Prevention and Control of Seasonal Influenza With Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 Influenza Season

The annual influenza prevention recommendations are provided in this report. The annual influenza prevention recommendations are provided in this report. August 15, 2014 / 63(32);691-697 This report updates the 2013 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding use of seasonal influenza vaccines (1CDCPrevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices—United States, 2013–2014.MMWR. 2013; 62Google Scholar). Updated information for the 2014–15 influenza season includes 1) antigenic composition of U.S. seasonal influenza vaccines; 2) vaccine dose considerations for children aged 6 months through 8 years; and 3) a preference for the use, when immediately available, of live attenuated influenza vaccine (LAIV) for healthy children aged 2 through 8 years, to be implemented as feasible for the 2014–15 season but not later than the 2015–16 season. Information regarding issues related to influenza vaccination not addressed in this report is available in the 2013 ACIP seasonal influenza recommendations (1CDCPrevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices—United States, 2013–2014.MMWR. 2013; 62Google Scholar). For recommendations pertaining to use of influenza vaccines in children, ACIP reviewed data on the relative efficacy and safety of LAIV and inactivated influenza vaccines (IIVs). An adapted version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of the evidence (2Ahmed F U.S. Advisory Committee on Immunization Practices (ACIP) handbook for developing evidence-based recommendations. Version 1.2.. US Department of Health and Human Services, CDC, Atlanta, GA2013Google Scholar). Evidence summary tables and assessment of risk and benefits are available at http://www.cdc.gov/vaccines/acip/recs/grade/table-refs.html. Information in this report reflects discussion during public meetings of ACIP on February 26, 2014, and June 25, 2014. Meeting minutes, information on ACIP membership, and information on conflicts of interest are available at http://www.cdc.gov/vaccines/acip/meetings/meetings-info.html. Modifications were made during review at CDC to update and clarify wording. Any updates will be posted at http://www.cdc.gov/flu. Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Vaccination optimally should occur before onset of influenza activity in the community. Health care providers should offer vaccination soon after vaccine becomes available (by October, if possible). Vaccination should be offered as long as influenza viruses are circulating. Children aged 6 months through 8 years who require 2 doses (see “Vaccine Dose Considerations for Children Aged 6 Months through 8 Years”) should receive their first dose as soon as possible after vaccine becomes available, and the second dose ≥4 weeks later. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health care visits and hospitalizations when vaccine is available.Recommendations for routine use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of the Centers for Disease Control and Prevention (CDC) on use of vaccines and related agents for the control of vaccine-preventable diseases in the civilian population of the United States. Recommendations for routine use of vaccines in children and adolescents are harmonized to the greatest extent possible with recommendations made by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetrics and Gynecology (ACOG). Recommendations for routine use of vaccines in adults are harmonized with recommendations of AAFP, ACOG, and the American College of Physicians (ACP). ACIP recommendations adopted by the CDC Director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report (MMWR). Additional information regarding ACIP is available at http://www.cdc.gov/vaccines/acip. Recommendations for routine use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP). ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of the Centers for Disease Control and Prevention (CDC) on use of vaccines and related agents for the control of vaccine-preventable diseases in the civilian population of the United States. Recommendations for routine use of vaccines in children and adolescents are harmonized to the greatest extent possible with recommendations made by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetrics and Gynecology (ACOG). Recommendations for routine use of vaccines in adults are harmonized with recommendations of AAFP, ACOG, and the American College of Physicians (ACP). ACIP recommendations adopted by the CDC Director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report (MMWR). Additional information regarding ACIP is available at http://www.cdc.gov/vaccines/acip. Antibody levels induced by vaccine decline postvaccination (3Ambrose CS Yi T Walker RE Connor EM Duration of protection provided by live attenuated influenza vaccine in children.Pediatr Infect Dis J. 2008; 27: 744-748Crossref PubMed Scopus (57) Google Scholar, 4Ochiai H Shibata M Kamimura K Niwayama S Evaluation of the efficacy of split-product trivalent A(H1N1), A(H3N2), and B influenza vaccines: reactogenicity, immunogenicity and persistence of antibodies following two doses of vaccines.Microbiol Immunol. 1986; 30: 1141-1149Crossref PubMed Scopus (25) Google Scholar, 5Kunzel W Glathe H Engelmann H Van Hoecke C Kinetics of humoral antibody response to trivalent inactivated split influenza vaccine in subjects previously vaccinated or vaccinated for the first time.Vaccine. 1996; 14: 1108-1110Crossref PubMed Scopus (90) Google Scholar, 6Song JY Cheong HJ Hwang IS et al.Long-term immunogenicity of influenza vaccine among the elderly: risk factors for poor immune response and persistence.Vaccine. 2010; 28: 3929-3935Crossref PubMed Scopus (121) Google Scholar). Although a 2008 literature review found no clear evidence of more rapid decline among the elderly (7Skowronski DM Tweed SA De Serres G Rapid decline of influenza vaccine-induced antibody in the elderly: is it real, or is it relevant?.J Infect Dis. 2008; 197: 490-502Crossref PubMed Scopus (140) Google Scholar), a 2010 study noted a statistically significant decline in titers 6 months postvaccination among persons aged ≥65 years (although titers still met European Medicines Agency levels considered adequate for protection) (6Song JY Cheong HJ Hwang IS et al.Long-term immunogenicity of influenza vaccine among the elderly: risk factors for poor immune response and persistence.Vaccine. 2010; 28: 3929-3935Crossref PubMed Scopus (121) Google Scholar). A case-control study conducted in Navarre, Spain, during the 2011–12 season revealed a decline in vaccine effectiveness primarily affecting persons aged ≥65 years (8Castilla J Martinez-Baz I Martinez-Artola V et al.Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12.Euro Surveill. 2013; 18Crossref Scopus (111) Google Scholar). Although delaying vaccination might permit greater immunity later in the season, deferral might result in missed opportunities to vaccinate and difficulties in vaccinating a population within a limited time. Vaccination programs should balance maximizing likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after influenza virus circulation begins. For 2014–15, U.S.-licensed influenza vaccines will contain the same vaccine virus strains as those in the 2013–14 vaccine. Trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/California/7/2009 (H1N1)-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like (Yamagata lineage) virus. Quadrivalent influenza vaccines will contain these antigens, and also a B/Brisbane/60/2008-like (Victoria lineage) virus (9Food and Drug Administration. February 28, 2014: Vaccines and Related Biological Products Advisory Committee meeting summary minutes. Available at http://www.fda.gov/advisorycommittees/committeesmeetingmaterials/bloodvaccinesandotherbiologics/vaccinesandrelatedbiologicalproductsadvisorycommittee/ucm391605.htm.Google Scholar). Various influenza vaccine products are anticipated to be available during the 2014–15 season (Table 1). These recommendations apply to all licensed influenza vaccines used within Food and Drug Administration–licensed indications. Differences between ACIP recommendations and labeled indications have been noted (Table 1).Table 1:Influenza vaccines—United States, 2014–15 influenza season** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.Trade nameManufacturerPresentationMercury content from thimerosal (µg Hg/0.5 mL)Ovalbumin content (µg/0.5mL)Age indicationsRouteInactivated influenza vaccine, quadrivalent (IIV4), standard doseContraindications** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Severe allergic reaction to any component of the vaccine, including egg protein, or after previous dose of any influenza vaccine.Precautions** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Moderate to with or of within 6 weeks of of influenza of by from from from from influenza vaccine, trivalent standard doseContraindications** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Severe allergic reaction to any component of the vaccine, including egg protein, or after previous dose of any influenza vaccine.Precautions** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Moderate to with or of within 6 weeks of of influenza is years; ACIP not be used in children aged 6 months through 8 years of risk for noted in this with 2010 no licensed inactivated seasonal influenza vaccine is available for a aged through 8 years who a the risk for influenza be providers should with the or the benefits and of influenza vaccination with before this vaccine. be used in persons aged is years; ACIP not be used in children aged 6 months through 8 years of risk for noted in this with 2010 no licensed inactivated seasonal influenza vaccine is available for a aged through 8 years who a the risk for influenza be providers should with the or the benefits and of influenza vaccination with before this vaccine. be used in persons aged of by Vaccines and from from inactivated vaccine, A dose of vaccine from is the is the with the influenza vaccine, standard Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Severe allergic reaction to any component of the vaccine, including egg protein, or after previous dose of any influenza vaccine.Precautions** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Moderate to with or of within 6 weeks of of influenza Vaccines and not in to contain of egg is a dose of influenza vaccine, trivalent doseContraindications** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Severe allergic reaction to any component of the vaccine, including egg protein, or after previous dose of any influenza vaccine.Precautions** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Moderate to with or of within 6 weeks of of influenza inactivated vaccine, A dose of vaccine from influenza vaccine, trivalent Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Severe allergic reaction to any component of the vaccine.Precautions** Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Moderate to with or of within 6 weeks of of influenza adults and children, the recommended of vaccination is the The for and children is the of the guidance regarding and for be found in Recommendations on Immunization at attenuated influenza vaccine, quadrivalent Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Severe allergic reaction to any component of the vaccine, including egg protein, or after previous dose of any influenza use of or in children and ACIP not be used for persons with egg and children aged years who have or who have a noted in the within the or for report a health care or within the should not be to persons who have influenza within the previous who care for persons who require a should not receive or should avoid with persons for after Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. Package inserts for U.S.-licensed vaccines are available at http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm093833.htm.: Moderate to with or of within 6 weeks of of influenza in persons aged years and might to risk for to is and in the at after in the vaccination The dose is between Health care providers should the when available, to children aged 2 through years with or might to children who might be at greater risk for and at risk for after or of children aged 2 through years should be the a health care or Children or to this and children who have or who a noted in the within the months should not receive ACIP Advisory Committee on Immunization Immunization providers should check Food and Drug Administration–approved prescribing information for 2014–15 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings, and precautions. 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This guidance the virus composition of the 2014–15 seasonal influenza vaccine is the same as it was for the 2013–14 season, children aged 6 months through 8 years dose of vaccine in 2014–15 if dose of 2013–14 seasonal influenza vaccine, of previous vaccination information regarding or 2 doses are is in this report. are also recommendations regarding the use of live attenuated influenza vaccine (LAIV) for healthy children aged 2 through 8 immediately available, LAIV should be used for healthy children aged 2 years through 8 years who have no or precautions. inactivated influenza vaccine should be used if LAIV is not immediately Vaccination should not be to ACIP for 2014 available at for Immunization and Immunization for and US of of The Immunization ACIP