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• W1449276711 abstract "This is an abridged version of the annual update for influenza vaccine administration, which includes recommendations for immunosuppressed hosts. This is an abridged version of the annual update for influenza vaccine administration, which includes recommendations for immunosuppressed hosts. Recommendations and Reports/August 25, 2017/66(2);1–20 This report updates the 2016–17 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines (MMWR Recomm Rep 2016;65[No. RR-5]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. A licensed, recommended, and age-appropriate vaccine should be used. For the 2017–18 season, quadrivalent and trivalent influenza vaccines will be available. Inactivated influenza vaccines (IIVs) will be available in trivalent (IIV3) and quadrivalent (IIV4) formulations. Recombinant influenza vaccine (RIV) will be available in trivalent (RIV3) and quadrivalent (RIV4) formulations. Live attenuated influenza vaccine (LAIV4) is not recommended for use during the 2017–18 season due to concerns about its effectiveness against (H1N1)pdm09 viruses during the 2013–14 and 2015–16 seasons. Recommendations for different vaccine types and specific populations are discussed. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is available. Updates to the recommendations described in this report reflect discussions during public meetings of ACIP held on October 20, 2016; February 22, 2017; and June 21, 2017. New and updated information in this report includes the following:•Vaccine viruses included in the 2017–18 U.S. trivalent influenza vaccines will be an A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).•Information on recent licensures and labelling changes is discussed, including licensure of Afluria Quadrivalent (IIV4; Seqirus, Parkville, Victoria, Australia); Flublok Quadrivalent (RIV4; Protein Sciences, Meriden, Connecticut); and expansion of the age indication for FluLaval Quadrivalent (IIV4; ID Biomedical Corporation of Quebec, Quebec City, Quebec, Canada), previously licensed for ≥3 years, to ≥6 months.•Pregnant women may receive any licensed, recommended, age-appropriate influenza vaccine.•Afluria (IIV3; Seqirus, Parkville, Victoria, Australia) may be used for persons aged ≥5 years, consistent with Food and Drug Administration–approved labeling.•FluMist Quadrivalent (LAIV4; MedImmune, Gaithersburg, Maryland) should not be used during the 2017–18 season due to concerns about its effectiveness against influenza A(H1N1)pdm09 viruses in the United States during the 2013–14 and 2015–16 influenza seasons. This report focuses on the recommendations for use of vaccines for the prevention and control of influenza during the 2017–18 season in the United States. A Background Document containing further information and a summary of these recommendations are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to licensed influenza vaccines used within Food and Drug Administration–licensed indications, including those licensed after the publication date of this report. Updates and other information are available at CDC’s influenza website (https://www.cdc.gov/flu). Vaccination and health care providers should check CDC’s influenza website periodically for additional information. Routine annual influenza vaccination of all persons aged ≥6 months without contraindications continues to be recommended. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is available. Updated information and guidance in this report includes the following: •2017–18 U.S. trivalent influenza vaccines will contain an A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)–like virus and a B/Brisbane/60/2008–like virus (Victoria lineage). Quadrivalent vaccines will include an additional vaccine virus strain, a B/Phuket/3073/2013–like virus (Yamagata lineage). This represents a change in the influenza A(H1N1)pdm09 virus component from the previous season.•Recent regulatory actions, including two new licensures and one labelling change are described:°Afluria Quadrivalent (IIV4; Seqirus, Parkville, Victoria, Australia) was licensed by FDA in August, 2016 for persons aged ≥18 years. Regulatory information is available at https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm518291.htm.°Flublok Quadrivalent (RIV4; Protein Sciences, Meriden, Connecticut) was licensed by FDA in October 2016, for persons aged ≥18 years. Regulatory information is available at https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm524660.htm.