New age groups targeted to receive influenza vaccine

November 2006

WASHINGTON — The 2006 influenza season is expected to have more influenza vaccine doses available than ever before, but reaching at-risk populations is still going to require proper planning to administer the doses, as well as education to get people vaccinated, according to health officials.

Numbers are expected to reach more than 100 million, possibly 115 million. At press time health officials expected about 75 million vaccines would have been distributed by the end of October. Health officials remain positive after 26 million doses were distributed in September.

“We feel like that is a lot of doses to have in the first month, when initial vaccination activities are taking place, to really get started on this effort,” Jeanne M. Santoli, MD, MPH, with the National Center for Immunization and Respiratory Diseases, said at the National Vaccine Advisory Committee Meeting in September. “The goal is to get all providers some vaccine early so that people can be vaccinated, and vaccination and distribution continues.”

2006 recommendations

The 2006 influenza season is seeing a few changes. A new group of children is included in routine recommendations: the 24- to 59-month-old age group. Last year’s recommendation included children aged between 6 and 23 months.

“The basis for this recommendation, which took place in February of this year, was the increased risk for clinic and emergency department visits among these 24- to 59-month-old children,” Santoli said.

A second, longstanding recommendation whose importance is emphasized this year is that children less than 9 years of age who receive influenza vaccine for the first time should get a second inoculation at least one month later.

It is also recommended that at-risk children older than 2 years, especially those with chronic lung illness, or children of any age with chronic conditions, should receive the polysaccharide pneumococcal vaccine to prevent pneumonia. The vaccination is appropriate at this time of year and can be administered at the same time as the influenza vaccine, according to William Plested, III, MD, president of the American Medical Association, who spoke at a National Foundation for Infectious Diseases press conference held in early October. The pneumococcal vaccine is a single vaccination that does not need to be repeated each year.

Potential issues this season

Vaccine supply for 3-year-olds may be limited. There are only two licensed products by one manufacturer for this age group and most of these products were reserved by the time the new recommendation was made, according to Santoli.

“We do anticipate providers trying to order more vaccine because of the new recommendation [6- to 59-month-olds] and having had difficulty finding vaccine that they could use in a 3-year-old,” Santoli said. “So in June, we issued some guidance to help pediatric providers who don’t have sufficient vaccine to reach all of their 6- to 59-month-old patients.”

As a result, the CDC recommended that the focus of vaccination be on 6 to 23-month-old children because of higher risks for hospitalization in that age group.

Also, providers who see both children and adults may find it difficult to equally distribute doses. “We want to set realistic expectations because when people’s expectations aren’t met, they get frustrated,” Santoli said. “We don’t want to deter the public from seeking vaccination. Last year we talked about delay because that’s what we were seeing, but that use of the term ‘delay’ may have led some of the public to say, ‘Oh, I need to step aside because there’s not enough vaccine,’ and then that exacerbated the issue that we have vaccine available later in the seasons but we don’t necessarily have people lined up to get the vaccine then.”

Maximizing what is available

Four manufacturers produce seasonal influenza vaccine and the FDA is currently trying to bring more doses into the country, possibly even resulting in a fifth manufacturer, according to Julie Gerberding, MD, MPH, director of the CDC, at the NFID press conference.

Grandparents, school-aged children in kindergarten through eighth grade at-risk for transmitting the virus and health care workers are being targeted this year to stress the importance of proper education and adherence to influenza vaccine recommendations, in part by the National Influenza Vaccine Summit.

Recommendations and proper education still stand to get parents, or caregivers, and close household contacts of young children, especially those at risk, vaccination.

Katherine Poehling, MD, MPH, Vanderbilt University Medical Center, talked about a few other strategies to get at-risk populations vaccinated at the 2006 American Academy of Pediatrics National Conference and Exhibition. She suggested standing orders and reminding everyone in the practice or office to talk about influenza with patients and parents. Poehling cited a clinic that attempts to remind each patient of influenza immunization three times. For example, at the desk when the patient arrives, in the examination room when directed there by a nurse and then again when the physician walks in. After hearing it three times, it becomes hard to resist, Poehling said.

Another strategy she suggested was the recall-reminder system. Letters, postcards and telephone calls are all equally efficacious, although postcards are the least expensive. The recall-reminder system has been shown to increase vaccination rates 17% to 27% and have been effective in both academic and private practice settings.

Other recommendations: continuous education throughout the year, postcard invitations to influenza shot parties and drop-in vaccinations.

“We’re working hard this year to get anyone who wants a flu shot to get a flu shot,” Gerberding said. “Vaccination is here, the time is now.”

About influenza

Influenza is not always easy to diagnose in infants.

Typical symptoms present in adults are not always present in infants, so the symptoms won’t always be the same, according to Julia McMillan, MD, with the Committee on Infectious Diseases, American Academy of Pediatrics and professor of pediatrics at Johns Hopkins University School of Medicine, who also spoke at the NFID flu press conference.

The influenza virus appears in the United States every year and circulates the country for about three months. During these months, approximately four to five of every 1,000 infants younger than 6 months and one in every 1,000 infants older than 6 months will be hospitalized. Five of every 1,000 children will visit a clinical office or emergency department because of influenza-related illness and the younger the child, the more likely the parents to seek medical attention, according to McMillan.

“Many parents rely on their children’s pediatricians to help make health care recommendations, including on immunization,” McMillan said. “It is important that providers inform parents that influenza infection can be serious for a child with chronic illness and that the best way to prevent infection is through an annual vaccination.”

For more information:

• Santoli J. Seasonal influenza vaccine update. Presented at: National Vaccine Advisory Committee Meeting; Sept. 26-27, 2006; Washington, D.C.
• Poehling K. Influenza burden, diagnosis, treatment and prevention in children. Presented at: American Academy of Pediatrics National Conference and Exhibition; Oct. 7-10, 2006; Atlanta.