Both TIV and LAIV prepared for the 2008—09 season will include A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Florida/4/2006-like antigens. These viruses will be used because they are representative of influenza viruses that are forecasted to be circulating in the United States during the 2008—09 influenza season and have favorable growth properties in eggs.
TIV and LAIV can be used to reduce the risk for influenza virus infection and its complications. Vaccination providers should administer influenza vaccine to any person who wishes to reduce the likelihood of becoming ill with influenza or transmitting influenza to others should they become infected.
Healthy, nonpregnant persons aged 2—49 years can choose to receive either vaccine. Some TIV formulations are FDA-licensed for use in persons as young as age 6 months (see Recommended Vaccines for Different Age Groups). TIV is licensed for use in persons with high-risk conditions. LAIV is FDA-licensed for use only for persons aged 2—49 years. In addition, FDA has indicated that the safety of LAIV has not been established in persons with underlying medical conditions that confer a higher risk for influenza complications. All children aged 6 months—8 years who have not been vaccinated previously at any time with at least 1 dose of either LAIV or TIV should receive 2 doses of age-appropriate vaccine in the same season, with a single dose during subsequent seasons.
Target Groups for Vaccination
Influenza vaccine should be provided to all persons who want to reduce the risk of becoming ill with influenza or of transmitting it to others. However, emphasis on providing routine vaccination annually to certain groups at higher risk for influenza infection or complications is advised, including all children aged 6 months—18 years, all persons aged >50 years, and other adults at risk for medical complications from influenza or more likely to require medical care should receive influenza vaccine annually. In addition, all persons who live with or care for persons at high risk for influenza-related complications, including contacts of children aged <6 months, should receive influenza vaccine annually (Boxes 1 and 2). Approximately 83% of the United States population is included in one or more of these target groups; however, <40% of the U.S. population received an influenza vaccination during 2007—2008.
Children Aged 6 Months—18 Years
Beginning with the 2008—09 influenza season, annual vaccination for all children aged 6 months—18 years is recommended. Annual vaccination of all children aged 6 months—4 years (59 months) and older children with conditions that place them at increased risk for complications from influenza should continue. Children and adolescents at high risk for influenza complications should continue to be a focus of vaccination efforts as providers and programs transition to routinely vaccinating all children. Annual vaccination of all children aged 5—18 years should begin in September 2008 or as soon as vaccine is available for the 2008—09 influenza season, if feasible. Annual vaccination of all children aged 5—18 years should begin no later than during the 2009—10 influenza season.
Healthy children aged 2—18 years can receive either LAIV or TIV. Children aged 6—23 months, those aged 2—4 years who have evidence of possible reactive airways disease (see Considerations When Using LAIV) or who have medical conditions that put them at higher risk for influenza complications should receive TIV. All children aged 6 months—8 years who have not received vaccination against influenza previously should receive 2 doses of vaccine the first year they are vaccinated.
Persons at Risk for Medical Complications
Vaccination to prevent influenza is particularly important for the following persons who are at increased risk for severe complications from influenza, or at higher risk for influenza-associated clinic, emergency department, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to these persons:
- all children aged 6 months—4 years (59 months);
- all persons aged >50 years;
- children and adolescents (aged 6 months—18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;
- women who will be pregnant during the influenza season;
- adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological, or metabolic disorders (including diabetes mellitus);
- adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
- adults and children 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; and
- residents of nursing homes and other chronic-care facilities.
Persons Who Live With or Care for Persons at High Risk for Influenza-Related Complications
To prevent transmission to persons identified above, vaccination with TIV or LAIV (unless contraindicated) also is recommended for the following persons. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to these persons:
- healthy household contacts (including children) and caregivers of children aged <59 months (i.e., aged <5 years) and adults aged >50 years; and
- healthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.
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