°The age indication for FluLaval Quadrivalent (IIV4; ID Biomedical Corporation of Quebec, Quebec City, Quebec, Canada) was extended from ≥3 years to ≥6 months in November 2016. Regulatory information is available at https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm366061.htm. Children aged 6 through 35 months may receive FluLaval Quadrivalent at the same 0.5 mL per dose (containing 15 μg of hemagglutinin [HA] per vaccine virus) as is used for older children and adults. This licensure creates an additional option for vaccination of children aged 6 through 35 months, in addition to the previously available 0.25 mL per dose presentation (containing 7.5 μg of HA per vaccine virus) of Fluzone Quadrivalent (IIV4; Sanofi Pasteur, Swiftwater, Pennsylvania).•Pregnant women may receive any licensed, recommended, age-appropriate influenza vaccine.•Afluria (IIV3; Seqirus, Parkville, Victoria, Australia) is now recommended for persons aged ≥5 years, consistent with FDA-approved labelling.•In light of its low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013–14 and 2015–16 seasons, for the 2017–18 season, ACIP continues the recommendation that LAIV4 should not be used. Because LAIV4 is still a licensed vaccine that might be available and that some providers might elect to use, for informational purposes only, reference is made in this report to previous recommendations for its use. Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Recommendations regarding timing of vaccination, considerations for specific populations, the use of specific vaccines, and contraindications and precautions are summarized in the sections that follow. Optimally, vaccination should occur before onset of influenza activity in the community. Health care providers should offer vaccination by the end of October, if possible. Children aged 6 months through 8 years who require 2 doses (see Children Aged 6 Months through 8 Years) should receive their first dose as soon as possible after vaccine becomes available, to allow the second dose (which must be administered ≥4 weeks later) to be received by the end of October. Although some available data indicate that early vaccination (e.g., in July and August) might be associated with suboptimal immunity before the end of the influenza season, particularly among older adults, the relative contribution of potential waning of immunity compared with those of other determinants of the impact of vaccination (e.g., timing and severity of the influenza season, the impact of missed opportunities when individuals delay vaccination and fail to return later in the season, and programmatic constraints) is unknown. Although delaying vaccination might result in greater immunity later in the season, deferral also might result in missed opportunities to vaccinate, as well as difficulties in vaccinating a population within a more constrained time period. Community vaccination programs should balance maximizing likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after onset of influenza circulation occurs. Revaccination later in the season of persons who have already been fully vaccinated is not recommended. Vaccination should continue to be offered as long as influenza viruses are circulating and unexpired vaccine is available. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health care visits and hospitalizations when vaccine is available. Vaccination efforts should be structured to ensure the vaccination of as many persons as possible before influenza activity in the community begins. In any given season, the optimal time to vaccinate cannot be predicted precisely because influenza seasons vary in timing and duration. Moreover, more than one outbreak might occur in a given community in a single year. In the United States, localized outbreaks that indicate the start of seasonal influenza activity can occur as early as October. However, in 74% of influenza seasons from 1982–83 through 2015–16, peak influenza activity (which often is close to the midpoint of influenza activity for the season) has not occurred until January or later, and in 59% of seasons, the peak was in February or later (10CDCThe flu season. US Department of Health and Human Services, CDC, Atlanta, GA2015Google Scholar). In recent seasons, initial shipments of influenza vaccine have arrived to some vaccine providers as early as July. Very early availability of vaccine as compared with typical onset and peak of influenza activity raises questions related to the ideal time to begin vaccination. Several observational studies of influenza vaccine effectiveness have reported decreased vaccine protection within a single season, particularly against influenza A(H3N2) (11Kissling E Valenciano M Larrauri A et al.Low and decreasing vaccine effectiveness against influenza A(H3) in 2011/12 among vaccination target groups in Europe: Results from the I-MOVE multicentre case-control study.Euro Surveill. 