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US Centers for Disease Control and Prevention: 2008-2009 Influenza Vaccination Update

This year’s update includes recommendations for routine vaccination of children age 5-18, beginning either this flu season or next. A continued focus of vaccination effort remains children aged 6 months through adolescence who are at increased risk for complications of the flu. Either trivalent inactivated influenza vaccine (TIV) or live attenuated influenza vaccine (LAIV) can be used for healthy people ages 2 to 49 years old. Adults over age 49, people at higher risk for influenza complications because of underlying medical conditions, children with possible reactive airways disease (recurrent or recent wheezing), and children ages 6 to 23 months should receive TIV. Special recommendations for 2 doses of vaccine are recommended for children in certain age groups depending on previous flu vaccine history. LAIV should not be administered to children under age 5 who have possible reactive airways disease. The CDC notes that oseltamivir-resistant influenza A (H1N1) strains have been identified in the United States and some other countries.

The CDC’s Advisory Committee on Immunization Practices summarizes 5 major updates in their guidelines for influenza control and prevention for the 2008-2009 season.

National Guideline Clearinghouse

Brief Summary

Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008.
[Link to free full-text guideline online]

BIBLIOGRAPHIC SOURCE

Fiore AE, Shay DK, Broder K, Iskander JK, Uyeki TM, Mootrey G, Bresee JS, Cox NS, Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP). Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recomm Rep 2008 Aug 8;57(RR-7):1-60. [PubMed abstract] [MMWR free full-text article online]

FDA WARNING/REGULATORY ALERT

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

• April 2, 2008, Relenza (zanamivir): GlaxoSmithKline informed healthcare professionals of changes to the warnings and precautions sections of prescribing information for Relenza. There have been reports (mostly from Japan) of delirium and abnormal behavior leading to injury in patients with influenza who are receiving neuraminidase inhibitors, including Relenza.
• March 4, 2008, Tamiflu (oseltamivir phosphate): Roche and the U.S. Food and Drug Administration (FDA) informed healthcare professionals of neuropsychiatric events associated with the use of Tamiflu, in patients with influenza. Roche has updated the PRECAUTIONS section of the package insert to include the new information and guidance under the Neuropsychiatric Events heading.
  

EXCERPT

MAJOR RECOMMENDATIONS

Primary Changes and Updates in the Recommendations

The 2008 recommendations include five principal changes or updates:

• Beginning with the 2008—09 influenza season, annual vaccination of all children aged 5 to 18 years is recommended. Annual vaccination of all children aged 5 to 18 years should begin in September or as soon as vaccine is available for the 2008—09 influenza season, if feasible, but annual vaccination of all children aged 5 to 18 years should begin no later than during the 2009—10 influenza season.
• Annual vaccination of all children aged 6 months to 4 years (59 months) and older children with conditions that place them at increased risk for complications from influenza should continue. Children and adolescents at high risk for influenza complications should continue to be a focus of vaccination efforts as providers and programs transition to routinely vaccinating all children.
• Either trivalent inactivated influenza vaccine (TIV) or live, attenuated influenza vaccine (LAIV) can be used when vaccinating healthy persons aged 2 to 49 years. Children aged 6 months to 8 years should receive 2 doses of vaccine if they have not been vaccinated previously at any time with either LAIV or TIV (doses separated by >4 weeks); 2 doses are required for protection in these children. Children aged 6 months to 8 years who received only 1 dose in their first year of vaccination should receive 2 doses the following year. LAIV should not be administered to children aged <5 years with possible reactive airways disease, such as those who have had recurrent wheezing or a recent wheezing episode. Children with possible reactive airways disease, persons at higher risk for influenza complications because of underlying medical conditions, children aged 6 to 23 months, and persons aged >49 years should receive TIV.
• The 2008—09 trivalent vaccine virus strains are A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Florida/4/2006-like antigens
• Oseltamivir-resistant influenza A (H1N1) strains have been identified in the United States and some other countries. However, oseltamivir or zanamivir continue to be the recommended antivirals for treatment of influenza because other influenza virus strains remain sensitive to oseltamivir, and resistance levels to other antiviral medications remain high.

© 1998-2008 National Guideline Clearinghouse
Date Modified: 11/24/2008

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RELATED RESOURCES FROM EPOCRATES
EOL Diseases: Influenza monograph