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From the Department of State Health Services Immunization Branch
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October 3, 2008
The 2008-2009 Influenza Season – Updated Recommendations for the Prevention and Control of Influenza
The goal of the Vaccine Advisory is to disseminate, in a timely manner, practical information related to vaccines, vaccine-preventable diseases, and the vaccine programs managed by the Immunization Branch.The Immunization Branch welcomes readers’ input to improve the contents of this document.
The Vaccine Advisory in now available online! To view past issues, go to: www.dshs.state.tx.us/immunize/vacadvise/
Hurricane Response Immunization Recommendations
- Tetanus: Per current CDC guidelines, responders should receive a tetanus booster if they have not been vaccinated for tetanus during the past 10 years. Td (tetanus/diphtheria) or Tdap (tetanus/diphtheria/pertussis) can be used.
- Hepatitis B: Hepatitis B vaccine series is recommended for persons who will be performing direct patient care or otherwise expected to have contact with bodily fluids.
- Influenza (flu): Influenza vaccine is recommended for hurricane evacuees and responders. A flu outbreak in an area affected by a hurricane could pose an increased threat to the general public.
This advisory presents new and updated recommendations for the prevention and control of influenza. It updates the 2007 recommendations by CDC’s Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents. Principal updates and changes include a new recommendation that annual vaccination be administered to all children 6 months through age 18 years beginning in the 2008-2009 season. Previously, the recommendation had been for all children age 6 months through 59 months of age.
This advisory contains:
- Advisory Committee on Immunization Practices new recommendations for use of influenza
- Texas Vaccines for Children Program
- Texas school and child-care facilities requirements for influenza vaccine
- Texas surveillance update
- Reporting vaccine adverse events
- Additional Resources
1) ACIP new and updated recommendations for use of influenza
On February 27, 2008, the ACIP made new recommendations to expand the recommended ages for annual influenza vaccination of children to include all children from 6 months through 18 years of age. The previous recommendation was for vaccination of children 6 months to 59 months of age and children at higher risk for influenza complication.
On August 8, 2008, the new and updated recommendations were published in the Morbidity and Mortality Weekly Report (MMWR). It can be found at www.cdc.gov/mmwr/preview/mmwrhtml/rr5707a1.htm.
Recommendations for the 2008 influenza season include:
- Annual vaccination for all children aged 6 months through 18 years is recommended.
- Annual vaccination of children aged 6 months through 4 years (59 months) and older children with conditions that place them at increased risk for complications from influenza should continue. Children and adolescents at high risk for influenza complications should continue to be a focus of vaccination efforts as providers and programs transition to routinely vaccinating all children. Recommendations for these children have not changed and can be found at [link no longer active. Please see CDC ACIP home page.]
- A new recommendation that annual vaccination be administered to all children aged 5-18 years, beginning in the 2008-2009 influenza season, if feasible, but no later than the 2009-2010 influenza season.
- Children aged 6 months through 8 years should receive two doses of influenza vaccine (doses separated by 4 or more weeks) if they have not been vaccinated previously at any time with at least one dose of either LAIV or TIV.
- A child who needed TWO doses of influenza vaccine but only received one should receive TWO doses the next (chronologic) year.
- If one or more years elapse after the first vaccination year, then only ONE dose should be administered annually.
- Guidance for screening for wheezing in potential LAIV recipients 2-4 years of age can be found at www.cdc.gov/mmwr/preview/mmwrhtml/mm5646a4.htm.
- Either trivalent inactivated influenza vaccine (TIV) or live, attenuated influenza vaccine (LAIV) can be used when vaccinating healthy persons aged 2-49 years (the previous recommendation was to administer LAIV to persons aged 5-49 years;
- Persons at higher risk of influenza complications because of underlying medical conditions, children aged 6 months through 23 months, and persons aged >49 years should receive TIV.
- The 2008-2009 trivalent vaccine virus strains are A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Florida/4/2006-like antigens.
- Annual recommendations for adults for 2008 have not changed and can be found at [link no longer active. Please see CDC ACIP home page.]
- The antiviral medications recommended for treatment of influenza (oseltamivir or zanamivir) have not changed for the 2008-2009 influenza season and can be found at www.cdc.gov/mmwr/preview/mmwrhtml/rr5606a1.htm.
