immunization update 2007 satellite broadcast/webcast august 9, 2007 influenza vaccine segment

Immunization Update 2007Satellite Broadcast/Webcast

August 9, 2007

Influenza Vaccine Segment

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ACIP Statements Published Since August 2006

• Rotavirus (8/11/2006)• General Recommendations (12/1/2006)• Tdap (adult) (12/15/2006)• Hepatitis B (adult) (12/8/2006)• Human papillomavirus (3/23/2007)• Varicella (6/22/2007)• Influenza (7/13/2007)

All ACIP statements available at www.cdc.gov/vaccines/pubs/ACIP-list.htm

2007-2008 InfluenzaVaccine Recommendations

• Children 6 months through 8 years of age who received only 1 dose in their first year of vaccination should receive 2 doses the SECOND YEAR they are vaccinated

Source: MMWR 2007;56 (RR-6)


• Importance of 2 doses for children younger than 9 years of age being vaccinated for the first time

• Immunization providers should offer influenza vaccine and schedule immunization clinics throughout the influenza season



• Healthcare administrators implement policies to encourage vaccination of healthcare personnel (HCP)

• Change in storage requirement for live attenuated influenza vaccine


Impact of Influenza, 1990-1999

• Approximately 36,000 influenza-associated deaths during each influenza season

• Persons 65 years of age and older accounted for more than 90% of deaths

• Average of 226,000 hospitalizations during each influenza season


Influenza Vaccination of Children

• ACIP recommends annual influenza vaccination of children 6 through 59 months of age (inactivated influenza vaccine only)

• Vaccination of household contacts and out-of-home caregivers of all children birth through 59 months of age


Timing of Influenza Vaccination

• Influenza activity can occur as early as October

• In more than 80% of influenza seasons peak activity has not occurred until January or later

• In more than 60% of seasons the peak was in February or later



• Immunization providers should begin offering vaccine soon after it becomes available and if possible by October

• Providers should offer vaccine during routine healthcare visits or during hospitalizations whenever vaccine is available


Month of Peak Influenza Activity United States, 1976-2006

0

5

10

15

20

25

30

35

40

45

50

Nov Dec Jan Feb Mar Apr May

Pe

rce

nt

13%

19%

45%

13%

3% 3%3%



• Consider scheduling organized vaccination campaigns after at least mid-October

• Scheduling campaigns after mid-October will minimize the need for cancellations because vaccine is unavailable


• Continue to offer influenza vaccine in December, especially to healthcare personnel and those at high risk of complications

• Continue to vaccinate throughout influenza season (December-March)


Inactivated Influenza Vaccine Recommendations, 2007-2008

• Conditions that increase the risk of influenza complications:– Age

65 years and older 59 months and younger

– Pulmonary (emphysema, asthma)– Cardiovascular– Metabolic (diabetes)– Renal dysfunction – Hemoglobinopathy– Immunosuppression, including HIV infection– Conditions that compromise respiratory function

or increase the risk of aspiration

Inactivated Influenza Vaccine Recommendations, 2007-2008

• Persons at increased risk of influenza complications

–Residents of long term care facilities

–Persons 6 months to 18 years of age receiving chronic aspirin therapy

–Pregnant women

Pregnancy and Influenza Vaccine

• Risk of hospitalization more than 4 times higher than among nonpregnant women

• Risk of complications comparable to nonpregnant women with high risk medical conditions

• ACIP recommends vaccination with inactivated influenza vaccine for ALL women who will be pregnant during influenza season


Influenza Vaccine Recommendations, 2007-2008

• Immunization providers should administer influenza vaccine to any person who wishes to reduce the likelihood of becoming ill with influenza or transmitting influenza to others

• Household members of high-risk persons

• Healthcare personnel, including home care

• Employees of long-term care facilities


Influenza Vaccine Recommendations, 2007-2008

Benefits of Influenza Vaccination of Healthcare Personnel (HCP)

