New CDC Recommendation: All Children Should Receive Annual Seasonal Flu Vaccines
CME/CE Released: 07/27/2009; Valid for credit through 07/27/2010
July 27, 2009 — The US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is changing its recommendation for annual seasonal influenza vaccination for children aged 6 months to 18 years to a "full recommendation," Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, announced.
In addition, the CDC is advising a seasonal flu vaccine for anyone who feels they need one.
"While we are focusing a lot of attention on the 2009 H1N1 influenza virus, we do expect seasonal strains to emerge, and we are issuing updates of which strains to expect," Dr. Schuchat said. These include the A-H1N1, A-H3N2, and B strains, "which are available in this year's vaccine," she noted. "This past year's recommendations encouraged annual vaccination [of children].... This year, [the CDC] is no longer just advising vaccination whenever feasible but is [issuing] a full-out recommendation" of the seasonal flu vaccine.
Only about 40% of the US population received a flu vaccine last year. The CDC is recommending and emphasizing "an intensification of use" of the vaccine.
The CDC has specifically recommended that healthcare workers be immunized, as well as that campers at sleepover summer camps and attendees of military academies where there have been notable outbreaks of influenza receive the flu vaccine and antiviral agents, but only if appropriate.
"I don't think antiviral prophylaxis is a good idea," Dr. Schuchat said, noting that oseltamivir-resistant influenza strains have been reported.
Dr. Schuchat said that the latest laboratory-confirmed case count for the H1N1 influenza virus is 43,771 cases and 302 deaths, "but this is the last time we will be reporting cases in this way." Instead, the CDC will have a FluView Weekly Surveillance Report, updated every Friday, on its Web site.
The National Institutes of Health announced yesterday that clinical trials will begin as early as next week of 2 H1N1 influenza vaccine candidates in adults, either alone or in conjunction with the seasonal flu vaccine and, if safe, in children.
Sanofi Aventis and CSL Biotherapies, manufacturers of the 2 candidate vaccines, told a US Food and Drug Administration (FDA) advisory committee yesterday that they expect to have a vaccine available by October. Dr. Schuchat said that she is concerned that the flu season could be well underway by that time, because the school year begins within weeks in many areas.
The virus is unpredictable, she said, "skipping entire communities, while hitting others really hard." In addition, the virus can cause a wide spectrum of illness, from mild symptoms to respiratory arrest and neurological problems, including seizures. "That is why we are taking the virus so seriously." H1N1 often affects young, apparently healthy individuals, as well as those at high risk, and it could affect more than 40% of the population.
"We are preparing for the worst-case scenario of 60% of the population being affected," Dr. Schuchat said. "The value of worst-case scenario planning is that it allows for continuity planning."
The FDA's Advisory Committee on Immunization Practices is set to meet July 29 to propose H1N1 vaccine recommendations. Children aged 0 to 4 years will likely be the top priority, followed by school-age children, healthcare workers, pregnant women, and adults with chronic diseases.
Today, the FDA announced it had issued an emergency use authorization for a third diagnostic test for the 2009 H1N1 influenza virus because a public health emergency involving H1N1 was declared on April 26, 2009. It is the Focus Diagnostics Influenza H1N1 (2009) Real-Time Reverse Transcription Polymerase Chain Reaction diagnostic test.
The emergency use authorization allows Focus Diagnostics to distribute the test to laboratories certified under the Clinical Laboratory Improvement Amendments to perform high-complexity tests. This test is intended for use in the detection of the 2009 H1N1 influenza virus in patients with symptoms of respiratory infection.
The test does not indicate the stage of infection, nor does a negative result preclude influenza virus infection, FDA officials emphasize.
MMWR Morb Mortal Wkly Rep. Posted online July 24, 2009.
Clinical Context
Annual epidemics of seasonal influenza lead to serious disease among persons in any age group. However, rates of serious illness and death are highest among persons 65 years and older, children younger than 2 years, and persons of any age who have medical conditions that place them at increased risk for complications from influenza.