2013; 18 (pii=): 20390Crossref PubMed Scopus (147) Google Scholar, 12Belongia EA Sundaram ME McClure DL Meece JK Ferdinands J VanWormer JJ Waning vaccine protection against influenza A (H3N2) illness in children and older adults during a single season.Vaccine. 2015; 33: 246-251Crossref PubMed Scopus (93) Google Scholar, 13Castilla J Martínez-Baz I Martínez-Artola V et al.Primary Health Care Sentinel NetworkNetwork for Influenza Surveillance in Hospitals of Navarre. Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12.Euro Surveill. 2013; 18 (pii=): 20388Crossref PubMed Scopus (110) Google Scholar, 14Pebody R Andrews N McMenamin J et al.Vaccine effectiveness of 2011/12 trivalent seasonal influenza vaccine in preventing laboratory-confirmed influenza in primary care in the United Kingdom: Evidence of waning intra-seasonal protection.Euro Surveill. 2013; 18 (:pii=): 2038918Crossref Scopus (119) Google Scholar). In some of these studies decline in VE was particularly pronounced among older adults (12Belongia EA Sundaram ME McClure DL Meece JK Ferdinands J VanWormer JJ Waning vaccine protection against influenza A (H3N2) illness in children and older adults during a single season.Vaccine. 2015; 33: 246-251Crossref PubMed Scopus (93) Google Scholar,13Castilla J Martínez-Baz I Martínez-Artola V et al.Primary Health Care Sentinel NetworkNetwork for Influenza Surveillance in Hospitals of Navarre. Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12.Euro Surveill. 2013; 18 (pii=): 20388Crossref PubMed Scopus (110) Google Scholar). Some studies have documented decline in protective antibodies over the course of one season (15Ochiai H Shibata M Kamimura K Niwayama S Evaluation of the efficacy of split-product trivalent A(H1N1), A(H3N2), and B influenza vaccines: Reactogenicity, immunogenicity and persistence of antibodies following two doses of vaccines.Microbiol Immunol. 1986; 30: 1141-1149Crossref PubMed Scopus (24) Google Scholar, 16Künzel W Glathe H Engelmann H Van Hoecke C Kinetics of humoral antibody response to trivalent inactivated split influenza vaccine in subjects previously vaccinated or vaccinated for the first time.Vaccine. 1996; 14: 1108-1110Crossref PubMed Scopus (89) Google Scholar, 17Song JY Cheong HJ Hwang IS et al.Long-term immunogenicity of influenza vaccine among the elderly: Risk factors for poor immune response and persistence.Vaccine. 2010; 28: 3929-3935Crossref PubMed Scopus (120) Google Scholar), with antibody levels decreasing with greater time elapsed postvaccination. However, the rate and degree of decline observed has varied. Among adults in one study, HA and neuraminidase antibody levels declined slowly, with a two-fold decrease in titer estimated to take >600 days (18Petrie JG Ohmit SE Johnson E Truscon R Monto AS Persistence of antibodies to influenza hemagglutinin and neuraminidase following one or two years of influenza vaccination.J Infect Dis. 2015; 212: 1914-1922Crossref PubMed Scopus (75) Google Scholar). A review of studies reporting postvaccination seroprotection rates among adults aged ≥60 years noted that seroprotection levels meeting Committee of Proprietary Medicinal Products standards were maintained for ≥4 months for the H3N2 component in all 8 studies and for the H1N1 and B components in five of seven studies (19Skowronski DM Tweed SA De Serres G Rapid decline of influenza vaccine-induced antibody in the elderly: Is it real, or is it relevant?.J Infect Dis. 2008; 197: 490-502Crossref PubMed Scopus (139) Google Scholar). A recent multiseason analysis from the U.S. Influenza Vaccine Effectiveness (U.S. Flu VE) Network found that VE declined by about 7% per month for H3N2 and influenza B, and 6%–11% per month for H1N1pdm09 (20Ferdinands JM Fry AM Reynolds S et al.Intraseason waning of influenza vaccine protection: Evidence from the US Influenza Vaccine Effectiveness Network, 2011–12 through 2014–15.Clin Infect Dis. 2017; 64: 544-550PubMed Google Scholar). VE remained greater than zero for at least 5 to 6 months after vaccination. Similar waning effects have not been observed consistently across age groups and virus subtypes in different populations, and the observed decline in protection could be attributable to bias, unmeasured confounding, or the late season emergence of antigenic drift variants that are less well-matched to the vaccine