• Reduction in nosocomial influenza and influenza-related deaths

• Reduction in staff illness and illness-related absenteeism

• Reduction of direct medical costs and indirect costs from work absenteeism


Influenza Vaccination of Healthcare Personnel

• Only 42 percent of U.S. healthcare personnel were vaccinated in 2004

Reasons HCP Do Not Receive Influenza Vaccine

• Concern about vaccine adverse events• Perception of a low personal risk of • influenza virus infection• Insufficient time or inconvenience• Reliance on homeopathic medications• Avoidance of all medications• Fear of needles


Factors Facilitating HCP Influenza Vaccination

• Desire for self-protection

• Previous receipt of influenza vaccine

• Desire to protect patients

• Perceived effectiveness of the vaccine


Strategies to Improve HCPInfluenza Vaccination Levels

• Education

• Role models

• Reduction of financial and time barriers

• Monitor and report influenza vaccination levels in the facility

• Signed vaccination declination* (?)

• Legislation and regulation (?)

*Examples of vaccination declination forms available in Infection Control and Hospital Epidemiology, November 2005, and from the Immunization Action Coalition at www.immunize.org

Trivalent Inactivated Influenza Vaccine (TIV) Schedule

Age Group6-35 mos

3-8 yrs

9 years or older

Dose0.25 mL

0.50 mL

0.50 mL

# Doses1 or 2

1 or 2

1


Influenza Vaccination of Children

• Children 6 months through 8 years of age who received only 1 dose in their first year of vaccination should receive 2 doses the second year they are vaccinated

• Children who are in their third or more year of being vaccinated and who received only 1 dose in each of their first 2 years of being vaccinated should continue receiving a single annual dose


Inactivated Influenza Vaccines Available in 2007-2008

Vaccine Package Dose Age ThimerosalFluzone(sanofi pasteur)

Multidose vial* Age-dependent >6 mos Yes

Single dose syringe*

0.25 mL 6-35 mos No

Single dose syringe

0.5 mL >36 mos No

Single dose vial

0.5 mL >36 mos No

Fluvirin(Novartis)

Multidose vial 0.5 mL >4 yrs Yes

Fluarix(GSK)Flulaval(GSK)

Single dose syringe

Multidose vial

0.5 mL

0.5 mL

>18 yrs

>18 yrs

Trace

Yes

*vaccines approved for children younger than 4 years

Live Attenuated Influenza Vaccine (LAIV)

• Approved only for healthy persons 5 years through 49 years of age who are not pregnant

–healthcare personnel

–persons in close contact with high-risk groups

–persons who want to reduce their risk of influenza


LAIV Schedule

Age Group

5 through 8 years

-no previous

influenza vaccine

-previous influenza

vaccine

9 through 49 years

Number of Doses2

(separated by 6-10 weeks)

1 or 2

1

Use of LAIV Among CloseContacts of High Risk Persons

• Inactivated influenza vaccine is preferred for close contacts of severely immunosuppressed persons who require care in a protective environment

• Persons who receive LAIV should refrain from contact with severely immunosuppressed persons for 7 days after vaccination

• Persons who receive LAIV do not need to be excluded from visitation of patients who are not severely immunosuppressed


Influenza VaccineStorage and Handling

• Both TIV and LAIV should be stored at refrigerator temperature (35o- 46o F) at all times

• Neither vaccine should be exposed to freezing temperature

Administration of LAIV

• Severely immunosuppressed persons should not administer LAIV

• Other persons at increased risk for influenza complications* may administer LAIV

• Gloves and masks are not required

*e.g., pregnant women, persons with asthma and persons 50 years of age or older

Influenza Antiviral Use, 2007-2009

• Neither amantadine nor rimantadine should be used for treatment or chemoprophylaxis of influenza A infections during the 2007-2008 influenza season

• Oseltamivir or zanamivir should be prescribed if an antiviral drug is indicated for the treatment of influenza


CDC Vaccines and ImmunizationContact Information

• Hotline (800) CDC-INFO

• Email [email protected]

• Website www.cdc.gov/nip

• Broadcast Updates and Resources

Web Page

www.cdc.gov/vaccines/ed/broadcasts.htm

immunization update 2007 satellite broadcast/webcast august 9, 2007 influenza vaccine segment

Documents

influenza seasonsource

influenza seasonpersons

impact of influenza

influenzaassociated

years of age

year of vaccination

older59 months

months of agesource