Table 6. Summary of Information Contained in This NACI Statement.

The following table highlights key information for immunization providers.

Please refer to the remainder of the Statement for details.

1. What a) Basic information about the Disease (e.g. agent, symptoms, epidemiology) b) Basic information about the Vaccine (e.g. efficacy, safety)	Influenza is a respiratory infection caused by influenza A and B viruses and occurs in Canada every year, generally during late fall and the winter months. Infection typically starts with a headache, chills and cough, followed rapidly by fever, loss of appetite, muscle aches and fatigue, running nose, sneezing, watery eyes and throat irritation. Nausea, vomiting and diarrhea may also occur, especially in children. Most people will recover from influenza within a week or ten days, but some - including those 65 years of age and older and adults and children with chronic conditions, such as diabetes and cancer - are at greater risk of more severe complications, such as pneumonia. Additional information about influenza can be accessed at: http://www.phac-aspc.gc.ca/im/vpd-mev/influenza-eng.php FluMist® is a live, attenuated, trivalent influenza vaccine administered by the intranasal route as a spray. There is a single dosing formula available containing 106.5-7.5 fluorescent focus units of each influenza strain in a 0.2 mL dose (administered as 0.1 mL dose in each nostril). FluMist® was approved in Canada in 2010, and as been available for use in the United States since 2003. Efficacy and safety studies have demonstrated that FluMist® is safe and well tolerated.
2. Who Groups recommended to immunize	NACI recommends that FluMist® can be used for the prevention of influenza in: • Healthy children and adolescents 2-17 years of age (NACI Recommendation Grade A). • Children 24 months and older with stable, non-severe asthma (NACI Recommendation Grade B) • Children with chronic health conditions (excluding severe asthma and immune compromising conditions) (NACI Recommendation Grade B) • Healthy adults 18-59 years of age (NACI Recommendation Grade A)
3. How • Dose, schedule • Precautions, contraindications • Co-administration	The recommended vaccine dosage per administration is 0.2 mL (0.1 mL per nostril) for individuals 2-59 years of age. • Children 2-8 years of age inclusive who have not previously received seasonal influenza vaccine are recommended to receive a two dose schedule. An initial dose of 0.2 mL (0.1 mL in each nostril) is followed by a second 0.2 mL dose (0.1 mL in each nostril) administered at least 4 weeks later. • For all other individuals, including children 2-8 years of age who have previously received seasonal influenza vaccine, the recommended schedule is one 0.2 mL dose (0.1 mL in each nostril). The use of FluMist® should be carefully evaluated in individuals: • Persons with serious acute febrile illness should not be vaccinated until their symptoms have abated. If nasal congestion is present that might impede delivery of the vaccine, deferral of FluMist® or administration of trivalent inactivated influenza vaccine (TIV) should be considered instead. The use of FluMist® is contraindicated in: • Children <24 months of age • Individuals with a history of anaphylaxis to a previous dose of influenza vaccine or have a history of hypersensitivity to the non-medicinal ingredients contained in the vaccine, including those with egg allergy • Children and adolescents 2-17 years of age receiving ongoing aspirin therapy or aspirin-containing therapy. The use of aspirin-containing medications in individuals <18 years should be delayed at least four weeks after vaccination with FluMist®. • Pregnant women • Individuals with severe asthma (as defined as currently on oral or high dose inhaled glucocorticosteriods or active wheezing) and those with medically attended wheezing in the 7 days prior to vaccination • Individuals with occurrence of Guillain-Barré Syndrome within eight weeks of any prior influenza vaccination. • Individuals with immune compromising conditions • Health care workers providing care to individuals with severe immune compromising conditions. FluMist® may be administered concurrently with the MMR and varicella vaccines. • If not administered at the same time, the administration of another live vaccine should only be administered at least four weeks prior to, or after the receipt of FluMist®. FluMist® should not be administered until 48 hours after antiviral agents active against influenza (e.g. oseltamivir and zanamivir) are stopped, and antiviral agents should not be administered until two weeks after receipt of FluMist® unless medically indicated. If antiviral agents are administered within this time frame (from 48 hours before to two weeks after FluMist®), revaccination should take place at least 48 hours after the antivirals are stopped. No data currently exist about the concomitant use of nasal corticosteroids or other intranasal medications.
4. Why • ”Counseling Points” for providers to emphasize with clients when discussing these recommendations	Vaccination is the most effective way to prevent influenza. Each year there is a new vaccine to protect against the influenza virus strains that are expected in the coming influenza season. Even if the vaccine strains have not changed, getting influenza vaccine every year reinforces optimal protection. Annual influenza vaccination is encouraged for all Canadians, particularly those at high risk of influenza complications, those who could spread influenza to someone at risk and those who provide essential community services. FluMist® is administered through the intranasal route which may increase compliance during administration. It can be used in children 2-17 years of age inclusive, and in healthy adults 18-59 years of age inclusive. Nasal congestion and rhinorrhea are the most common adverse reactions observed.