Table 2. Recommendations on choice of influenza vaccine type for individual- and public health program-level decision-making by age group.
| Recipient by age group | Vaccine types authorized for use | Recommendations on choice of influenza vaccine | |
|---|---|---|---|
| 6–23 months | IIV3-SDa IIV3-Adj IIV4-SD |
• A quadrivalent influenza vaccine licensed for this age group should be used in infants and young children without contraindications, given the burden of influenza B disease in this age group and the potential for lineage mismatch between the predominant circulating strain of influenza B and the strain in a trivalent vaccine. • If a quadrivalent vaccine is not available, any of the available trivalent vaccines licensed for this age group should be used. |
|
| 2–17 yearsb | IIV3-SDa IIV4-SD IIV4-cc (nine years of age and over) LAIV4 |
• An age appropriate IIV4-SD, LAIV4, or IIV4-cc (IIV4-cc only authorized for nine years of age and older) should be used in children without contraindications, including those with non-immune compromising chronic health conditions, given the burden of influenza B disease in this age group and the potential for lineage mismatch between the predominant circulating strain of influenza B and the strain in a trivalent vaccine. o There are currently no IIV4-cc vaccines licensed for children younger than nine years of age. • LAIV4 may be given to children with: o Stable, non-severe asthma o Cystic fibrosis who are not being treated with immunosuppressive drugs (e.g. prolonged systemic corticosteroids) o Stable HIV infection, if the child is currently being treated with HAART and has adequate immune function • LAIV should not be used in children for whom it is contraindicated for, such as those with: o Severe asthma (defined as currently on oral or high-dose inhaled glucocorticosteroids or active wheezing) o Medically attended wheezing in the seven days prior to vaccination o Current receipt of aspirin or aspirin-containing therapy o Immune compromising conditions, with the exception of stable HIV infection, i.e. if the child is treated with HAART (for at least four months) and has adequate immune function • LAIV is contraindicated in pregnant adolescents. IIV4-SD or IIV4-ccc should be used instead. • If IIV4-SD, IIV4-ccc, and LAIV4 are not available, IIV3-SD should be used. |
|
| 18–59 years | IIV3-SDa IIV4-SD IIV4-cc LAIV4 |
• Any of the available influenza vaccines should be used in adults without contraindications. o There is some evidence that IIV may provide better efficacy than LAIV in healthy adults • LAIV is not recommended for the following: o Pregnant women o Adults with any of the chronic health conditions identified in List 1, including immune compromising conditions o Healthcare workers |
|
| 60–64 years | IIV3-SDa IIV4-SD IIV4-cc |
• Any of the available influenza vaccines should be used in those without contraindications. | |
| 65 years and olderd | IIV3-SDa IIV3-Adj IIV3-HDe IIV4-SD IIV4-cc |
Individual-level decision-making | Public health program-level decision-making |
| • IIV-HD should be used over IIV-SD, given the burden of influenza A(H3N2) disease and the good evidence of IIV3-HD providing better protection compared to IIV3-SD in adults 65 years of age and older. o Other than a recommendation for using IIV-HD over IIV-SD formulations, NACI has not made comparative individual-level recommendations on the use of the other available vaccines in this age group. In the absence of a specific product, any of the available age appropriate influenza vaccines should be used. |
• Any of the available influenza vaccines should be used. o There is insufficient evidence on the incremental value of different influenza vaccines (i.e. cost-effectiveness assessments have not been performed by NACI) to make comparative public health program-level recommendations on the use of the available vaccines. |
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Abbreviations: HAART, highly active antiretroviral therapy; IIV, inactivated influenza vaccine; IIV3-Adj, adjuvanted trivalent inactivated influenza vaccine; IIV3-HD, high-dose trivalent inactivated influenza vaccine; IIV3-SD, standard-dose trivalent inactivated influenza vaccine; IIV4-cc, quadrivalent mammalian cell-culture based inactivated influenza vaccine; IIV4-HD, high-dose quadrivalent inactivated influenza vaccine; IIV4-SD, standard-dose quadrivalent inactivated influenza vaccine; LAIV, live attenuated influenza vaccine; LAIV4, quadrivalent live attenuated influenza vaccine; NACI, National Advisory Committee on Immunization
a IIV3-SD formulations will not be available for use in Canada during the 2021-2022 influenza season
b Refer to Table 4 of the NACI Seasonal Influenza Vaccine Statement for 2021–2022 for a summary of vaccine characteristics of LAIV compared with IIV in children 2–17 years of age (5)
c IIV4-cc is currently authorized for use in adults and children nine years of age and older
d Refer to Table 5 of the NACI Seasonal Influenza Vaccine Statement for 2021–2022 for a comparison of the vaccine characteristics of influenza vaccine types available for use in adults 65 years of age and older (5)
e IIV3-HD formulations will not be available for use in Canada during the 2021-2022 influenza season
Source: Table reproduced from the NACI Seasonal Influenza Vaccine Statement for 2021–2022 (5)