Immunization News Archive

CDC Publishes ACIP'S Influenza Vaccination Recommendations For 2007

GSK to offer influenza vaccine Fluarix starting January 8, 2007.

National Adult Immunization Awareness Week is Scheduled for September 23-29

National Adult Immunization Awareness Week (NAIAW) is September 23rd through September 29th. This year marks the 20th consecutive observance of NAIAW and is a great opportunity for individuals and organizations to promote the importance of adult and adolescent immunization. More information [including a comprehensive 84-page 2007 Campaign Kit from the National Foundation for Infectious Diseases and Tools and Presentations for NAIAW 2007 from the California Adult Immunization Coalition] can be found online.

Annual Influenza Vaccination Critical to Protecting Adults and Children with Diabetes

Many health care professionals care for persons with diabetes, and all can play a role in protecting them from influenza each year. The American College of Physicians urges members to access new practice resources from the National Foundation for Infectious Diseases (NFID) designed to help practices educate and immunize their patients with diabetes.

Access numerous tools and strategies that can be customized for use in various clinical settings to help address immunization barriers and improve patient education.

ACP participated in the development of and supports the goals of NFID’s initiative and encourages members to begin using these materials in time for the upcoming influenza season.

ACP has spearheaded a number of quality improvement programs around diabetes and immunization. Our Inform, Implement, Immunize: ACP’s Immunization Outreach Program (I3) is an innovative quality improvement program that uses a practice-based, team-oriented model to train teams of physicians, nurses or other allied health professionals, and office administrators. I3 helps physicians and their staff to develop and improve strategies for immunizing their patients against influenza, and also HPV, herpes zoster, pneumococcal disease, pertussis, tetanus, and Hepatitis B.

Closing the Gap (CTG), a team-oriented, practice based, on-line educational intervention, helps physicians and their staff to develop and improve strategies for creating systems change in their practices, to improve the care they provide to patients with conditions ranging from diabetes to cardiovascular risk. From 2003 until now ACP has run 4 CTG programs, 3 on diabetes and 1 on cardiovascular risk and primary prevention. Seventy-three practices from through out the nation and over 220 participants have participated in these programs and we have collected data on more than 5,000 patients. We have accumulated a rich body of data on the program that has informed us on what practice designs have had the most impact on immunizing patients with diabetes and cardiovascular risk.

NFID’s Improving Influenza Vaccination Rates in Adults and Children with Diabetes initiative is made possible by an unrestricted educational grant to NFID from sanofi pasteur.


Official CDC Health Advisory: Hepatitis A in a Food Handler Who Served Persons From Multiple States

To access the health advisory, go here.

More information about hepatitis A is available online or by calling the CDC information line at (800) CDC-INFO ([800] 232-4636).

New Vaccines on the Horizon

Three major adult vaccines will likely be introduced within the next year. All have the potential to significantly impact the internist’s medical practice:

Pertussis

  • Incidence/Prevalence: According to the CDC, in 2004, U.S. adults 19–64 years of age accounted for 27% of reported 25,827 pertussis cases; however the true number of pertussis cases is likely 600,000 annually by CDC estimates. The average annual incidence is approximately 3.3 cases per 100,000 population
  • Clinical Presentation: Symptoms range from mild coughing to classic pertussis; complications include rib fractures and pneumonia. Adults with pertussis often transmit the infection to others, including infants.
  • Vaccine Update: In 2005, the FDA approved a single dose booster vaccine for persons 11-64 years of age to provide protection against tetanus, diphtheria, and pertussis (Tdap). On October 26, 2005, the Advisory Committee on Immunization Practices (ACIP) published provisional recommendations for adults age 11 to 64. A formal recommendation by the ACIP is expected in June 2006.