Currently, annual influenza vaccination is the most effective method for preventing infection and its complications. The trivalent inactivated influenza vaccine (TIV) is used for any person 6 months and older, including those with high-risk conditions. The live, attenuated influenza vaccine (LAIV) may be used for healthy, nonpregnant persons aged 2 to 49 years. Both TIV and LAIV have been demonstrated to be effective in children and adults. There is no preference for LAIV or TIV when considering vaccination of healthy, nonpregnant persons aged 2 to 49 years.
The aim of this report was to provide updates from the 2008 recommendations by CDC's Advisory Committee on Immunization Practices regarding the use of influenza vaccine for the prevention and control of seasonal influenza.
Study Highlights
- 3 principal changes in the 2009 vs 2008 recommendations include the following:
- Annual vaccination must be administered to all children aged 6 months to 18 years for the 2009-2010 influenza season.
- Vaccines containing the 2009-2010 trivalent vaccine virus strains A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Brisbane/60/2008-like antigens should be used.
- Most seasonal influenza A (H1N1) virus strains tested from the United States and other countries are now resistant to oseltamivir. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2009-2010 influenza season.
- The 2009 influenza vaccination recommendations for children and teens aged 6 months to 18 years include the following:
- All children aged 6 months to 18 years should be vaccinated annually.
- Children and teens at higher risk for influenza complications should continue to be a focus of vaccination efforts. They include those who:
- Are aged 6 months to 4 years (59 months)
- Have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus)
- Are immunocompromised
- Are receiving long-term aspirin therapy and therefore might be at risk of experiencing Reye's syndrome after influenza virus infection
- Are residents of long-term care facilities
- Will be pregnant during the influenza season
- Children younger than 6 months cannot receive influenza vaccination.
- Household (including breast-feeding mothers) and other close contacts of children younger than 6 months, including older children and teens, should be vaccinated.
- The 2009 influenza vaccination recommendations for adults (> 18 years) include the following:
- Any adult who wants to reduce the risk of becoming ill with influenza or of transmitting it to others
- Persons 50 years or older
- Women who will be pregnant during the influenza season
- Persons who have chronic pulmonary, cardiovascular, renal, hepatic, cognitive, neurologic/neuromuscular, hematologic or metabolic disorders
- Persons who have immunosuppression (including immunosuppression caused by medication or by HIV)
- Residents of nursing homes and other long-term care facilities
- Healthcare personnel
- Household contact and caregivers of children aged younger than 5 years and adults older than 50 years, with particular emphasis on vaccinating contacts of children younger than 6 months
- Household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza
- Seasonal influenza vaccines are not expected to provide substantial protection against infection with the recently identified novel influenza A (H1N1). Information on vaccination issues related to the novel influenza A H1N1 virus will be published later in 2009.
- TIV is administered via the intramuscular route, whereas the LAIV is intended for intranasal administration only.
- For use of TIV or LAIV, a moderate or severe illness with or without fever is a precaution. LAIV should not be administered to close contacts of immunosuppressed persons who require a protected environment.
- TIV and LAIV are contraindicated in persons known to have anaphylactic hypersensitivity to eggs or to other components of the influenza vaccine.
- All children ages 6 months to 8 years who have not been vaccinated previously at any time with at least 1 dose of either LAIV (if appropriate) or TIV should receive 2 doses of age-appropriate vaccine in the same season, with a single dose during subsequent seasons.
Clinical Implications
- The available influenza vaccines include a TIV, which is used for any person 6 months and older, and the LAIV, which may be used for healthy, nonpregnant persons aged 2 to 49 years.
- The 2009 Advisory Committee on Immunization Practices influenza vaccination campaign recommends vaccination in all children ages 6 months to 18 years and any adult, especially those considered high-risk, who wants to reduce the risk of becoming ill with influenza or transmitting it to others.
fuente: http://cme.medscape.com/viewarticle/706509?src=cmemp
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