1. 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

2. 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 ACIP Influenza Statement:
Vaccine virus strains for
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

3. Vaccine Components
Vaccine virus strains same as those in the 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.

4. Intradermal Influenza Vaccine
A new intradermally-administered TIV, Fluzone Intradermal® (sanofi pasteur) licensed in May 2011
Indicated for persons aged 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

5. Influenza Vaccine Dosing for Children 6 Months Through 8 Years of Age
Did the child receive ≥1 dose of the 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

6. 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

7. 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