Attenuated Influenza Vaccine (LAIV) Vaccine Protocol
Persons age 2 through 49 years
1. CONDITION FOR PROTOCOL: To reduce incidence of morbidity and mortality of influenza disease.
2. POLICY OF PROTOCOL: The nurse will implement this protocol for live attenuated influenza (LAIV) vaccination.
Precautions
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
Currently healthy person age 2 through 49 years.
Proceed to vaccinate if meets remaining criteria.
Person is age 6 through 23 months of age or 50
years or older.
Do not give LAIV. Vaccinate using the age-appropriate IIV
protocol.
Person is a household contact of or healthcare
worker for someone who is severely immunocompromised and who requires protective isolation.
 Instruct the person receiving LAIV not to come in contact
with the immunocompromised person for 7 days following
vaccination; OR
 Offer to provide IIV and use the age-appropriate IIV
protocol.
Person had a life-threatening allergic reaction
(anaphylaxis) to a previous dose of influenza
vaccine.
Do not vaccinate; _____________________
Child age 2 through 18 years who is currently on
aspirin therapy.
Do not give LAIV. Vaccinate using the age-appropriate IIV
protocol.
Person has life-threatening allergic reaction
(anaphylaxis) to a component of LAIV.
Do not vaccinate; _____________________
Person has had Guillan-Barré syndrome (GBS)
within 6 weeks of a previous dose of influenza
vaccine.
[Refer to primary care provider for assessment of situation and
risk-benefit determination.]
[Proceed to vaccinate after discussing risk and benefit of
influenza vaccination and GBS.]
Pregnant woman.
Do not give LAIV. Vaccinate using the age-appropriate IIV
protocol.
Person has an egg allergy or allergy testing is
suggestive of egg allergy even though the person
has never been exposed to eggs.
Do not give LAIV.
[Follow the egg allergy algorithm to determine whether or not to
vaccinate with IIV and follow IIV protocol.]
[Give RIV if available using the age-appropriate IIV protocol.]
[Refer to primary care provider for further evaluation.]
Person has any reported chronic medical condition,
including asthma or recurrent wheezing in children
age 2 through 4 years.
Do not give LAIV. Vaccinate using the age-appropriate IIV
protocol.
Person has nasal congestion that blocks their ability Defer vaccination until congestion resolves or if available, offer
an IIV product and use the age-appropriate IIV protocol.
to breathe through the nose.
[Defer vaccination until 4 weeks have passed.]
Person received another live virus vaccine within the
[Give inactivated influenza vaccine if available. Follow the
past 4 weeks.
appropriate protocol for age.]
Person is currently on antibiotic therapy.
Proceed to vaccinate.
Document reviewed and updated:____________ – Sample protocol: Attenuated Influenza Vaccine (LAIV) – MDH rev 8-2015
Sample - Attenuated Influenza Vaccine (LAIV) Vaccine Protocol
Person is currently on influenza antiviral therapy.
Defer vaccination until 48 hours following the last dose or give
IIV using the age-appropriate IIV protocol.
Person has a mild illness defined as temperature
less than ____°F/°C with symptoms such as: [to be
determined by medical prescriber]
Proceed to vaccinate.
Child has a 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]
4. PRESCRIPTION:

Give FluMist spray: 0.1 mL into each nostril.

Follow the attached algorithm in order to determine which children age 2 through 8 years* need a second dose of
LAIV.

Give the 2nd dose at least 4 weeks after the first dose.
*This age range applies to LAIV only because LAIV is licensed for children starting at age 2 years. Certain inactivated influenza
vaccines allow the second dose for children as young as age 7 months (when dose one was given at age 6 months). Please refer to
the: Inactivated Influenza Vaccine (IIV) Protocol, Children Age 6 Months through 8 Years.
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: Attenuated Influenza Vaccine (LAIV) – 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)