2011-12 Influenza Vaccine Recommendations The Advisory Committee on Immunization Practices of CDC issued updated recommendations for influenza vaccination for the 2011-12 season. They were published in the August 18 issue of “Morbidity and Mortality Weekly Report”. The 2010 recommendation for routine annual influenza vaccination for all persons aged 6 months and older in the U.S. has not changed. Vaccine strains will remain the same as those included in the 2010 version. They include A/California, A/Perth and B/Brisbane. The influenza A virus strain is derived from the 2009 pandemic H1N1 influenza A virus. The recommendation for annual vaccination remains in effect despite the fact that the 2011 vaccine contains the same strains as 2010. This is because levels of protective antibody decline over the course of the year. So individuals vaccinated in 2010 should receive another inoculation to ensure optimal protection. Children aged 6 months through 8 years usually need two doses of influenza vaccine administered a minimum of four weeks apart, during their first season of vaccination to optimize immune response. Since the 2011-12 vaccine strains are unchanged from last year, children aged 6 months through 8 years who received at least one dose of the 2010-11 seasonal vaccine will require only a single dose of the 2011-12 vaccine. This differs from previous recommendations that children in this age group who had received only a single dose of the prior season’s vaccine should be given two does in the following year. However, children in the 6 months to 8 years age group who did not receive at least one dose of the 2010-11 vaccine, or, for whom it is not certain whether the 2010-11 vaccine was received, should be given two doses of the 2011-12 seasonal vaccine. This year approximately 166 million doses of vaccine will be produced. That compares favorably with the 157 million doses produced last year. Despite this good availability, vaccination rates for pregnant women and healthcare professionals remain below desirable levels. Pregnant women and children younger than 6 months of age are known to be at higher risk for severe illness from influenza, and vaccination during pregnancy has been shown to decrease that risk to both mother and child. Hospitalization rates for influenza in infants during the first 6 months of life are lower among those whose mothers were vaccinated. It is currently recommended that all healthcare workers be vaccinated annually. During the 2010-11 season, the estimated coverage rate among healthcare professionals was only 63.5%. Although this was slightly up from the 62% in the 2009-10 season, it remained well below the Healthy People 2020 goal of 90%. Fluzone Intradermal A new intradermally administered trivalent inactivated vaccine (TIV) preparation was licensed in May 2011 under the name Fluzone Intradermal from SanofiPasteur. It is indicated for people 18 to 64 years of age and contains less of the antigen than the traditional intramuscular TIV preparations in a smaller volume (0.1 mL vs. 0.5 mL). The intradermal vaccine is administered in a single dose (preferably over the deltoid muscle) and comes in a prefilled microinjection syringe. The most common adverse reactions include injection-site erythema, swelling, pain and pruritis. With the exception of pain, the CDC notes these reactions occurred more frequently 2011-12 Influenza Vaccine Recommendations than with the intramuscular injection but generally resolved within three to seven days. The agency writes that this vaccine is an alternative to other TIV preparations for those in the indicated age range with no preferred recommendation. History of Allergy to Eggs The Advisory Council on Immunization Practices notes that history of allergy to eggs should be taken into account. For those who have experienced only hives after exposure to eggs, it is recommended that the inactivated vaccine, rather than live attenuated vaccine, should be given. For those individuals, the vaccine should be administered by a healthcare provider familiar with the potential manifestations of egg allergy, and that vaccine recipients be observed for at least 30 minutes after receipt of the vaccine. The Council states that other measures such as dividing and administering the vaccine by a two-step approach and skin testing with vaccine are not necessary. Persons who have had reaction to egg involving angioedema, respiratory distress or required epinephrine or other emergency treatments are more likely to have a serious systemic or anaphylactic reaction on re-exposure to egg products. The Committee suggests that such persons should be referred to a physician with expertise in the management of allergic conditions for further risk assessment prior to vaccination. Resources: “Updated Influenza Vaccine Recommendations Issued”, Medscape Medical News; Megan Brooks, August 18, 2011. “Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011”, Morbidity and Mortality Monthly Report, Aug. 26, 2011/Vol. 60/No. 33/pg. 1117-1152. “Influenza Vaccination Coverage Among Health-Care Personnel – United States, 2010-11 Influenza Season”, Morbidity and Mortality Monthly Report, Aug. 19, 2011/Vol. 60/No. 32/pg. 1073-1116. “Influenza Vaccination Coverage Among Pregnant Women – United States, 2010-11 Influenza Season”, Morbidity and Mortality Monthly Report, Aug. 19, 2011/Vol. 60/No. 32/pg. 1073-1116.
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