Issue
Number 501
January 3, 2005
CONTENTS OF THIS ISSUE
- MMWR publishes ACIP's updated interim influenza
vaccination recommendations for the 2004-05 influenza season
- Update: CDC continues to supplement its website with
information related to the influenza vaccine shortage
- New: IAC screening questionnaires help providers
determine if patients have contraindications to influenza vaccine
- Teleconference on starting local immunization coalitions
is scheduled for January 11
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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American
Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices;
CDC, Centers for Disease Control and Prevention; FDA, Food and Drug
Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and
Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine
Information Statement; VPD, vaccine-preventable disease; WHO, World Health
Organization.
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January 3, 2005
MMWR PUBLISHES ACIP'S UPDATED INTERIM INFLUENZA VACCINATION RECOMMENDATIONS
FOR THE 2004-05 INFLUENZA SEASON
On December 17, ACIP formally approved updated interim influenza vaccination
recommendations. The updated interim recommendations modify the interim
recommendations ACIP approved on October 5 in response to Chiron
Corporation's announcement that none of its influenza vaccine would be
distributed in the United States. On December 24, CDC published "Updated
Interim Influenza Vaccine Recommendations--2004-05 Influenza Season" in MMWR.
It is reprinted below in its entirety, excluding one footnote.
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On October 5, 2004, CDC was notified by Chiron Corporation that none of its
inactivated influenza vaccine (Fluvirin) would be available for distribution
in the United States for the 2004-05 influenza season. At that time, CDC, in
coordination with the Advisory Committee on Immunization Practices (ACIP),
issued interim recommendations to direct available inactivated influenza
vaccine to persons in certain priority groups. CDC has been working with
Aventis Pasteur, Inc., to distribute the remaining supply of its inactivated
influenza vaccine Fluzone so that it reaches persons in the priority groups
established on October 5. In addition, on December 7, the U.S. Department of
Health and Human Services announced that up to 4 million doses of the
GlaxoSmithKline influenza vaccine Fluarix, authorized for use by the Food
and Drug Administration under an Investigational New Drug (IND) application,
would be available to help alleviate the influenza vaccine shortage this
season.
The primary goal of the annual influenza vaccination recommendations by CDC
and ACIP is to reduce the risk for complications from influenza among
persons who are most vulnerable. This year, the reduced national supply of
inactivated influenza vaccine led CDC and ACIP to issue interim influenza
vaccination recommendations that were more restrictive than usual. Since the
interim recommendations were issued on October 5, the influenza vaccine
supply and demand situation has continued to evolve in the United States
such that some, but not all, local areas appear to have adequate supplies to
meet the demand for vaccine from persons in the interim priority groups.
This has resulted in unused vaccine in some areas of the country.
Influenza disease activity in the United States has remained relatively low
but is expected to increase during the weeks ahead. In addition, influenza
vaccination coverage among this season's interim priority groups is lower
than it has been in recent influenza seasons. Given these considerations,
CDC recommends that aggressive efforts should continue to reach unvaccinated
persons in high-risk priority groups and use available vaccine to vaccinate
such persons. Adequate time remains for persons in these priority groups to
receive the benefits of vaccination before influenza begins to widely
circulate in most communities. CDC will continue to allocate available
vaccine to states that have insufficient supplies of vaccine to reach these
priority groups.
In addition to these ongoing activities, in coordination with ACIP, CDC is
issuing updated interim recommendations for influenza vaccination during the
2004-05 season. If the locally available supply is sufficient to meet the
local demand for vaccine from persons listed below under the heading,
Priority Groups for Inactivated Influenza Vaccination, vaccination may
expand to also include persons listed below under the heading, Additional
Priority Groups for Inactivated Influenza Vaccination in Areas of Sufficient
Supply. Decisions to expand priority groups are left to the discretion of
state and local health departments. Vaccine providers and health departments
with vaccine should aggressively reach out to vaccinate persons in the
priority groups established on October 5. These persons include those at
highest risk for complications from influenza and healthcare professionals
caring for persons at high risk, and should remain a focus even where
vaccine supplies are sufficient to support expansion to other groups.
