Algorithm for Determining Recommended Influenza Immunization Actions for Children

Is the patient aged >= 6 months?

• Yes
• No

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Influenza Vaccination Not Recommended at This Time

• Influenza vaccination is not currently recommended at this time for this patient.
• Vaccination is recommended for household or caregiver contacts of children who are recommended for vaccination on the basis of age or medical condition, particularly for contact of children aged < 6 months.
• For children who are recommended to receive a second vaccine dose, a later visit should be scheduled.

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Six Months or Older

Does the patient have any contraindications at this time?

• Yes
• No

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No Contraindications

How many doses of influenza vaccine has the patient received this season?

• 0
• 1
• 2

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No Influenza Vaccine Needed

• No additional influenza vaccination is recommended for this season.

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Had One Dose This Season

Was the patient aged >= 9 years at the time of the first dose?

• Yes
• No

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One Dose This Season and Under 9 Yrs Old

Did the patient receive 2 influenza vaccine doses in the initial season?

• Yes
• No

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One Dose This Season, Under 9 Yrs, Didn't Get 2 Doses in Initial Season

Is it the first or second season in which the patient will be vaccinated?

• Yes
• No

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One Dose This Season, Under 9 Yrs, Didn't Get 2 Doses in Initial Season, 1st or 2nd Vaccination Season

What type of vaccine was the first dose this season?

• TIV
• LAIV

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First Dose Was TIV

Has 4 weeks elapsed since the first dose?

• No
• Yes: Give second dose of influenza vaccine.

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First Dose was LAIV

Has 6 weeks elapsed since the first dose?

• No
• Yes: Give second dose of influenza vaccine.

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No Doses This Season

Is the patient between 6 months and 59 months?

• Yes
• No

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Vaccinate now

• Administer first dose of influenza vaccine (see Table 3 and Table 4).
• Vaccination is recommended for household or caregiver contacts of children who are recommended for vaccination on the basis of age or medical conditions, particularly for contacts of children aged < 6 months.
• Determine whether a second dose is recommended for the patient.

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No Doses This Season and Aged 60 Months or Older

Does the patient have any high-risk conditions?

• Yes
• No

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No Doses This Season and Aged 60 Months or Older and No High Risk Conditions

Is the patient a household contact of a child aged < 5 years or of anyone with a high-risk condition or has the child (or parent) requested that influenza vaccine be provided?

• Yes
• No

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Source: Modified with permission from the American Academy of Pediatrics' Committee on Infectious Diseases.  Prevention of influenza: recommendations for influenza immunization of children, 2006-2007.  Pediatrics 2007;119:846-51,315.

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