As the 2015-16 influenza season approaches, the CDC has released a Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) that recaps what its Advisory Committee on Immunization Practices (ACIP) has recommended so far this year regarding seasonal influenza vaccine use.
The Aug. 7 report pulls from decisions made at the ACIP meetings held Feb. 26 and June 24-25 that addressed the antigenic composition of U.S. seasonal influenza vaccines, the vaccine products expected to be available for the 2015-16 flu season, an updated algorithm for determining the appropriate number of doses for children ages 6 months through 8 years, and recommendations for the use of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) for healthy children ages 2 through 8.
Vaccination Dosage for Children
AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., told AAFP News that although many of the current influenza vaccination recommendations mirror last year's guidance, figuring out which children need two vaccine doses rather than one remains a common challenge for physicians.
"The recommendation isn't different from last year, but it gets docs every time," Savoy said. "Long story short, if you have a kid 6 months to 8 years old who has ever gotten two influenza vaccines (in the same or different seasons, regardless of which vaccine was used), then he or she only needs one dose this year. If you don't know, or know he or she has not had two already, give one vaccine (dose) today and a second dose four weeks from now."
- A CDC Morbidity and Mortality Weekly Report on Aug. 7 recapped what the agency's Advisory Committee on Immunization Practices (ACIP) has recommended so far this year regarding seasonal influenza vaccine use.
- AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., told AAFP News that although many of the current influenza vaccination recommendations mirror last year's guidance, figuring out which children need two vaccine doses rather than one remains a common challenge for physicians.
- A number of new or updated influenza vaccine products are available for the 2015-16 flu season.
Additional Key Points
Savoy said a key takeaway from the MMWR report is to start recommending vaccination in your office early. "The goal is to vaccinate before the influenza season arrives in your community, so aim for October at the latest," Savoy said. "Continue to vaccinate throughout the season until activity ceases in the spring."
Noting that the ACIP recommends vaccinating everyone age 6 months or older who doesn't have a contraindication to the vaccine, Savoy emphasized that there is no ACIP-preferred influenza vaccine, so vaccination should not be delayed to wait on a particular formulation.
"With the growing number of licensed influenza products, there is always a question about which one 'should' be used," she said. But the ACIP currently considers all FDA-licensed influenza vaccines to be comparable to one another, even though the group briefly offered a preferential recommendation for LAIV rather than IIV use in healthy children last year. The ACIP withdrew the recommendation after data from subsequent observational studies comparing LAIV and IIV vaccine effectiveness indicated that LAIV did not perform as well as expected based on observations from earlier randomized trials.
New and updated influenza vaccine products the FDA has approved for the 2015-16 flu season include:
- bioCSL's Afluria for intramuscular administration, an IIV given via the Stratis needle-free jet injector, for patients ages 18-64;
- Protein Science's trivalent recombinant influenza vaccine (RIV3) Flublok for patients ages 18 and older; and
- Sanofi Pasteur's Fluzone Intradermal Quadrivalent for patients ages 18-64.
Finally, Savoy said the ACIP has stated that an egg allergy in an adult patient (18 or older) doesn't automatically disqualify the patient from being vaccinated.
Patients who experience only hives after exposure to eggs can receive RIV3 or IIV. If IIV is used, it should be given by a health care professional who is familiar with the potential manifestations of egg allergy, and the patient must be observed for at least 30 minutes after vaccine administration.
"Aside from previous allergic reaction to the actual influenza vaccine itself, adults can receive the influenza vaccine," Savoy said.
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