ACIP recommends annual influenza vaccination for all children age 6 months and older who do not have a contraindication to the vaccine.
Ask the Experts: Influenza: For Children
There are now five inactivated influenza vaccine options for children younger than age 3 years.
Cell-culture-based Flucelvax Quadrivalent (ccIIV4, CSL Seqirus) is available to children beginning at age 6 months: administer 0.5 mL/dose intramuscularly (IM).
There are four egg-based quadrivalent inactivated influenza vaccines (IIV4s), all given as IM injections, available for children age 6 through 35 months:
• Afluria Quadrivalent (CSL Seqirus): 0.25 mL/dose
• Fluarix Quadrivalent (GSK): 0.5 mL/dose
• FluLaval Quadrivalent (GSK): 0.5 mL/dose
• Fluzone Quadrivalent (Sanofi): 0.25 mL or 0.5 mL per dose
Children age 6 months through 8 years should receive a second dose 4 weeks or more after the first dose 1) if they are receiving influenza vaccine for the first time, 2) if they have not received a total of at least two doses of any seasonal influenza vaccine before July 1 of the current year, or 3) if their vaccination history is unknown. The two previous doses need not have been received during the same season or consecutive seasons.
Children who are age 8 years and are recommended to receive two doses during the current season but who have a 9th birthday during the current season before receiving dose 2 should still receive dose 2.
Immunize.org’s handout titled “Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months through 8 Years” provides additional guidance on this issue; it is available at www.immunize.org/catg.d/p3093.pdf.
Yes. CDC advises that doses of FluMist administered in past seasons can be counted.
They need just one dose of any appropriate influenza vaccine annually.
The two doses may be the same or different products.
The child should always receive the dose appropriate for his or her age at the time of the clinic visit; at age 37 months that would be a 0.5 mL dose of Afluria Quadrivalent.
Yes. Multi-dose vials of inactivated influenza vaccine contain a small amount of thimerosal to prevent bacterial and fungal growth in the vial. Thimerosal-containing vaccines are safe to use in children. No scientific evidence indicates that thimerosal in vaccines causes adverse events unless the patient has a severe allergy to thimerosal. Despite this, a few states have enacted legislation that restricts the use of thimerosal-containing vaccines in children. To find out if your state has such restrictions, check with your state immunization program (see www.immunize.org/coordinators for contact information).
Yes, but only if the 9-year-old meets all of the criteria below:
- they turned 9 years old during the current season, and
- they received one dose during the current season before turning 9, and
- they have no or unknown history of receiving any previous dose of influenza vaccine before July 1 of the current year.
A CDC study has shown a small increased risk for febrile seizures during the 24 hours after a child receives the inactivated influenza vaccine at the same time as the PCV13 vaccine or DTaP vaccine. However, the risk of febrile seizure with any combination of these vaccines is small and ACIP recommends giving these vaccines at the same visit if indicated. The risk for febrile seizures in children who received PCV15 or PCV20 concurrently with an influenza vaccine has not been studied. See www.cdc.gov/vaccinesafety/concerns/febrile-seizures.html for more information about febrile seizures after vaccination.