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.



School-age children have the highest incidence of influenza (1,6), although the illness is often not diagnosed (7). Children in day care and school are a major source of influenza transmission (1,6,8). Vaccinate children in day care and school as early as possible to protect the entire community. Studies have shown that 80% coverage in pediatric age groups can confer significant protection among people who did not receive influenza vaccine (9).

Severe complications of influenza are most common in children younger than age 2 and those with certain medical conditions (Box 2) (1). In 2012-2013, about 34% of all reported influenza hospitalizations in the United States (US) occurred in children younger than age 18 (10). The most commonly reported underlying medical conditions were asthma, neurologic disorders, and immune suppression, but 44% of children hospitalized for influenza had no identified underlying medical conditions (10). About 90% of influenza-associated pediatric deaths occurred in children who had not received influenza vaccine; 40% of the deaths were in children with no known chronic health problems (11). In New York State (NYS), 23% of influenza hospitalizations last season occurred in children younger than age 18 (12), and in New York City (NYC), emergency department visits for influenza-related illness (ILI) were highest in children younger than 5 years of age (13). See Box 3 for vaccine dosing guidance for children through age 18 (2).


Despite the life-saving potential of influenza vaccines, coverage in New York City (NYC) children remains low. Only 65% of NYC children aged 6 through 59 months, and 46% of children aged 5 through 8 years, were vaccinated with at least 1 dose of influenza vaccine last season (unpublished data). In addition, only 31% of children aged 9 through 18 were vaccinated. These rates remain far below the Healthy People 2020 goal of 80% coverage in these age groups. All children aged 6 months to 18 years should receive influenza vaccine as soon as it becomes available, especially those with conditions that put them at higher risk for severe disease, and so should their close contacts, including caregivers and day care providers (2,14). Younger children may require a second dose of vaccine in order to provide protective antibody levels.

For children aged 6 months through 8 years (2):

  • Give 1 dose of vaccine to children who have received
    • a total of 2 or more doses of seasonal influenza vaccine since July 1, 2010; OR
    • 2 or more doses of seasonal vaccine before July 1, 2010, and 1 or more doses of monovalent 2009(H1N1) vaccine; OR
    • 1 or more doses of seasonal vaccine before July 1, 2010, and 1 or more doses of seasonal vaccine since July 1, 2010.
Children 6 months through 8 years who do not meet at least 1 of these criteria should be given 2 doses this season.
  • Give the first dose as soon as vaccine becomes available and the second dose ≥4 weeks later. It usually takes about 2 weeks after the second dose for protection to begin.
See important additional vaccine information (PDF) and the Advisory Committee on Immunization Practices' recommended immunization schedule (PDF).

PDF version of Box 3

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