DUR: Influenza 2004-2005
The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control (CDC) and Prevention recently issued recommendations on the prevention and control of influenza for the 2004 – 2005 influenza season. The recommendations appear in the May 28, 2004 recommendations and reports series of Morbidity and Mortality Weekly Report, and are available online at www.cdc.gov/mmwr/weekcvol.html.
The 2004 recommendations include new or updated information about the vaccination of health care workers with Live, Attenuated Influenza Vaccine (LAIV); influenza vaccine in children 6 to 23 months of age; personnel who may administer influenza vaccines; and an assessment of the vaccine supply and timing of the influenza vaccination.
Vaccination of Health Care Workers
Studies have shown that up to 25 percent of health care workers are infected with influenza every flu season. Influenza vaccination of health care workers reduces
transmission of influenza to high-risk persons who may have a suboptimal response to the vaccines. Nationally, only 36 percent of health care workers receive annual
influenza vaccinations.
Visit www.idinchildren.com/monograph/0402/cmei.pdf for a Web-based Continuing Medical Education (CME) course, “Importance of Vaccinating Health Care Workers Against Influenza.”
2004 – 2005 Influenza Season
The 2004 – 2005 influenza vaccine formulation includes one virus from last year’s vaccine (A/NewCaledonia/20/99 [H1N1]-like) and two new viruses
(A/Fujian/411/2002-like [H3N2] and B/Shanghai/361/2002-like).
Influenza vaccines are available for purchase from the manufacturers listed below and from distributors listed on the Health Industry Distributors Association (HIDA) Web site at www.hidanetwork.com/.
Manufacturer |
Phone |
Vaccine |
|
Sanofi Pasteur |
1-800-822-2463 | Inactivated influenza vaccine | |
Novartis |
1-800-244-7668 | Inactivated influenza vaccine (only for people over 4 years of age) |
|
| Medlmmune | 1-877-358-6478 | FluMist* (only for healthy people 5 to 49 years of age) | |
| * Requires treatment authorization | |||
Live Attenuated Influenza Vaccine (LAIV)
FluMist, a trivalent LAIV, for nasal administration, is licensed to prevent illness from influenza A and B in healthy persons between 5 and 49 years of age. LAIV should
not be given to anyone at increased risk for influenza-related complications (see list on a following page) or with a history of Guillain-Barré syndrome. Instead,
inactivated vaccines should be given to such persons.
Health care workers not caring for severely immunocompromised patients may receive either LAIV or the inactivated vaccine. An inactivated vaccine is preferred for vaccinating household members, health care workers and others who have close contact with severely immunocompromised persons during periods when such patients require care in a protected environment. Health care workers receiving LAIV should avoid contact with severely immunocompromised patients for seven days after receiving the vaccine.
Influenza Vaccine For Children
Children 6 months of age or older may receive inactivated influenza vaccine. Healthy children over 5 years of age may receive either inactivated influenza vaccine or LAIV.
Note: LAIV requires prior authorization if dispensed by a pharmacy.
Number of Doses
Previously unvaccinated children under 9 years of age should receive two doses of influenza vaccine. If the child is receiving inactivated vaccine, the two doses should be more than one month apart. If the child is receiving LAIV, the two doses should be six to 10 weeks apart. If a child under 9 years of age receives influenza vaccine for the first time and does not receive a second dose during the same season, only one dose of vaccine should be administered the following season.