Herpes Zoster

  • Incidence/Prevalence: According to the NIH, more than 500,000 people develop shingles each year, many of them age 50 and over. At any given time, approximately 500,000 people have shingles.
  • Clinical Presentation: Caused by the varicella-zoster virus, shingles results in an outbreak of rash or blisters on the skin, often accompanied by burning or tingling pain, or sometimes numbness. Postherpetic neuralgia can be a painful after-effect, especially in older populations.
  • Vaccine Update: Merck, Inc., has developed a vaccine (zoster vaccine live or ZOSTAVAX). A study published in the New England Journal of Medicine (June 2, 2005) found that the vaccine reduced the incidence, severity, and duration of shingles by more than 50%. The FDA is currently reviewing Merck’s application for licensure. This vaccine would have a significant impact on the health of the aging U.S. population, and the practice of the internal medicine physician.

Human Papillomavirus (HPV)

  • Incidence/Prevalence: Approximately 20 million people are currently infected with HPV. About 6.2 million Americans get a new genital HPV infection each year.
  • Clinical Presentation: Human papillomavirus is the most common sexually transmitted infection in the U.S., causing Pap test abnormalities and genital warts. Persistent infection with certain HPV types leads to cervical cancer. Each year about 15,000 women in the U.S. are diagnosed with cervical cancer; an estimated 4,100 women die of the disease each year.
  • Vaccine Update: GlaxoSmithKline and Merck have developed vaccines that target two types of HPV HPV-16 and HPV-18 that cause about 70% of cervical cancers (Cervarix, GSK; Gardasil, Merck). Merck is awaiting response from the FDA by June 2006. GlaxoSmithKline plans to apply to the FDA by the end of 2006. It expected that the initial approval would be indicated for adult women up to age 26.


Late-season Influenza Vaccination January 2006

Additional quantities of influenza vaccine remain available for sale. Two sources of vaccine known to the National Influenza Vaccine Summit include sanofi pasteur (1 800 VACCINE or www.vaccineshoppe.com) and FFF Enterprises (1 800 843-7477).

The medical literature confirms that most patients will accept vaccine when recommended by their physicians. This is valuable service you can provide to your patients and for public health.

Although influenza activity is widespread in parts of the country, you can still protect your unvaccinated patients from influenza.

The Advisory Committee on Immunization Practices (ACIP) advocates continuing influenza immunization through January and beyond.

Flu is wide spread in the Southwest United States, but influenza is unpredictable and it is not possible to say when flu will peak in any given area.

Although influenza season runs from Fall until Spring, influenza typically peaks in January or later. Since 1976, annual influenza activity in the United States has peaked 24 times during January or later and 18 times in February or later.

Even when influenza is occurring in a community, patients who have not been infected, particularly those at high risk of complications from the disease, can still benefit from vaccination. For example, another type of influenza virus could emerge later in the season causing a second peak of influenza disease.

This year’s vaccine virus components appear to be a good match to the wild viruses that have been isolated and typed so far in the U.S.

Influenza is a serious vaccine-preventable disease, with an average annual burden of 36,000 deaths and over 200,000 hospitalizations annually. Influenza and pneumonia together constitute the 7th leading cause of death in the United States.

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Flu Vaccine Locator Services

The American Lung Association (ALA) Flu Locator web site is available at flucliniclocator.org. To find a Flu Clinic in your area, enter your zip code into the Flu Clinic Locator to the right. You will get the date, times, address, and phone number of the Clinics offering flu shots near you, as well as a map showing where the Clinic is located.

2-1-1, A New Flu Vaccination Finder Call Service. Another important new resource to help citizens find a flu shot this fall. Those who do not Internet access can call 2-1-1 and the operator can then use the Flu Locator site to help the person find a nearby influenza clinic. 2-1-1 is an easy to remember telephone number that connects callers to information about critical health and human services available in their community. Connecticut, Hawaii, Idaho, Iowa, Minnesota, North Dakota, New Jersey, Texas, Utah, Vermont and West Virginia have statewide 211-phone service. 2-1-1 serves over 46% of the US population with 169 active 2-1-1 systems covering all or part of 32 states (including 13 states with 100% coverage) plus Washington, DC and Puerto Rico and growing.

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Current ACIP Recommendations for Influenza Vaccination

View the most current ACIP recommendations for influenza vaccination at the CDC website.

