Healthcare providers should vaccinate any person who failed to get vaccinated in the previous vaccination season and who wants to reduce their risk of acquiring influenza during their upcoming travel, particularly if they are at high risk for influenza-related complications. This includes persons who are traveling to the tropics, traveling with organized tourist groups at any time of year, or traveling to the Southern Hemisphere during April-September.

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WHICH TRAVELERS ARE RECOMMENDED TO BE VACCINATED?

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?

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?

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?

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?

As of January 1, 2006, the use of a VIS for influenza vaccine given to a child or an adult became mandatory under the National Vaccine Injury Compensation Program. Two VISs are published annually, one for LAIV and one for TIV. Each can be found at www.immunize.org/vis along with many translations.

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A VACCINE INFORMATION STATEMENT (VIS) MANDATORY OR IT ONLY RECOMMENDED WHEN ADMINISTERING 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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HOW SERIOUS A PROBLEM INFLUENZA (THE FLU) 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.

Additional Information:
V

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WHEN SHOULD INFLUENZA (THE FLU) VACCINE BE GIVEN?

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?

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?

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?

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?

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.?

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?

The following answer assumes "radio Base Station Antennas" refers to base stations used for personal wireless communications services such as cellular telephone, Personnel Communications Services (PCS), and Enhanced Specialized Mobile radio (ESMR). In the United States, the frequency band allocated for base stations used for personal wireless communications is 869-894 MHz for cellular service, 851-866 MHz for ESMR, and 1930-1990 MHz for PCS. The IEEE exposure limits (maximum permissible exposure—MPE) for occupational exposure (controlled environments where exposures may be incurred by persons who are aware of the potential for exposure) are frequency dependent and are expressed in terms of incident power density. The appropriate value to compare with the MPE is the incident power density averaged over the vertical cross-section of the human body. The occupational exposure limits are also time-averaged over any six-minute interval. The IEEE C95.1-1991 MPE values are shown in the table below:
IEEE C95.1-1991 Maximum Permissible Exposure (MPE) Values
Frequency Band Power Density
General mw/cm2 W/cm2
851-866 MHz f/300 mW/cm2 2.84-2.88 28.4-28.8
869-894 MHz f/300 mW/cm2 2.90-2.98 29.0-29.8
1930-1990 MHz f/300 mW/cm2 6.43-6.63 64.3-66.3
NOTE: f is in MHz
As indicated above, these values are for continuous exposure (t > 6 minutes) and are to be compared with the spatial average of the incident power density. all base stations used for personal wireless telecommunications services in the United States are required to comply with the FCC limits (as mandated by the Telecommunications Act of 1996). The FCC limits are based on a hybrid of the IEEE limits and the 1986 recommendations of the National Council on Radiation Protection and Measurements. The FCC MPEs are the same as the IEEE values for frequencies below 1500 MHz but are capped at 5 mW/cm2 (50 W/cm2) for frequencies greater than 1500 MHz.

Both the FCC and IEEE MPEs for exposure of the public (uncontrolled environments) are one-fifth of the above values. As above, the value to compare with the MPE is the incident power density averaged over the vertical cross-section of the human body. The averaging time for the general public is 30 minutes. Thus, for transient exposures lasting six minutes or less, the MPEs for occupational exposure and exposure of the general public MPEs are the same. For cases of simultaneous exposure from antennas operating in different frequency bands, the ratio of the spatially averaged incident power density in each frequency band to the corresponding MPE for that band is determined and the sum of all such ratios must be less than unity in order to comply.

R. C. Petersen
Manager, Wireless and Optical
Technologies Safety Department

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WHAT ARE CURRENT RECOMMENDED IEEE EMF OCCUPATIONAL EXPOSURE LEVELS AND GUIDELINES FOR RADIO BASE STATION ANTENNAS?

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?

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?

Yes. As long as a child is eligible to receive nasal spray vaccine (i.e., is in the proper age range and health status), it is acceptable to give 1 dose of each type of influenza vaccine. The doses should be spaced at least 4 weeks apart.

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WHEN A CHILD NEEDS 2 DOSES OF INFLUENZA VACCINE, CAN I GIVE 1 DOSE EACH TYPE (INJECTABLE AND NASAL SPRAY)?

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?