What is the recommended influenza vaccination schedule for children aged 6 months to 18 years in the Philippines, including vaccine type, dosing regimen, timing, and contraindications?

Flu Vaccine Recommendation in Pediatrics in Philippines

All children aged 6 months to 18 years in the Philippines should receive annual influenza vaccination, following the same evidence-based recommendations established by the American Academy of Pediatrics (AAP) and CDC, as there are no Philippines-specific guidelines that contradict these international standards. 1

Core Vaccination Schedule

Age-Based Dosing

Children 6-35 months:

• May receive either 0.25 mL or 0.5 mL dose depending on the vaccine product
• Afluria: 0.25 mL per dose
• Fluzone: Either 0.25 mL or 0.5 mL per dose (both acceptable)
• Fluarix, FluLaval, Flucelvax: 0.5 mL per dose 1, 2

Children ≥36 months (3 years) through 18 years:

• All children receive 0.5 mL per dose regardless of vaccine brand 1

Number of Doses Required

This is the most critical decision point and depends on vaccination history:

TWO doses needed (4 weeks apart) for:

• Children 6 months through 8 years receiving influenza vaccine for the first time ever
• Children 6 months through 8 years who received only 1 dose before July 1 of the current year
• Children whose vaccination status is unknown 1

ONE dose needed for:

• All children ≥9 years (regardless of history)
• Children 6 months through 8 years who have received ≥2 doses previously in their lifetime 1

Important caveat: For 8-year-olds requiring 2 doses, complete both doses even if the child turns 9 between dose 1 and dose 2 1

Vaccine Type Selection

Any licensed, age-appropriate influenza vaccine can be used without preference for one product over another. This includes: 1

• Inactivated Influenza Vaccine (IIV) - intramuscular injection
• Live Attenuated Influenza Vaccine (LAIV) - intranasal spray (for eligible children ≥2 years)
• Recombinant Influenza Vaccine (RIV) - now approved for children ≥9 years 3

The two doses do not need to be the same brand or formulation if 2 doses are required 1

Timing

Ideally vaccinate by the end of October to ensure protection before influenza season peaks. However, vaccination should be offered as soon as vaccine becomes available, especially for children requiring 2 doses who need the 4-week interval between doses 1

Contraindications

Absolute Contraindications (All Vaccines):

• Infants <6 months of age
• History of severe allergic reaction (anaphylaxis) to any component of the vaccine
• History of severe allergic reaction after previous dose of any influenza vaccine 1, 4

Additional Contraindications for LAIV (Intranasal):

• Children <2 years of age
• Immunocompromised children
• Children with chronic medical conditions including:
  • Asthma or chronic pulmonary disease
  • Hemodynamically significant cardiac disease
  • Chronic renal dysfunction
  • Diabetes mellitus or chronic metabolic disease
  • Hemoglobinopathies (including sickle cell disease)
  • Conditions compromising respiratory function
• Children 2-4 years with history of recurrent wheezing or medically attended wheezing in previous 12 months
• Children on aspirin or salicylate-containing medications 1, 4, 1

Precautions (Not Contraindications):

• Moderate-to-severe acute illness with or without fever - defer vaccination until recovery
• History of Guillain-Barré syndrome within 6 weeks of previous influenza vaccination - requires careful risk-benefit assessment 4, 5

Minor illnesses with or without fever are NOT contraindications - children with mild upper respiratory symptoms or allergic rhinitis can be vaccinated 4, 5

High-Risk Groups Requiring Priority Vaccination

Special emphasis should be placed on vaccinating children with conditions that increase risk of influenza complications: 1, 6

• Asthma or chronic pulmonary diseases (including cystic fibrosis)
• Hemodynamically significant cardiac disease
• Immunosuppressive disorders or therapy, HIV infection
• Sickle cell anemia and other hemoglobinopathies
• Chronic renal dysfunction
• Chronic metabolic disease including diabetes mellitus
• Neurodevelopmental disorders, seizure disorders, neuromuscular abnormalities
• Children on long-term aspirin therapy

Egg Allergy Considerations

Children with egg allergy can receive influenza vaccine. Even those with history of severe egg allergy (anaphylaxis) can be vaccinated, though the following precautions apply: 4

• Administer in medical setting with appropriate resuscitative equipment available
• Observe for 30 minutes after vaccination
• Consider allergy consultation for those with history of severe reactions

Administration Site

• Infants and young children: Anterolateral thigh muscle
• Older children and adolescents: Deltoid muscle 2, 7

Common Pitfalls to Avoid

1. Do NOT split a 0.5 mL dose into two 0.25 mL doses - if wrong dose given, administer additional volume to complete full dose 1

2. Do NOT delay vaccination waiting for a specific product or thimerosal-free formulation - the safety of thimerosal-containing vaccines is well-established 3

3. Do NOT withhold vaccination from children with mild illness or minor upper respiratory symptoms 4, 5

4. Do NOT assume a child needs only 1 dose based on age alone - vaccination history is critical for children 6 months through 8 years 1

Philippines-Specific Context

While the Philippine Guidelines for Periodic Health Examination address pediatric immunization broadly 8, they do not provide specific influenza vaccination schedules that differ from international standards. Therefore, the AAP/CDC recommendations should be followed in the Philippines, as these represent the highest quality, most recent evidence-based guidelines available 1, 3.