The primary changes and updates for 2005 include the following:

  • ACIP recommends that persons with any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration be vaccinated against influenza (see Target Groups for Vaccination).

  • ACIP emphasizes that all health-care workers should be vaccinated against influenza annually, and that facilities that employ health-care workers be strongly encouraged to provide vaccine to workers by using approaches that maximize immunization rates.

  • Use of both available vaccines (inactivated and LAIV) is encouraged for eligible persons every influenza season, especially persons in recommended target groups. During periods when inactivated vaccine is in short supply, use of LAIV is especially encouraged when feasible for eligible persons (including health-care workers) because use of LAIV by these persons might considerably increase availability of inactivated vaccine for persons in groups at high risk.

  • The 2005--06 trivalent vaccine virus strains are A/California/7/2004 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Shanghai/361/2002-like antigens. For the A/California/7/2004 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/New York/55/2004 virus, and for the B/Shanghai/361/2002-like antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003 virus or B/Jiangsu/10/2003 virus (see Influenza Vaccine Composition).

  • CDC and other agencies will assess the vaccine supply throughout the manufacturing period and will make recommendations preceding the 2005--06 influenza season regarding the need for tiered timing of vaccination of different risk groups. In addition, CDC will publish ACIP recommendations regarding inactivated vaccine subprioritization (tiering) on a later date in MMWR.

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Projection for the 2005-06 Influenza Vaccine Supply

Sanofi pasteur representatives have announced publicly that they plan to produce between 50 and 60 million doses and MedImmune representatives indicate that about 3 million doses of their Live Attenuated Influenza Vaccine (LAIV) will be available. Meanwhile, Chiron’s Liverpool facility is making changes in response to observations and inspections by both the British regulatory authority (MHRA) and the U.S. Food and Drug Administration (FDA). If Chiron is able to complete its remediation plan and secure FDA approval, company officials indicate they plan to produce 18-26 million doses for use in the U.S. On August 31, 2005, FDA informed Chiron that their “responses and proposed corrective actions“ following the FDA inspection in July were “generally acceptable.” A company press release notes that they must still obtain supplemental FDA approvals. In late May, 2005, GlaxoSmithKline (GSK) submitted a Biologics License Application to the FDA for its influenza vaccine, and the FDA licensed that vaccine on August 31. Company officials have indicated that they plan to sell about 8 million doses in the U.S.

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Ordering Influenza Vaccine

  • MedImmune still has quantities of its live attenuated vaccine (FluMist™) available for pre-booking.

  • Sanofi pasteur continues to pre-book orders for its pediatric influenza vaccine in the pre-filled syringe presentation.

  • Distributors for the influenza vaccines produced by Chiron and GlaxoSmithKline have been taking orders for those products. Prospective customers should check with these distributors regarding availability.

  • Providers may need to explore several potential sources to find influenza vaccine.

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CDC Influenza Vaccine Communications Update

For the 2005-06 influenza season, CDC will have information and updates for the public, providers, and the press available on its website, as well as its annual educational print materials for the public and providers. Electronic files of campaign materials are now available for download from the CDC Flu Gallery website. CDC will continue to make appropriate materials available over time.

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CDC Announces Vaccine Prebooking and Distribution Strategies for 2005-2006 Influenza Season

The Centers for Disease Control and Prevention has announced new prebooking and distribution strategies for the 2005-2006 influenza season.

CDC is encouraging implementation of a two-tiered prebooking strategy which will require providers to submit two requests for supplies, using 1) the number of doses needed based on anticipated demand among persons in the priority groups, in the event vaccine supply is limited, and 2) the number of doses needed based on priority group use, plus other groups, if supplies prove sufficient to meet demand from other persons seeking vaccination.