| Recommended Groups to Receive Influenza Vaccine | ||||
| 1. | Groups at high risk for complications from influenza-related complications: |
|||
| a. | Healthy children between 6 and 23 months of age | |||
| b. | All persons 65 years of age and older | |||
| c. | Persons 6 months of age or older who: | |||
| – | Live in long-term care facilities that house persons with chronic medical conditions | |||
| – | Have chronic cardiac or pulmonary conditions, including asthma | |||
| – | Have required regular medical follow-up or hospitalization during the preceding year due to chronic metabolic diseases (including diabetes), renal dysfunction, hemoglobinopathies or immunosuppression (including immunosuppression caused by medications or HIV) | |||
| d. | Persons between 6 months and 19 years of age who receive long-term aspirin therapy, and therefore might be at risk for Rye’s syndrome after an influenza infection | |||
| e. | Women who will be pregnant during the influenza season. Pregnant women have an increased risk of hospitalization due to complications from influenza. No adverse fetal effects have been associated with flu vaccine. Influenza vaccination can occur in any trimester. Previously, it was recommended that pregnant women, with no other risk factors, be vaccinated during the second or third trimester. | |||
| 2. | Persons who can transmit influenza to others at high risk: | |||
| a. | All personnel in hospital and outpatient settings, including emergency response workers | |||
| b. | Employees of long-term care facilities, assisted living and other residences for persons in high-risk groups who have contact with patients or residents | |||
| c. | Persons who provide home care to those in high-risk groups | |||
| d. | Household members (including children) of those in high-risk groups | |||
| e. | Household contacts and out-of-home caretakers of children up to 23 months of age | |||
| 3. | Depending upon availability, influenza vaccine should be considered for the following: | |||
| a. | Persons who provide essential community services | |||
| b. | Students and others in institutional settings (for example, dormitories) | |||
| c. | Persons at high risk due to plans to travel to the tropics or with large, organized tourist groups at any time of the year, or to the Southern Hemisphere between April and September. If a flu vaccine is not available, these persons should be informed of the symptoms of influenza and be advised to carry anti-viral medications for prophylaxis or treatment. Those who received flu vaccine during the flu season do not need to be revaccinated for travel before the next year’s influenza vaccine formulation is available. | |||
| d. | Persons who wish to reduce the chances of becoming ill with influenza | |||
Timing of Annual Influenza Vaccination
The Centers for Disease Control (CDC) will assess the vaccine supply throughout the manufacturing period and will make recommendations regarding the need for tiered timing of vaccination for different risk groups.
September or as soon as the vaccine is available:
- Primary care sites, medical specialty practices, home health agencies and hospitals: Persons at risk for complications from influenza (see above) should receive a vaccination when they come for routine health care or are hospitalized. This is particularly important for children under 9 years of age who receive the flu vaccine for the first time and therefore require two doses.
October, when flu vaccine is available:
- Long-term care facilities: All residents and employees should be vaccinated.
- All inpatient and outpatient facilities and home health agencies: Persons at risk, such as health care workers, contacts of high-risk persons, including household contacts and out-of-home caretakers of children up to 23 months of age.
- Vaccination clinics: Should be scheduled for late October and November.
November through March:
- All health care facilities : Patients and employees, including new hires and newly admitted unvaccinated patients, should continue to be vaccinated.
- Non-medical facility worksites: Begin vaccination.
- All facilities: Anyone who wishes to avoid getting influenza.
Additional Recommendations:
- Vaccinate throughout the flu season: Flu season usually lasts until March or April. Influenza vaccine can and should be administered throughout the flu season (October – March).
- Administer Pneumococcal Vaccine (PPV23) to persons at risk: People at risk for pneumococcal disease includes everyone over 65 years of age, people under 65 years of age with chronic medical conditions and residents of long-term care facilities.
- Standing Orders: The use of standing orders is the single most effective strategy for increasing adult vaccination rates in traditional and non-traditional inpatient and outpatient settings. For more information on strategies to increase adult immunization vaccination rates visit the CDC Web site.
Antiviral Medications
Antiviral drugs are an adjunct, not a substitute for, vaccination for preventing and controlling influenza. Amantadine and rimantadine* are approved for the prophylaxis
and treatment of influenza A. Two neuraminidase-inhibitors, zanamivir and oseltamivir, are approved for the treatment of influenza A and B. Oseltamivir is also approved for prophylaxis of influenza A and B.
* Requires treatment authorizaztion.
Additional Information
CDC Influenza Web sites:
| Disease surveillance information: www.cdc.gov/flu/professionals/surveillance.htm | |
| Vaccine availability information: www.cdc.gov/nip/news/shortages/default.htm |