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Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Nasal Influenza Vaccine for Younger Children and 2007 Updates


The fall, winter, and spring are terrific for outdoor activities, but they are also the peak seasons in the U.S. for being exposed to the influenza virus. Young children and elders are particularly prone to severe infections and the attendant complications. It has been suggested that a nasal vaccine (sprayed into the nose), such as FluMist, containing a weakened form of the live virus, provides better protection against influenza than does an intramuscular injection of inactivated (“killed”) virus, currently provided as trivalent inactivated vaccine (TIV).

The U.S. Food and Drug Administration has just approved expanding the population for use of FluMist to include children between the ages of 2 and 5 years. Previously, the lower age limit was felt to be 5 years of age. In the clinical study cited by the FDA to support their new recommendation, it was observed that children under the age of 2 years had an increased risk for wheezing and hospitalization.

As with certain other immunizations, there can be side effects, which in the case of FluMist include runny nose and/or nasal congestion, as well as fever in children ages 2 to 6 years. It should not be used in any person who suffers from asthma or in children under the age of 5 years with recurrent wheezing.

For 2007, here are important updates on current recommendations for immunization:

1. The trivalent inactivated vaccine (TIV) is supplied as a 0.5 milliliter dose containing 15 micrograms each of A/Solomon Islands/3/2006 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia2506/2004-like antigen. Trade names for this vaccine are Fluzone and Fluvirin.
2. Two doses of TIV administered at least 1 month apart are recommended for children aged 6 months to 8 years who are receiving TIV for the first time. Those who only received one dose in their first year should receive two doses the following year.
3. For FluMist, two doses administered at least 6 weeks apart are recommended for children aged 2 to 8 years who are receiving this vaccine for the first time. Those who received only 1 dose in their first year of vaccination should receive 2 doses in the following year.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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