These recommendations were formally approved by ACIP on December 17, 2004,
to take effect on January 3, 2005. Implementation is being delayed to allow
extra time for vaccine to reach the initial priority groups and to allow
time for state and local health departments to prepare for increased
requests for vaccination.
Priority Groups for Inactivated Influenza Vaccination
Inactivated influenza vaccine is recommended for persons in the following
priority groups:
- all children aged 6-23 months;
- adults aged >=65 years;
- persons aged 2-64 years with underlying
chronic medical conditions;
- all women who will be pregnant during the
influenza season;
- residents of nursing homes and
long-term-care facilities;
- children aged 2-18 years on chronic
aspirin therapy;
- healthcare workers involved in direct
patient care; and
- out-of-home caregivers and household
contacts of children aged <6 months.
Additional Priority Groups for Inactivated
Influenza Vaccination in Areas of Sufficient Supply
Where supply is sufficient, inactivated influenza vaccine also is
recommended for persons in the following additional priority groups:
- out-of-home caregivers and household
contacts of persons in high-risk groups (e.g., persons aged >=65 years;
persons with chronic conditions such as diabetes, heart or lung disease,
or weakened immune systems because of illness or medication; and
- children aged <2 years); and
- all adults aged 50-64 years.
Use of Live, Attenuated Influenza Vaccination
Intranasally administered, live, attenuated influenza vaccine, if available,
should be encouraged for all healthy persons who are aged 5-49 years and are
not pregnant, especially healthcare workers and out-of-home caregivers and
household contacts of persons in high-risk groups (e.g., persons aged >=65
years; persons with chronic conditions such as diabetes, heart or lung
disease, or weakened immune systems because of illness or medication; and
children aged <2 years).
However, healthcare workers who care for severely immunocompromised patients
in special care units should receive the inactivated vaccine.
Other Vaccination Recommendations
Persons in the priority groups identified above should be encouraged to
search locally for vaccine if their regular healthcare provider does not
have vaccine available.
Children aged <9 years require 2 doses of vaccine if they have not
previously been vaccinated. All children who are at high risk for
complications from influenza, including those aged 6-23 months, should be
vaccinated with a first or second dose, depending on vaccination status.
However, doses should not be held in reserve to ensure that 2 doses will be
available. Instead, available vaccine should be used to vaccinate persons in
priority groups on a first-come, first-serve basis.
Vaccination of Persons in Nonpriority Groups
Persons who are not included in one of the priority groups or additional
priority groups described above should be informed about the vaccine supply
situation and asked to forego or defer vaccination with inactivated
influenza vaccine. Live, attenuated influenza vaccine, if available, should
be encouraged for all healthy persons aged 5-49 years.
Persons Who Should Not Receive Influenza Vaccine
Persons in the following groups should not receive influenza vaccine without
the recommendation of their physicians:
- persons with a severe allergy (i.e.,
anaphylactic allergic reaction) to hens' eggs; and
- persons who previously had onset of
Guillain-Barré syndrome during the 6 weeks after receiving influenza
vaccine.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a7.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5350.pdf
To receive a FREE electronic subscription to MMWR (which includes new ACIP
statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
Two additional documents related to the December 17 updated interim
influenza vaccination recommendations are also available. They are a press
release titled "CDC's Advisory Committee on Immunization Practices Expands
Priority Groups for Inactivated Influenza Vaccination," dated December 17,
and an Official CDC Health Update titled "Updated Interim Influenza
Vaccination Recommendations 2004-05," dated December 22.
To access the press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r041217.htm
To access the health update, click
here.
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January 3, 2005
UPDATE: CDC CONTINUES TO SUPPLEMENT ITS WEBSITE WITH INFORMATION
RELATED TO THE INFLUENZA VACCINE SHORTAGE
CDC recently updated its Influenza web section, adding to its web page
of questions and answers about influenza vaccine administration and
posting Spanish-language versions of three patient-education flyers
that are part of the "CDC Flu Prevention Toolkit: Real people. Real
solutions." Following are descriptions of and links to these
documents.
