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The 4th Annual National Influenza Vaccine Summit was hosted by the Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA) in mid-April. ECBT participated in the conference along with approximately 130 stakeholders involved in the research, production, distribution, administration, and advocacy of the influenza (flu) vaccine.  The purpose of each Summit is to discuss important issues related to the influenza vaccine and to work together to achieve the Healthy People 2010 goals for influenza vaccination.  At the meeting, participants discussed: the importance of all stakeholders working together to create and deliver consistent messages on the benefits of influenza vaccination; development of tools and strategies to facilitate the provision of vaccine; and methods to address barriers that may reduce influenza vaccinations, such as reimbursement issues and possible shortages.

An example of a change made by the Advisory Committee on Immunization Practices (ACIP) resulting from the 2003 Summit was the decision for the CDC and other agencies to wait until the beginning of each flu season to determine if there is a sufficient amount of vaccine available for everyone to begin receiving it in September and October.  In the event of a limited supply, a two-tiered system, recommending that high-risk people be given the opportunity to receive the vaccine first, is put into effect.

ECBT was invited to participate in this year’s invitation-only Summit because of the ACIP’s new pediatric recommendation to routinely vaccinate all healthy children 6-23 months of age with the flu vaccine.  The decision to implement this recommendation was made because studies have shown that infants and children younger than two years old are at increased risk for influenza-related complications, including hospitalizations. Hospitalization rates are highest among children aged 0-1 years and are comparable to rates reported among people 65 years of age and older.

In addition to children less than two years of age, the ACIP recommendations also advise that close contacts of children aged 0–23 months receive an influenza vaccination. For children younger than 9 years who were not previously vaccinated, two doses of inactivated influenza vaccine (flu shot) should be administered more than 1 month apart, and if possible, the second dose should be administered before December. If a child under age 9 who is receiving vaccine for the first time does not receive a second dose of vaccine within the same season, only 1 dose of vaccine should be administered the following season. Two doses are not required at that time.

Inactivated influenza vaccine for children 6-23 months of age is currently available both with thimerosal as a preservative and preservative-free. For the 2004-05 flu season, it is predicted that 6-8 million doses of inactivated flu vaccine without thimerosal will be available. However, it is important to note that the ACIP does not specifically recommend that children receive thimerosal-free flu vaccine. In addition, this population can not receive the live attenuated influenza vaccine (i.e., FluMist) because it is currently only indicted for healthy people 5-49 years of age. To view the full ACIP recommendations on the Prevention and Control of Influenza, please visit http://www.cdc.gov/mmwr/preview/mmwrhtml/rr53e430a1.htm

Flu vaccine has been covered by the Vaccines for Children (VFC) program since March 1, 2003. The following groups of VFC-eligible children can now receive influenza vaccine through the VFC program -- all infants and children ages 6-23 months and children and adolescents 2-18 years of age who have risk factors or are household contacts of people with risk factors.

During the 2004 Summit, the participants discussed numerous issues related to the new recommendation for children. One issue of particular interest to ECBT was the possibility of giving the first dose of flu (the priming dose) to children AFTER the flu season is over using any leftover flu vaccine, but BEFORE the vaccine expires. This issue will need to be discussed further with the Summit participants before it can be promoted to vaccine providers.

At the meeting, ECBT also shared their concern that providers or parents may hold back on vaccinating children under 1 years of age due to the fact that parents may not have introduced eggs (yolks and whites) into the child’s diet yet, and the ACIP recommendations state that persons who have a hypersensitivity to eggs should avoid flu vaccination. ECBT suggested that the leading medical societies take this issue into consideration when promoting the new pediatric recommendation to their members and offer guidelines to avoid any confusion when it comes to vaccinating young children with the flu vaccine.

Subsequent to the meeting, Summit participants were asked to endorse NFID’s new initiative “Kids need flu vaccine too!”  In addition, NFID recently created an online CME program titled, “Increasing Pediatric Influenza Immunization in Infants and Children,” to highlight the ACIP and the American Academy of Pediatrics (AAP) pediatric influenza recommendations and to examine best practice models pediatricians can use to design influenza vaccination programs. For more information on this CME program, please visit http://www.pedflumodels.com/

ECBT will keep you updated on the latest information related to flu vaccination for children and you can also visit the CDC/NIP Flu webpage for updates related to the flu recommendations and related materials at http://www.cdc.gov/flu/