2) Texas Vaccines for Children Program
TVFC-supplied influenza vaccine is reserved for children 6 months to 18 years of age. The DSHS has received a portion of the TVFC vaccine, and orders have been placed with McKesson and will begin shipping the week of September 29th. Providers should not place additional vaccine orders until they have received all of their initial order. The vaccines for the initial orders will be arriving in phases through the end of October.
After providers have received their full orders and additional vaccine is needed, DSHS will accept and fill orders throughout the influenza season. Please remember that flu vaccination is now routinely recommended and should be given simultaneously with other recommended vaccines.
If you have questions regarding the influenza vaccine or ordering process, please call your LHD, HSR, or TVFC Consultant.
ImmTrac users may use the code “Influenza” to report administration of the flu vaccine to children under 18 years of age. Although ImmTrac will record the administration of flu vaccine, the ImmTrac immunization scheduler will not currently generate recommendations for flu vaccine. For more information about ImmTrac, go to: www.immtrac.com.
4) Texas school and child-care facilities requirements for influenza vaccine
Currently, the influenza vaccine is not required for school or day-care attendance. Legislation was passed in 2007 authorizing DSHS to increase immunization awareness and participation in the state’s early childhood vaccination program. DSHS is publishing information on its website to educate parents about the benefits of annual vaccinations against influenza. The DSHS Immunization Branch has developed a Flu Fact Sheet for Child-Care Settings; and, together with the Department of Family & Protective Services (DFPS) distributes the fact sheet annually to parents of children attending child-care facilities each August or September. Information on the immunization requirements for children attending child-care facilities, flu information targeting children, and the recommended immunizations can be found at www.dshs.state.tx.us/immunize/school/default.shtm.
5) Texas surveillance update
The official reporting period for the 2008-2009 influenza season begins October 1, 2008. The State of Texas utilizes a sentinel surveillance system for influenza. Activity is determined based on data from multiple sources, including reports of influenza-like illness from clinical practitioners who participate in the Sentinel Provider Surveillance Network (SPSN), specimens submitted to the DSHS laboratory for viral culture, and outbreak reports from hospitals, longterm care facilities, and schools. For more information on SPSN please visit: www.dshs.state.tx.us/idcu/disease/influenza/surveillance/ILINet/. If you are interested in participating in the SPSN, please contact Irene Brown, SPSN coordinator at (512) 458-7676.
Flu Activity Reports are posted at www.dshs.state.tx.us/idcu/disease/influenza/surveillance/.
For more information about flu, please visit the following website: www.dshs.state.tx.us/idcu/disease/influenza/.
An influenza-associated death in all persons 18 years of age and less is a reportable condition in Texas.
6) Reporting adverse vaccine events
Clinically significant adverse events following vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS).
Adverse events from privately purchased vaccine may be reported directly to VAERS at http://vaers.hhs.gov/. Secure web-based reporting is available on the VAERS website. Contact 800-VAC-RXNS for forms and information.
In Texas, reports of events following vaccination at public health clinics or with vaccine provided through public funding such as the Texas Vaccines for Children (TVFC) program should be reported through the Texas Department of State Health Services, Immunization Branch (MC 1946), P.O. Box 149347, Austin, TX 78714-9347. The pre-addressed and postagepaid VAERS form with this address can be obtained by calling the Immunization Branch. A copy of the form is also available in the TVFC toolkit. To request a VAERS form or additional information, call the VAERS contact in your area:
- In Texas: 800.252.9152
- For Bexar County: 210.207.2087
- For City of Houston: 713.558.3518
For the public:
- “Why Vaccination Matters” Video on U-Tube: www.youtube.com/user/cdcflu
- Information from the Centers for Disease Control and Prevention (CDC) about Influenza (Flu) Vaccination: www.cdc.gov/vaccines/vpd-vac/flu/default.htm
- Guidance to Individuals Seeking Flu Vaccination:
Individuals are encouraged to seek influenza vaccination from their usual healthcare provider, especially those who fall into any of the risk groups. Other resources are also available:
- The American Lung Association hosts a web-based Flu Clinic Locator, which searches for clinics by zip code. It can be found at http://www.lung.org/lung-disease/influenza/flu-vaccine-finder/.
- Local health departments and DSHS health service regional offices may also host clinics or maintain lists of local clinics on their websites. Call or check the website of your local health department for more information.
We hope you generously forward this advisory to others who may benefit from this information.
Texas Department of State Health Services Immunization Branch
P.O. Box 149347, Austin, Texas, 78714-9347. 1-800-252-9152
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