Looking at the prevention and control of influenza – recommendations of the Advisory Committee on Immunisation Practices (ACIP), 2008.

THIS report updates the 2007 recommendations by the CDC’s Advisory Committee on Immunisation Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC: Prevention and control of influenza: recommendations of the Advisory Committee on Immunisation Practices [ACIP]. MMWR 2007; 56[No. RR-6]).

The 2008 recommendations include new and updated information. Principal updates and changes include:
 

The Centers for Disease Control and Prevention recommends that annual vaccination of all children aged six months through four years continue to be a primary focus of vaccination efforts because these children are at higher risk for influenza complications compared with older children. –Reuters

1. A new recommendation that annual vaccination be administered to all children aged five to 18 years, beginning in the 2008–09 influenza season, if feasible, but no later than the 2009–10 influenza season;

2. A recommendation that annual vaccination of all children aged six months through four years (59 months) continue to be a primary focus of vaccination efforts because these children are at higher risk for influenza complications compared with older children;

3. A new recommendation that either trivalent inactivated influenza vaccine or live, attenuated influenza vaccine (LAIV) be used when vaccinating healthy persons aged two through 49 years (the previous recommendation was to administer LAIV to person aged five to 49 years);

4. A recommendation that vaccines containing the 2008–09 trivalent vaccine virus strains A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Florida/4/2006-like antigens be used; and

5. New information on antiviral resistance among influenza viruses in the United States. Persons for whom vaccination is recommended are listed in the summaries below. These recommendations also include a summary of safety data for US licensed influenza vaccines.

This report and other information are available at CDC’s influenza website (http://www.cdc.gov/flu), including any updates or supplements to these recommendations that might be required during the 2008–09 influenza season.

Vaccination and healthcare providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.

Summary of influenza vaccination recommendations, 2008: children and adolescents aged six months to 18 years

Vaccination of all children aged six months to 18 years should begin before or during the 2008–09 influenza season if feasible, but no later than during the 2009–10 influenza season. Vaccination of all children aged five to 18 years is a new ACIP recommendation.

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 and adolescents. Recommendations for these children have not changed. Children and adolescents at higher risk for influenza complication are those:

·Aged six months to four years;

·Who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus);

·Who are immunosuppressed (including immunosuppression caused by medications or by human immunodeficiency virus);

·Who have 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;

·Who are receiving long-term aspirin therapy who therefore might be at risk of experiencing Reye’s syndrome after influenza virus infection;

·Who are residents of chronic-care facilities; and,

·Who will be pregnant during the influenza season.

Note that children aged less than six months should not receive influenza vaccination. Household and other close contacts (e.g. daycare providers) of children aged less than six months, including older children and adolescents, should be vaccinated.

Summary of influenza vaccination recommendations, 2008: adults

Annual recommendations for adults have not changed. Annual vaccination against influenza is recommended for any adult who wants to reduce the risk for becoming ill with influenza or of transmitting it to others.

Vaccination is also recommended for all adults in the following groups, because these persons are either at high risk for influenza complications, or are close contacts of persons at higher risk:

·Persons aged more than 50 years;

·Women who will be pregnant during the influenza season;

·Persons who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus);

·Persons who have immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus);

·Persons who have 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;

·Residents of nursing homes and other chronic-care facilities;

·Healthcare personnel;

·Household contacts and caregivers of children aged less than five years and adults aged more than 50 years, with particular emphasis on vaccinating contacts of children aged less than six months; and,

·Household contacts and caregivers of persons with medical conditions that put them at high risk for severe complications from influenza.

This article excerpted from Berita MPA Newsletter, January 2009 Issue. The article was extracted from Morbidity and Mortality Weekly Report, Recommendations and Reports, August 8, 2008 / Vol. 57 / No. RR-7 at www.cdc.gov.mmwr. This article is courtesy of the Malaysian Paediatric Association for the Positive Parenting Programme, Childhood Immunisation Initiative. For further information, please visit www.mypositiveparenting.org