Now's the time to make flu season game plan

If you think there is time for a breather before gearing up for the upcoming flu season, think again. The CDC has already begun issuing flu bulletins for the 2004 - 2005 season, and vaccine distributors have been taking orders since December.

Several changes will affect vaccine-ordering decisions, and FPs should take heed.

Influenza vaccine is now recommended for 6- to 23-month-olds.
The vaccine is covered by the Vaccines for Children Program for the above group, as well as for those 2 to 18 years old who have risk factors or are household contacts of people with risk factors.

In general, vaccine recommendations are becoming more and more complex, and the flu vaccine recommendations are no exception, said Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, a member of the AAFP Commission on Clinical Policies and Research.

The use of an electronic health record or tracking program will help the physician stay on top of the details and not be befuddled by cutoff dates and catch-up vaccinations.

"The devil's in the details on this one," Campos-Outcalt said.

For instance, children younger than 9 years who have never been vaccinated with the flu vaccine will require a booster shot at least a month after the first dose. This may require some coordination on the part of the physician. Some doctors' offices may consider offering "vaccine days," during which the practice invites patients to come in to catch up on immunizations.

Another area ripe for misinterpretation involves the AAFP recommendation for pregnant women, Campos-Outcalt said. It advises giving the flu vaccine to women who will be in the second or third trimester during flu season. The National Immunization Program, as of late March, called for vaccinating all women who would be pregnant during flu season. The AAFP is reviewing its policy and may revise it.

These factors -- coupled with increased awareness of flu risks as a result of the early, harsh onset of the 2003 - 2004 flu season -- will likely increase demand for the vaccine, said Campos-Outcalt.

The three manufacturers are making production decisions based on projections for demand. Total influenza production is expected to be between 90 million and 100 million doses, compared with 86.9 million doses in 2003.

For the latest from the CDC on flu information for clinicians, go to http://www.cdc.gov/flu/professionals/; for AAFP immunization recommendations, go to http://www.aafp.org/x10631.xml.

To reach writer Toni Lapp, e-mail tlapp@aafp.org.

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