CDC Expert Commentary

It's a First: Universal Flu Vaccination

Daniel B. Jernigan, MD, MPH

Disclosures

November 22, 2010

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Hello, I'm Dr. Dan Jernigan. I'm Associate Deputy Director of Center for Disease Control's (CDC's) Influenza Division. I'm happy to speak with you today as part of the CDC Expert Video Commentary Series on Medscape Today, I want to talk to you about influenza vaccination during the 2010-2011 season.

Last season, the world went through the first influenza pandemic in more than 40 years. And while the pandemic was less severe than many feared, millions of people in the United States became ill, hundreds of thousands were hospitalized, and thousands of people died.

This season, the Advisory Committee on Immunization Practices (ACIP) and CDC have recommended universal influenza vaccination. This means that all persons, 6 months and older (without a contraindication to influenza vaccine) should be vaccinated. The recommendation seeks to remove barriers to immunization and signals the importance of preventing influenza across the entire population. It will ensure that the following important populations will get vaccinated:

  • Healthy people 19-49 years of age. These people were not recommended for vaccination in previous influenza seasons, but they were unusually affected by the 2009 H1N1 pandemic;

  • People in previously recommended "high-risk" groups who are unaware that they have 1 or more risk factors; and

  • People who did not have a previous specific recommendation for vaccination but who are now identified as being at higher risk for serious flu-related complications.

The universal recommendation recognizes the practicality and value of issuing a simple and clear message regarding the importance of influenza vaccination in the hopes of removing impediments to vaccination and expanding coverage. It will help ensure that everyone knows that they should receive an influenza vaccine.

While the vaccination recommendation is universal this season, it continues to be especially important that people at increased risk for serious flu complications get a flu vaccine.

Studies conducted during the pandemic demonstrated that the groups already known to be at increased risk for influenza complications were also at greater risk for serious 2009 H1N1-related complications, including:

  • People 65 and older;

  • Children younger than 5, but especially children younger than 2 years old;

  • Pregnant women; and

  • People with certain medical conditions, including asthma, diabetes, and heart disease.

For example, pregnant women had a disproportionally high risk for mortality due to 2009 H1N1. They were 6 times more likely to die from 2009 H1N1 than other people.

Children also were at high risk. More flu-related pediatric illness and death were reported during the 2009 H1N1 pandemic than in any previous flu season. Infants had the highest rates of hospitalization, emphasizing how important it is that close contacts of children younger than 6 months (who are too young to receive the flu vaccine) be vaccinated. This season, many children will need to have 2 doses of the 2010-2011 flu vaccine to be fully protected.

In addition, data collected during the pandemic led to the establishment of new ACIP high-risk groups for influenza complications, including the following:

  • American Indians and Alaska Natives; and

  • Persons who are morbidly obese.

American Indians and Alaska Natives were demonstrated to have a higher risk for death from 2009 H1N1 influenza than people in other racial/ethnic populations. They have been added to the ACIP list of people prioritized for receipt of influenza vaccination because of their high-risk status.

Also during the pandemic, morbid obesity in adults, defined as a body mass index (BMI) of 40 or more, was shown to be a risk factor specific to the 2009 H1N1 influenza virus. People who are morbidly obese also were added to the ACIP list of people prioritized for receipt of influenza vaccination because of their high-risk status.

Providers should begin administering influenza vaccine to their patients when the vaccine becomes available and continue vaccinating into the winter and beyond.

For additional information about influenza vaccination during the 2010-2011 season, please visit www.cdc.gov/flu.

Daniel B. Jernigan, MD, MPH, is a Captain in the United States Public Health Service and serves as the Deputy Director of the Influenza Division in the National Center for Immunization and Respiratory Diseases at CDC. The Influenza Division is responsible for national surveillance of influenza and serves as 1 of 4 World Health Organization Collaborating Centers for Control of Influenza. The Division provides epidemiologic and laboratory leadership in various research, investigative, and preparedness activities for seasonal, avian, and pandemic influenza.

Dr. Jernigan completed his undergraduate degree at Duke University, his Doctor of Medicine from Baylor College of Medicine, and his Master of Public Health from the University of Texas. He is board-certified in internal medicine and has completed an additional residency in preventive medicine. Dr. Jernigan joined the CDC's Epidemic Intelligence Service in 1994 working in the Respiratory Diseases Branch, and has remained with the Coordinating Center for Infectious Diseases since that time.

Dr. Jernigan is active in the field of infectious diseases epidemiology and response. He has published peer-reviewed articles and book chapters on various emerging infectious disease topics and has supervised outbreak investigations of viral, bacterial, and fungal infections associated with emerging and antibiotic-resistant pathogens. These findings led to improvements in disease detection and infection control. He has led epidemiology and surveillance teams for national and international responses, including bioterrorism-related anthrax, West Nile virus, SARS, the 2009 H1N1 influenza pandemic, and public health management following natural disasters. During the 2009 H1N1 pandemic, Dr. Jernigan provided vital leadership to teams of experts dedicated to domestic and international disease surveillance, and laboratory issues including diagnostics, immunology, antiviral surveillance, and zoonosis.

In his current role as Deputy Director of the Influenza Division, Dr. Jernigan serves as Senior Medical Officer, and Senior Public Health Service Officer for the Influenza Division. He is responsible for oversight and direction of 235 staff members with primary supervision of budget, communications, policy, preparedness, and program support. He serves as project officer for research and development of new influenza diagnostic tests and serves as a principle investigator for influenza research and public health evaluation activities.

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