The following priority groups should be used as a guide for prebooking orders for inactivated influenza vaccine:

  • Persons aged >65 years.
  • Persons aged 2-64 years with underlying chronic medical conditions.
  • All women who will be pregnant during the influenza season.
  • All children aged 6-23 months.
  • Health-care workers involved in direct patient care.
  • Out-of-home caregivers and household contacts of children aged <6 months.
  • Residents of nursing homes and long-term-care facilities.
  • Children aged 6 months-18 years on chronic aspirin therapy.

These strategies for prebooking and distribution do not apply to live, attenuated influenza vaccine (LAIV), manufactured by MedImmune, which can be ordered in the usual manner for those persons for whom LAIV is indicated. LAIV can be administered to healthy persons aged 5-49 years who are not pregnant, including health-care workers who are not caring for severely immunocompromised patients in special care units.

For more information, see the following announcement in the latest issue of MMWR.

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Medicare Demonstration Project Pays for Flu Medicines

Seniors who get the flu can get assistance to help pay for antiviral medicines under a demonstration project announced today by the Centers for Medicare & Medicaid Services (CMS).

"There are prescription drugs that have been proven to prevent the flu and its serious complications, and Medicare is taking steps to make these drugs more affordable," said CMS Administrator Mark McClellan, M.D., Ph.D. "This demonstration program will provide useful evidence on how prescription drug coverage affects the health and costs for Medicare beneficiaries ahead of the drug benefit in 2006."

The demonstration is intended to last through May 31, 2005. Each beneficiary can get up to a total of two prescriptions filled during the demonstration period. The project is designed to help determine if coverage for these medicines can significantly reduce the impact of flu on Medicare beneficiaries, especially those currently without drug coverage.

Dr. McClellan emphasized that the flu vaccine remains the best protection for Medicare beneficiaries and he urged seniors who have yet to be vaccinated to do so. Adults who are age 65 and older and other Americans with chronic illnesses are in the high priority group to obtain flu vaccines, and there is an adequate vaccine supply for these groups.

In the United States, four antiviral medications (amantadine, rimantadine, oseltamivir, and zanamivir) are approved for treatment of flu. Detailed information about each medication, including dosage and approved persons for use, is available online.

Dr. McClellan added that antiviral medicine could be used in cases of outbreaks in communities, for residents of institutions or anyplace where people at high risk for complications from flu are in close contact with each other, to protect individuals who may be exposed to flu.

"Because there are reports of increasing flu activities in some areas of the country, it's important to stay vigilant," Dr. McClellan said. "People with Medicare who develop symptoms of flu or find that they may have been exposed to flu should contact their doctor as soon as possible."

The demonstration is designed for beneficiaries with Medicare Part B who do not have drug coverage. Beneficiaries can take their prescription for anti-viral flu treatment directly to a Medicare participating pharmacy. If the beneficiary has met their Part B deductible, Medicare will pay 80 percent of the cost of the drug up to the Medicare allowed payment, which is 95 percent of the average wholesale price for brand drugs and 90 percent of the average wholesale price for generic drugs.

Those Medicare beneficiaries who participate in the Medicare-Approved Drug Discount Card Program will pay 20 percent of your card sponsor's negotiated cost for the drug or 20 percent of the Medicare allowed payment, whichever is lower. Thus Medicare beneficiaries with drug discount cards are assured of paying the lowest copayment level. Those who participate in the program's Transitional Assistance can also use their $600 drug credit for antiviral medicines.

Medicare Advantage plan members may also participate. The prescription can simply be taken to a pharmacy to be filled just as if it would be under traditional Medicare. For beneficiaries who are treated as part of a covered Part A hospital stay, the antiviral medicines will also be covered.

Approximately 36,000 deaths are attributed to flu and pneumonia in the United States each year, and more than 90 percent of these deaths occur in people age 65 and older. Many of the deaths occur in patients who experience complications after the flu, such as pneumonia. These complications can be alleviated with flu medicines taken early in the course of disease. Some flu medicines have also been shown to reduce the likelihood of contracting the flu from someone who may have the flu.

Symptoms of flu often include fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, and muscle aches. The Centers for Disease Control and Prevention reports that flu activity has been low so far this season. However, the level of flu activity is unpredictable and the season often lasts until late spring.

