ACIP Recommendations Update for the 2011-2012 U.S. Influenza Season Lisa Grohskopf, MD, MPH Influenza Division Centers for Disease Control and Prevention National Public Health Information Coalition (NPHIC) Call August 11, 2011 National Center for Immunization & Respiratory Diseases Influenza Division

Objectives Provide a summary of influenza vaccine guidance approved by the Advisory Committee on Immunization Practices (ACIP) at the June, 2011 ACIP meeting Topics discussed in the 2011-2012 ACIP Influenza Statement: Vaccine virus strains for 2011-2012 Newly approved intradermal TIV preparation Vaccine dosing for children 6 months through 8 years of age Influenza vaccine for persons with egg allergies *TIV= trivalent inactivated vaccine

2011-2012 Vaccine Components Vaccine virus strains same as those in the 2010-2011 vaccine: A/California/7/2009 (H1N1)-like A/Perth/16/2009 (H3N2)-like B/Brisbane/60/2008-like Since protection from vaccine has been shown to decline over time, annual vaccination is recommended for optimum protection against influenza, even in seasons in which vaccine virus strains do not change.

Intradermal Influenza Vaccine A new intradermally-administered TIV, Fluzone Intradermal® (sanofi pasteur) licensed in May 2011 Indicated for persons aged 18-64 years Contains less antigen than regular intramuscular TIV preparations (9 mcg per strain instead of 15 mcg), but similarly effective in inducing immune response Administered intradermally via a single-dose, prefilled microinjection syringe Smaller volume than other TIV preparations Is an alternative to other seasonal vaccines for the indicated age group No preferential recommendation *TIV= trivalent inactivated vaccine

Influenza Vaccine Dosing for Children 6 Months Through 8 Years of Age Did the child receive ≥1 dose of the 2010-2011 seasonal influenza vaccine? Administer 2 doses this season* No/Not Sure Administer 1 dose this season Yes *Doses should be administered a minimum of 4 weeks apart

Influenza Vaccination of Persons with Egg Allergies All currently available influenza vaccines are produced in chickens’ eggs Final vaccine product contains a small amount of residual egg protein, posing some risk of allergic reaction in susceptible individuals Influenza vaccine package inserts in the past have included “hypersensitivity” to egg as a contraindication of receipt of vaccine Relatively general term including reactions of all severities However, several studies of use of TIV indicate that egg-allergic persons with a history of less severe reactions to egg (hives) can receive vaccine safely

Influenza Vaccination of Persons with Egg Allergies Individuals who have experienced only hives following exposure to egg should receive influenza vaccine with the following additional measures: As studies published to date involved use of TIV, TIV rather than LAIV should be used; Vaccine should be administered by a healthcare provider who is familiar with the potential manifestations of egg allergy; and Vaccine recipients should be observed for at least 30 minutes for signs of a reaction following administration of each vaccine dose Those with more severe reactions to egg (e.g., anaphylaxis) should receive further risk assessment from a clinician with expertise in management of allergic conditions before receipt of vaccine All vaccines should be administered in settings where personnel and equipment needed for rapid recognition and treatment of anaphylaxis are available