Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
New Seasonal Influenza Vaccine Recommendations
MMWR; ePub 2016 Aug 26; Grohskopf, Sokolow, et al
The Advisory Committee on Immunization Practices (ACIP) has issued its updated recommendations regarding the use of seasonal influenza vaccines, with routine annual influenza vaccination recommended for all persons ≥6 months who do not have contraindications. Other primary changes and updates in the recommendations include:
• In light of low effectiveness against influenza A(H1N1)pdm09 in the US during the 2013–14 and 2015–16 seasons, for the 2016–17 season, ACIP makes the interim recommendation that LAIV4 (Live Nasal Flu Vaccine) should not be used.
• 2016–17 US trivalent influenza vaccines will contain an A/California/7/2009 (H1N1)–like virus, an A/Hong Kong/4801/2014 (H3N2)–like virus and a B/Brisbane/60/2008–like virus (Victoria lineage). Quadrivalent vaccines will include an additional vaccine virus strain, a B/Phuket/3073/2013–like virus (Yamagata lineage).
• Recent new vaccine licensures include:
◊ An MF59-adjuvanted trivalent inactivated influenza vaccine (aIIV3), Fluad (Seqirus, Holly Springs, NC), was licensed by FDA in November 2015 for persons aged ≥65 years. aIIV3 is an acceptable alternative to other vaccines licensed for persons in this age group. ACIP and CDC do not express a preference for any particular vaccine product.
◊ A quadrivalent formulation of Flucelvax (cell culture-based inactivated influenza vaccine [ccIIV4], Seqirus, Holly Springs, NC) was licensed by FDA in May 2016, for persons aged ≥4 years. ccIIV4 is an acceptable alternative to other vaccines licensed for persons in this age group. No preference is expressed for any particular vaccine product.
• Recommendations for influenza vaccination of persons with egg allergy have been modified, including:
◊ A recommendation that persons with a history of severe allergic reaction to egg (ie, any symptom other than hives) should be vaccinated in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.
Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines. MMWR Recomm Rep. 2016;65(No. RR-5):1–54. doi:10.15585/mmwr.rr6505a1.
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USPSTF: Interventions to Avert Perinatal Depression, JAMA; 2019 Feb 12; US Preventive Services Task Force
PERT alerts improve pulmonary embolism outcomes, Benninghoff M. Critical Care Congress 2019, Abstract 490
ACIP Updates Adult Immunization Schedule, Ann Intern Med; 2019 Feb 5; Kim, Hunter, et al
USPSTF: Interventions to Prevent Child Maltreatment, JAMA; 2018 Nov 27; US Preventive Services Task Force
Cholesterol Guidelines Stress Lifetime Approach, Circulation; ePub 2018 Nov 10; Grundy, et al
While most people who develop influenza infections do well and recover without problems, influenza remains an important cause of hospitalization and death among older adults, young children, pregnant women, and those with chronic medical conditions, including chronic cardiovascular and pulmonary diseases, and obesity. Duration of immunity from influenza vaccine lasts at least 6 to 8 months with inconsistent data about whether there is waning of immunity after 6 months. There is no recommendation to wait for administration of vaccine once the vaccine is available, and the current recommendation is to offer the vaccine by the end of October. While there is no official preference for one influenza vaccine over another, it is worth noting that high dose flu vaccine, which contains 4 times the amount of antigen than standard dose flu vaccine, has superior immunogenicity compared with standard-dose vaccine in individuals aged >65 years. —Neil Skolnik, MD