CDC Updated Influenza Recommendations

Angie SzumlinskiUncategorized

It is hard to believe that the summer of 2013 is coming to a close, but it is, and as we end another summer, we should be planning our program strategy for preventive immunizations.  The Centers for Disease Control has recently released updated information regarding the 2013-14 influenza vaccine.  The basics remain the same immunize high risk populations and healthcare personnel as soon as the vaccine becomes available (preferably by October).

Influenza claims many lives each year, so let’s work at reducing these numbers and protect our frail elderly.  It is also very important to offer the influenza vaccine to our direct care staff.  Remember:

  • Caregivers live in the community with direct contact to young children and seniors who may be ill.
  • Providing the influenza vaccine to this population will assist in reducing the risk that infections will be brought into our homes.
  • If a team member presents with signs and symptoms of illness do not allow them to work, send them home until they are symptom free.
  • Track all infections including employee infections.
  • Consider discussing the use of anti-viral medications with your Medical Director.
  • Consider limiting visitors during peak flu season or if you experience active cases of influenza in your home.
  • Remind caregivers, residents and visitors to wash their hands!  Many homes provide hand sanitizer stations throughout their homes.  This is very helpful and has proven to reduce the risk of infection however nothing totally replaces soap and water!

Stay well and have a happy fall!

Below is a summary of the recommendations of the Advisory Committee on Immunization Practices for the 2013-2014 season in the United States. The full recommendations will be published in Morbidity and Mortality Weekly Report (MMWR).

Note on abbreviations: This document includes revised abbreviations to refer to currently available influenza vaccines. Specifically:

  • The former abbreviation TIV (Trivalent Inactivated Influenza Vaccine, previously used for inactivated influenza vaccines) has been replaced with the new abbreviation IIV (Inactivated Influenza Vaccine). For 2013-14, IIVs as a class will include:
    • egg-based and cell culture-based trivalent inactivated influenza vaccines (IIV3), and
    • egg-based quadrivalent inactivated influenza vaccine (IIV4).
  • RIV refers to recombinant hemagglutinin influenza vaccine, available as a trivalent formulation (RIV3) for 2013-14;
  • LAIV refers to live-attenuated influenza vaccine, available as a quadrivalent formulation (LAIV4) for 2013-14.
  • LAIV, IIV, and RIV denote vaccine categories; numeric suffix specifies the number of antigens in the vaccine.
  • Where necessary to refer specifically to cell culture-based vaccine, the prefix “cc” is used (e.g., “ccIIV3”).

Primary Changes and Updates in the Recommendations

  • Routine annual influenza vaccination of all persons aged 6 months and older continues to be recommended.
  • 2013-14 U.S. trivalent influenza vaccines will contain an A/California/7/2009 (H1N1)-like virus, an H3N2 virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011, and a B/Massachusetts/2/2012-like virus. Quadrivalent vaccines will include an additional vaccine virus, a B/Brisbane/60/2008-like virus.
  • Several new, recently-licensed vaccines will be available for the 2013-14 season, and are acceptable alternatives to other licensed vaccines indicated for their respective age groups when otherwise appropriate:
    • A quadrivalent live attenuated influenza vaccine (LAIV4; Flumist® Quadrivalent [MedImmune]) is expected to replace the trivalent (LAIV3) formulation. FluMist® Quadrivalent is indicated for healthy, nonpregnant persons aged 2 through 49 years;
    • A quadrivalent inactivated influenza vaccine (IIV4; Fluarix® Quadrivalent [GlaxoSmithKline]) will be available, in addition to the previous trivalent formulation. Fluarix® Quadrivalent is indicated for persons aged 3 years and older;
    • A quadrivalent inactivated influenza vaccine (IIV4; Fluzone® Quadrivalent [Sanofi Pasteur]) will be available in addition to the previous trivalent formulation. Fluzone® Quadrivalent is indicated for persons aged 6 months and older;
    • A trivalent cell culture-based inactivated influenza vaccine (ccIIV3; Flucelvax® [Novartis]), which is indicated for persons aged 18 years and older; and
    • A recombinant hemagglutinin (HA) vaccine (RIV3; FluBlok® [Protein Sciences]), which is indicated for persons aged 18 through 49 years.
  • Within approved indications and recommendations, no preferential recommendation is made for any type or brand of licensed influenza vaccine over another.

Timing of Vaccination

  • In general, health-care providers should begin offering vaccination soon after vaccine becomes available, and if possible, by October.
  • All children aged 6 months–8 years who are recommended for 2 doses (Figure 1) should receive their first dose as soon as possible after vaccine becomes available; these children should receive the second dose ≥4 weeks later.

Available Vaccine Products and Indications

A variety of influenza vaccine products are available (Table 1), including (as of July 2013) five newly approved vaccines. For many vaccine recipients, more than one type or brand of vaccine may be appropriate within indications and ACIP recommendations. Where more than one type of vaccine is appropriate and available, no preferential recommendation is made for use of any influenza vaccine product over another.

Persons at Risk for Medical Complications Due to Influenza

Vaccination to prevent influenza is particularly important for persons who are at increased risk for severe complications from influenza, or at higher risk for influenza-related outpatient, emergency department, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons (no hierarchy is implied by order of listing):

  • All children aged 6 through 59 months;
  • All persons aged ≥50 years;
  • Adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus);
  • Persons who have immunosuppression (including immunosuppression caused by medications or by HIV infection);
  • Women who are or will be pregnant during the influenza season;
  • Children and adolescents (aged 6 months–18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s syndrome after influenza virus infection;
  • Residents of nursing homes and other long-term care facilities;
  • American Indians/Alaska Natives;
  • Persons who are morbidly obese (BMI ≥40).

Persons Who Live With or Care for Persons at Higher Risk for Influenza-Related Complications

All persons aged ≥6 months should be vaccinated annually. Continued emphasis should be placed on vaccination of persons who live with or care for persons at higher risk for influenza-related complications. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to persons at higher risk for influenza-related complications listed above, as well as these persons:

  • Healthcare personnel (HCP);
  • Household contacts (including children) and caregivers of children aged ≤59 months (i.e., aged <5 years) and adults aged ≥50 years, with particular emphasis on vaccinating contacts of children aged <6 months; and
  • Household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.

HCP and persons who are contacts of persons in these groups and who are not contacts of severely immunocompromised persons (those living in a protective environment) may receive any influenza vaccine which is otherwise indicated. Individuals who care for the severely immunocompromised should receive either IIV or RIV3.