What type of influenza vaccine is recommended for different patient groups, including older adults, young children, and individuals with certain health conditions?

Influenza Vaccine Type Recommendations by Patient Population

For children aged 6 months to 8 years, use trivalent inactivated influenza vaccine (TIV), with live attenuated influenza vaccine (LAIV) as an alternative only in healthy children aged 5-8 years; for adults aged 18-64 years, use standard-dose trivalent or quadrivalent vaccines; and for adults aged 65 years and older, use high-dose trivalent or quadrivalent egg-based vaccines. 1, 2

Young Children (6 months to 8 years)

Infants and Toddlers (6 months to 4 years)

• Only inactivated influenza vaccine (TIV) is approved for children aged 6 months to 4 years. 3
• The minimum age for TIV is 6 months, while LAIV cannot be used until age 5 years. 3
• Children under 2 years face the highest risk of influenza complications, making vaccination critical in this age group. 1
• Children receiving influenza vaccine for the first time require 2 doses separated by at least 4 weeks for TIV. 3, 1

Children Aged 5-8 Years

• For healthy children aged 5-8 years, LAIV may be used as an alternative to TIV. 3
• LAIV has demonstrated superior efficacy compared to TIV in children, with multiple studies showing LAIV provides better protection in this age group. 4
• LAIV is contraindicated in children with asthma, reactive airways disease, recurrent wheezing, or any chronic pulmonary conditions. 3, 1
• Children aged 5-8 years receiving vaccine for the first time need 2 doses separated by at least 6 weeks for LAIV or 4 weeks for TIV. 3

Adolescents and Young Adults (9-49 years)

Healthy Individuals

• Healthy persons aged 9-49 years can receive either standard-dose inactivated vaccine or LAIV. 3
• For adults aged 18-64 years, standard-dose trivalent or quadrivalent (cell-based, egg-based, MF59-adjuvanted, or recombinant) vaccines are appropriate. 2

High-Risk Conditions

• Individuals with chronic pulmonary disease (including asthma), cardiovascular disease, diabetes mellitus, renal dysfunction, hemoglobinopathies, or immunosuppression must receive only inactivated vaccines—never LAIV. 3, 1
• Pregnant women in any trimester should receive only inactivated influenza vaccine. 3
• Persons on long-term aspirin therapy (children and adolescents aged 6 months to 18 years) require inactivated vaccine only. 3

Older Adults (50 years and older)

Adults Aged 50-64 Years

• All adults aged 50-64 years should receive annual inactivated influenza vaccine regardless of risk factors. 3
• This age-based recommendation exists because 29% of persons aged 50-64 years have one or more high-risk medical conditions. 3
• Standard-dose trivalent or quadrivalent vaccines are appropriate for this age group. 2

Adults Aged 65 Years and Older

• Adults aged 65 years and older should receive high-dose trivalent or high-dose quadrivalent egg-based influenza vaccine. 2
• This population has increased prevalence of high-risk conditions and benefits from enhanced immune response provided by high-dose formulations. 3
• Vaccine effectiveness against invasive pneumococcal disease in persons aged 65 years and older ranges from 44-75%. 3

Special Populations Requiring Specific Vaccine Types

Immunocompromised Patients

• Immunocompromised persons (HIV infection, transplant recipients, chemotherapy patients, those on immunosuppressive medications) must receive only inactivated or recombinant vaccines—never LAIV. 1, 5
• This includes patients with congenital immunodeficiency, leukemia, lymphoma, multiple myeloma, Hodgkin's disease, and those receiving alkylating agents or long-term corticosteroids. 3

Healthcare Workers and Caregivers

• Healthcare workers should receive annual inactivated influenza vaccine to protect themselves and prevent transmission to high-risk patients. 3
• Household contacts and caregivers of children aged 0-23 months or persons with high-risk conditions should receive annual vaccination. 3

Nursing Home Residents

• Residents of nursing homes and long-term care facilities should receive inactivated influenza vaccine annually. 3
• Vaccination reduces hospitalization/pneumonia by 50-60% and death by 80% in this population. 5

Critical Implementation Considerations

Timing and Dosing

• Vaccination should begin as soon as vaccine becomes available and ideally be completed by the end of October. 1, 6
• Children requiring 2 doses should start vaccination early to ensure both doses are completed before peak influenza season. 1, 6

Common Pitfalls to Avoid

• Never delay vaccination waiting for a specific vaccine product when multiple appropriate options exist—any licensed, age-appropriate vaccine is acceptable. 1
• Do not assume LAIV can be used in patients with "mild" asthma or reactive airways disease—any history of wheezing or chronic pulmonary condition is a contraindication. 3
• Never use LAIV in contacts of severely immunocompromised persons requiring protected environments. 6
• Racial and ethnic disparities exist, with Black, Hispanic, and American Indian/Alaska Native children having 3-4 fold higher influenza-associated in-hospital deaths, requiring targeted vaccination efforts. 1