strain. Vaccination efforts should continue throughout the season because the duration of the influenza season varies and influenza activity might not occur in certain communities until February or March. Providers should offer influenza vaccine routinely, and organized vaccination campaigns should continue throughout the influenza season, including after influenza activity has begun in the community. Although vaccination by the end of October is recommended, vaccine administered in December or later, even if influenza activity has already begun, is likely to be beneficial in the majority of influenza seasons. All persons aged ≥6 months without contraindications should be vaccinated annually. However, vaccination to prevent influenza is particularly important for persons who are at increased risk for severe complications from influenza and for influenza-related outpatient, ED, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons at increased risk for medical complications attributable to severe influenza who do not have contraindications (no hierarchy is implied by order of listing):•all children aged 6 through 59 months;•all persons aged ≥50 years;•adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);•persons who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection);•women who are or will be pregnant during the influenza season;•children and adolescents (aged 6 months through 18 years) who are receiving aspirin- or salicylate-containing medications and who might be at risk for experiencing Reye syndrome after influenza virus infection;•residents of nursing homes and other long-term care facilities;•American Indians/Alaska Natives; and•persons who are extremely obese (BMI ≥40). ACIP recommends that LAIV4 not be used during the 2017–18 season for any population. Providers who elect to use it should consider previous guidance for use of LAIV4 for high-risk populations (Table 1).Table 1:Contraindications and precautions to the use of influenza vaccines — United States, 2017–18 influenza seasonaImmunization providers should check Food and Drug Administration–approved prescribing information for 2017–18 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, and precautions. Package inserts for US-licensed vaccines are available at https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm.Vaccine typeContraindicationsPrecautionsIIVHistory of severe allergic reaction to any component of the vaccinebHistory of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of IIV and LAIV. However, ACIP recommends that any licensed, recommended, and appropriate IIV or RIV may be administered to persons with egg allergy of any severity (see Persons with a History of Egg Allergy). or after previous dose of any influenza vaccineModerate-to-severe acute illness with or without feverHistory of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccineRIVHistory of severe allergic reaction to any component of the vaccineModerate-to-severe acute illness with or without feverHistory of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccineLAIVFor the 2017–18 season, ACIP recommends that LAIV not be used. Content is provided for information.History of severe allergic reaction to any component of the vaccinebHistory of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of IIV and LAIV. However, ACIP recommends that any licensed, recommended, and appropriate IIV or RIV may be administered to persons with egg allergy of any severity (see Persons with a History of Egg Allergy). or after a previous dose of any influenza vaccineConcomitant aspirin or salicylate-containing therapy in children and adolescentsChildren aged 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a health care provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode has occurred during the preceding 12 monthsChildren and adults who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection)Close contacts and caregivers of severely immunosuppressed persons who require a protected environmentPregnancyReceipt of influenza antiviral medication within the previous 48 hoursModerate-to-severe acute illness with or without feverHistory of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccineAsthma in persons aged ≥5 yearsOther underlying medical conditions that might predispose to complications after wild-type influenza infection (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])ACIP, Advisory Committee on Immunization Practices; IIV, Inactivated Influenza Vaccine; LAIV, Live-Attenuated Influenza Vaccine; RIV, Recombinant Influenza Vaccine.a Immunization providers should