What’s New in the 2014–15 CDC Influenza Vaccine Recommendations

September 2014

Technically Speaking

Monthly Column by Deborah Wexler, MD

Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.

Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.

TECHNICALLY SPEAKING

What’s New in the 2014–15 CDC Influenza Vaccine Recommendations

Published September 2014

Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit www.immunize.org/acip/acip_vax.asp.

The Centers for Disease Control and Prevention’s (CDC) annual update on the use of influenza vaccine, Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) — United States, 2014–15 Influenza Season, was published in the August 15 issue of MMWR on pages 691-697.

All people age 6 months and older who do not have contraindications should receive influenza vaccination annually — a core ACIP recommendation since the 2010-11 influenza season. Healthcare providers should begin recommending and providing influenza vaccination as soon as vaccine is available and continue vaccinating as long as influenza viruses are circulating.

Changes in the 2014-15 ACIP recommendations

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As in previous seasons, children age 6 months through 8 years need two doses of influenza vaccine during their first vaccination season in order to prime and optimize their immune response. ACIP recommends you use one of two possible approaches to determine the number of doses needed for the 2014–15 season. The first approach considers only doses of seasonal influenza vaccine received since July 1, 2010. The second approach may be used when a well-documented vaccination history from before the 2010–11 season is available. For details, see Figure 1 on page 695 of the ACIP recommendations or refer to the Immunization Action Coalition’s handout titled Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months Through 8 Years During the 2014–2015 Influenza Season. Children who need two doses should receive their first dose as soon as possible after vaccine becomes available, and the second dose ≥ 4 weeks later.

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Based on ACIP’s review of evidence indicating that the live attenuated influenza vaccine (LAIV, FluMist®, MedImmune) is more effective than inactivated influenza vaccine (IIV) against laboratory-confirmed influenza among younger children, the committee has stated a preference for the use of LAIV in healthy children age 2 through 8 years who have no contraindications or precautions to its use. Because both LAIV and injectable influenza vaccine (IIV) are effective in protecting children, the recommendation stresses that if LAIV is not immediately available, administer IIV. IIV should be used to ensure that opportunities to vaccinate and protect children are not missed or delayed.

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For people with chronic conditions that might predispose them to a higher risk of influenza complications (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus]), the use of LAIV should be considered a precaution. Previously, LAIV was contraindicated for these individuals.

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For people with asthma who are age 5 years and older, the use of LAIV should be considered a precaution. Previously, LAIV was contraindicated for all people with asthma. LAIV continues to be contraindicated for children age 2 through 4 years who have asthma or who have had a medically documented or provider-described episode of wheezing within the past 12 months.

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Taking influenza antiviral medications within the previous 48 hours was previously listed as a precaution to the use of LAIV; however, ACIP now lists it as a contraindication.

Be sure to consult the ACIP recommendations (pages 691-697) for complete details about influenza vaccine use including all contraindications and precautions.

If you have additional questions, be sure to check the following helpful influenza vaccine resources.

From CDC

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Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 Influenza Season on pages 691-697

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CDC’s Influenza web section

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CDC’s free resources related to influenza

From the Immunization Action Coalition

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Influenza (IIV) Vaccine Information Statement (and available translations)

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