On December 20, four Q&A segments were added to the web page
"Questions & Answers: Vaccine Administration." To access the updated
web page, go to:
http://www.cdc.gov/flu/about/qa/vaxadmin.htm
On December 16, three Spanish-language flyers were added to the "CDC
Flu Prevention Toolkit: Real people. Real solutions." They are "Estoy
lista para todo--hasta para la gripe" ("I'm ready for anything--even
flu season"); "Tuve que quedarme en casa por la gripe" ("I had to take
a flu break"); and "Yo tengo habitos saludables" ("I practice healthy
habits"). Materials in the kit provide tips on ways to prevent
influenza other than vaccination.
To access "Estoy lista para todo--hasta para la gripe," go to:
http://www.cdc.gov/flu/toolkit/stories/readyforanything-files.htm
Click on the size and layout option(s) you prefer. The
English-language version is also available at this link.
To access "Tuve que quedarme en casa por la gripe," go to:
http://www.cdc.gov/flu/toolkit/stories/flubreak-files.htm
Click on the size and layout option(s) you prefer. The
English-language version is also available at this link.
To access "Yo tengo habitos saludables," go to:
http://www.cdc.gov/flu/toolkit/stories/healthyhabits-files.htm
Click on the size and layout option(s) you prefer. The
English-language version is also available at this link.
For ongoing information about new and updated additions to CDC's
Influenza web section, go to:
http://www.cdc.gov/flu/whatsnew.htm
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January 3, 2005
NEW: IAC SCREENING QUESTIONNAIRES HELP PROVIDERS DETERMINE IF PATIENTS
HAVE CONTRAINDICATIONS TO INFLUENZA VACCINE
IAC recently created two screening questionnaires for patients and the
parents of children to fill out while waiting to be seen for influenza
vaccination. The questionnaires are "Screening Questionnaire for
Injectable Influenza Vaccination" and "Screening Questionnaire for
Intranasal Influenza Vaccination."
Patients or parents' answers to the questionnaires can alert health
professionals to the contraindications or precautions a potential
vaccinee has to either form of influenza vaccine. Please note that
these questionnaires are NOT intended to help health professionals
determine whom to vaccinate in a situation where the supply of
influenza vaccine is limited. CDC has created questionnaires that can
help health professionals prioritize vaccine use during the current
vaccine shortage. Links to CDC's questionnaires will be given at the
end of this article.
To access a ready-to-print (PDF) version of IAC's "Screening
Questionnaire for Injectable Influenza Vaccination," go to:
http://www.immunize.org/catg.d/p4066.pdf
To access a web-text (HTML) version of it, go to:
http://www.immunize.org/catg.d/p4066.htm
To access a ready-to-print (PDF) version of IAC's "Screening
Questionnaire for Intranasal Influenza Vaccination," go to:
http://www.immunize.org/catg.d/p4067.pdf
To access a web-text (HTML) version of it, go to:
http://www.immunize.org/catg.d/p4067.htm
To access a ready-to-print (PDF) version of CDC's questionnaire "Who
should and who should not get a flu shot?" go to:
http://www.cdc.gov/flu/professionals/flugallery/pdf/vaccinescreeningform.pdf
To access a ready-to-print (PDF) version of CDC's questionnaire
"Patient Screening Form for Health Care Providers Offering FluMist
Live Attenuated Intranasal Influenza Vaccine during the 2004-05 Flu
Season," go to:
http://www.cdc.gov/flu/professionals/flugallery/pdf/flumistscreeningform.pdf
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January 3, 2005
TELECONFERENCE ON STARTING LOCAL IMMUNIZATION COALITIONS IS SCHEDULED
FOR JANUARY 11
The National Immunization Coalition TA [technical assistance] Network
has scheduled a teleconference on starting local immunization
coalitions for 1PM ET on January 11. The network is a program of the
Center for Health Communication, Academy for Educational Development (AED).
The teleconference facilitator is Joan Clayton-Davis, a senior
technical advisor at AED and manager of its Nashville office.
Learning objectives of the teleconference include the following:
- Learn key steps in establishing a
local immunization coalition
- Identify factors that support
maintaining and sustaining a local coalition
To register for the teleconference, email
Katherine Shrout at kshrout@aed.org
In your email, include this message: "Sign me up for the Starting a
Coalition call." |
