Practice Guideline Briefs

ACIP Releases 2006-2007 Influenza Vaccination Recommendations

Am Fam Physician. 2006 Aug 15;74(4):673-677.

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention has issued updated guidelines for the use of influenza vaccine and antiviral agents for prophylaxis and treatment of influenza A. The full report was published in the July 28, 2006, issue of Morbidity and Mortality Weekly Report and is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e628a1.htm.

Changes from previous recommendations include the following:

  • Neither amantadine (Symmetrel) nor rimantadine (Flumadine) should be used for chemoprophylaxis against influenza A because of recent data indicating widespread resistance of influenza viruses to these medications. Until susceptibility to these agents has been reestablished among circulating influenza A viruses, oseltamivir (Tamiflu) or zanamivir (Relenza) may be prescribed if antiviral treatment or chemoprophylaxis of influenza is indicated (Table 1).

  • Children 24 to 59 months of age and their household contacts and out-of-home caregivers should be vaccinated against influenza. This change extends the recommendations for vaccination of children so that all children six to 59 months of age are vaccinated annually (Table 2).

  • Previously unvaccinated children six months to less than nine years of age should receive two doses of influenza vaccine. Children six months to less than nine years of age who receive trivalent inactivated influenza vaccine should have a booster dose administered at least one month after the initial dose, before the onset of influenza season, if possible. Children five to less than nine years of age who receive live, attenuated influenza vaccine should have a second dose six to 10 weeks after the initial dose, before the influenza season, if possible. If a child six months to less than nine years of age was vaccinated for the first time during a previous influenza season but did not receive a second dose of vaccine in the same season, only one dose of vaccine should be administered this season.

  • Health care professionals should routinely offer influenza vaccine to patients throughout the influenza season, even after influenza activity has been documented in their communities.

TABLE 1

Recommended Dosages of Antivirals for Influenza Chemoprophylaxis and Treatment

Agent Age group (years)
1 to 6 7 to 9 10 to 12 13 to 64 65 and older

Oseltamivir (Tamiflu)

Chemoprophylaxis, influenza A and B

Dosage varies by child’s weight*

Dosage varies by child’s weight*

Dosage varies by child’s weight*

75 mg once daily

75 mg once daily

Treatment, influenza A and B†

Dosage varies by child’s weight‡

Dosage varies by child’s weight

Dosage varies by child’s weight

75 mg twice daily

75 mg twice daily

Zanamivir (Relenza)

Chemoprophylaxis, influenza A and B

Not recommended in children 1 to 4 years of age

Ages 5 to 9: 10 mg (two inhalations) once daily

10 mg (two inhalations) once daily

10 mg (two inhalations) once daily

10 mg (two inhalations) once daily

Treatment, influenza A and B

Not recommended

10 mg (two inhalations) twice daily

10 mg (two inhalations) twice daily

10 mg (two inhalations) twice daily

10 mg (two inhalations) twice daily


*—Chemoprophylaxis dosing for oseltamivir is 30 mg once daily in children weighing 15 kg (33 lb) or less; 45 mg once daily in children weighing more than 15 kg to 23 kg (50 lb, 10 oz); 60 mg once daily in children weighing more than 23 kg to 40 kg (88 lb); and 75 mg once daily in children weighing more than 40 kg.

†—A reduction in the dosage of oseltamivir is recommended for persons with creatinine clearance of less than 30 mL per minute.

‡—Treatment dosing for oseltamivir is 30 mg twice daily in children weighing 15 kg or less; 45 mg twice daily in children weighing more than 15 kg to 23 kg; 60 mg twice daily in children weighing more than 23 kg to 40 kg; and 75 mg twice daily in children weighing more than 40 kg.

Adapted from Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2006;55(RR-10):28.

TABLE 1   Recommended Dosages of Antivirals for Influenza Chemoprophylaxis and Treatment

View Table

TABLE 1

Recommended Dosages of Antivirals for Influenza Chemoprophylaxis and Treatment

Agent Age group (years)
1 to 6 7 to 9 10 to 12 13 to 64 65 and older

Oseltamivir (Tamiflu)

Chemoprophylaxis, influenza A and B

Dosage varies by child’s weight*

Dosage varies by child’s weight*

Dosage varies by child’s weight*

75 mg once daily

75 mg once daily

Treatment, influenza A and B†

Dosage varies by child’s weight‡

Dosage varies by child’s weight

Dosage varies by child’s weight

75 mg twice daily

75 mg twice daily

Zanamivir (Relenza)

Chemoprophylaxis, influenza A and B

Not recommended in children 1 to 4 years of age

Ages 5 to 9: 10 mg (two inhalations) once daily

10 mg (two inhalations) once daily

10 mg (two inhalations) once daily

10 mg (two inhalations) once daily

Treatment, influenza A and B

Not recommended

10 mg (two inhalations) twice daily

10 mg (two inhalations) twice daily

10 mg (two inhalations) twice daily

10 mg (two inhalations) twice daily


*—Chemoprophylaxis dosing for oseltamivir is 30 mg once daily in children weighing 15 kg (33 lb) or less; 45 mg once daily in children weighing more than 15 kg to 23 kg (50 lb, 10 oz); 60 mg once daily in children weighing more than 23 kg to 40 kg (88 lb); and 75 mg once daily in children weighing more than 40 kg.

