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Meningococcal, influenza, smallpox, rotavirus, and combination vaccines in children Jan E Drutz, MD INFLUENZA VACCINE Influenza virus infections have been a significant cause of respiratory illness, especially during this past century [7], and a leading cause of morbidity and mortality. Manifestations of infection with influenza A and B have consisted of classic upper respiratory signs and symptoms of rhinitis and tracheitis, which may be complicated by viral or bacterial pneumonia.
Preparations Influenza A is classified into subtypes based upon two surface antigens, hemagglutinin (H) and neuraminidase (N). Three subtypes of hemagglutinin (H1, H2, and H3) and two subtypes of neuraminidase (N1, N2) exist. The influenza vaccine currently available is a trivalent preparation of inactivated whole or split virions made up of two type A and one type B inactivated components.
Target groups Although the vaccine can be administered to anyone older than six months, it is specifically recommended for those with chronic pulmonary diseases, those with hemodynamically significant cardiac disease, those undergoing immunosuppressive therapy and those with a hemoglobinopathy. Other individuals considered to be at risk are HIV-infected patients, those with chronic metabolic disease, chronic kidney disease, and diabetes mellitus, as well as those receiving long-term aspirin therapy. Close personal contacts of high-risk patients also should be immunized [8].
Because children younger than two years are at increased risk for influenza-related hospitalization, the ACIP and AAP are "encouraging" the use of influenza vaccine in healthy children aged 6 to 23 months and in household contacts and out-of-home caretakers of children younger than two years of age for the 2002 to 2003 influenza season (show table 1) [9,10]. Providers should be aware that all currently available influenza vaccines for use in children younger than four years contain thimerosal[10]. (See "Environmental toxicants and children", section on Mercury). Influenza vaccine shortages are not predicted for the upcoming season, but if the supply is limited, other at-risk groups would probably be preferentially vaccinated.
Dosing For children who are six months to nine years of age and are receiving influenza vaccine for the first time, two doses of the split virus vaccine should be given intramuscularly one month apart. Children who are six to 35 months of age should be given 0.25 mL IM, and those who are three to eight years of age should receive 0.5 mL IM. Children who are nine to 12 years of age should receive a single dose (0.5 mL) of the split virus vaccine. Patients who are 12 years of age and older may be given either the whole virus or split virus vaccine (0.5 mL) IM.
Adverse reactions Influenza vaccine does not cause an influenza infection in recipients. It can be administered safely during any stage of pregnancy. Local reaction consists of a brief period of tenderness at the injection site. Systemic response may include fever, malaise, and/or myalgia lasting for one to two days, especially in individuals not previously exposed to influenza virus antigens. Skin rash, tenderness, swelling, and/or redness may occur as a delayed-hypersensitivity reaction to one of the vaccine components. Influenza vaccine is contraindicated in patients with a history of anaphylaxis to chickens, egg protein, or other vaccine components.