Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 501            January 3, 2005

CONTENTS OF THIS ISSUE

  1. MMWR publishes ACIP's updated interim influenza vaccination recommendations for the 2004-05 influenza season
  2. Update: CDC continues to supplement its website with information related to the influenza vaccine shortage
  3. New: IAC screening questionnaires help providers determine if patients have contraindications to influenza vaccine
  4. Teleconference on starting local immunization coalitions is scheduled for January 11

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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
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January 3, 2005
MMWR PUBLISHES ACIP'S UPDATED INTERIM INFLUENZA VACCINATION RECOMMENDATIONS FOR THE 2004-05 INFLUENZA SEASON

On December 17, ACIP formally approved updated interim influenza vaccination recommendations. The updated interim recommendations modify the interim recommendations ACIP approved on October 5 in response to Chiron Corporation's announcement that none of its influenza vaccine would be distributed in the United States. On December 24, CDC published "Updated Interim Influenza Vaccine Recommendations--2004-05 Influenza Season" in MMWR. It is reprinted below in its entirety, excluding one footnote.

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On October 5, 2004, CDC was notified by Chiron Corporation that none of its inactivated influenza vaccine (Fluvirin) would be available for distribution in the United States for the 2004-05 influenza season. At that time, CDC, in coordination with the Advisory Committee on Immunization Practices (ACIP), issued interim recommendations to direct available inactivated influenza vaccine to persons in certain priority groups. CDC has been working with Aventis Pasteur, Inc., to distribute the remaining supply of its inactivated influenza vaccine Fluzone so that it reaches persons in the priority groups established on October 5. In addition, on December 7, the U.S. Department of Health and Human Services announced that up to 4 million doses of the GlaxoSmithKline influenza vaccine Fluarix, authorized for use by the Food and Drug Administration under an Investigational New Drug (IND) application, would be available to help alleviate the influenza vaccine shortage this season.

The primary goal of the annual influenza vaccination recommendations by CDC and ACIP is to reduce the risk for complications from influenza among persons who are most vulnerable. This year, the reduced national supply of inactivated influenza vaccine led CDC and ACIP to issue interim influenza vaccination recommendations that were more restrictive than usual. Since the interim recommendations were issued on October 5, the influenza vaccine supply and demand situation has continued to evolve in the United States such that some, but not all, local areas appear to have adequate supplies to meet the demand for vaccine from persons in the interim priority groups. This has resulted in unused vaccine in some areas of the country.

Influenza disease activity in the United States has remained relatively low but is expected to increase during the weeks ahead. In addition, influenza vaccination coverage among this season's interim priority groups is lower than it has been in recent influenza seasons. Given these considerations, CDC recommends that aggressive efforts should continue to reach unvaccinated persons in high-risk priority groups and use available vaccine to vaccinate such persons. Adequate time remains for persons in these priority groups to receive the benefits of vaccination before influenza begins to widely circulate in most communities. CDC will continue to allocate available vaccine to states that have insufficient supplies of vaccine to reach these priority groups.

In addition to these ongoing activities, in coordination with ACIP, CDC is issuing updated interim recommendations for influenza vaccination during the 2004-05 season. If the locally available supply is sufficient to meet the local demand for vaccine from persons listed below under the heading, Priority Groups for Inactivated Influenza Vaccination, vaccination may expand to also include persons listed below under the heading, Additional Priority Groups for Inactivated Influenza Vaccination in Areas of Sufficient Supply. Decisions to expand priority groups are left to the discretion of state and local health departments. Vaccine providers and health departments with vaccine should aggressively reach out to vaccinate persons in the priority groups established on October 5. These persons include those at highest risk for complications from influenza and healthcare professionals caring for persons at high risk, and should remain a focus even where vaccine supplies are sufficient to support expansion to other groups.

These recommendations were formally approved by ACIP on December 17, 2004, to take effect on January 3, 2005. Implementation is being delayed to allow extra time for vaccine to reach the initial priority groups and to allow time for state and local health departments to prepare for increased requests for vaccination.

