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November 18, 2010

Influenza Vaccination for Children: A Quick Reference Guide


Eric J. Kasowski, DVM, MD, MPH

Posted: 11/10/2010

The Advisory Committee on Immunization Practices, or ACIP, and CDC have recommended that everyone 6 months and older, without a contraindication to the influenza vaccine, get vaccinated each year. Children 6 months through 8 years getting a seasonal influenza vaccine for the first time need 2 doses of vaccine, 4 weeks apart, to be fully protected.

The availability of 2 influenza vaccines last season -- the trivalent seasonal vaccine and the monovalent 2009 H1N1 vaccine -- may result in questions from parents and healthcare providers about how many influenza vaccinations children need this season, and there are different answers to those questions depending on a child's vaccination history.

•Children who did not receive the monovalent 2009 H1N1 vaccine last year, even if they have received 2 doses of trivalent seasonal vaccine in the past, need 2 doses of 2010-2011 seasonal vaccine.
•Children who have never received a trivalent seasonal flu vaccine in the past or whose vaccination status is unknown should get 2 doses of 2010-2011 flu vaccine.
•Children who received only 1 dose of the trivalent seasonal influenza vaccine for the first time last year should get 2 doses of 2010-2011 flu vaccine.
Some children will only need 1 dose of this year's flu vaccine.

•Children who received 2 doses of trivalent seasonal 2009-2010 vaccine and either 1 or 2 doses of 2009 H1N1 monovalent vaccine only need 1 dose of 2010-2011 seasonal vaccine.
•Children who got either 1 or 2 doses of monovalent 2009 H1N1 vaccine in addition to 1 dose of the 2009-2010 trivalent seasonal vaccine and who have received at least 1 dose of a seasonal flu vaccine prior to the 2009-2010 flu season need only 1 dose of the 2010-2011 influenza vaccine.
•Lastly, all children aged 9 years and older need only 1 dose of the 2010-2011 flu vaccine.
Vaccination is especially important for children at higher risk for serious flu-related complications. This includes: children younger than 5 years of age, and especially those younger than 2 years of age, and children of any age with chronic health conditions like asthma, diabetes, or heart disease.

In addition, children younger than 6 months old are too young to receive the influenza vaccine, but they have the highest hospitalization rate among children. Therefore, it is important that healthcare workers and other close contacts, such as child care providers and family members, get vaccinated to help protect these children.

Vaccination of pregnant women also is important, and recent studies have shown that influenza vaccination during pregnancy can provide protection for infants for up to 6 months after they are born.

There are 2 types of influenza vaccine: (1) inactivated vaccine, commonly referred to as the "flu shot," and (2) live, attenuated vaccine, which comes as a nasal spray. The inactivated flu shot can be administered to children aged 6 months and older. The live, attenuated nasal spray vaccine is a good option for otherwise healthy people 2-49 years of age. Contraindications to the nasal spray vaccine include:

•A history of asthma or wheezing episodes within the previous 12 months;
•Chronic pulmonary or cardiovascular disease;
•Weakened immune system; and
•Long-term aspirin therapy.
Vaccination should begin as soon as influenza vaccine is available. Early vaccination is especially important for children requiring 2 doses of vaccine.

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