Recommendations for Using TIV and LAIV During the 2007–08 Influenza Season

On October 24, 2007 CDC's Advisory Committee on Immunization Practices (ACIP) recommended expanding the use of the nasal influenza vaccine LAIV (FluMist®) to include healthy children ages 2-4 years old (24-59 months old) without a history of asthma or recurrent wheezing. The vaccine continues to be recommended for healthy persons ages 5-49 years who are not pregnant. "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.

NOTE: The text below is taken directly from Prevention & Control of Influenza - Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007 Jul 13;56(RR06):1-54. Also available as PDF (720K).

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Target Groups for Vaccination
Persons at Increased Risk for Medical Complications
Persons Who Live With or Care for Persons at High Risk

Both TIV and LAIV prepared for the 2007–08 season will include A/Solomon Islands/3/2006 (H1N1)-like, A/Wisconsin/ 67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. These viruses will be used because they are representative of influenza viruses that are anticipated to circulate in the United States during the 2007–08 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. Immunization 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 5–49 years can choose to receive either vaccine.

TIV is FDA-approved for persons aged 6 months and older, including those with high-risk conditions, whereas LAIV is FDA-approved for use only among healthy persons aged 5–49 years. All children aged >6 months–8 years who have not been vaccinated previously at any time with 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

All persons at risk for medical complications from influenza or more likely to require medical care and all persons who live with or care for persons at high risk for influenza-related complications should receive influenza vaccine annually. Approximately 73% of the United States population is included in one or more of these target groups; however, only an estimated one third of the United States population received an influenza vaccination in 2006–2007. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to these persons.

Persons at Increased Risk for Medical Complications

Vaccination with TIV is recommended 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:

All children aged 6–59 months (i.e., 6 months–4 years);
All persons aged 50 years and older;
Children and adolescents (aged 6 months–18 years) who are receiving long-term aspirin therapy and who therefore 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:

Healthcare personnel;
Healthy household contacts (including children) and caregivers of children aged 59 months and younger (i.e., aged <5 years) and adults aged 50 years and older; and
Healthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.