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Choice of influenza vaccine for children

Category	Type of influenza vaccine
Age
0 through 5 months	Influenza vaccine not licensed for this age group Vaccination of mothers with IIV during pregnancy can provide protection for the infant Household contacts and out-of-home caregivers should receive IIV or LAIV*
6 through 23 months	IIV (LAIV not licensed for this age group)
≥24 months	IIV or LAIV*
Chronic medical disorders
Age 2 through 4 years and any of the following^¶: A diagnosis of asthma Parent- or caregiver-reported wheezing or asthma verified by a health care provider in the previous 12 months Documented wheezing in the previous 12 months	IIV
Weakened immune system due to disease (eg, HIV, AIDS, cancer), medication (eg, chronic glucocorticoids), or anatomic or functional asplenia (eg, sickle cell disease)^¶	IIV
Children <19 years of age who are receiving long-term aspirin therapy^¶	IIV
Asthma in children ≥5 years^Δ	IIV
Neurologic, neuromuscular, and neurodevelopmental conditions (eg, cerebral palsy, epilepsy, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, spinal cord injury)^Δ	IIV
Chronic lung disease (eg, cystic fibrosis)^Δ	IIV
Heart disease (eg, congenital heart disease, pulmonary hypertension)^Δ; excludes isolated systemic hypertension	IIV
Blood disorders^Δ	IIV
Endocrine disorders (eg, diabetes mellitus)^Δ	IIV
Kidney disorders^Δ	IIV
Liver disorders^Δ	IIV
Metabolic disorders (eg, inherited metabolic disorders, mitochondrial disorders)^Δ	IIV
Class III obesity (BMI ≥40 for adults or BMI >95^th percentile value for children <18 years)^◊	IIV or LAIV*
History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine^Δ^§	Precaution for influenza vaccination with IIV or LAIV^¥
Other conditions
Pregnancy^¶	IIV
History of severe allergic reaction to any component of the vaccine or after a previous dose of any influenza vaccine^¶^‡^†	Contraindication for influenza vaccination with LAIV or IIV
CSF leak or cochlear implant^¶	IIV
Receipt of oseltamivir or zanamivir in past 48 hours, receipt of peramivir in past 5 days, or receipt of baloxavir in past 17 days^¶	IIV
Close contact of person who is severely immunosuppressed and requires a protected environment^¶	IIV
Household or close contact of an infant <6 months of age or of an individual with chronic medical disorder or other condition with increased risk of severe or complicated influenza infection except severely immunocompromised person who requires protected environment	IIV or LAIV*
Resident of long-term care facility	IIV
Native Americans, including Alaska Natives	IIV or LAIV*

IIV: inactivated influenza vaccine; LAIV: live attenuated influenza vaccine; BMI: body mass index; CSF: cerebrospinal fluid.

* LAIV may be administered to individuals who are healthy, nonpregnant, and 2 through 49 years of age.

¶ Contraindication to LAIV.

Δ Precaution for LAIV.

◊ Refer to UpToDate content on obesity in children for details.

§ Precaution for IIV.

¥ It is not known whether Guillain-Barré syndrome increases the risk of Guillain-Barré syndrome in children who developed Guillain-Barré syndrome within 6 weeks after a dose of influenza vaccine. The theoretic risk should be balanced against the potential morbidity and mortality of influenza infection.

‡ Contraindication for IIV.

† Although the prescribing information for LAIV includes severe allergic reaction to egg as a contraindication, the Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend any licensed vaccine that is appropriate for age and health status for individuals with egg allergy of any severity.

Reference:

Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022-23 influenza season. MMWR Recomm Rep 2022; 71:1.

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