Among those who could transmit influenza to high-risk persons, vaccinees can receive LAIV
if they are healthy, in the proper age group, and not in contact with a severely immunocompromised person (ie, one who requires reverse isolation).
This led some in attendance to call for additional data on adverse events like seizures at the June meeting, while others tasked the work group with clarifying and separating contraindications from precautions before opening up use of the LAIV
to a wider population.
A study conducted in a child care setting demonstrated that limited genetic change occurred in the LAIV
strains following replication in the vaccine recipients (225).
A systematic review found evidence of increased efficacy of LAIV
compared to inactivated influenza vaccine (IIV) in this age group; both types of vaccine have similar rates of adverse reactions.
The influenza work group also assessed influenza vaccine safety data in children aged 2-8 years and found no evidence for an increased risk of serious adverse events or medically attended wheezing after LAIV
Similarly, in an unpublished study of 197 day care attendees aged 8-36 months, 80% of the 98 who received LAIV
shed one or more virus strains, with a mean duration of 7.6 days.
Regardless of whether a child receives LAIV
or TIV, those younger than 9 years of age who are receiving influenza vaccine for the first time should receive 2 doses 4 weeks apart.
Also, there are no data on transmission of LAIV
from vaccine recipients to immunosuppressed contacts, so the use of the TIV is preferred for vaccinating household members, health care workers, and others who have close contact with immunosuppressed individuals because of the theoretical risk that a live vaccine could be transmitted and cause disease.
The mechanism for improved efficacy of LAIV
in young children (2-8 years) is largely unknown.
** The interval between 2 doses in children under 9 years of age is 4 weeks for TIV and 6 to 10 weeks for LAIV
* ACIP reiterates a previous recommendation that all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated (see Box and Recommendations for Using TIV and LAIV
During the 2007-08 Influenza Season).
The investigators randomized 243 HIV-positive children aged 5-18 years at the start of the 2004-2005 flu season: 122 to intranasal LAIV
and 121 to injected TIV.
At a meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, committee members unanimously agreed that healthy children with no contraindications should receive the quadrivalent live attenuated influenza vaccine (LAIV
) rather than an inactivated vaccine, provided that the LAIV
is readily available.
A child being immunized against influenza for the first time before his of her ninth birthday should receive 2 doses--4 weeks apart for TIV, 6 weeks apart for LAIV
. The doses can be 2 of either TIV of LAIV
of 1 of each.
A risk-based prioritization scheme for the inactivated (injectable) influenza vaccine and a stronger recommendation for immunization of health care workers with the live attenuated influenza vaccine (LAIV
, or Flu-Mist) are among the proposed changes to the yearly influenza vaccine statement discussed at a meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP).