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Annual vaccination against infection with influenza virus types A and B is strongly recommended for all adults over the age of 65 years and for persons of all ages, who are at risk for influenza induced mortality or the development of serious complications after influenza infection (chronic cardiac, pulmonary, metabolic, renal or immunological disorders, residence in institutional care facilities).1 Vaccination is also recommended for children who receive long term salicylate therapy, to reduce the risk of Reye syndrome, which occasionally occurs during convalescence from influenza and varicella infection and shows a strong correlation with the use of salicylates.2
The absolute number of children at risk for complications of influenza is small. For them, inactivated purified surface antigen (subunit) or detergent disrupted (split) influenza vaccines are available to be administered every year. Whole virus vaccines, which can be used in adults, are not recommended for children because of a higher incidence of vaccine induced systemic reactions,3 such as transient fever. Previously unvaccinated children less than 9 years of age should receive two doses of half the adult dose (currently 7.5 μg haemagglutinin per vaccine component) at least one month apart to guarantee a satisfactory antibody response.4 Clinical trials such as the one by Gonzalez et alreported in this issue of the journal5 and others6-10 show that this policy is safe in those vulnerable young individuals.
Healthy children are currently not a target for routine influenza vaccination although there are at least two good reasons to support …