Prevention and Control of Influenza, Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Nicole M. Smith, PhD; Joseph S. Bresee, MD; David K. Shay, MD; Timothy M. Uyeki, MD; Nancy J. Cox, PhD; Raymond A. Strikas, MD


Morbidity and Mortality Weekly Report. 2006;55(27):1-41. 

In This Article

Summary and Introduction

This report updates the 2005 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2005;54[No. RR-8]:1-44). The 2006 recommendations include new and updated information. Principal changes include 1) recommending vaccination of children aged 24-59 months and their household contacts and out-of-home caregivers against influenza; 2) highlighting the importance of administering 2 doses of influenza vaccine for children aged 6 months-<9 years who were previously unvaccinated; 3) advising health-care providers, those planning organized campaigns, and state and local public health agencies to a) develop plans for expanding outreach and infrastructure to vaccinate more persons than the previous year and b) develop contingency plans for the timing and prioritization of administering influenza vaccine, if the supply of vaccine is delayed and/or reduced; 4) reminding providers that they should routinely offer influenza vaccine to patients throughout the influenza season; 5) recommending that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in the United States until evidence of susceptibility to these antiviral medications has been re-established among circulating influenza A viruses; and 6) using the 2006-07 trivalent influenza vaccine virus strains: A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. For the A/Wisconsin/67/2005 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus; for the B/Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus. A link to this report and other information can be accessed at

In the United States, epidemics of influenza typically occur during the winter months and have been associated with an average of approximately 36,000 deaths per year in the United States during 1990-1999.[1] Influenza viruses cause disease among all age groups.[2,3,4] Rates of infection are highest among children, but rates of serious illness and death are highest among persons aged ≥65 years, children aged <2 years, and persons of any age who have medical conditions that place them at increased risk for complications from influenza.[2,5,6,7]

Influenza vaccination is the primary method for preventing influenza and its severe complications. As indicated in this report from the Advisory Committee on Immunization Practices (ACIP), annual influenza vaccination is now recommended for the following groups ( Box ):

  • persons at high risk for influenza-related complications and severe disease, including
    - children aged 6-59 months,
    - pregnant women,
    - persons aged ≥50 years,
    - persons of any age with certain chronic medical conditions; and

  • persons who live with or care for persons at high risk, including
    - household contacts who have frequent contact with persons at high risk and who can transmit influenza to those persons at high risk and
    - health-care workers.

Vaccination might prevent hospitalization and death among persons at high risk and might also reduce influenza-related respiratory illnesses and physician visits among all age groups, prevent otitis media among children, and decrease work absenteeism among adults.[8,9,10,11,12,13,14,15,16,17,18] Although influenza vaccination levels increased substantially during the 1990s, further improvements in vaccination coverage levels are needed, especially among persons aged <65 years with known risk factors for influenza complications; among blacks and Hispanics aged ≥65 years; among children aged 6-23 months; and among health-care workers. ACIP recommends using strategies to improve vaccination levels, including using reminder/recall systems and standing orders programs.[19,20,21,22] Although influenza vaccination remains the cornerstone for the control of influenza, information on antiviral medications also is presented in this report because these agents are an important adjunct to vaccine.


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