Expanded Recommendation for Influenza Immunization for All Children From Age 6 Months Through 18 Years: Implementation Starting No Later Than the 2009-2010 Influenza Season

Board Chair Approved: March 13, 2008

The American Academy of Family Physicians has adopted the above recommendation for the expansion of the influenza immunization which is consistent with that of the Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention (CDC) on immunizations. The provisional recommendation of the ACIP is posted on the CDC website at: http://www.cdc.gov/vaccines/recs/provisional/downloads/flu-3-21-08.pdf (2-page PDF file; About PDFs). This recommendation was developed by the Advisory Committee on Immunization Practices, with the American Academy of Family Physicians, and the American Academy of Pediatrics.

This recommendation is part of the overall framework of expanding the influenza immunization to school aged children in 2009-2010; then household contacts of school-age children in 2010-2011 and universal vaccination in 2012-2013. Supply, safety and cost-effectiveness are all issues. Influenza infection incidence is highest in the 5-14 year old cohort. There are 5-7/100 outpatient visits and 10-30/100 illness episodes in this age group. Vaccine effectiveness is quite high and there may be indirect protective effects (herd immunity). Low expectations for coverage would exist for the first few years. There needs to be consideration of alternate sites for immunization as the medical home may not have the capacity to immunize this group. The proposed recommendations are:

For Universal recommendation for influenza vaccination of all children age 6 months to 18 years as soon as feasible, but no later than the 2009-2010 season; and
To promote these recommendations prior to the recommended date in order to allow the healthcare system to plan for this change.

An expanded recommendation for universal coverage from age 6 months through 18 years is a worthwhile change. Such a recommendation will simplify influenza vaccine delivery. The proposed implementation starting with provision of "no later than 2009-2010" is appreciated, thus allowing family physicians to gear up to vaccinate this widened population. As a result, continued educational initiatives to support more widespread immunization are necessary.

For all ACIP provisional recommendations go to: http://www.cdc.gov/vaccines/recs/provisional/default.htm.