†—A reduction in the dosage of oseltamivir is recommended for persons with creatinine clearance of less than 30 mL per minute.

‡—Treatment dosing for oseltamivir is 30 mg twice daily in children weighing 15 kg or less; 45 mg twice daily in children weighing more than 15 kg to 23 kg; 60 mg twice daily in children weighing more than 23 kg to 40 kg; and 75 mg twice daily in children weighing more than 40 kg.

Adapted from Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2006;55(RR-10):28.

TABLE 2

Persons for Whom Influenza Vaccination Is Recommended

Persons at high risk for influenza-related complications and severe disease

Children six to 59 months of age

Pregnant women

Persons 50 years of age and older

Persons of any age with certain chronic medical conditions

Persons who live with or care for persons at high risk

Household contacts who have frequent exposure to persons at high risk

Health care professionals

TABLE 2   Persons for Whom Influenza Vaccination Is Recommended

View Table

TABLE 2

Persons for Whom Influenza Vaccination Is Recommended

Persons at high risk for influenza-related complications and severe disease

Children six to 59 months of age

Pregnant women

Persons 50 years of age and older

Persons of any age with certain chronic medical conditions

Persons who live with or care for persons at high risk

Household contacts who have frequent exposure to persons at high risk

Health care professionals

  • The 2006-2007 trivalent influenza vaccine virus strains include A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. For the A/Wisconsin/67/2005 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus; for the B/Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus (Table 3).

TABLE 3

Approved Influenza Vaccines by Age Group, 2006-2007 Season

Vaccine* Manufacturer Availability Age group Number of doses Route of administration

TIV (Fluzone)

sanofi pasteur

0.25 mL (prefilled syringe)

6 to 35 months

1 or 2†

IM‡

0.5 mL (prefilled syringe)

36 months and older

1 or 2†

IM‡

0.5 mL (vial)

36 months and older

1 or 2†

IM‡

5.0 mL (multidose vial)

6 months and older

1 or 2†

IM‡

TIV (Fluvirin)

Novartis Vaccine

0.5 mL (prefilled syringe)

4 years and older

1 or 2†

IM‡

5.0 mL (multidose vial)

4 years and older

1 or 2†

IM‡

TIV (Fluarix)

GlaxoSmithKline

0.5 mL (prefilled syringe)

18 years and older

1

IM‡

LAIV (FluMist)

MedImmune

0.5 mL (sprayer)

5 to 49 years

1 or 2§

Intranasal¶


TIV = trivalent inactivated vaccine; IM = intramuscular; LAIV= live, attenuated influenza vaccine.

*—A 0.5-mL dose contains 15 mcg each of A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. For the A/Wisconsin/67/2005 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus, and for the B/Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus.

†—Two doses administered at least one month apart are recommended for children six months to less than nine years of age who are receiving influenza vaccine for the first time.

‡—For adults and older children, the recommended site of vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral aspect of the thigh.

§—Two doses administered at least six weeks apart are recommended for children five to less than nine years of age who are receiving influenza vaccine for the first time.

¶—One dose equals 0.5 mL, divided equally between both nostrils.

Adapted from Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2006;55(RR-10):15.

TABLE 3   Approved Influenza Vaccines by Age Group, 2006-2007 Season

View Table

TABLE 3

Approved Influenza Vaccines by Age Group, 2006-2007 Season

Vaccine* Manufacturer Availability Age group Number of doses Route of administration

TIV (Fluzone)

sanofi pasteur

0.25 mL (prefilled syringe)

6 to 35 months

1 or 2†

IM‡

0.5 mL (prefilled syringe)

36 months and older

1 or 2†

IM‡

0.5 mL (vial)

36 months and older

1 or 2†

IM‡

5.0 mL (multidose vial)

6 months and older

1 or 2†

IM‡

TIV (Fluvirin)

Novartis Vaccine

0.5 mL (prefilled syringe)

4 years and older

1 or 2†

IM‡

5.0 mL (multidose vial)

4 years and older

1 or 2†

IM‡

TIV (Fluarix)

GlaxoSmithKline

0.5 mL (prefilled syringe)

18 years and older

1

IM‡

LAIV (FluMist)

MedImmune

0.5 mL (sprayer)

5 to 49 years

1 or 2§

Intranasal¶


TIV = trivalent inactivated vaccine; IM = intramuscular; LAIV= live, attenuated influenza vaccine.

*—A 0.5-mL dose contains 15 mcg each of A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. For the A/Wisconsin/67/2005 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus, and for the B/Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus.

†—Two doses administered at least one month apart are recommended for children six months to less than nine years of age who are receiving influenza vaccine for the first time.

‡—For adults and older children, the recommended site of vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral aspect of the thigh.

§—Two doses administered at least six weeks apart are recommended for children five to less than nine years of age who are receiving influenza vaccine for the first time.

¶—One dose equals 0.5 mL, divided equally between both nostrils.

Adapted from Centers for Disease Control and Prevention. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2006;55(RR-10):15.

CARRIE ARMSTRONG


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