An early 2003-04 flu season in the United States has been accompanied by an unusually high and persistent demand for vaccine. This has resulted in a decreasing supply of trivalent inactivated vaccine (the flu shot).

Usual influenza vaccination recommendations are established by the Advisory Committee for Immunization Practices (ACIP) . In light of the current situation, however, on December 11, 2003 , CDC issued interim recommendations for influenza vaccination this season. These recommendations place an emphasis on using remaining supplies of trivalent inactivated vaccine (flu shot) for vaccination of people at high risk for complications from influenza, including healthy children aged 6 to 23 months. Healthy people between the ages of 5 and 49 years old who wish to get vaccine should consider being vaccinated with the intranasally administered live, attenuated influenza vaccine (LAIV, a nasal-spray flu vaccine), a substantial supply of which remains available.

Listed below are interim recommendations to focus use of remaining supplies of trivalent inactivated vaccine.

Who Should Be Vaccinated With the Flu Shot This Season

* Emphasis should be placed on targeting trivalent inactivated vaccine (flu shot) to persons at high risk for complications from influenza including: all children aged 6-23 months, adults aged > 65 years, pregnant women in their second or third trimester during influenza season, and persons aged > 2 years with underlying chronic conditions.
* Persons at high risk should be encouraged to search locally for vaccine if their usual health-care provider no longer has vaccine available.
* All children at high risk of complications from influenza, including those aged 6-23 months, who present for vaccination should be vaccinated with a first or second dose, depending on vaccination status. Doses should not be held in reserve to ensure that two doses will be available.
* Next priority should be given to vaccinating those persons at greatest risk for transmission of disease to persons at high risk, including household contacts and health-care workers.

Who Should Be Vaccinated With LAIV

* Healthy persons aged 5-49 years should be encouraged to be vaccinated with intranasally administered live, attenuated influenza vaccine.

Other Vaccination Recommendations

* Decisions about vaccinating healthy persons, including adults aged 50-64 years, with inactivated influenza vaccine should be made on a case-by-case basis, depending on local disease activity, vaccine coverage, feasibility, and supply.
* Health departments should work with their health-care providers to reallocate influenza vaccine to health-care providers in need when possible.

Who Should Not Get Flu Vaccine

People in the following groups should not get flu vaccine before talking with their doctor:

* People who are have a severe allergy (i.e. anaphylactic allergic reaction) to hens' eggs
* It is prudent to avoid vaccination in people who previously developed Guillain-Barré syndrome (GBS) the 6 weeks after getting a fl