check Food and Drug Administration–approved prescribing information for 2017–18 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, and precautions. Package inserts for US-licensed vaccines are available at https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm.b History of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of IIV and LAIV. However, ACIP recommends that any licensed, recommended, and appropriate IIV or RIV may be administered to persons with egg allergy of any severity (see Persons with a History of Egg Allergy). Open table in a new tab ACIP, Advisory Committee on Immunization Practices; IIV, Inactivated Influenza Vaccine; LAIV, Live-Attenuated Influenza Vaccine; RIV, Recombinant Influenza Vaccine. All persons aged ≥6 months without contraindications should be vaccinated annually; however, continued emphasis should be placed on vaccination of persons who live with or care for persons at higher risk for influenza-related complications. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to persons at higher risk for influenza-related complications listed above, as well as these persons:•health care personnel, including physicians, nurses, and other workers in inpatient and outpatient-care settings, medical emergency-response workers (e.g., paramedics and emergency medical technicians), and employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients. ACIP guidance for immunization of health care personnel has been published previously (21Shefer A Atkinson W Friedman C et al.Immunization of health-care personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR Recomm Rep. 2011; 60Google Scholar);•household contacts (including children) and caregivers of children aged ≤59 months (i.e., aged <5 years) and adults aged ≥50 years, particularly contacts of children aged <6 months; and•household contacts (including children) and caregivers of persons with medical conditions that put them at high risk for severe complications from influenza. ACIP recommends that LAIV4 not be used during the 2017–18 season for any population. Providers who elect to use it should consider previous guidance for use of LAIV4 for persons who care for or have contact with immunocompromised persons (22Pearson ML Bridges CB Harper SA Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP).MMWR Recomm Rep. 2006; 55PubMed Google Scholar). Health care personnel and persons who are contacts of persons in these groups and who are contacts of severely immunocompromised persons (those living in a protected environment) may receive any IIV or RIV that is otherwise indicated. ACIP and HICPAC have previously recommended that health care personnel who receive LAIV should avoid providing care for severely immunosuppressed patients requiring a protected environment for 7 days after vaccination, and that hospital visitors who have received LAIV4 should avoid contact with severely immunosuppressed persons (i.e., persons requiring a protected environment) for 7 days after vaccination. However, such persons should not be restricted from visiting less severely immunosuppressed patients. Children aged 6 through 35 months may receive one of two products at the appropriate volume for each dose needed: 0.5 mL FluLaval Quadrivalent (containing 15 μg of HA per vaccine virus) or 0.25 mL Fluzone Quadrivalent (containing 7.5 μg of HA per vaccine virus). These are the only two influenza vaccine products licensed for this age group. Care should be taken to administer the appropriate volume for each needed dose of either product. In either instance, the needed volume may be administered from an appropriate prefilled syringe, a single dose vial, or multidose vial, as supplied by the manufacturer. Note, however, that if a 0.5 mL single-use vial of Fluzone Quadivalent is used for a child aged 6 through 35 months, only half the volume should be administered and the other half should be discarded. Before November 2016, the only influenza vaccine formulations licensed for children aged 6 through 35 months were the 0.25 mL (containing 7.5 μg of HA per vaccine virus) dose formulations of Fluzone and Fluzone Quadrivalent. The recommendation for use of a reduced dose volume for children in this age group (half that recommended for persons aged ≥3 years) was based on increased reactogenicity noted among children (particularly younger children) following receipt of influenza vaccines in trials conducted during the 1970s. This increased reactogenicity was primarily observed with whole-virus inactivated vaccines (23Wright PF Thompson J Vaughn WK Folland DS Sell SH Karzon DT Trials of influenza A/New Jersey/76 virus vaccine in normal children: An overview of age-related antigenicity and reactogenicity.J Infect Dis. 1977; 136: S731-S741Crossref PubMed Scopus (120) Google Scholar, 24Wright PF Dolin R La Montagne JR Summary of clinical trials of influenza vaccines–II.J Infect Dis. 1976; 134: 633-638Crossref PubMed Scopus (67) Google Scholar, 25Wright PF Sell SH Thompson J Karzon DT Clinical reactions and serologic response following inactivated monovalent influenza type B vaccine in young children and infants.J Pediatr. 