Time to Gear Up for 2008-09 Influenza Season
Expanded Vaccination Recs Target Infants, Toddlers, Health Care Workers
By Adam Schoof
10/7/2008
The shortening days and cooler temperatures of fall herald the onset of a seasonal charge familiar to most family physicians: administration of annual influenza vaccine. The influenza vaccination recommendations for the 2008-09 influenza season released by the CDC's Advisory Committee on Immunization Practices, or ACIP, and approved by the AAFP this summer should prove helpful as FPs start receiving their vaccine supplies.
The recommendations reflect an expansion of the age groups targeted for immunization, now advising that all children ages 6 months to 18 years be vaccinated. Previous recommendations had not included routine administration of the vaccine to children ages 5 years to 18 years.
It's a change family physician Jonathan Temte, M.D., Ph.D., an associate professor in the department of family medicine at the University of Wisconsin, Madison, and a member of the ACIP, said he welcomes.
"This will provide a lot of protection for families and should lower transmission throughout the community," Temte said.
"This will provide a lot of protection for families and should lower transmission throughout the community," Temte said.
Furthermore, the recommendations state, "Vaccination is recommended for any person who wishes to reduce the likelihood of becoming ill with influenza or transmitting influenza to others."
Also new this season is a recommendation that either trivalent inactivated influenza vaccine, or TIV, or live attenuated influenza vaccine, or LAIV, may be used when vaccinating healthy individuals ages 2 years through 49 years; the previous recommendation was to administer LAIV to people ages 5 years to 49 years.
But whichever vaccine product is used, Temte said, FPs should begin giving the influenza vaccine as soon as feasible.
"In general, health care professionals should begin offering vaccination soon after vaccine becomes available and, if possible, by October," Temte said. "The biggest predictor of a patient getting an influenza vaccination is that his or her doctor recommends the vaccine."
Although CDC officials have predicted this year's influenza vaccine supply -- estimated to top 130 million doses -- will be sufficient to cover all groups recommended for immunization, should supply delays occur, recommendations for tiered use will be available from the CDC's Seasonal Flu Web site.
Also new this season is a recommendation that either trivalent inactivated influenza vaccine, or TIV, or live attenuated influenza vaccine, or LAIV, may be used when vaccinating healthy individuals ages 2 years through 49 years; the previous recommendation was to administer LAIV to people ages 5 years to 49 years.
But whichever vaccine product is used, Temte said, FPs should begin giving the influenza vaccine as soon as feasible.
"In general, health care professionals should begin offering vaccination soon after vaccine becomes available and, if possible, by October," Temte said. "The biggest predictor of a patient getting an influenza vaccination is that his or her doctor recommends the vaccine."
Although CDC officials have predicted this year's influenza vaccine supply -- estimated to top 130 million doses -- will be sufficient to cover all groups recommended for immunization, should supply delays occur, recommendations for tiered use will be available from the CDC's Seasonal Flu Web site.
Recommendations Focus on Health Care Workers
A primary focus of the 2008-09 influenza recommendations is vaccinating health care workers, Temte said.
"Only about 40 percent of health care workers get their annual influenza vaccine," Temte said. "They are notorious for coming to work while ill. A health care worker has the opportunity to spread influenza to at-risk individuals because of the nature of the health care setting. Therefore, health care workers have the obligation to keep their patients safe through their own behaviors."
Another concern is that patients may refuse influenza vaccination because of fears that the vaccine itself will make them ill or cause adverse effects.
"There are always a few people who will refuse influenza vaccine," Temte said. "There is a belief among some potential recipients that influenza vaccine can cause influenza, (which is) not true. Moreover, there has been some inappropriate fear created regarding trace amounts of mercury in some influenza vaccines."
"Only about 40 percent of health care workers get their annual influenza vaccine," Temte said. "They are notorious for coming to work while ill. A health care worker has the opportunity to spread influenza to at-risk individuals because of the nature of the health care setting. Therefore, health care workers have the obligation to keep their patients safe through their own behaviors."
Another concern is that patients may refuse influenza vaccination because of fears that the vaccine itself will make them ill or cause adverse effects.
"There are always a few people who will refuse influenza vaccine," Temte said. "There is a belief among some potential recipients that influenza vaccine can cause influenza, (which is) not true. Moreover, there has been some inappropriate fear created regarding trace amounts of mercury in some influenza vaccines."
Autism Fears Unfounded, Says CDC
Thimerosal, a mercury-containing preservative, has been used in certain vaccines and other products since the 1930s. In recent years, some individuals and consumer groups have claimed that thimerosal can cause neuropsychological dysfunction, including autism spectrum disorders, but the preponderance of evidence from numerous studies does not support such an association.
Check Out Free Flu Resources for You, Your Patients
If you're seeking ways to get the influenza immunization message out to your patients and community, take a look at the many free resources available from the CDC's online Flu Gallery. There, you can find a host of print materials for your office or clinic; a video on seasonal flu; resources developed for National Influenza Vaccination Week, Dec. 8-14, including a media toolkit; public service announcements in combined audio-video and audio-only formats; and even electronic greeting cards to send to patients, their families, and your co-workers. Many items are available in both English and Spanish, and all are ready for downloading.
Still, the AAFP, the American Academy of Pediatrics and the Public Health Service agreed in 1999 that the thimerosal used in vaccines should be reduced or eliminated as a precaution. Although most vaccines now are thimerosal-free, some TIV products still contain trace amounts of the preservative.
However, the current recommendations state, "The benefits of influenza vaccination for all recommended groups, including pregnant women and young children, outweigh concerns on the basis of a theoretical risk from thimerosal exposure through vaccination. … No scientifically conclusive evidence has demonstrated harm from exposure to vaccine containing thimerosal preservative."
However, the current recommendations state, "The benefits of influenza vaccination for all recommended groups, including pregnant women and young children, outweigh concerns on the basis of a theoretical risk from thimerosal exposure through vaccination. … No scientifically conclusive evidence has demonstrated harm from exposure to vaccine containing thimerosal preservative."
