TABLE 2

LAIV4 Compared With IIV3 and IIV4

Vaccine CharacteristicLAIV4IIV3IIV4
Route of administrationIntranasal sprayIM or ID injectionaIM injectiona
Type of vaccineLive virusKilled virusKilled virus
ProductAttenuated, cold-adaptedInactivated subvirion or surface antigenInactivated subvirion or surface antigen
No. of included virus strains4 (2 influenza A, 2 influenza B)3 (2 influenza A, 1 influenza B)4 (2 influenza A, 2 influenza B)
Vaccine virus strains updatedAnnuallyAnnuallyAnnually
Frequency of administrationbAnnuallyAnnuallyAnnually
Approved age groupsAll healthy people aged 2–49 yAll people aged ≥6 mo (ID 18–64 y)All people aged ≥6 mo
Interval between 2 doses in children4 wk4 wk4 wk
Can be given to people with medical risk factors for influenza-related complications?NoYesYes
Can be given to children with asthma or children aged 2–4 y with wheezing in the previous year?NocYesYes
Can be simultaneously administered with other vaccines?YesdYesdYesd
If not simultaneously administered, can be administered within 4 wk of another live vaccine?No, prudent to space 4 wk apartYesYes
Can be administered within 4 wk of an inactivated vaccine?YesYesYes
  • Data sources: American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2012–2013. Pediatrics. 2012;130(4):780–792; Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2012–13 influenza season. MMWR Morb Mortal Wkly Rep. 2012;61(32):613–618; and Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: interim recommendations of the Advisory Committee on Immunization Practices (ACIP), 2013. MMWR Morb Mortal Wkly Rep. 2013;62(18):356.

  • a The preferred site of IIV intramuscular injection for infants and young children is the anterolateral aspect of the thigh.

  • b See Fig 2 for decision algorithm to determine number of doses of seasonal influenza vaccine recommended for children during the 2013–2014 influenza season.

  • c LAIV4 is not recommended for children with a history of asthma. In the 2- through 4-year age group, there are children who have a history of wheezing with respiratory illnesses in whom reactive airways disease is diagnosed and in whom asthma may later be diagnosed. Therefore, because of the potential for increased wheezing after immunization, children 2 through 4 years of age with recurrent wheezing or a wheezing episode in the previous 12 months should not receive LAIV4. When offering LAIV4 to children in this age group, a pediatrician should screen those who might be at higher risk of asthma by asking the parents/guardians of 2-, 3-, and 4-year-olds (24- through 59-month-olds) the question: “In the previous 12 months, has a health care professional ever told you that your child had wheezing?” If the parents answer yes to this question, LAIV4 is not recommended for these children.

  • d LAIV4 coadministration has been evaluated systematically only among children 12 to 15 months of age with measles-mumps-rubella and varicella vaccines. IIV coadministration has been evaluated systematically only among adults with pneumococcal polysaccharide and zoster vaccines.