1976; 88: 31-35Abstract Full Text PDF PubMed Scopus (37) Google Scholar, 26Gross PA Reactogenicity and immunogenicity of bivalent influenza vaccine in one- and two-dose trials in children: a summary.J Infect Dis. 1977; 136: S616-S625Crossref PubMed Scopus (45) Google Scholar, 27Bernstein DI Zahradnik JM DeAngelis CJ Cherry JD Clinical reactions and serologic responses after vaccination with whole-virus or split-virus influenza vaccines in children aged 6 to 36 months.Pediatrics. 1982; 69: 404-408Crossref PubMed Google Scholar). Studies with vaccines more similar to currently available split-virus inactivated products demonstrated less reactogenicity (27Bernstein DI Zahradnik JM DeAngelis CJ Cherry JD Clinical reactions and serologic responses after vaccination with whole-virus or split-virus influenza vaccines in children aged 6 to 36 months.Pediatrics. 1982; 69: 404-408Crossref PubMed Google Scholar). Recent comparative studies of 0.5 mL vs. 0.25 mL doses of IIV3 conducted among children aged 6 through 23 months (28Skowronski DM Hottes TS Chong M et al.Randomized controlled trial of dose response to influenza vaccine in children aged 6 to 23 months.Pediatrics. 2011; 128: e276-89Crossref PubMed Scopus (50) Google Scholar) and 6 through 35 months (29Halasa NB Gerber MA Berry AA et al.Safety and immunogenicity of full-dose trivalent inactivated influenza vaccine (TIV) compared with half-dose TIV administered to children 6 through 35 months of age.J Pediatric Infect Dis Soc. 2015; 4: 214-224Crossref PubMed Scopus (21) Google Scholar) noted no significant difference in reactogenicity at the higher dose. In a randomized trial comparing immunogenicity and safety of 0.5 mL FluLaval Quadrivalent with 0.25 mL Fluzone Quadrivalent, safety and reactogenicity were similar between the two vaccines. In a post-hoc analysis, superior immunogenicity was noted for the B components of FluLaval Quadrivalent among infants aged 6 through 17 months and for unprimed children (those who had not previously received at least 2 doses of influenza vaccine) aged 6 through 35 months (30Jain VK Domachowske JB Wang L et al.Time to change dosing of inactivated quadrivalent influenza vaccine in young children: Evidence from a phase III, randomized, controlled trial.J Pediatric Infect Dis Soc. 2017; 6: 9-19PubMed Google Scholar). Evidence from several studies indicates that children aged 6 months through 8 years require 2 doses of influenza vaccine (administered a minimum of 4 weeks apart) during their first season of vaccination for optimal protection (31Neuzil KM Jackson LA Nelson J et al.Immunogenicity and reactogenicity of 1 versus 2 doses of trivalent inactivated influenza vaccine in vaccine-naive 5-8-year-old children.J Infect Dis. 2006; 194: 1032-1039Crossref PubMed Scopus (160) Google Scholar, 32Allison MA Daley MF Crane LA et al.Influenza vaccine effectiveness in healthy 6- to 21-month-old children during the 2003-2004 season.J Pediatr. 2006; 149: 755-762Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar, 33Ritzwoller DP Bridges CB Shetterly S Yamasaki K Kolczak M France EK Effectiveness of the 2003-2004 influenza vaccine among children 6 months to 8 years of age, with 1 vs 2 doses.Pediatrics. 2005; 116: 153-159Crossref PubMed Scopus (152) Google Scholar, 34Eisenberg KW Szilagyi PG Fairbrother G et al.New Vaccine Surveillance Network. Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003–2004 and 2004–2005 influenza seasons.Pediatrics. 2008; 122: 911-919Crossref PubMed Scopus (116) Google Scholar). Children aged 6 months through 8 years who have previously received ≥2 total doses of trivalent or quadrivalent influenza vaccine before July 1, 2017 require only 1 dose for 2017–18. The 2 doses of influenza vaccine do not have to have been administered in the same season or consecutive seasons. Children in this age group who have not previously received ≥2 doses of trivalent or quadrivalent influenza vaccine before July 1, 2017 require 2 doses for the 2017–18 season. The" @default.
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