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Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008

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Morbidity and Mortality Weekly Report www.cdc.gov/mmwr Recommendations and Reports August 8, 2008 / Vol. 57 / No. RR-7 Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008 depardepardepartment of health and human servicesvicesvices Centers for Disease Control and PreventionPrevention MMWR CONTENTS The MMWR series of publications is published by the Coordinating Center for Health Information and Service, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Introduction......................................................................... 1 Human Services, Atlanta, GA 30333. Methods .............................................................................. 3 Suggested Citation: Centers for Disease Control and Prevention. Primary Changes and Updates in the Recommendations ..... 3 [Title]. MMWR 2008;57(No. RR-#):[inclusive page numbers]. Background and Epidemiology ............................................ 4 Centers for Disease Control and Prevention Influenza Vaccine Efficacy, Effectiveness, and Safety ............ 8 Julie L. Gerberding, MD, MPH Recommendations for Using TIV and LAIV During the Director Tanja Popovic, MD, PhD 2008–09 Influenza Season .............................................. 25 Chief Science Officer Additional Information About Vaccination of Specific James W. Stephens, PhD Populations ...................................................................... 26 Associate Director for Science Steven L. Solomon, MD Recommendations for Vaccination Administration Director, Coordinating Center for Health Information and Service and Vaccination Programs ............................................... 30 Jay M. Bernhardt, PhD, MPH Future Directions for Research and Recommendations Director, National Center for Health Marketing Katherine L. Daniel, PhD Related to Influenza Vaccine ............................................ 33 Deputy Director, National Center for Health Marketing Seasonal Influenza Vaccine and Avian or Swine Influenza ... 34 Editorial and Production Staff Recommendations for Using Antiviral Agents for Frederic E. Shaw, MD, JD Seasonal Influenza .......................................................... 35 Editor, MMWR Series Susan F. Davis, MD Sources of Information Regarding Influenza (Acting) Assistant Editor, MMWR Series and Its Surveillance ......................................................... 44 Teresa F. Rutledge Responding to Adverse Events After Vaccination ................ 44 (Acting) Managing Editor, MMWR Series David C. Johnson National Vaccine Injury Compensation Program ................ 44 (Acting) Lead Technical Writer-Editor Reporting of Serious Adverse Events After Antiviral David C. Johnson Medications ..................................................................... 44 Project Editor Peter M. Jenkins Additional Information Regarding Influenza Virus (Acting) Lead Visual Information Specialist Infection Control Among Specific Populations .................. 44 Lynda G. Cupell References......................................................................... 45 Malbea A. LaPete Visual Information Specialists Quang M. Doan, MBA Erica R. Shaver Information Technology Specialists Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN David W. Fleming, MD, Seattle, WA William E. Halperin, MD, DrPH, MPH, Newark, NJ Margaret A. Hamburg, MD, Washington, DC King K. Holmes, MD, PhD, Seattle, WA Deborah Holtzman, PhD, Atlanta, GA John K. Iglehart, Bethesda, MD Dennis G. Maki, MD, Madison, WI Sue Mallonee, MPH, Oklahoma City, OK Stanley A. Plotkin, MD, Doylestown, PA Patricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WI Barbara K. Rimer, DrPH, Chapel Hill, NC John V. Rullan, MD, MPH, San Juan, PR Anne Schuchat, MD, Atlanta, GA Dixie E. Snider, MD, MPH, Atlanta, GA John W. Ward, MD, Atlanta, GA Vol. 57 / RR-7 Recommendations and Reports 1 Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008 Prepared by Anthony E. Fiore, MD1 David K. Shay, MD1 Karen Broder, MD2 John K. Iskander, MD2 Timothy M. Uyeki, MD1 Gina Mootrey, DO3 Joseph S. Bresee, MD1 Nancy J. Cox, PhD1 1Influenza Division, National Center for Immunization and Respiratory Diseases 2Immunization Safety Office, Office of the Chief Science Officer, Office of the Director 3Immunization Services Division, National Center for Immunization and Respiratory Diseases Summary This report updates the 2007 recommendations by CDC’s Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2007;56[No. RR-6]). The 2008 recommendations include new and updated information. Principal updates and changes include 1) a new recommendation that annual vaccination be adminis­ tered to all children aged 5–18 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 6 months through 4 years (59 months) continue to be a primary focus of vaccination efforts because these children are at higher risk for influenza complications com­ pared 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 2 through 49 years (the previous recommendation was to administer LAIV to person aged 5–49 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 boxes 1 and 2. These recommendations also include a summary of safety data for U.S. 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 health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information. Introduction group, but rates of infection are highest among children (1–3). Rates of serious illness and death are highest among In the United States, annual epidemics of influenza occur persons aged >65 years, children aged <2 years, and persons typically during the late fall through early spring seasons. of any age who have medical conditions that place them at Influenza viruses can cause disease among persons in any age increased risk for complications from influenza (1,4,5). An annual average of approximately 36,000 deaths during 1990– 1999 and 226,000 hospitalizations during 1979–2001 have The material in this report originated in the National Center for Immunization and Respiratory Diseases, Anne Schuchat, MD, Director; been associated with influenza epidemics (6,7). the Influenza Division, Nancy Cox, PhD, Director; the Office of the Annual influenza vaccination is the most effective method Chief Science Officer, Tanja Popovic, MD, Chief Science Officer; the for preventing influenza virus infection and its complications. Immunization Safety Office, John Iskander, MD, Acting Director, and Influenza vaccine can be administered to any person aged the Immunization Services Division, Lance Rodewald, MD, Director. Corresponding preparer: Anthony Fiore, MD, Influenza Division, >6 months (who does not have contraindications to vaccina- National Center for Immunization and Respiratory Diseases, CDC, tion) to reduce the likelihood of becoming ill with influenza 1600 Clifton Road, NE, MS A-20, Atlanta, GA 30333. Telephone: or of transmitting influenza to others. Trivalent inactivated 404-639-3747; Fax: 404-639-3866; E-mail: [email protected]. influenza vaccine (TIV) can be used for any person aged 2 MMWR August 8, 2008 >6 months, including those with high-risk conditions (Boxes BOX 2. Summary of influenza vaccination recommendations, 1 and 2). Live, attenuated influenza vaccine (LAIV) may be 2008: adults used for healthy, nonpregnant persons aged 2–49 years. If Annual recommendations for adults have not changed. vaccine supply is limited, priority for vaccination is typically Annual vaccination against influenza is recommended assigned to persons in specific groups and of specific ages who for any adult who wants to reduce the risk for becoming are, or are contacts of, persons at higher risk for influenza ill with influenza or of transmitting it to others. Vacci­ complications. Because the safety or effectiveness of LAIV has nation also is recommended for all adults in the follow­ not been established in persons with underlying medical con­ ing groups, because these persons are either at high risk ditions that confer a higher risk for influenza complications, for influenza complications, or are close contacts of per­ these persons should only be vaccinated with TIV. Influenza sons at higher risk: viruses undergo frequent antigenic change (i.e., antigenic drift), • persons aged >50 years; and persons recommended for vaccination must receive an • women who will
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