CDC's universal flu vaccination policy garners support from AAP

The American Academy of Pediatrics is urging physicians to adhere to the Centers for Disease Control and Prevention's universal influenza recommendations in its latest policy statement.

The statement, printed online Aug. 30 in Pediatrics, encourages doctors to follow the CDC's guidance and immunize all patients 6 months and older against the flu, rather than concentrate on those in high-risk groups. The goal is to reduce transmission of influenza this flu season.

"Previous recommendations were really based on the principle of trying to target these [high-risk] groups," said Michael T. Brady, MD, chair of the AAP Committee on Infectious Diseases, which wrote the policy statement. "The new recommendations, which go for universal vaccination, is a response to the fact that just targeting people hasn't necessarily resulted in adequate protection in the U.S."

However, the guidelines tell physicians to pay particular attention to children at high risk of influenza complications. Those at risk include children with asthma, diabetes, immunosuppression, morbid obesity and neurologic disorders, among other conditions.

"We want to make sure those more likely to get severe disease are a top priority and always on [physicians'] minds," Dr. Brady said.

The statement recommends that doctors make flu vaccines easily accessible by extending office hours during peak vaccination periods, creating walk-in flu clinics and collaborating with institutions, such as schools and churches, to immunize community members. The AAP also suggests that pediatricians vaccinate the parents of children who are too young to be immunized against the flu (link).

New this season is the inclusion of a pandemic 2009 influenza A(H1N1) virus in the 2010-11 seasonal influenza vaccine. The flu vaccine will include an A/Perth/16/2009 (H3N2)-like virus and a B/Brisbane/60/2008-like virus. Manufacturers began shipping the vaccine to health care professionals in late July. Projections show about 170 million seasonal flu vaccine doses will be produced.

The AAP recommends that physicians begin administering the vaccine to patients and staff as soon as it is available. The typical flu season lasts from October through April.

Children 9 and older need one dose of this year's trivalent influenza vaccine, according to CDC recommendations, which the AAP encourages physicians to follow. The number of doses required for children younger than 9 depends, in part, on their flu vaccination history.

Children younger than 9 who receive the trivalent seasonal flu vaccine for the first time this year need two doses of the immunization. Physicians should administer the second dose at least four weeks after the first.

Two doses should be administered to children in this age group if:

• They did not receive at least one dose of the monovalent H1N1 vaccine.
• They received the trivalent flu vaccine for the first time in the 2009-10 season, but got only one dose.
• They received an influenza vaccine in the 2009-10 season, but it is unclear if it was a seasonal or monovalent H1N1 immunization.

Physicians should administer a single dose of the trivalent vaccine to children younger than 9 who were immunized against seasonal influenza before the 2009-10 flu season and received at least one dose of the H1N1 monovalent immunization.