Influenza is the most frequent cause of death from a vaccine-preventable disease in the United States. From 1990 through 1999, an average of approximately 36,000 influenza-associated pulmonary and circulatory deaths occurred during each influenza season. In addition to fatalities, seasonal influenza is also responsible for more than 200,000 hospitalizations per year. Rates of infection from seasonal influenza are highest among children, but the risks for complications, hospitalizations, and deaths are higher among adults ages 65 and older, children younger than 5 years, and people of any age who have medical conditions that place them at increased risk for complications from influenza.

A novel H1N1 virus was first detected in March of 2009 and quickly spread to pandemic levels. In the U.S., it is estimated that approximately 43-89 million persons became ill with 2009 pandemic H1N1 from April 2009 to April 2010. The virus also resulted in significant hospitalizations and deaths among children, adults 19-65 years, obese persons, and pregnant and post-partum women.

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HOW SERIOUS A PROBLEM INFLUENZA IN THE U.S.?

You can begin offering vaccine as soon as vaccine becomes available. Early vaccination of children younger than age 9 years who are first time vaccinees can be helpful in assuring routine second doses before the influenza season begins.

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WHEN SHOULD INFLUENZA (THE FLU) VACCINE BE GIVEN?

Beginning with the 2010-11 vaccination season, ACIP recommends annual vaccination for all people ages 6 months and older who do not have a contraindication to the vaccine.

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RECOMMENDED TO GET VACCINATED AGAINST INFLUENZA (THE FLU)?

Information regarding influenza surveillance is available October through May from the CDC influenza website at www.cdc.gov/flu/weekly/fluactivity.htm.

In addition, periodic updates about influenza are published in the MMWR. State and local health departments should be consulted regarding availability of influenza vaccine, access to vaccination programs, information about state or local influenza activity, and for reporting influenza outbreaks and receiving advice regarding their control.

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WHERE CAN I GET INFORMATION ON INFLUENZA (THE FLU) AND ITS SURVEILLANCE?

Peak influenza activity does not generally occur until February. Providers are encouraged to continue vaccinating patients throughout the influenza season, including into the spring months (e.g., through May), as long as they have vaccine in the refrigerator and unvaccinated patients in their office.

Because influenza occurs in many areas of the world during April through September, vaccine should be given to travelers who missed vaccination in the preceding fall and winter. Another late season use of vaccine is for children younger than age 9 years who were vaccinated for the first time in the current vaccination season but failed to get their second dose. For each of these situations, vaccine can be given through the month of June since injectable influenza vaccine customarily has a June 30 expiration date.

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HOW LATE IN THE SEASON CAN I VACCINATE MY PATIENTS WITH INFLUENZA VACCINE?

Protection from influenza vaccine is thought to persist for a year or less because of waning antibody and because of changes in the circulating influenza virus from year to year.

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HOW LONG DOES IMMUNITY FROM INFLUENZA (FLU) VACCINE LAST?

Influenza is the most frequent cause of death from a vaccine-preventable disease in the United States. From 1990 through 1999, an average of approximately 36,000 influenza-associated pulmonary and circulatory deaths occurred during each influenza season. In addition to fatalities, seasonal influenza is also responsible for more than 200,000 hospitalizations per year. Rates of infection from seasonal influenza are highest among children, but the risks for complications, hospitalizations, and deaths are higher among adults ages 65 and older, children younger than 5 years, and people of any age who have medical conditions that place them at increased risk for complications from influenza.

A novel H1N1 virus was first detected in March of 2009 and quickly spread to pandemic levels. In the U.S., it is estimated that approximately 43-89 million persons became ill with 2009 pandemic H1N1 from April 2009 to April 2010. The virus also resulted in significant hospitalizations and deaths among children, adults 19-65 years, obese persons, and pregnant and post-partum women.

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HOW SERIOUS THE FLU?

The most important factor in preventing outbreaks is annual vaccination of all occupants of the facility, and all persons in the facility who share the same air as the high-risk occupants. Groups that should be targeted include physicians, nurses, and other personnel in hospitals and outpatient settings who have contact with high-risk patients in all age groups, and providers of home care to high-risk persons (e.g., visiting nurses, volunteers).

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ARE THERE RECOMMENDATIONS FOR THE PREVENTION OF INSTITUTIONAL OUTBREAKS INFLUENZA?

Vaccines can be administered at any time before or after administration of an "allergy injection."

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WHAT THE RECOMMENDED INTERVAL FOR RECEIVING INFLUENZA VACCINE AFTER AN ALLERGY INJECTION?

ACIP recommends annual influenza vaccination for all children age 6 months and older who do not have a contraindication to the vaccine.

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WHICH CHILDREN SHOULD RECEIVE INFLUENZA FLU VACCINE?

ACIP's influenza recommendations for children age 6 months through 8 years have changed for the 2011–12 season. According to the new algorithm, certain children need 2 doses of influenza vaccine this influenza season, separated by at least 4 weeks. Here is a summary:

• Children age 6 months through 8 years who did not receive AT LEAST 1 dose of the 2010–11 vaccine should receive 2 doses, separated by at least 4 weeks, REGARDLESS of their previous influenza vaccination history.
• Children age 6 months through 8 years whose influenza vaccination status from the previous season is not known should also receive 2 doses at least 4 weeks apart.
• Children age 6 months through 8 years who received 1 dose of seasonal influenza vaccine during the 2010–11 season need ONLY 1 dose this season. This is because the vaccine strains are the same this season as last season.

You may find this Immunization Action Coalition handout helpful: www.immunize.org/catg.d/p3093.pdf.

