ACIP recommends flu shots for all school children

Feb 27, 2008 (CIDRAP News) – The federal Advisory Committee on Immunization Practices (ACIP) today recommended influenza vaccination for all school-age children, boosting the number of children targeted for flu shots by about 30 million.

The ACIP, whose recommendations are routinely adopted by the Centers for Disease Control and Prevention (CDC), said children from ages 5 through 18 should get flu shots, the CDC announced in a news release.

The CDC already recommends flu shots for children from 6 to 59 months old, along with people aged 50 and older, those with certain chronic medical conditions, people in nursing homes, pregnant women, healthcare workers, and other close contacts and caregivers of those who run an increased risk of flu complications.

"The expanded recommendation is to take effect as soon as feasible, but no later than the 2009-2010 influenza season," the CDC said.

The agency said healthy children bear "a significant burden" from flu. In addition, there is evidence that reducing flu transmission in children may limit its spread among their household contacts and in the community, officials said.

Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said the recommendation should reduce children's need for flu-related medical care and school absenteeism.

Increased coverage
The CDC said the recommendation increases the number of children targeted for flu shots by about 30 million. On the basis of current vaccination rates, the agency predicts that about 7 million more children will be vaccinated as a result of the recommendation, according to a Reuters report published today.

In calling for full implementation of the recommendation by the fall of 2009, the CDC said this will allow time to plan for vaccinating so many more children. "However, immunization providers should begin efforts to offer influenza vaccination to all children aged 6 months through 18 years in the 2008-09 influenza season if feasible," the statement said.

"This new recommendation will help parents understand that all children can benefit from vaccination and further encourages providers to start vaccination of children through age 18 next year," Schuchat said.

The last major expansion of flu-shot recommendations came in February 2006, when the ACIP endorsed vaccination for 2-, 3-, and 4-year-olds (ages 24 through 59 months), which added an estimated 16 million children to the targeted groups. In 2004 the CDC began recommending flu immunization for children aged 6 through 23 months.

Last week the CDC reported that 22 children had died of flu so far this season. In the 2006-07 season, 68 children died of flu-related causes, including 39 who were between the ages of 5 and 17, according to CDC data. Of 53 children older than 6 months whose vaccination status was known, 50 had not been vaccinated.

FluMist production to triple
In the wake of today's ACIP recommendation, MedImmune announced plans to raise production of its nasal-spray flu vaccine, FluMist, to 12 million doses for next season, nearly triple this year's production. The vaccine uses a live but weakened virus.

"To support this move by the ACIP, MedImmune is preparing to manufacture a record number of FluMist doses—about 12 million—for the upcoming flu season, with the intention of continuing to substantially increase production in subsequent seasons," the company said in a news release.

Dr. Frank J. Malinoski, MedImmune's senior vice president of medical and scientific affairs, said the company's plan to sharply boost production was partly but not wholly in anticipation of the ACIP recommendation.

"We've been hearing from public health groups like the National Association of County and City Health Officials who've been saying we need to move to this next step for a while," he told CIDRAP News. "We've also been hearing from customers . . . that they see a need for a needle-free vaccine as something they're interested in and want to use more."

Malinoski said the company made about 4 million doses of FluMist for this season and sold just under that number. "We essentially sold out," he said. In September, just before the start of flu immunization season, the Food and Drug Administration expanded the indication for FluMist to cover 2-, 3- and 4-year-olds; previously it was indicated only for healthy people aged 5 to 49 years.

Malinoski predicted there will be challenges in implementing the ACIP recommendation. He added that MedImmune has seen healthcare providers use a number of innovative methods to immunize children against flu, including school-based immunization programs.

"A lot of flu immunization in adults is done in the workplace, and if you think about kids, school is their workplace," he said. "So it makes sense to do it that way."

The CDC said ACIP recommendations become CDC recommendations as soon as they are accepted by the CDC director and the secretary of the Department of Health and Human Services.

See also:

Feb 27 CDC news release
http://www.cdc.gov/media/pressrel/2008/r080227.htm

CDC data on 2007-08 flu season
http://www.cdc.gov/flu/weekly/weeklyarchives2006-2007/06-07summary.htm

Feb 27 MedImmune news release

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