A 4 month-old full term female with history of eczema and egg allergy presents for her 4 month well child visit in October. Mother is requesting an influenza vaccine be given with her scheduled 4 month vaccines. When questioned about the egg allergy, mom states that she had hives and respiratory distress after eating eggs previously. Should this patient receive the influenza vaccine at this visit?

A. No, her severe egg allergy is a contraindication to giving the vaccine.

B. No, she is not old enough to receive the vaccine at this visit.

C. Yes, she can receive the vaccine if monitored closely in clinic for signs of anaphylaxis.

D. Yes, she can receive the vaccine without additional monitoring.

E. Yes, she can receive the vaccine, but she will need a second vaccine dose.

 

The correct answer is B. The CDC recommends annual influenza vaccines be given starting at age 6 months for Inactivated Influenza Vaccine (IIV), 2 years for Live Attenuated Influenza Vaccine (LAIV), and 18 months for recombinant influenza vaccine (RIV).

 

If the patient had been 6 months of age, answer choice C would have been correct. Severe egg allergy is NOT a contraindication to receiving the influenza vaccine. However, the patient should be closely monitored by a medical provider after administration for signs of severe allergic reaction.

 

If the patient is 6 months to 8 years of age, then you should ask if the child has received 2 doses or more TOTAL. If not, then give 2 doses of influenza vaccine, given 4 weeks apart as minimum interval. It is important to note that the 2 doses of influenza vaccine do not have to have been given in the same season or consecutive seasons to count. The 2 dose series should be based on age of first vaccination. In other words, if the first dose is given at age 8, and the child turns 9 during the same season, they should still receive the second dose of the influenza vaccine.

 

A systematic review and meta-analysis posted in Vaccine journal in March 2020 showed influenza “vaccination offered high protection against influenza hospitalization in children… Effectiveness was higher against H1N1 (74%) and Influenza B (51%) and moderate against H3N2 (41%)… and significantly higher in fully vs partially vaccinated children” (62% vs 34%, respectively).

 

References

1. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#note-flu

2. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Influenza-Implementation-Guidance/Pages/Annual-AAP-Influenza-Policy.aspx

3. https://www.sciencedirect.com/science/article/pii/S0264410X20302619

Influenza vaccine effectiveness against influenza-associated hospitalization in children: A systematic review and meta-analysis. Vaccine. Volume 38, Issue 14, 23 March 2020, Pages 2893-2903

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