2007-08 Influenza Immunization Recs Emphasize Key Considerations

By News Staff
7/27/2007

The Academy recently updated its annual influenza immunization recommendations. They are included in a new policy statement, "Immunization Against Influenza 2007-2008," approved July 18 by AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky.

Although the revised recommendations, which are consistent with those developed by the CDC's Advisory Committee on Immunization Practices, contain relatively few outright changes from last season's recommendations, they re-emphasize some key considerations.

All children ages 6 months to 8 years who have not been immunized against influenza should receive two doses of vaccine the first year they are immunized, with single annual doses administered in subsequent years.
Children ages 6 months to 8 years who received only one dose of annual influenza vaccine in a previous season should receive two doses this season, with single annual doses administered in subsequent years.
All individuals, including school-aged children, who want to reduce their risk of becoming ill with influenza or of transmitting influenza to others, should be vaccinated.
Immunization providers should offer influenza vaccine and schedule immunization clinics throughout the entire influenza season.
Health care facilities should seriously consider making the level of influenza immunization coverage among their health care professionals a measure of their patient-safety quality programs and implement policies to boost immunization among health care personnel.

Overview of Targeted Populations

Patient populations targeted for immunization include people at increased risk for severe complications from influenza or at higher risk for influenza-associated clinic, hospital or emergency department visits; those who live with or care for patients at increased risk for influenza-related complications, such as health care professionals; children, because of their increased risks for hospitalization and clinic or emergency room visits; and anyone who wants to reduce their chance of contracting influenza.

Members Report Their 2007-08 Immunization Plans

Despite continuing miscues in the U.S. influenza vaccine supply and distribution system that left some physicians with unused product at the end of the 2006-07 influenza season, almost nine out of 10 Academy members report that they will offer the vaccine during the 2007-08 season. That's according to preliminary results from an AAFP member survey conducted earlier this year.

Of those who said they would offer the vaccine, nearly one in five (19.3 percent) said that they planned to order more vaccine for the coming season than they did for 2006-07. Sixty-two percent said that they would order the same amount they had previously, and 15.5 percent said they would order less.

The CDC recommends administering either tetravalent inactivated vaccine, known as TIV, or live, attenuated influenza vaccine, or LAIV, to reduce the risk for influenza. TIV is approved for use in individuals ages 6 months or older, including healthy people and those with chronic medical conditions. LAIV -- available as a nasal mist -- is approved for use in nonpregnant healthy people ages 5 to 49 years.

An algorithm outlining recommended influenza immunization actions for children is available from the CDC Web site.

Specific Immunization Recommendations

Immunization with TIV is recommended for these at-risk individuals:

children ages 6 to 59 months,
adults 50 or older,
women who will be pregnant during the influenza season,
children and teens (ages 6 months to 18 years) on long-term aspirin therapy,
children and adults with certain chronic conditions or compromised respiratory function,
immunosuppressed individuals, and
residents of nursing homes and other long-term, chronic care facilities.

Use of LAIV in eligible individuals, including health care personnel, should be encouraged when TIV is in short supply, so that more TIV is available to administer to those in whom the live, attenuated form of the vaccine is contraindicated.

In addition, possible advantages of LAIV include its ability to induce a broad mucosal and systemic immune response and its ease of administration via the intranasal route. The vaccine's biggest potential downside is its higher cost compared with that of TIV.

Visit the CDC Web site to review ACIP's comprehensive recommendations for prevention and control of seasonal influenza.

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