Flu Vaccination
On February 24, 2010, the Advisory Committee on Immunization Practices (ACIP) voted to expand annual seasonal flu recommendations to everyone 6 months and older. The expanded recommendation is to take effect in the 2010–2011 influenza season. The new recommendation seeks to remove barriers to influenza immunization and signals the importance of preventing influenza across the entire population. Previous ACIP recommendations for seasonal influenza vaccination – which focused on vaccination of higher risk persons, children 6 months through 18 years of age and close contacts of higher risk persons – already applied to approximately 85 percent of the U.S. population. Provisional influenza vaccine recommendations for the 2010-11 flu season include:
- All people age 6 months and older are now recommended to receive annual influenza vaccination.
- The 2010-2011 trivalent vaccines will contain A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens. Compared to the 2009-10 Northern Hemisphere influenza vaccine, the influenza A(H1N1) and A(H3N2) strains are changed. The A/California/7/2009 (H1N1)-like strain is the same strain that was included in the pandemic influenza A(H1N1) 2009 monovalent vaccines.
- An additional inactivated vaccine (Agriflu, manufactured by Novartis, licensed by FDA on November 27, 2009) will be available.
- Age indications for two inactivated influenza vaccines have changed. Afluria, manufactured by CSL Vaccines, is now licensed for use in people age 6 months and older. Fluarix, manufactured by GSK Biologicals, is now licensed for use in people age 3 years and older.
- A higher dose formulation of an inactivated seasonal influenza vaccine (Fluzone High-Dose, manufactured by sanofi pasteur, licensed by FDA on December 23, 2009) for use in people age 65 years and older will be available. Fluzone High-Dose contains four times the amount of influenza antigen compared to other inactivated seasonal influenza vaccines. ACIP has not expressed a preference for Fluzone High-Dose or any other licensed inactivated influenza vaccine for use in people age 65 and older.
During an average year, an estimated 5-20% of Americans get the flu, approximately 36,000 die and more than 200,000 are hospitalized from flu-related complications. With the new recommendations, almost all Americans should be vaccinated. Reasons ACIP cited for universal vaccination include:
- The value of protecting all those 19 to 49 years of age, who have been hard hit by the 2009 H1N1 pandemic virus, which is likely to continue circulating into next season and beyond.
- Many people in currently recommended “higher risk” groups are unaware of their risk factor or that they are recommended for vaccination.
- New data collected over the course of the 2009 H1N1 pandemic indicate that some people who do not currently have a specific recommendation for vaccination may also be at higher risk of serious flu-related complications, including those people who are obese, post-partum women and people in certain racial/ethnic groups.
Flu vaccine providers will be challenged to vaccinate large numbers of persons. CDC and ACIP have long recommended flu vaccination throughout the entire flu season. However, national and Michigan data show that most seasonal flu doses are typically given in the first 2-3 months of the flu season every year.
Influenza-like illness surveillance data and seasonal influenza vaccine administration data recorded in the Michigan Care Improvement Registry (MCIR) from the 2004-05 through the 2008-09 flu seasons indicate that the majority of flu vaccine doses in Michigan are administered in the beginning of October, administration peaks in mid-November and then gradually declines. However, on average, the number of visits for influenza-like illness does not peak until mid-February. Expanding vaccination efforts throughout the winter and into the spring will allow health care providers to protect more people from this serious disease.
Changing the way we vaccinate against influenza is more important now than ever before.
The ACIP provisional influenza vaccine recommendations for the 2010-11 flu season are posted on the CDC website at www.cdc.gov/vaccines/recs/provisional.
