Freedman and Leder listed criteria for identification of a patient who may be inadequately vaccinated against influenza. The authors are from the University of Alabama at Birmingham and the Royal Melbourne Hospital in Australia.


A patient may be considered to be inadequately vaccinated against influenza if s/he will have a significant risk of exposure to influenza and at least one of the following conditions:


(1) The patient was unable to be vaccinated because of:

(1a) a medical contraindication

(1b) lack of available vaccine

(1c) refusal of vaccine (not listed in original table)


(2) Protective immunity has not had a chance to develop, with exposure only a few days (less than 14 days) after vaccination.


(3) The vaccine may not be protective because:

(3a) the person will be exposed to a strain not covered in the current vaccine

(3b) the patient will have a significant exposure to avian influenza

(3c) the patient will have exposure to a pandemic strain of influenza (a pandemic strain occurs after an antigenic shift and would not be covered by a vaccine, as in 3a)


An inadequately vaccinated patient who is at risk for exposure to influenza should be considered for chemoprophylaxis with oseltamivir or other agent.


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