City Health Information
Volume 32 (2013) New York City Department of Health and Mental Hygiene No. 3; 11-18



Influenza Prevention and Control, 2013-2014
  • Vaccinate everyone aged 6 months and older against influenza as early as possible.
  • Give inactivated vaccine to all pregnant women in any trimester.
  • Get your flu vaccination as soon as vaccine becomes available and ensure that your staff does the same.



All vaccines can potentially cause minor reactions. The most common adverse reactions to IIV are injection site soreness, redness, swelling, low-grade fever, aches, itching, and fatigue. While there are few contraindications to IIV, people with moderate to severe acute febrile illness should defer vaccination until their illness improves (36-38). A history of GBS within 6 weeks following a dose of IIV is considered a precaution for its use (2). Injection site reactions, including redness, swelling, induration, and itching, are more common with the IIV intradermal vaccine than with the intramuscular formulations, but these reactions resolve within 3 to 7 days.

The most common reactions to LAIV4 are runny nose, nasal congestion, cough, headache, myalgia, fever, and wheezing (36,39).

Allergy to egg protein is not an absolute contraindication to administration of IIV when proper precautions are taken, but must be distinguished from allergy to influenza vaccine. Patients with less severe egg allergy, ie, those who can eat lightly cooked egg without a reaction, can receive IIV per the usual protocol. Patients who have previously experienced only hives after eating eggs or foods containing eggs can also receive IIV (egg- or cell culture-based) or RIV3, but not LAIV4. The vaccine should be administered by a health care provider who is familiar with the potential manifestations of egg allergy, and the patient should be observed for at least 30 minutes for signs of a reaction (2).

Patients aged 18 through 49 who have experienced severe symptoms (eg, cardiovascular changes or respiratory distress) or who required epinephrine or other emergency medical intervention after egg exposure may receive RIV3 if there are no other contraindications. If RIV3 is unavailable or the recipient is outside the indicated age range, refer to a physician with expertise in managing allergic conditions for further risk assessment, as such patients are more likely to have a serious systemic or anaphylactic reaction upon reexposure to egg protein (2). A previous severe allergic reaction to influenza vaccine is always a contraindication to receipt of vaccine, regardless of the component suspected responsible for the reaction (2). If the component responsible for causing the allergic reaction (ie, egg protein or thimerosal) is known, consider using an alternative formulation that doesn't contain that component (ie, egg-free RIV3 or preservative-free vaccine). All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available (2).

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