Updated Recommendations for Flu Vaccination

As the calendar advances to the fall months, we are reminded everywhere that it’s time for the annual influenza vaccination. In August 2011, the Advisory Committee on Immunization Practices (ACIP) updated its vaccination recommendations to include new guidelines for children ages 6 months through 8 years, and for persons with egg allergy.

Here are some highlights from their report, published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (Prevention and control of influenza with vaccines: recommendations from the Advisory Committee on Immunization Practices. MMWR. 2011;60:1128-1132. Also online at www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm) 

Influenza strains: The 2011-2012 influenza virus strains remain unchanged from those in the 2010-2011 vaccine. The current “cocktail” contains A/California/7/2009 (H1N1)-, A/Perth/16/2009 (H3N2)-, and B/Brisbane/60/2008-like antigens.

Who should get vaccinated: Because vaccine efficacy and antibody titers both decline in the year following vaccination, the CDC recommends an annual flu shot for everybody 6 months and older. Ideally, patients should be vaccinated as soon in the year as vaccine becomes available.

Recommendations for children ages 6 months through 8 years:  For best response, children who are being immunized for the first time should receive 2 doses of vaccine, 4 or more weeks apart.

Previously, children in this age group who received a single dose of initial vaccine required 2 doses the next season. However, since the vaccine is unchanged from last year, children who have received at least a single dose of the 2010-2011 vaccine will only need 1 dose of the 2011-2012 preparation. If the child’s vaccination history is nil or unknown, plan to give the 2 doses of the 2011-2012 vaccine.

Recommendations for persons with egg allergy: Most vaccine manufacturers list egg allergy as a contraindication to vaccination. However, several studies show trivalent inactivated vaccine (TIV) to be safe in patients with egg allergy, and some TIV product package inserts list severe egg allergy (anaphylaxis) as the only contraindication to vaccination. Keep in mind that various commercial vaccine preparations vary with respect to the quantity of egg protein present. Up to 1.4 ug/mL (0.7 ug/0.5 mL dose) appears to be safe and well tolerated. Package inserts are not required to list the ovalbumin concentration of the vaccine; if in doubt, ask the manufacturer.

ACIP advises the following:
• For children and adults who are mildly allergic (reaction limited to hives) to eggs, give TIV, rather than live attenuated influenza vaccine (LAIV), preparations. The patient should be observed for 30 minutes after vaccination for signs of egg allergy.
• Children and adults with severe allergic reactions (angioedema, respiratory distress, emesis, etc) or who have required epinephrine(Drug information on epinephrine) after egg exposure and who are at risk for anaphylaxis should be referred to/evaluated by someone experienced in handling severe allergy, as a preliminary to vaccination. 
• The patient should receive the vaccine in an office equipped to handle anaphylaxis.
• Any history of anaphylaxis in response to the influenza vaccine contraindicates future vaccinations.

Available vaccines:
The Table summarizes the range of commercially available influenza vaccines to choose from.

Table. Flu vaccine choices

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