Table 2. Choice of influenza vaccine for selected age and risk groups (for persons without a contraindication to the vaccine)a.
| Recipient by age group | Vaccine types available for use | Comments |
|---|---|---|
| Children 6–23 months of age | • TIV • QIV • Adjuvanted TIV |
As TIV, QIV and adjuvanted TIV are authorized for this age group NACI recommends that, given the burden of influenza B disease, QIV should be used. If QIV is not available, either unadjuvanted or adjuvanted TIV should be used. |
| Children 2–17 years of age | • TIV • QIV • Quadrivalent LAIV |
In children without contraindications to the vaccine, any of the following vaccines can be used: LAIV; QIV; or TIV. The current evidence does not support a recommendation for the preferential use of LAIV in children and adolescents 2–17 years of age. Given the burden of influenza B disease in children and the potential for lineage mismatch between the predominant circulating strain of influenza B and the strain in a trivalent vaccine, NACI continues to recommend that a quadrivalent formulation of influenza vaccine be used in children and adolescents 2–17 years of age. If a quadrivalent vaccine is not available, TIV should be used. LAIV is contraindicated for children with immune compromising conditions. LAIV, TIV or QIV can be used in children with chronic health conditions and without contraindications (see the Contraindications and Precautions (Section II) and Choice of vaccine product for children 2 to 17 years of age (Section V) sections of the Statement for more details) (4). |
| Adults 18–59 years of age | • TIV • QIV • Quadrivalent LAIV |
TIV and QIV are the recommended products for adults with chronic health conditions. TIV and QIV, instead of LAIV, are recommended for health care workers. LAIV is contraindicated for adults with immune compromising conditions. |
| Adults 60–64 years of age | • TIV • QIV |
TIV and QIV are authorized for use in this age group. |
| Adults 65 years of age and older | • TIV • QIV • Adjuvanted TIV • High-dose TIV |
At the programmatic level, NACI recommends that any of the four influenza vaccines available for use in adults 65 years of age and older should be used: standard-dose TIV, high-dose TIV, MF59-adjuvanted TIV, and QIV. High-dose TIV is expected to provide superior protection compared to standard-dose TIV; however, with cost-effectiveness assessments having been outside the scope of the evidence review and without data on the relative efficacy/effectiveness between high-dose TIV, MF59-adjuvanted TIV, and QIV, there is insufficient evidence to make a comparative recommendation on the use of these vaccines at the programmatic level (Grade I). At the individual level, NACI recommends that high-dose TIV should be offered over standard-dose TIV to persons 65 years of age and older. NACI concludes that, given the burden of disease associated with influenza A(H3N2) and the good evidence of better efficacy compared to standard-dose TIV in this age group, high-dose TIV should be offered over standard-dose TIV to persons 65 years of age and older (Grade A). There is insufficient evidence to make comparative recommendations on the use of MF59-adjuvanted TIV and QIV over standard-dose TIV (Grade I). |
| Pregnant women | • TIV • QIV |
LAIV is not recommended because of the theoretical risk to the fetus from administering a live virus vaccine. |
Abbreviations: LAIV, live attenuated influenza vaccine (quadrivalent formulation); QIV, quadrivalent inactivated influenza vaccine; TIV, trivalent inactivated influenza vaccine
a Updated recommendations noted in bold