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Immunization Update 2007 Satellite Broadcast/Webcast August 9, 2007 Influenza Vaccine Segment. Graphics subject to change. This material in the public domain. ACIP Statements Published Since August 2006. Rotavirus (8/11/2006) General Recommendations (12/1/2006) Tdap (adult) (12/15/2006)

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slide1
Immunization Update 2007

Satellite Broadcast/Webcast

August 9, 2007

Influenza Vaccine Segment

Graphics subject to change.

This material in the public domain.

acip statements published since august 2006
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 influenza vaccine recommendations
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)

2007 2008 influenza vaccine recommendations1
2007-2008 InfluenzaVaccine Recommendations
  • 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

Source: MMWR 2007;56 (RR-6)

2007 2008 influenza vaccine recommendations2
2007-2008 InfluenzaVaccine Recommendations
  • Healthcare administrators implement policies to encourage vaccination of healthcare personnel (HCP)
  • Change in storage requirement for live attenuated influenza vaccine

Source: MMWR 2007;56 (RR-6)

impact of influenza 1990 1999
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

Source: MMWR 2007;56 (RR-6)

influenza vaccination of children
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

Source: MMWR 2007;56 (RR-6)

timing of influenza vaccination
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

Source: MMWR 2007;56 (RR-6)

timing of influenza vaccination1
Timing of Influenza Vaccination
  • 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

Source: MMWR 2007;56 (RR-6)

month of peak influenza activity united states 1976 2006
Month of Peak Influenza Activity United States, 1976-2006

45%

19%

13%

13%

3%

3%

3%

Source: MMWR 2007;56 (RR-6)

timing of influenza vaccination2
Timing of Influenza Vaccination
  • 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

Source: MMWR 2007;56 (RR-6)

timing of influenza vaccination3
Timing of Influenza Vaccination
  • 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
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 20081
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
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

Source: MMWR 2007;56 (RR-6)

influenza vaccine recommendations 2007 2008
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
influenza vaccine recommendations 2007 20081
Influenza Vaccine Recommendations, 2007-2008
  • Household members of high-risk persons
  • Healthcare personnel, including home care
  • Employees of long-term care facilities

Source: MMWR 2007;56 (RR-6)

benefits of influenza vaccination of healthcare personnel hcp
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

Source: MMWR 2006;55 (RR-2)

influenza vaccination of healthcare personnel
Influenza Vaccination of Healthcare Personnel
  • Only 42 percent of U.S. healthcare personnel were vaccinated in 2004
reasons hcp do not receive influenza vaccine
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

Source: MMWR 2006;55 (RR-2)

factors facilitating hcp influenza vaccination
Factors Facilitating HCP Influenza Vaccination
  • Desire for self-protection
  • Previous receipt of influenza vaccine
  • Desire to protect patients
  • Perceived effectiveness of the vaccine

Source: MMWR 2006;55 (RR-2)

strategies to improve hcp influenza vaccination levels
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

slide23

Dose

0.25 mL

0.50 mL

0.50 mL

Trivalent Inactivated Influenza Vaccine (TIV) Schedule

# Doses

1 or 2

1 or 2

1

Age Group

6-35 mos

3-8 yrs

9 years or older

Source: MMWR 2007;56 (RR-6)

influenza vaccination of children1
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

Source: MMWR 2007;56 (RR-6)

inactivated influenza vaccines available in 2007 2008
Inactivated Influenza Vaccines Available in 2007-2008

*vaccines approved for children younger than 4 years

live attenuated influenza vaccine laiv
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

Source: MMWR 2007;56 (RR-6)

laiv schedule
Age Group

5 through 8 years

-no previous

influenza vaccine

-previous influenza

vaccine

9 through 49 years

Number of Doses

2

(separated by 6-10 weeks)

1 or 2

1

LAIV Schedule
use of laiv among close contacts of high risk persons
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

Source: MMWR 2007;56 (RR-6)

influenza vaccine storage and handling
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
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
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

Source: MMWR 2007;56 (RR-6)

cdc vaccines and immunization contact information
CDC Vaccines and ImmunizationContact Information
  • Hotline (800) CDC-INFO
  • Email nipinfo@cdc.gov
  • Website www.cdc.gov/nip
  • Broadcast Updates and Resources

Web Page

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