An adaptation of Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods [1] was used to evaluate relative benefits and harms of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) for healthy children aged 2 through 8 years. As of the 2013-14 influenza season, the Advisory Committee on Immunization Practices (ACIP) recommendations stated that healthy children in this age group may receive either vaccine, with no preferential recommendation for one over the other. Outcome values and evidence of benefits and harms were reviewed in accordance with GRADE methods as adopted by the ACIP [1]. The primary policy question was “Should LAIV be recommended preferentially over IIV for healthy children aged 2 through 8 years?” While several individual studies noted greater relative efficacy of LAIV relative to TIV among children [2-4] , most studies conducted among adults have generally noted either similar efficacy or greater relative efficacy of IIV [5-11] . Because it is unclear at what age the greater relative efficacy of LAIV begins to decline, and given considerations to the feasibility of implementation of a potential change in program, this assessment focused on younger children.

The rationale for the selected age range included the following considerations:

1) LAIV is not licensed in the U.S. for children under 2 years of age [12], and 2) 8 years is the current upper age limit for consideration of whether a child needs one or two doses of influenza vaccine [13], and was selected for programmatic consistency.