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Information for patients

The American Lung Association's Flu Shot Locator helps providers and patients find local clinics that have vaccine available.

The Federal government's Medicare website has information for Medicare Enrollees, including where to find vaccines and Medicare coverage and payment policies related to the flu vaccine.

The CDC's Healthy Habits website offers information on how to protect individuals and prevent them from spreading germs at home, school, or work.

The CDC also Offers Influenza Information in Other Languages.

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CDC Issues Flu Vaccine Self - Screen Form

The CDC has developed a form (available in English and in Spanish) to enable self-screening by patients visiting health care providers to receive a flu shot. It should be especially useful in flu clinics. The form is based on the most current ACIP recommendations for this influenza season and will help providers to more easily screen potential vacinees. In flu clinics, the form may help to reduce long lines by enabling the early identification of those who should not be vaccinated during this influenza season. These persons could "take themselves out of line" or seek clarification or answers from clinical staff before leaving the clinic area.

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States Issue Emergency Orders For Flu Vaccine

To date, eight states and the District of Columbia have issued emergency orders directing providers not to give the flu vaccine to anyone not identified by CDC as high risk. Most orders identify penalties for non-compliance which vary in severity. Individual counties also have implemented orders similar to their state's action and several have acted where no state action has occurred.

Gregory Buck, MD, Chair, ACP Wisconsin Chapter Health and Public Policy Committee, reported that the state of Wisconsin imposed an "emergency order' on the distribution of the flu vaccine that carries a penalty of court action.

The emergency orders can be accessed below for California, District of Columbia, Florida, Massachusetts, Michigan, New Mexico, Dutchess County (New York), Oregon, South Carolina, King County (Washington), and Wisconsin.

Additional state information on this and other issues relating to the flu vaccine shortage, such as price gouging, implementation of vaccination guidelines, reallocation guidance, and educational materials can be found on the Association of State and Territorial Health Officials' (ASTHO) web site. The ASTHO site also has links to state health departments.

For local government information visit the National Association of County and City Health Officials (NACCHO) Web site.

Emergency Orders

California
District of Columbia
Florida
Massachusetts
Michigan
New Mexico
New York - Health Order by the Dutchess County, NY Commissioner of Health
Oregon
South Carolina
Washington State - King County, WA Flu Vaccine Health Order
Wisconsin

If you have any questions on these or other topics, please contact Shuan Tomlinson at 800-338-2746 ext. 4547.

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States Respond to Vaccine Crisis

At an October 12th briefing, Centers for Disease Control and Prevention (CDC) Director Julie Gerberding, MD condemned price gouging as a moral offense in the context of the current flu vaccine crisis and urged states to prosecute offenses to the fullest extend of the law. States—not the federal government—are responsible for defining price gouging and prosecuting offenses. State and local health officials will be working with CDC to help prioritize the distribution of the remaining supplies of vaccine to the highest risk individuals.

Price Gouging. To date, attorneys general in Florida and Kansas have filed suits against a Florida pharmaceutical distributor company, Meds-Stat, for price gouging. Meds-Stat is being sued for violations of the Kansas consumer protection law and the Florida trade practices law. The state of Connecticut has launched an investigation into allegations of price gouging in the state.

In addition, over a dozen states have issued consumer warnings about possible flu vaccine price gouging. The Rhode Island Attorney General, Patrick C. Lynch, warned hospitals, doctors' office, pharmacies, nursing homes, and other health care providers about potential price gouging, and urged aggrieved consumers to call his office's Consumer Protection Unit.

Attorney General Lynch cited a survey conducted last week by the American Society of Health-System Pharmacists that found that 55 percent of 2,800 hospitals pharmacy directors surveyed reported that they were contacted by "opportunistic vendors offering to sell flu vaccine at highly inflated prices." Four out of five hospitals reported being offered the vaccine at more than four times the original market value, and nearly 20 percent of the hospitals contacted report having been offered the vaccine at a price more than 10 times the original market value.

