First AD

Second AD

A healthy 26-month-old child is in your office. He received a 0.25 cc dose of a trivalent inactivated shot (Fluzone) 6 weeks ago as his first ever flu vaccine.

A. 0.25 cc of the trivalent shot (Fluzone)

B. A full dose of quadrivalent live attenuated nasal vaccine (FluMist)

C. 0.25 cc of a quadrivalent shot (Fluzone)

For this 26-month old child it is fine to give any age-approved flu vaccine for each of the two needed doses.

CDC does not recommend one age-approved flu vaccine over another and this includes deciding between trivalent or quadrivalent vaccine or between injection or nasal spray vaccine. Both quadrivalent and trivalent influenza vaccines are available for the 

 although this is probably the last year for any trivalent vaccines.

Some studies show very low, if any, efficacy for young children getting only one of the two needed doses of inactivated flu vaccine.  Moderate-to-good  efficacy is seen after a single dose of FluMist, but two doses are still recommended for a child under nine who is flu-vaccine naÃ¯ve.

Centers for Disease Control and Prevention. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2013–2014. 

A child receives a trivalent inactivated flu shot for his first ever flu vaccine. For his second dose, you only have on hand the quadrivalent live attenuated nasal vaccine. Is this a problem? 

Are Age-Appropriate Flu Vaccines Interchangeable?