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 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?

CDC recommends that seasonal influenza vaccine be administered to all age groups as soon as it becomes available. Antibody to seasonal inactivated influenza vaccine declines in the months following vaccination. However, antibody level at a point several months after vaccination does not necessarily correlate with clinical vaccine effectiveness. There are no studies that compare vaccine effectiveness according to the month when the vaccination was given. The authors of a review on antibody declines among the elderly after vaccination reported, "In conclusion, we found no compelling evidence for more rapid decline of the influenza vaccine-induced antibody response in the elderly, compared with young adults, or evidence that seroprotection is lost at 4 months if it has been initially achieved after immunization." (See Skowronski, et al., Rapid Decline of Influenza Vaccine-Induced Antibody in the Elderly: Is it Real, or Is It Relevant? Journal of Infectious Diseases 2008;197:490-502).In addition, there is a lack of evidence for late-season outbreaks among vaccinated persons that can be attributed to waning immunity.

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WE HAVE NOTICED THAT CDC RECOMMENDS BEGIN VACCINATING WITH SEASONAL INFLUENZA VACCINE AS EARLY SEPTEMBER OR EVEN EARLIER. DOES PROTECTION FROM DECLINE WANE WITHIN 3 4 MONTHS OF VACCINATION? SHOULD I WAIT UNTIL OCTOBER NOVEMBER TO VACCINATE MY ELDERLY MEDICALLY FRAIL PATIENTS?

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?

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 child should always receive the dose appropriate for his or her age at the time of the clinic visit; at age 37 months that would be 0.5 mL.

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IF A CHILD RECEIVES INFLUENZA VACCINE AT AGE 34 OR 35 MONTHS FOR THE FIRST TIME (0.25 ML DOSE) AND THEN RETURNS SECOND DOSE 37 MONTHS, SHOULD WE GIVE ANOTHER 0.25 0.5 THAT INDICATED AGES 3 OLDER?

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?

It is never too early to begin planning for the coming fall's influenza vaccination program. The most important thing you can do initially is to place your order for vaccine from your usual source. Some manufacturers often stop taking pre-orders in mid-May. Be sure to include vaccine for pediatric patients needing two doses and also for your facility's healthcare workers as part of your overall campaign.

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WE ARE ALWAYS CONCERNED THAT THERE WON'T BE ENOUGH VACCINE TO VACCINATE OUR PATIENTS IN THE FALL. WHAT CAN DO ASSURED WE'VE DONE ALL POSSIBLY AVOID THIS TYPE OF SITUATION?

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?

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)?

http://hps.org/publicinformation/ate/q5906.pdf

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HOW DO YOU CALCULATE THE ENERGY OF PHOTONEUTRONS PRODUCED THROUGH INTERACTION WITH 7.5 MEV BREMSSTRAHLUNG FROM A LINAC? TARGET GENERAL COMMERCIAL PRODUCTS IN TRUCKS.

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?

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?

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?

There are a number of opportunistic gadgets on the market to allegedly protect the user from hazards of cellular phones. You can search the Internet to find the latest, ranging from antenna shields to whole-body shielding materials. Most experts believe that these devices take advantage of customers' misunderstanding and unfounded fears to sell products with no real value. First of all, cell phones that operate within the guidelines established by national and international safety panels have never been shown to pose a health risk to the user (see answers to other questions on cell phone safety on this website). Secondly, placing any kind of shield over the antenna of a cell phone will in most cases cause it to increase its RF output as it attempts to compensate for signal loss in the shield and maintain a quality phone call. The U.S. Food and Drug Administration published an advisory on cell phones several years ago that said if you are concerned about risks of using a cell phone, then simply use it less. That is still good advice today. Gary Zeman, ScD, CHP Lawrence Berkeley National Laboratory

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ARE THERE PRODUCTS AVAILABLE TO THE GENERAL PUBLIC THAT CAN BE PURCHASED PROTECT CELLULAR OR PORTABLE TELEPHONE USERS FROM RADIATION? IF SO, WHERE THESE FOUND?

Yes. Influenza vaccine commonly contains three influenza vaccine virus strains; two for A viruses and one for a B virus which are prepared based on circulating viruses from the previous influenza season. Infection from one virus type does not confer immunity to other types and it would not be unusual to have exposure to more than one type during a typical influenza season. By all means, vaccinate this person!

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IF AN UNVACCINATED PATIENT HAS JUST RECOVERED FROM A DIAGNOSED CASE OF INFLUENZA COMES INTO OUR CLINIC, SHOULD WE VACCINATE HIM?

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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?