Priority Groups for Inactivated Influenza Vaccination

Inactivated influenza vaccine is recommended for persons in the following priority groups:

  • all children aged 6-23 months;
  • adults aged >=65 years;
  • persons aged 2-64 years with underlying chronic medical conditions;
  • all women who will be pregnant during the influenza season;
  • residents of nursing homes and long-term-care facilities;
  • children aged 2-18 years on chronic aspirin therapy;
  • healthcare workers involved in direct patient care; and
  • out-of-home caregivers and household contacts of children aged <6 months.

Additional Priority Groups for Inactivated Influenza Vaccination in Areas of Sufficient Supply

Where supply is sufficient, inactivated influenza vaccine also is recommended for persons in the following additional priority groups:

  • out-of-home caregivers and household contacts of persons in high-risk groups (e.g., persons aged >=65 years; persons with chronic conditions such as diabetes, heart or lung disease, or weakened immune systems because of illness or medication; and
  • children aged <2 years); and
  • all adults aged 50-64 years.

Use of Live, Attenuated Influenza Vaccination

Intranasally administered, live, attenuated influenza vaccine, if available, should be encouraged for all healthy persons who are aged 5-49 years and are not pregnant, especially healthcare workers and out-of-home caregivers and household contacts of persons in high-risk groups (e.g., persons aged >=65 years; persons with chronic conditions such as diabetes, heart or lung disease, or weakened immune systems because of illness or medication; and children aged <2 years).

However, healthcare workers who care for severely immunocompromised patients in special care units should receive the inactivated vaccine.

Other Vaccination Recommendations

Persons in the priority groups identified above should be encouraged to search locally for vaccine if their regular healthcare provider does not have vaccine available.

Children aged <9 years require 2 doses of vaccine if they have not previously been vaccinated. All children who are at high risk for complications from influenza, including those aged 6-23 months, should be vaccinated with a first or second dose, depending on vaccination status. However, doses should not be held in reserve to ensure that 2 doses will be available. Instead, available vaccine should be used to vaccinate persons in priority groups on a first-come, first-serve basis.

Vaccination of Persons in Nonpriority Groups

Persons who are not included in one of the priority groups or additional priority groups described above should be informed about the vaccine supply situation and asked to forego or defer vaccination with inactivated influenza vaccine. Live, attenuated influenza vaccine, if available, should be encouraged for all healthy persons aged 5-49 years.

Persons Who Should Not Receive Influenza Vaccine

Persons in the following groups should not receive influenza vaccine without the recommendation of their physicians:

  • persons with a severe allergy (i.e., anaphylactic allergic reaction) to hens' eggs; and
  • persons who previously had onset of Guillain-Barré syndrome during the 6 weeks after receiving influenza vaccine.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a7.htm

To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5350.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html

Two additional documents related to the December 17 updated interim influenza vaccination recommendations are also available. They are a press release titled "CDC's Advisory Committee on Immunization Practices Expands Priority Groups for Inactivated Influenza Vaccination," dated December 17, and an Official CDC Health Update titled "Updated Interim Influenza Vaccination Recommendations 2004-05," dated December 22.

To access the press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r041217.htm

To access the health update, click here.
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January 3, 2005
UPDATE: CDC CONTINUES TO SUPPLEMENT ITS WEBSITE WITH INFORMATION RELATED TO THE INFLUENZA VACCINE SHORTAGE

CDC recently updated its Influenza web section, adding to its web page of questions and answers about influenza vaccine administration and posting Spanish-language versions of three patient-education flyers that are part of the "CDC Flu Prevention Toolkit: Real people. Real solutions." Following are descriptions of and links to these documents.

On December 20, four Q&A segments were added to the web page "Questions & Answers: Vaccine Administration." To access the updated web page, go to:
http://www.cdc.gov/flu/about/qa/vaxadmin.htm

On December 16, three Spanish-language flyers were added to the "CDC Flu Prevention Toolkit: Real people. Real solutions." They are "Estoy lista para todo--hasta para la gripe" ("I'm ready for anything--even flu season"); "Tuve que quedarme en casa por la gripe" ("I had to take a flu break"); and "Yo tengo habitos saludables" ("I practice healthy habits"). Materials in the kit provide tips on ways to prevent influenza other than vaccination.

