Immunization Update 2007 Satellite Broadcast/Webcast August 9, 2007 Influenza Vaccine Segment
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Transcript of 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)
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 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
• 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
• 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
• 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 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
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%
Source: MMWR 2007;56 (RR-6)
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)
• 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)
Timing of Influenza Vaccination
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
Source: MMWR 2007;56 (RR-6)
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
Source: MMWR 2007;56 (RR-6)
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
Source: MMWR 2006;55 (RR-2)
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
Source: MMWR 2006;55 (RR-2)
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 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
Source: MMWR 2007;56 (RR-6)
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
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
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 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
Source: MMWR 2007;56 (RR-6)
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
Source: MMWR 2007;56 (RR-6)
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