* Trivalent inactivated vaccine.
§Children aged 6 months--8 years who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine, who have never received a seasonal influenza vaccine before, or who were vaccinated for the first time with the seasonal 2009--10 seasonal vaccine but who received only 1 dose should receive 2 doses of the 2010--11 influenza vaccine formula, spaced 4 or more weeks apart.
§For adults and older children, the recommended site of vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral aspect of the thigh.
¶Afluria (CSL Biotherapies) is approved in the United States by the Food and Drug Administration for use in persons aged 6 months and older. However, the Advisory Committee on Immunization Practices recommends that the 2010--11 formulation of Afluria not be administered to children aged 6 months--8 years because of an increased frequency of fever or febrile seizures reported among young children (mostly children aged younger than 5 years) who received a similar vaccine in Australia in 2010. Therefore, another age-appropriate, licensed seasonal influenza vaccine formulation should be used for prevention of influenza in children aged 6 months--8 years. If no other age-appropriate, licensed seasonal influenza vaccine is available for a child aged 5--8 years who has a medical condition that increases the child's risk for influenza complications, Afluria may be given. Providers should discuss with the parents or caregivers the benefits and risks of influenza vaccination with Afluria before administering this vaccine. See second footnote above for dose information when administering Afluria to children aged 5--8 years.
** Trivalent inactivated vaccine high dose. A 0.5-mL dose contains 60 mcg each of A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens.
††Live attenuated influenza vaccine.
§§ FluMist is shipped refrigerated and stored in the refrigerator at 36°F--46°F (2°C--8°C) after arrival in the vaccination clinic. The dose is 0.2 mL divided equally between each nostril. Health-care providers should consult the medical record, when available, to identify children aged 2--4 years with asthma or recurrent wheezing that might indicate asthma. In addition, to identify children who might be at greater risk for asthma and possibly at increased risk for wheezing after receiving LAIV, parents or caregivers of children aged 2--4 years should be asked: "In the past 12 months, has a health-care provider ever told you that your child had wheezing or asthma?" Children whose parents or caregivers answer "yes" to this question and children who have asthma or who had a wheezing episode noted in the medical record within the past 12 months should not receive FluMist.