIV3) 0.5 mL IM (preferred)
- Flublok (RIV3) 0.5 mL IM (preferred)
- Afluria (IIV3) 0.5 mL IM (jet injector not available for >64 yo)
- Fluarix (IIV3) 0.5 mL IM
- FluLaval (IIV3) 0.5 mL IM
- Fluzone (IIV3) 0.5 mL IM
- Flucelvax (ccIIV3) 0.5 mL IM
Contraindications: - Severe allergic rxn (e.g., anaphylaxis) to any prior flu vaccine. If giving ccIIV3 or RIV3, and prior rxn was to any other flu vaccine formulation, then considered a precaution.
- Although hx of severe allergic rxn (e.g., anaphylaxis) to egg is a labeled contraindication to egg-based IIV3s, ACIP recommends that everyone ≥6 mo w/ egg allergy should receive influenza vaccine, and any vaccine (egg-based or non–egg-based) otherwise appropriate for age and health status can be used.
Precautions: - Moderate or severe acute illness w/ or w/o fever
- GBS hx w/in 6wk of a previous influenza vaccine dose
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