LAIV4 Compared With IIV3 and IIV4

Vaccine CharacteristicLAIV4IIV3IIV4
Route of administrationIntranasal sprayIntramuscular or intradermal injectionaIntramuscular 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?Not preferredYesYes
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, recommended to space 4 wk apartYesYes
Can be administered within 4 wk of an inactivated vaccine?YesYesYes
  • Sources: American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2013–2014. Pediatrics. 2013;132(4):e1089–e1104; and Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–2015 influenza season. MMWR Recomm Rep. 2014;63(32):691–697.

  • 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 2014–2015 influenza season.

  • c LAIV4 is not recommended for children with a history of asthma. In the 2- through 4-y age group, there are children who have a history of wheezing with respiratory illnesses in whom reactive airway 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 y of age with recurrent wheezing or a wheezing episode in the previous 12 mo 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 or guardians of 2-, 3-, and 4-y-olds (24- through 59-mo-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 12–15 mo of age with measles–mumps–rubella and varicella vaccines. IIV coadministration has been evaluated systematically only among adults with pneumococcal polysaccharide and zoster vaccines.