From the CDC:

 

Influenza Vaccination for Pregnant Women

Pregnant and postpartum women are at higher risk for severe illness and complications from influenza than women who are not pregnant because of changes in the immune system, heart, and lungs during pregnancy (367). Vaccination during pregnancy has been shown to protect infants from influenza (170,368), including infants aged <6 months, for whom no influenza vaccines are currently licensed (368–370). The ACIP (Advisory Committee on Immunization Practices) and American College of Obstetricians and Gynecologists (ACOG) recommends that all women who are pregnant or who might be pregnant in the upcoming influenza season receive IIV because of this increased risk for serious illness and complications from influenza (371). Influenza vaccination can be administered at any time during pregnancy, before and during the influenza season.

 

Women who are or will be pregnant during influenza season should receive IIV. Live attenuated influenza vaccine (LAIV) is not recommended for use during pregnancy. Postpartum women can receive either LAIV or IIV (Influenza Inactivated Vaccine). Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV.

 

 

Influenza Vaccination of Persons With a History of Egg allergy

Severe allergic and anaphylactic reactions can occur in response to a number of influenza vaccine components, but such reactions are rare. With the exceptions of RIV and ccIIV3, currently available influenza vaccines are prepared by propagation of virus in embryonated eggs. A recent review of published data (including 4,172 patients, 513 of whom were reported to have a history of severe allergic reaction to egg) noted that no occurrences of anaphylaxis were reported, though some milder reactions did occur (372), suggesting that severe allergic reactions to egg-based influenza vaccines are unlikely. Vaccines containing as much as 0.7 µg/0.5 mL have been tolerated (360,373); however, a threshold below which no reactions would be expected is not known (360). Although ovalbumin content is not required to be disclosed on package inserts for vaccines used in the United States, manufacturers either report maximum albumin content in the package inserts or will provide this information on request. Among IIVs for which ovalbumin content was disclosed during the 2011–12 and 2012–13 seasons, reported maximum amounts were ≤1 µg/0.5 mL dose. Ovalbumin is not directly measured for Flucelvax, but it is estimated by calculation from the initial content in the reference virus strains to contain a maximum of 5x10-8 µg/0.5 mL dose of total egg protein (Novartis, unpublished data, 2013). Flublok is egg-free. It should be noted, however, that neither Flucelvax nor Flublok are licensed for children aged <18 years.

 

 

Vaccine Dose Considerations for Children Aged 6 Months Through 8 Years

Evidence from several studies indicates that children aged 6 months through 8 years require 2 doses of influenza vaccine (administered a minimum of 4 weeks apart) during their first season of vaccination to optimize immune response. In a study of children aged 5 through 8 years receiving trivalent inactivated influenza vaccine (IIV3) for the first time, the proportion of children with protective antibody responses was significantly higher (p<0.001 for influenza A(H1N1), p = 0.01 for influenza A(H3N2), and p<0.001 for influenza B) after 2 doses as compared with a single dose (115). Several studies have indicated that the time interval between two initial doses (from 4 weeks up to 1 year) of the same antigen may not be critical (363–365). However, because of the antigenic novelty of the 2009 influenza A(H1N1) pandemic virus, which is anticipated to continue circulating during the 2013–14 influenza season, exposure history to this vaccine virus antigen also must be considered. Children who last received seasonal (trivalent) influenza vaccine before the 2010–11 season but did not receive a vaccine containing 2009(H1N1) antigen (i.e., either in seasonal vaccine since July 2010 or monovalent 2009(H1N1) vaccine) will not have received this antigen. These children are recommended to receive 2 doses this season, even if 2 doses of seasonal influenza vaccine were received before the 2010–11 season. This recommendation is illustrated in the approaches outlined below. These recommendations are consistent with those of the American Academy of Pediatrics (366). Two approaches are recommended, both of which are acceptable.

 

The first approach (Figure 1), takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. This approach has the advantage of simplicity, particularly in settings in which it is difficult to ascertain vaccination history before the 2010–11 season. Using this approach, children aged 6 months through 8 years need only 1 dose of vaccine in the 2013–14 influenza season if they received a total of 2 or more doses of seasonal vaccine since July 1, 2010. Children who did not receive a total of 2 or more doses of seasonal vaccine since July 1, 2010, require 2 doses in the 2013–14 season.

In settings where adequate vaccination history from before the 2010–11 season is available, the second approach may be used. By this approach, if a child aged 6 months through 8 years is known to have received at least 2 doses of seasonal influenza vaccine during any prior season, and at least 1 dose of a 2009(H1N1)-containing vaccine (i.e., 2010–11, 2011–12, or 2012–13 seasonal vaccine or the monovalent 2009 [H1N1] vaccine) then the child needs only 1 dose for the 2013–14 season. Using this approach, children aged 6 months through 8 years need only 1 dose of vaccine in the 2013–14 season if they have received any of the following:

 

• 2 or more doses of seasonal influenza vaccine since July 1, 2010 or;

• 2 or more doses of seasonal influenza vaccine before July 1, 2010 and 1 or more doses of monovalent 2009(H1N1) vaccine or;

• 1 or more doses of seasonal influenza vaccine before July 1, 2010, and 1 or more doses of seasonal influenza vaccine since July 1, 2010.

Children aged 6 months through 8 years for whom one of these conditions is not met require 2 doses in the 2013–14 season.

 

For more information visit. http://www.cdc.gov/flu/