First AD

Second AD

With influenza season in full swing, the CDC does recommend continued vaccination with an appropriate flu vaccine. A number of options exist from a variety of manufacturers: trivalent, quadravalent, intradermal, high-dose, intranasal, “made” in egg, dog, or insect lines. All have different age indications leading to the potential for medical errors. Let’s look at 2 scenarios.

A 2-year-old child is given 0.25 cc of a flu vaccine NOT approved for use in children under the age of 3 years. (Sanofi’s Fluzone is the only approved inactivated flu vaccine for use under the age of 36 months.)

A. Give 0.25 cc of the approved flu vaccine (Fluzone) at the same visit

B. Give a dose of FluMist at the same visit

C. Wait a week and then give 0.25 cc of Fluzone or Flumist

D. Do nothing; the dose counts toward the 1 or 2 doses the child needs

Answer: D-Do nothing; the dose counts toward the 1 or 2 doses the child needs and does not need to be repeated.  

While the use is off-label, most experts feel the child will get an adequate immune response from inactivated flu vaccines other than Fluzone. Some of the other inactivated flu vaccines, however, have resulted in a higher rate of side effects such as fever in young children. FluMist is approved for most children over the age of 2 and if this child needed a second dose of flu vaccine for this season it could be given in 4 weeks.

Infection

So many vaccine options available-trivalent, quadravalent, intradermal, high-dose, intranasal, “made” in egg, dog, or insect lines-so many ways to go wrong. Here, 2 cautionary tales. 

Flu Season Scenarios: Don’t Get Tripped Up