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ACIP expands influenza vaccine recommendations
Previous recommendation was for children aged between 6 and 59 months.
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ATLANTA –The Advisory Committee on Immunization Practices voted 11-0 to expand the recommended ages for routine influenza vaccination to include all children aged between 6 months and 18 years; there was one abstention.
The Committee also approved a motion that the implementation of this recommendation should take effect as soon as feasible, but no later than the 2009-2010 influenza season.
This recommendation is expected to increase the number of children recommended for vaccination by about 30 million, according to a press release.
Anthony Fiore, MD, MPH, presented the influenza vaccine work group’s proposed language for the new recommendation at the ACIP meeting, held here in February. The work group’s presentations also included an update of its efforts made by Kathleen Neuzil, MD, MPH.
In their most recent discussions, most work group members initially favored expanding influenza vaccination to include all children aged up to 18 years during the 2009-2010 influenza season, according to Neuzil, chair of the influenza vaccine work group.
“Members felt that although the indirect effects [of vaccination] may be an added benefit, the strong evidence for the direct benefit to vaccinated children was sufficient to recommend the change to a universal childhood recommendation,” she said during her presentation. “[They felt that] by waiting until 2009, it allowed for implementation and assessment planning. It also would allow us to harmonize our message with other professional societies.”
The recommendation was based on several factors, including evidence that the influenza vaccine is safe and effective for school-aged children and evidence that influenza has a number of adverse effects on children in this age group and their contacts.
“There’s also the expectation that a simple, age-based influenza vaccine recommendation will improve the current low coverage rates among about 50% of school-aged children who already have either a risk-based or a contact-based indication for annual flu vaccination,” Neuzil said.
She added that a reduction of influenza transmission among children is expected to reduce the incidence of influenza among household contacts and within the community.
The work group’s initial recommendation proposed that all vaccine providers and programs should begin efforts to offer influenza vaccine to all children in this age group during the 2008-2009 season when possible, consistent with the ACIP’s current recommendation that all people who wish to receive the vaccine may do so, according to Fiore, of the National Center for Immunization and Respiratory Diseases influenza division.
“This last point was to make sure that we don’t undercut the efforts already underway,” Fiore said. “Some practitioners and programs are already offering vaccine to everyone, and we’d encourage them to continue their implementation planning, but also to continue offering vaccines to all persons.”
According to Neuzil, the work group endorsed the need for an improved impact assessment of any recommendation changes. In school-aged children, this assessment should include the ability to assess less severe effects and indirect effects, as well as the ability to consider laboratory-confirmed influenza infections.
“The work group did acknowledge that several factors will challenge the ability to demonstrate indirect effects, including what we anticipate to be low coverage in the early years of implementation, the variability of influenza epidemiology and vaccine effectiveness, and the small number of large population studies among adults with laboratory-confirmed outcomes,” Neuzil said.
“So, if we want to show indirect benefits in adults, we need to improve our surveillance capacity for laboratory-confirmed outcomes in adults.”
The work group also discussed the issue of expanding the universal vaccination recommendation to all adults beyond the wording of the current recommendation.
“There was a lot of discussion and some disagreement about the definite timeline for a universal vaccination recommendation to all age groups, and the work group will continue active discussions in this regard,” Neuzil said. “There was some thought that taking this incremental step of universal vaccination up to the age of 18 years would allow us to evaluate indirect effects, and that may influence a later universal recommendation.”
Other variables in this decision could include the information derived from observed indirect effects, the licensure of additional influenza vaccines specifically for older adults developed in the next few years and public engagement on vaccination opinions, according to Neuzil. – Cara Dickinson
For more information:
- Fiore A. 2008 prevention and control of influenza: recommendations of the ACIP. Presented at: Advisory Committee on Immunization Practices meeting; Feb. 27-28, 2008; Atlanta.