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WHICH OF OUR PEDIATRIC PATIENTS WILL NEED 2 DOSES INFLUENZA VACCINE FOR THE 2011–12 VACCINATION SEASON?

There are several vaccines that can be given to children. You can find information on all influenza vaccines available in the U.S. for the current season and the age groups approved by FDA by going to www.immunize.org/catg.d/p4072.pdf.

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WHICH INFLUENZA VACCINES CAN WE GIVE TO CHILDREN?

Yes. It is especially important to vaccinate pregnant women because of their increased risk for influenza-related complications. An increased risk of severe influenza infection was also observed in postpartum women (those delivered within the previous 2 weeks) during the 2009–2010 H1N1 pandemic. Vaccination can occur in any trimester, including the first. Only inactivated (injectable or TIV) vaccine should be given to pregnant women.

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INFLUENZA VACCINE RECOMMENDED FOR PREGNANT WOMEN?

Prior to the 2010-11 vaccination season, only children ages 6 months through 18 years and adults age 50 years and older were universally recommended for vaccination; recommendations for adults ages 19 through 49 years were targeted to people with specific risk factors, although other adults could be vaccinated if they wanted protection. Collectively, these targeted risk groups made up 85% of the U.S. population. During the 2009 H1N1 outbreak, additional risk groups were identified, such as obese individuals. The recommendation made by ACIP in February 2010 for universal vaccination simplifies previous recommendations, making it easier for healthcare providers to determine whom to vaccinate. The universal recommendation also makes it easier for patients to remember to get vaccinated every year.

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WE'RE GLAD THAT CDC HAS MADE A UNIVERSAL INFLUENZA VACCINATION RECOMMENDATION TO VACCINATE EVERYONE 6 MONTHS AND OLDER. WOULD YOU TELL US HOW THIS CAME ABOUT?

There are several reasons why this misconception persists: (1) Less than 1% of people who are vaccinated with the injectable vaccine develop flu-like symptoms, such as mild fever and muscle aches, after vaccination. These side effects are not the same as having influenza, but people confuse the symptoms. (2) Protective immunity doesn't develop until 1–2 weeks after vaccination. Some people who get vaccinated later in the season (December or later) may get influenza shortly afterward. These late vaccinees develop influenza because they were exposed to someone with the virus before they became immune. It is not the result of the vaccination. (3) To many people "the flu" is any illness with fever and cold symptoms. If they get any viral illness, they may blame it on the flu shot or think they got "the flu" despite being vaccinated. Influenza vaccine only protects against certain influenza viruses, not all viruses. (4) The influenza vaccine is not 100% effective, especially in older persons. For more information on this topic, go to: www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm

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SOME OF MY PATIENTS REFUSE INFLUENZA VACCINATION BECAUSE THEY INSIST "GOT THE FLU" AFTER RECEIVING INJECTABLE VACCINE IN PAST. WHAT CAN I TELL THEM?

Although the strains may sometimes be the same as in the previous year's vaccine, you should NOT use the previous season's vaccine you might still have in your refrigerator. Influenza vaccine distributed in the northern hemisphere expires on June 30 after each season; expired vaccine should NEVER be administered. Secondly, antibody titers that persons might have achieved from the previous year's vaccination will have waned and need to be boosted with a dose of the current year's vaccine.

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WHY DO PEOPLE RECEIVED INFLUENZA VACCINE LAST YEAR STILL NEED TO GET VACCINATED THIS WHEN THE VIRUSES HAVEN'T CHANGED?

No. CDC and ACIP express no preference for preservative-free vaccine for infants or any other group of vaccine recipients. See page 22 of the 2010–11 ACIP influenza recommendations: www.cdc.gov/mmwr/pdf/rr/rr5908.pdf.

No scientific evidence exists that thimerosal in vaccines, including influenza vaccines, is a cause of adverse events, unless the patient has a systemic allergy to thimerosal. However, some states have enacted legislation that restricts the use of thimerosal-containing vaccines. Check with your state immunization manager to see if your state is one of them (www.immunize.org/coordinators).

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ARE WE SUPPOSED TO GIVE INFANTS PRESERVATIVE-FREE INFLUENZA VACCINE?

Influenza is the most frequent cause of death from a vaccine-preventable disease in the United States. From 1990 through 1999, an average of approximately 36,000 influenza-associated pulmonary and circulatory deaths occurred during each influenza season. In addition to fatalities, seasonal influenza is also responsible for more than 200,000 hospitalizations per year. Rates of infection from seasonal influenza are highest among children, but the risks for complications, hospitalizations, and deaths are higher among adults ages 65 and older, children younger than 5 years, and people of any age who have medical conditions that place them at increased risk for complications from influenza.

A novel H1N1 virus was first detected in March of 2009 and quickly spread to pandemic levels. In the U.S., it is estimated that approximately 43-89 million persons became ill with 2009 pandemic H1N1 from April 2009 to April 2010. The virus also resulted in significant hospitalizations and deaths among children, adults 19-65 years, obese persons, and pregnant and post-partum women.

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IS THE FLU SERIOUS?

LAIV can be administered simultaneously with another live vaccine (e.g., MMR, varicella), but if not given at the same time, ACIP recommends waiting four weeks before administering the second live vaccine.

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A FIVE-YEAR-OLD CHILD RECEIVED HER SECOND MMR WEEK AGO. HOW LONG SHOULD SHE WAIT BEFORE RECEIVING LIVE ATTENUATED INFLUENZA VACCINE (LAIV)?