Recommendation for Use 135

oChildren with chronic pulmonary or cardiac diseases as well as immunosuppressed children. Children on aspirin therapy should also be immunised because of the risk of Reye’s syndrome.

!Category 2 – Contacts of high-risk persons - healthcare workers, caregivers of the elderly and high-risk patients, and persons living with high risk persons.

!Category 3 – Workplace vaccination.

!Category 4 – Personal protection.

Australian guidelines (Hall 2002) -

!Everyone 65 years of age and older

!Aboriginal and Torres Strait Islander people 50 years of age and older

!People six months of age and older with chronic illnesses requiring regular medical follow-up or hospitalisation in the previous year

!People six months of age and older with chronic illnesses of the pulmonary or circulatory systems (except asthma)

!Residents of nursing homes or long-term care facilities

!Children and teenagers aged six months to 18 years on long-term aspirin therapy (because aspirin treatment puts them at risk of Reye’s syndrome if they develop a fever)

!Healthcare and other workers providing care to the high-risk groups above.

!Other groups for whom influenza immunisation should be considered include pregnant women, overseas travelers and persons infected with HIV.

Most countries with guidelines will have similar recommendations. Canada, although having similar recommendations for priority groups, actively encourages vaccination of everyone above the age of 6 months (Orr 2004).

If a pandemic becomes a reality, recommendations will likely extend to everyone. However, frontline workers such as healthcare personnel, as well as police forces and military personnel, might be high priority targets.

Contraindications

Contraindications to influenza vaccination are:

!egg allergy – the vaccines are made in eggs, and, although rare, severe allergic reactions such as anaphylaxis can occur.

!acute febrile illness – vaccination should be delayed. Minor illnesses such as mild upper respiratory tract infections or allergic rhinitis are not contraindications.

!first trimester of pregnancy has in the past been seen as a contraindication. However, the ACIP recommendations changed in 2004, and currently the guidelines say that vaccination can occur in any trimester (Bettes 2005, Harper 2004).

!previous Guillain-Barré syndrome has in the past been considered as a contraindication, but this is now no longer a contraindication for the use of inactivated vaccine. (Fleming 2005).