Considerations When Using LAIV

Currently, LAIV is an option for vaccination of healthy, nonpregnant persons aged 5-49 years, including HCP and other close contacts of high-risk persons. No preference is indicated for LAIV or TIV when considering vaccination of healthy, nonpregnant persons aged 5-49 years. However, during periods when inactivated vaccine is in short supply, use of LAIV is encouraged when feasible for eligible persons (including HCP) because use of LAIV by these persons might increase availability of TIV for persons in groups targeted for vaccination, but who cannot receive LAIV. Possible advantages of LAIV include its potential to induce a broad mucosal and systemic immune response in children, its ease of administration, and the possibly increased acceptability of an intranasal rather than intramuscular route of administration.

If the vaccine recipient sneezes after administration, the dose should not be repeated. However, if nasal congestion is present that might impede delivery of the vaccine to the nasopharyngeal mucosa, deferral of administration should be considered until resolution of the illness, or TIV should be administered instead. No data exist regarding concomitant use of nasal cortosteroids or other intranasal medications (218).

LAIV should be administered annually according to the following schedule:

• Children aged 5-8 years previously unvaccinated at any time with either LAIV or TIV should receive 2 doses of LAIV separated by at least 6 weeks (note).

• Children aged 5-8 years previously vaccinated at any time with either LAIV or TIV should receive 1 dose of LAIV. However, a child of this age who received influenza vaccine for the first time in the previous season and did not receive 2 doses in that season should receive 2 doses as above during the current season.

• Persons aged 9-49 years should receive 1 dose of LAIV.

LAIV may be administered to persons with minor acute illnesses (e.g., diarrhea or mild upper respiratory tract infection with or without fever). However, if nasal congestion is present that might impede delivery of the vaccine to the nasopharyngeal mucosa, deferral of administration should be considered until resolution of the illness.

Whether concurrent administration of LAIV with other vaccines affects the safety or efficacy of either LAIV or the simultaneously administered vaccine is unknown. In the absence of specific data indicating interference, following ACIP's general recommendations for immunization is prudent (171). Inactivated vaccines do not interfere with the immune response to other inactivated vaccines or to live vaccines. Inactivated or live vaccines may be administered simultaneously with LAIV. However, after administration of a live vaccine, at least 4 weeks should pass before another live vaccine is administered.

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