Distribution of Vaccine to High Risk Individuals. In addition to their role in consumer protection, states will play an integral role in the distribution of the remaining 22.4 million does of flu vaccine. CDC will work with state and local health officials to identify ongoing critical needs and to distribute the remaining doses to individuals who are at the highest risk. Additional information on all aspects of the flu crisis can be found on the CDC Web site. A soon-to-be-released CDC Morbidity and Mortality Weekly Report (MMWR) will provide further updates on supply and distribution matters.

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CDC/Aventis Pasteur To Ship More Than 2 Million Doses of Influenza Vaccine to Providers Who Serve High-Priority Groups

More than 2 million doses of influenza vaccine were shipped this week by Aventis Pasteur to health care providers throughout the country who serve the high-priority groups recommended by the Centers for Disease Control and Prevention to receive influenza vaccine during the 2004-2005 season.

After pairing CDC information on geographic locations of high-priority risk groups and Aventis Pasteur US information on providers scheduled to receive vaccine for the high-risk populations, this round of influenza vaccine went to:

  • Department of Veterans Affairs
  • Long-term Care Facilities/Acute Care Hospitals
  • State Public Health Officials
  • Vaccines for Children program
  • Private Providers Who Care for Young Children

"More doses of vaccine will be going out over the next 6-7 weeks so there will be more opportunity for those who need the vaccine to get it in time for this year's influenza season," said CDC Director Dr. Julie Gerberding. "This shortage is frightening to people and they're rushing out and standing in long lines thinking they need the vaccine right now before it's all gone. We want them to know that more is coming, so as hard as it may be, please try and be patient and check with your provider ahead of time for availability of vaccine in your area."

To ensure that providers who ordered vaccine from Chiron this year get also get some of the vaccine they need for priority populations, CDC and Aventis are taking these actions:

  • filling remaining Vaccines For Children (VFC) orders to Aventis Pasteur.
  • contacting states that ordered vaccine from Chiron distributors to begin re-directing their orders to Aventis Pasteur.
  • collaborating with Chiron distributors to identify providers to high-priority populations including long-term care facilities, hospitals, and primary care and specialty physicians.
  • working with the Visiting Nurses Association of America to ensure high-priority populations it serves are immunized as recommended.

For the 2004-2005 influenza season, Aventis Pasteur produced 55.4 million doses of vaccine. Before the Chiron announcement on October 5, 2004, approximately 33 million doses had already been shipped to pediatricians, primary care and other office-based physicians, as well as to public health providers.

On October 5, 2004, CDC announced priority groups for vaccination with inactivated influenza vaccine for the 2004-2005 influenza season:

  • all children aged 6-23 months,
  • adults aged 65 years and older,
  • persons aged 2-64 years with underlying chronic medical conditions,
  • all women who will be pregnant during influenza season,
  • residents of nursing homes and long-term care facilities,
  • children 6 months-18 years of age on chronic aspirin therapy,
  • health-care workers with direct patient care, and
  • out-of-home caregivers and household contacts of children aged < 6 months.

Influenza season typically peaks in the United States between December and March. Because each season is unpredictable, it's not known how severe the 2004-2005 season might be.

Although vaccination is the best protection against influenza, everyone can take practical steps to help prevent spread of flu, such as avoiding close contact with people who are sick and keeping your distance from others if you're sick; when possible, staying home from work, school, and errands when you are sick; covering your mouth and nose when coughing or sneezing, and cleaning your hands often.

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CDC Develops Interim Recommendations on the Use of Antiviral Medications for the 2004-05 Influenza Season

Influenza antiviral medications are an important adjunct to influenza vaccine in the prevention and treatment of influenza. In the setting of the current vaccine shortage, CDC has developed interim recommendations on the use of antiviral medications for the 2004-05 influenza season.

CDC is issuing interim recommendations for the use of antiviral medications during the 2004-05 season. Local availability of these medications may vary from community to community, which could impact how these medications should be used.

