ACIP Makes Universal Flu Vaccination Recommendation

Prevnar 13 Approved for Pneumococcal Immunizations

March 03, 2010 12:05 am David Mitchell

The influenza vaccination recommendations for the 2010-2011 flu season should be a lot less complicated than those for the current season, thanks to a new recommendation from the CDC's Advisory Committee on Immunization Practices, or ACIP. During the committee's Feb. 24-25 meeting in Atlanta, ACIP members voted without objection to expand the recommendation for annual influenza vaccination( to include all people ages 6 months and older in whom the vaccine is not contraindicated.

ACIP members also voted to recommend that children ages 6 weeks to 5 years receive the recently approved 13-valent pneumococcal conjugate vaccine, Prevnar 13, in place of the currently used seven-valent Prevnar product.

The ACIP recommendations are considered provisional until they have been approved by the CDC director and HHS and published in Morbidity and Mortality Weekly Report.

Support for Universal Flu Immunization

According to the AAFP's 2009 immunization survey, more than 70 percent of Academy members are in favor of a universal flu vaccine recommendation.

"It's going to be a relatively minor addition," said Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to the ACIP. "Only 15 percent of the population didn't already have an indication for vaccination."

According to Campos-Outcalt, the problem with previous recommendations has been that many people in high-risk groups did not know they were considered "high risk" or that they were recommended to receive the vaccine.

"It might be easier to get people vaccinated now that it's a universal recommendation," said Campos-Outcalt, who is associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix. "We might get higher uptake."

Complexity of Previous Recommendations

Previously, seasonal flu vaccination was recommended for all children ages 6 months to 18 years and for all adults ages 50 and older. Those recommendations were simple enough to follow, but for people ages 19-49, things became more complex.

People ages 19-49 were recommended for vaccination if they were health care workers; residents of nursing homes or other long-term care facilities; or household contacts of high-risk individuals, including caregivers for children younger than age five years.

People in that age range also were indicated for vaccination if they had any of the following high-risk conditions:

  • chronic disorders of the cardiovascular or pulmonary systems, including asthma;
  • chronic metabolic diseases, including diabetes mellitus;
  • renal or hepatic dysfunction;
  • hemoglobinopathies;
  • immunocompromising conditions;
  • cognitive, neurologic or neuromuscular disorders;
  • pregnancy during fluenza season; and
  • asplenia.

2010-11 Flu Vaccine Supply

Campos-Outcalt said that despite the expanded recommendations, no supply problems are anticipated because new flu vaccine products are coming on the market. In fact, said the CDC, "based on current projections, more licensed types and brands of seasonal influenza vaccines will be available in the 2010-11 influenza season than have ever been available before."

Moreover, said the agency, less than half of the people recommended to receive flu vaccinations each year usually do so.

The 2010-2011 trivalent flu vaccine will include the 2009 influenza A (H1N1) virus. During the 2009-2010 flu season, separate vaccinations were required for seasonal flu and H1N1. Campos-Outcalt said H1N1 would have been included in the seasonal flu vaccine last year if it had surfaced before the decision on what to include in the seasonal vaccine had been made.

Pneumococcal Vaccine Details

Meanwhile, Prevnar 13 was recommended by the ACIP the same day it was approved by the FDA. The vaccine, which is manufactured by Collegeville, Pa.-based Wyeth Pharmaceuticals, replaces Prevnar, the seven-valent conjugate vaccine that was licensed in 2000 to prevent invasive pneumococcal disease and otitis media.

The seven Streptococcus pneumoniae serotypes that Prevnar was intended to prevent accounted for about 80 percent of invasive pneumococcal disease in North American children when the vaccine was licensed 10 years ago, according to the FDA. The agency said that within seven years of the vaccine's introduction, the rate of disease caused by those seven serotypes in children younger than 5 was reduced by 99 percent.

Of the remaining invasive pneumococcal disease burden in that age group, 62 percent of cases are caused by the six additional serotypes included in Prevnar 13, said FDA officials.

The new vaccine is administered in a four-dose series at ages 2, 4, 6 and 12-15 months.

According to Wyeth, children who started their vaccination series with Prevnar should complete the series with Prevnar 13. In addition, a booster dose of Prevnar 13 is recommended for children as old as 59 months who have completed the four-dose Prevnar series.

Pfizer, Wyeth's parent company, said it expects the new vaccine to be available in the United States during the first quarter of 2010.