2016-2017 Interim Recommendation

The AAFP supports the interim recommendation that the live attenuated influenza vaccine (LAIV) should not be used during the 2016-2017 influenza season for any age group.

Background

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted last week that live attenuated influenza vaccine (LAIV) should not be used during the 2016-2017 flu season for any age group. The ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone six months and older.

The ACIP had concerns about the lack of effectiveness of the vaccine. Of particular concern was the lack of LAIV effectiveness in providing protection against H1N1. Given that the target population coincides with the population most susceptible to severe morbidity and mortality if infected with H1N1, this is especially concerning.

Preliminary Data

The ACIP reported in May of 2016 that preliminary data on the effectiveness of LAIV among children two through 17 years during the 2015-2016 season had become available from the U.S. Influenza Vaccine Effectiveness Network. That data showed the estimate for LAIV vaccine effectiveness (VE) among study participants in that age group against any flu virus was 3 percent (with a 95 percent1 confidence interval (CI)(www.cdc.gov) of -49 percent to 37 percent). The 3 percent estimate means no protective benefit could be measured. In comparison, IIV (flu shots) had a VE estimate of 63 percent (with a 95 percent CI of 52 percent to 72 percent) against any flu virus among children two through 17 years. Additional non-CDC studies support the conclusion that LAIV worked less effectively than IIV this season. The data from 2015-2016 follows two previous seasons2 (2013-2014 and 2014-2015(www.cdc.gov)) showing poor and/or lower than expected vaccine effectiveness for LAIV.

Vaccine Supply

CHPS will follow this issue closely and will work to advise members about influenza vaccine supply issues as the ACIP recommendation is finalized and implemented.

References

1. Center for Disease Control and Prevention. Vaccine effectiveness - How well does the flu vaccine work?(www.cdc.gov) Accessed June 29, 2016.

2. Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) reaffirms recommendation for annual influenza vaccination.(www.cdc.gov) Accessed June 29, 2016.