To access "Estoy lista para todo--hasta para la gripe," go to:
http://www.cdc.gov/flu/toolkit/stories/readyforanything-files.htm Click on the size and layout option(s) you prefer. The English-language version is also available at this link.

To access "Tuve que quedarme en casa por la gripe," go to:
http://www.cdc.gov/flu/toolkit/stories/flubreak-files.htm Click on the size and layout option(s) you prefer. The English-language version is also available at this link.

To access "Yo tengo habitos saludables," go to:
http://www.cdc.gov/flu/toolkit/stories/healthyhabits-files.htm Click on the size and layout option(s) you prefer. The English-language version is also available at this link.

For ongoing information about new and updated additions to CDC's Influenza web section, go to:
http://www.cdc.gov/flu/whatsnew.htm
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January 3, 2005
NEW: IAC SCREENING QUESTIONNAIRES HELP PROVIDERS DETERMINE IF PATIENTS HAVE CONTRAINDICATIONS TO INFLUENZA VACCINE

IAC recently created two screening questionnaires for patients and the parents of children to fill out while waiting to be seen for influenza vaccination. The questionnaires are "Screening Questionnaire for Injectable Influenza Vaccination" and "Screening Questionnaire for Intranasal Influenza Vaccination."

Patients or parents' answers to the questionnaires can alert health professionals to the contraindications or precautions a potential vaccinee has to either form of influenza vaccine. Please note that these questionnaires are NOT intended to help health professionals determine whom to vaccinate in a situation where the supply of influenza vaccine is limited. CDC has created questionnaires that can help health professionals prioritize vaccine use during the current vaccine shortage. Links to CDC's questionnaires will be given at the end of this article.

To access a ready-to-print (PDF) version of IAC's "Screening Questionnaire for Injectable Influenza Vaccination," go to:
http://www.immunize.org/catg.d/p4066.pdf

To access a web-text (HTML) version of it, go to:
http://www.immunize.org/catg.d/p4066.htm

To access a ready-to-print (PDF) version of IAC's "Screening Questionnaire for Intranasal Influenza Vaccination," go to:
http://www.immunize.org/catg.d/p4067.pdf

To access a web-text (HTML) version of it, go to:
http://www.immunize.org/catg.d/p4067.htm

To access a ready-to-print (PDF) version of CDC's questionnaire "Who should and who should not get a flu shot?" go to:
http://www.cdc.gov/flu/professionals/flugallery/pdf/vaccinescreeningform.pdf

To access a ready-to-print (PDF) version of CDC's questionnaire "Patient Screening Form for Health Care Providers Offering FluMist Live Attenuated Intranasal Influenza Vaccine during the 2004-05 Flu Season," go to:
http://www.cdc.gov/flu/professionals/flugallery/pdf/flumistscreeningform.pdf
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January 3, 2005
TELECONFERENCE ON STARTING LOCAL IMMUNIZATION COALITIONS IS SCHEDULED FOR JANUARY 11

The National Immunization Coalition TA [technical assistance] Network has scheduled a teleconference on starting local immunization coalitions for 1PM ET on January 11. The network is a program of the Center for Health Communication, Academy for Educational Development (AED).

The teleconference facilitator is Joan Clayton-Davis, a senior technical advisor at AED and manager of its Nashville office.

Learning objectives of the teleconference include the following:

  1. Learn key steps in establishing a local immunization coalition
  2. Identify factors that support maintaining and sustaining a local coalition

To register for the teleconference, email Katherine Shrout at kshrout@aed.org In your email, include this message: "Sign me up for the Starting a Coalition call."

 

Immunization Action Coalition1573 Selby AvenueSt. Paul MN 55104
E-mail: admin@immunize.org Web: http://www.immunize.org/
Tel: (651) 647-9009Fax: (651) 647-9131

This page was updated on January 3, 2005