  1. CDC encourages the use of amantadine or rimantadine for chemoprophylaxis and use of oseltamivir or zanamivir for treatment as supplies allow, in part to minimize the development of adamantane resistance among circulating influenza viruses.
  2. People who are at high risk of serious complications from influenza may benefit most from antiviral medications. Therefore, in general, people who fall into these high risk groups should be given priority for use of influenza antiviral medications:

Treatment

  • Any person experiencing a potentially life-threatening influenza-related illness should be treated with antiviral medications.
  • Any person at high risk for serious complications of influenza and who is within the first 2 days of illness onset should be treated with antiviral medications. (Pregnant women should consult their primary provider regarding use of influenza antiviral medications.)
  • Rimantadine is not approved for treatment of children aged < 13 years. For treatment, these persons should receive amantadine (children aged 1-12), oseltamivir (children aged 1-12), or zanamivir (children aged 7-12).

Chemoprophylaxis

  • All persons who live or work in institutions caring for people at high risk of serious complications of influenza infection should be given antiviral medications in the event of an institutional outbreak. This includes nursing homes, hospitals, and other facilities caring for persons with immunosuppressive conditions, such as HIV/AIDS. When vaccine is available, vaccinated staff require chemoprophylaxis only for the 2-week period following vaccination. Vaccinated and unvaccinated residents should receive chemoprophylaxis for the duration of institutional outbreak activity. Rapid tests or other influenza tests should be used to confirm influenza as the cause of outbreaks as soon as possible. However, treatment and chemoprophylaxis should be initiated if influenza is strongly suspected and test results are not yet available. Other outbreak control efforts such as cohorting of infected persons, and the practice of respiratory hygiene and other measures also should be implemented. For further information on detection and control of influenza outbreaks in acute care facilities, see Detection and Control of Influenza Outbreaks in Acute Care Facilities.
  • All persons at high risk of serious influenza complications should be given antiviral medications if they are likely to be exposed to others infected with influenza. For example, when a high-risk person is part of a family or household in which someone else has been diagnosed with influenza, the exposed high-risk person should be given chemoprophylaxis for 7 days.
  1. Antiviral medications can be considered in other situations when the available supply of such medications is locally adequate.
  • Chemoprophylaxis of persons in communities where influenza viruses are circulating, which typically lasts for 6-8 weeks:
  • Persons at high risk of serious complications who are not able to get vaccinated.
  • Persons at high risk of serious complications who have been vaccinated but have not had time to mount an immune response to the vaccine. In adults, chemoprophylaxis should occur for a period of 2 weeks after vaccination. In children aged < 9 years, chemoprophylaxis should occur for 6 weeks after the first dose, or 2 weeks after the second dose, depending on whether the child is scheduled to receive one or two doses of vaccine.
  • Persons with immunosuppressive conditions who are not expected to mount an adequate antibody response to influenza vaccine.
  • Health-care workers with direct patient care responsibilities who are not able to obtain vaccine.
  • Treatment of infected adults and children aged >1 year who do not have conditions placing them at high risk for serious complications secondary to influenza infection.
  1. Where the supplies of both influenza vaccine and influenza antiviral medications may not be sufficient to meet demand, CDC does not recommend the use of influenza antiviral medications for chemoprophylaxis of non-high risk persons in the community.

For more information, visit the CDC website.

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CDC Releases Interim Vaccination Recommendations

Because of this urgent situation, CDC, in coordination with its Advisory Committee for Immunization Practices (ACIP), is issuing interim recommendations for influenza vaccination during the 2004-05 season. These interim recommendations were formally recommended by ACIP on October 5, 2004, and take precedence over earlier recommendations.

Priority Groups for Influenza Vaccination

The following priority groups for vaccination with inactivated influenza vaccine this season are considered to be of equal importance and are:

  • all children aged 6-23 months;
  • adults aged 65 years and older;
  • 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 6 months-18 years on chronic aspirin therapy;
  • health-care workers involved in direct patient care; and
  • out-of-home caregivers and household contacts of children aged < 6 months.

For more information, visit the CDC website.

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Page updated: 02/05/08

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