Inactivated Influenza
Vaccine (IIV) Protocol
Children Age 6 Months Through 8 Years
1. CONDITION FOR PROTOCOL: To reduce incidence of morbidity and mortality of influenza disease in children age 6
months through 8 years.
2. POLICY OF PROTOCOL: The nurse will implement this protocol for influenza vaccination.
Contraindications
Indications
3. CONDITION-SPECIFIC CRITERIA AND PRESCRIBED ACTIONS:
Instructions for persons adopting these protocols: The table below list indication, contraindication, and precaution
criteria and suggested prescribed actions that are necessary to implement the vaccine protocol. The prescribed
actions include examples shown in [ ] but may not suit your institution’s clinical situation and may not include all
possible actions. A licensed prescriber must review the criteria and actions and determine the appropriate action to be
prescribed. (Delete this paragraph before version is signed.)
Criteria
Prescribed Action
Child is currently healthy and age 6 months to
9 years
Proceed to vaccinate if meets remaining criteria.
Child is less than 6 months of age.
Do not vaccinate.
[Instruct parent to return when child turns age 6 months]
[Encourage parents to get vaccinated.]
Child is 9 years or older and healthy.
Follow either the LAIV protocol or the influenza protocol for
persons 9 years and older.
Child is currently healthy but has a chronic
medical condition.
Proceed to vaccinate if meets remaining criteria.
Child had a life-threatening allergic reaction
(anaphylaxis) to a previous dose of influenza
vaccine.
Do not vaccinate; _____________________
Child has a life-threatening allergic reaction
(anaphylaxis) to a component of currently
available IIV product.
Do not vaccinate; _____________________
[If allergy is related a component that is not in another vaccine
product on hand use that vaccine product, otherwise refer to
another vaccinator.]
Precautions
Child has a mild illness defined as temperature
less than ____°F/°C with symptoms such as:
Proceed to vaccinate.
[to be determined by medical prescriber]
Child has an acute moderate to severe illness
defined as temperature ____°F/°C or higher
with symptoms such as: [to be determined by
medical prescriber]
Defer vaccination and
[to be determined by medical prescriber]
Child has an egg allergy or allergy testing is
suggestive of egg allergy even though the
person has never been exposed to eggs.
[Follow the algorithm for evaluation of an egg allergy to determine
whether or not to proceed with vaccination.]
[Do not vaccinate; refer to primary care provider for evaluation of
whether or not to vaccinate.]
Child has a history of having Guillan-Barré
syndrome within 6 weeks of a previous
influenza vaccination.
Defer vaccination and ____________________________
[Refer to primary care provider for determination of risk and
benefit of influenza vaccination]
[Proceed to vaccinate after discussing risk and benefit of influenza
vaccination and GBS.]
Document reviewed and updated:____________
– Sample protocol: IIV 6 mo thru 8 yrs –
MDH rev 8-2015
Sample - Trivalent Inactivated Influenza Vaccine (TIV) Protocol - Children Age 6 months through 8 Years
4. PRESCRIPTION:
Give any of the following products that meet the age indication and administer according to dose and route described.
Product*
Dose
Route
Age Indication
Fluzone, trivalent (IIV3) or quadrivalent (IIV4)
0.25 mL
IM
6 months through 35 months
Fluzone, trivalent (IIV3) or quadrivalent (IIV4)
0.5 mL
IM
36 months or older
Fluarix, quadrivalent (IIV4)
0.5 mL
IM
3 years (36 months) or older
Fluvirin, trivalent (IIV3)
0.5 mL
IM
4 years or older
FluLaval, quadrivalent (IIV4)
0.5 mL
IM
3 years (36 months) or older
*Use of product names are intended to help users delineate specific product indications and are not intended to be an endorsement of any particular
product.

Follow the attached algorithm in order to determine which children age 6 months through 8 years need a second
dose of influenza vaccine.

Give the 2nd dose at least 4 weeks after the first dose.
5. MEDICAL EMERGENCY OR ANAPHYLAXIS: [Depending on clinic staffing, include one of the two options below.]
In the event of a medical emergency related to the administration of a vaccine. RN will apply protocols as described in
____________________________________________________________________________________________.
In the event of an onset of symptoms of anaphylaxis including:
o rash
o itchiness of throat
o difficulty breathing
o bodily collapse
o swollen tongue or throat
LPN or unlicensed assistive personnel (MA) will immediately contact the RN in order to implement the
____________________________________________________________________________________________.
6. QUESTIONS OR CONCERNS:
In the event of questions or concerns, call ____________________________at _____________________________.
This protocol shall remain in effect for all patients of ______________________________until rescinded or until
_____________________________________.
Name of prescriber: _______________________________________________________________________________
Signature: ________________________________________________________________________________________
Date: ___________________________
Document reviewed and updated:____________
– Sample protocol: IIV 6 mo thru 8 yrs –
MDH rev 8-2015
Algorithm for Evaluation of an Egg Allergy Preceding
Influenza Vaccination, 2015 –16
Can the person eat lightly
cooked egg (e.g., scrambled egg)
without reactions? 1, 2
Yes
Give vaccine per usual protocol.
No
After eating eggs or eggcontaining foods, does the
person experience ONLY hives?
Yes
Give IIV if indicated and observe
for reaction for at least 30
minutes after each dose.3
OR
Give Recombinant Influenza
Vaccine (RIV) if patient is 18 or
older
No
Does the person experience
other symptoms such as
 Cardiovascular changes
(e.g., hypotension)?
 Respiratory distress
(e.g., wheezing)?
 Gastrointestinal
(e.g., nausea/vomiting)?
 Reaction requiring
epinephrine?
Give RIV if patient is 18 or older
Yes
OR
IIV may be administered by a
health care provider with
advanced expertise in the
management of allergic reactions
(e.g., an allergist)
 Reaction requiring
emergency medical
attention?
1
Persons with egg allergy might tolerate egg in baked products (e.g., bread or cake). However, tolerance to egg-containing foods does
not exclude the possibility of egg allergy. Egg allergy may be confirmed by a consistent medical history of adverse reactions to eggs and
egg-containing foods, plus skin and/or blood testing for immunoglobulin E antibodies to egg proteins.
2
If there is not previous exposure to eggs but suspicions of egg allergies exist due to prior allergy testing, give RIV if available, or refer to
a health care provider with expertise in management of allergic conditions.
3
Vaccines should only be administered in settings where staff are familiar with and have appropriate equipment for response to
anaphylactic reactions.
Source:
Centers for Disease Control and Prevention: Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on
Immunization Practices, United States, 2015–16 Influenza Season, found at www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm
Minnesota Dept. of Health – Immunization Program
(9/15)
Influenza vaccine dosing algorithm for children 6 months through 8 years old
2015 –16 Influenza Vaccination Season
Did the child received 2* or
more doses of trivalent or
quadrivalent influenza vaccine
before July 1, 2015?
Yes
No or
Don’t Know
1 dose
2 doses
at least 4 weeks apart
*The two doses do not need to have been received during the same or consecutive seasons.
Source:
Centers for Disease Control and Prevention: Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on
Immunization Practices, United States, 2015–16 Influenza Season, found at www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm
Minnesota Dept. of Health – Immunization Program
(9/15)