Who should receive the influenza vaccination?

Who Should Receive Influenza Vaccination

Annual influenza vaccination is recommended for everyone 6 months of age and older, including all children, adolescents, and adults, with no upper age limit. 1

Universal Vaccination Recommendation

The most recent guidelines establish a universal vaccination policy rather than targeting only high-risk groups:

• All persons ≥6 months of age should receive annual influenza vaccination, regardless of health status 1
• This represents a shift from earlier risk-based approaches to comprehensive population coverage 1

Priority Groups Requiring Special Emphasis

While vaccination is universal, special effort must be made to vaccinate the following groups who face increased risk of complications or serve as transmission vectors 1:

High-Risk Medical Conditions (Any Age ≥6 Months)

• Children and adults with chronic pulmonary diseases (including asthma) 1
• Metabolic diseases (including diabetes mellitus) 1
• Hemoglobinopathies (including sickle cell disease) 1
• Hemodynamically significant cardiac disease 1
• Immunosuppression (including HIV infection and medication-induced immunosuppression) 1, 2
• Renal and hepatic disorders 1
• Neurologic and neurodevelopmental disorders 1

Age-Based Priority Groups

• All persons ≥65 years of age (due to increased hospitalization and mortality risk) 1
• All persons aged 50-64 years (24-32% have underlying high-risk conditions) 1
• All children 6 months through 59 months (children <2 years have elevated hospitalization risk) 1
• Infants born preterm (based on chronologic age, starting at 6 months) 1

Special Populations

• All pregnant women at any time during pregnancy (protects both mother and infant through transplacental antibody transfer) 1
• Postpartum women who did not receive vaccination during pregnancy 1
• Breastfeeding women (vaccination is safe for mothers and infants) 1
• Children and adolescents (6 months-18 years) receiving long-term aspirin therapy (risk of Reye syndrome after influenza infection) 1
• American Indian/Alaska Native children 1
• Residents of nursing homes and chronic-care facilities 1
• Persons who are morbidly obese (BMI ≥40) 1

Contacts and Caregivers

All household contacts and caregivers of high-risk individuals must be vaccinated to prevent transmission 1:

• Household contacts and out-of-home care providers of children <5 years, especially infants <6 months 1
• Household contacts of children with high-risk medical conditions 1
• All health care personnel (crucial for preventing healthcare-associated influenza infections) 1
• All child care providers and staff 1

Rationale for Universal Vaccination

The evidence supporting universal vaccination includes:

• Children have the highest attack rates during seasonal epidemics and serve as primary transmission vectors to household and community contacts 1
• School-aged children bear a large disease burden with significantly higher rates of influenza-related medical care compared to healthy adults 1
• More than two-thirds of children <6 years and almost all children ≥6 years spend significant time in group settings, increasing infection risk 1
• Reducing transmission among children decreases the burden across all age groups in the community 1
• Pediatric deaths occur even in previously healthy children: 64% of pediatric deaths during the 2014-2015 season occurred in children without underlying high-risk conditions 1

Important Caveats

Absolute Contraindications to Screen For

• Previous severe allergic reaction (anaphylaxis) to any influenza vaccine component 2, 3
• History of Guillain-Barré syndrome within 6 weeks of prior influenza vaccination (precaution, not absolute contraindication) 3

Not Contraindications

• Minor illnesses with or without fever (including mild upper respiratory infection or allergic rhinitis) are NOT contraindications 1, 3
• Egg allergy is NOT a contraindication: all children with egg allergy can receive influenza vaccine with no additional precautions beyond routine vaccination 1
• Moderate-to-severe acute febrile illness is a precaution; defer until symptoms abate 1, 3

Vaccine Selection Considerations

• Inactivated influenza vaccine (IIV) is preferred for all children as the primary choice 1
• Live attenuated influenza vaccine (LAIV) may be used for healthy, non-pregnant persons aged 2-49 years, but should NOT be used in immunocompromised patients, pregnant women, or children with asthma 1, 2, 3
• High-dose or adjuvanted vaccines are preferred for adults ≥65 years 3

Timing

• Vaccinate as soon as vaccine is available, ideally by the end of October 2, 3
• Annual vaccination is necessary because immunity declines within one year 1