CDC Advisory Committee Recommends Universal Influenza Vaccination

February 24, 2010

February 24, 2010 — All adults should receive an annual influenza vaccine beginning next flu season (2010-2011), a federal panel of immunization experts said today. The recommendation is a major change from existing guidelines for seasonal influenza vaccination, which include only certain groups.

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to expand its influenza vaccination recommendations to all people aged 6 months and older, including healthy adults younger than 50 years, a decision that drew applause during the meeting in Atlanta, Georgia.

Until now, ACIP recommendations for seasonal influenza vaccination focused on people between the ages of 6 months and 18 years and those aged 50 years and older, those at increased risk for complications from the illness, and anyone in close contact with higher-risk individuals. The committee had a permissive recommendation for all others, meaning they could receive the vaccine if they wanted it.

As a result of today's decision, physicians this fall will begin to offer the influenza vaccine to everyone older than 6 months unless contraindicated.

Simplified System

A benefit for physicians of offering universal vaccination is they will not need to remember or consult a list of priority groups that should receive vaccination if there is a shortage of vaccine supplies.

"This will be much simpler. We don't have to figure out who should get the vaccine," said American College of Physicians (ACP) representative Sandra Fryhofer, MD, speaking for Gregory Poland, MD, ACP's liaison representative to ACIP.

Another major reason cited for the change in recommendations is that the pandemic H1N1 influenza virus has been more severe in people aged 19 to 49 years than in older adults. The 2010-2011 seasonal influenza vaccine is expected to include a strain of the H1N1 virus, as recommended by both a US Food and Drug Administration (FDA) advisory panel and the World Health Organization within the past week.

In addition, new data show that some people who are not in a higher-risk group may still be at increased risk for flu-related complications, such as obese people and postpartum women, a CDC press release noted.

An attendee speaking in favor of expanding vaccination recommendations suggested another possible advantage. Stephen Allred, clinical director of the Web site www.getaflushot.com, said, "If we have universal recommendations, we may be able to influence insurance coverage [of vaccine cost]."

Potential for Vaccine Shortages

Some members of the ACIP work group on influenza vaccines, however, raised concerns that vaccine supply would not meet the increased demand of universal vaccination, ACIP member Susan Lett, MD, MPH, medical director of the immunization program at the Massachusetts Department of Health, Jamaica Plain, told the committee.

In reply, others present said that vaccine manufacturers have advance notice to make more vaccine and that more licensed brands of seasonal influenza vaccine will be available by the next flu season. Also, the increased number of adults who will receive the vaccine is only 10% to 15% of the population, some of the experts there estimated.

An option proposed by the work group was to phase in the universal vaccination, with completion in 2012. However, Work Group Chair Kathy Neuzil, MD, MPH, opposed this option.

"I don't believe that waiting until 2012 will solve our adult immunization problem," Dr. Neuzil said. She is an associate professor of medicine in the Division of Allergy and Infectious Diseases at the University of Washington, Seattle.

Typically, less than 50% of people who should get the seasonal influenza vaccine actually get it, according to CDC data. Some patients are unaware that they are in higher-risk groups, which include pregnant women, those with chronic medical diseases such as asthma and diabetes, and immune-suppressed individuals.

Before the vote, ACIP Chair Carol Baker, MD, professor of pediatrics and infectious diseases at Baylor College of Medicine in Houston, Texas, stressed the need to increase the number of people being vaccinated for influenza. "No matter what we do, we should enhance communicating with the public," she said.

The ACIP recommendation will become an official CDC recommendation once the CDC director and the US secretary of health and human services accept it.

Meeting of the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention, Atlanta, Georgia. February 24, 2010.

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