ATLANTA — The recommended target groups for annual influenza immunization have finally been broadened to include virtually the entire U.S. population.
Starting with the 2010-2011 season, universal immunization against influenza for everyone aged 6 months and older has the backing of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
The committee voted unanimously (with one member abstaining) to recommend annual influenza immunization for people aged 19-49 years who had not already been targeted in previous recommendations. The new group comprises 15% of the U.S. population aged 6 months and older. About 50% of 19- to 49-year-olds already had indications for immunization, including individuals with chronic medical conditions, pregnant women, health care workers, and household contacts of high-risk individuals.
Despite previous recommendations aimed at expanded immunization of adults, “coverage among 19- to 49-year-olds has been low regardless of indication for vaccination,” said Dr. Anthony Fiore of the CDC's National Center for Immunization and Respiratory Diseases.
Atlanta internist Sandra Fryhofer, American College of Physicians liasion to the ACIP, enthusiastically endorsed the move. “This is really exciting. It's about time, and it makes giving flu vaccines in the office much simpler. You won't have to wade through risk factors. The only decision will be whether you give a shot—the inactivated vaccine—or the live vaccine,” she said in an interview.
Dr. Doug Campos-Outcalt, liaison to the ACIP from the American Academy of Family Physicians, expressed similar support. “We polled our members, and a very large majority is in favor of just a uniform [recommendation] because it will be so much easier to remember. The implementation with that 15% is not going to be a huge challenge,” particularly with vaccination available at pharmacies and other alternative sites.
He added that the move should not overshadow the need to target health care workers specifically for influenza immunization. “All professional organizations need to work on that,” said Dr. Campos-Outcalt, of the department of family and community medicine at the University of Arizona, Phoenix.
The ACIP vote was made amidst a confluence of factors, most notably the 2009 influenza A(H1N1) pandemic. About 90% of hospitalizations and deaths caused by the pandemic strain occurred among individuals younger than 65 years, many of them adults aged 19-49 years. It's likely that 2009 H1N1–like viruses will continue circulating in 2010-2011, and it's unknown what proportion of healthy adults now have immunity, Dr. Fiore said.
Adults aged 19-24 years had been among the targeted priority groups for the 2009 H1N1 monovalent vaccine. Obesity, which affects 28% of U.S. adults, was identified as a new independent risk factor for severe illness with the 2009 H1N1 strain, he noted.
The composition of the northern hemisphere's 2010-2011 seasonal influenza vaccine, which was announced at a recent Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee meeting, will contain the same H1N1 virus used in the 2009 H1N1 monovalent vaccine.
Two newly licensed influenza vaccines and expanded age indications for two others should help ensure an adequate supply. These include Agriflu (Novartis) for adults 18 years and older and Fluzone High-Dose (Sanofi-Pasteur) for those aged 65 years and older. (See related story at right.) CSL's Afluria indication has been expanded to include people aged 6 months and older, and GlaxoSmithKline's Fluarix is now licensed for those aged 36 months and older, Dr. Fiore said.
“It's just exciting to have new things happening in flu,” Dr. Fryhofer said. “This is a deadly disease that kills 36,000 people a year. It's great that now we have a uniform indication to get people protected, and that we have more things to protect them with and more companies making them, so hopefully we won't have more shortages and delays like we've had in the past.”
Disclosures: Dr. Fiore and Dr. Fryhofer had no financial disclosures. Dr. Campos-Outcalt has given vaccine talks for the France Foundation, an independent medical education company that receives grants from various sources.
Healthy adults aged 19-49 years should receive the influenza vaccination annually, according to new recommendations.
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This Month's Talk Back Question
How will your practice respond to the endorsement of universal influenza immunization?