Gestapo Guidelines Elevated for Toxic Influenza Immunization in Children

" ... children younger than 9 years receive 2 doses of influenza vaccine in their second season of immunization if they only received 1 dose in the previous season ..."

http://www.medscape.com/viewarticle/572661

Guidelines Updated for Influenza Immunization in Children CME

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Disclosures
Release Date: April 8, 2008; Valid for credit through April 8, 2009
Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;
Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians

Authors and Disclosures

Laurie Barclay, MD
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Désirée Lie, MD, MSEd
Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

April 8, 2008 The American Academy of Pediatrics (AAP) has issued its 2007-2008 recommendations for influenza immunization in children. The revised guidelines, developed by the 2007-2008 Committee on Infectious Diseases, are published in the April issue of Pediatrics.

"The purpose of this statement is to update the current recommendations for routine use of influenza vaccine in children, which were originally published in a condensed format in April 2007," write Joseph A. Bocchini, Jr, MD, and colleagues from the 2007-2008 Committee on Infectious Diseases. "Highlights include (1) harmonization of the recommendation of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) that children younger than 9 years receive 2 doses of influenza vaccine in their second season of immunization if they only received 1 dose in the previous season; and (2) additional detail on the recommended storage, dosage, and administration of live-attenuated influenza vaccine (LAIV), including the recent licensure of LAIV for children as young as 2 years."

The revised AAP guidelines recommend annual influenza immunization for all children with high-risk conditions who are at least 6 months of age, all healthy children ages 6 through 59 months, all household contacts and out-of-home caregivers of children who have high-risk conditions and of healthy children younger than 5 years, and all healthcare clinicians.

To help prevent influenza-associated complications, the committee mandates increased efforts to identify and immunize all children at high risk and all healthy children ages 6 through 59 months and to inform their parents when annual immunizations are due. Previously unimmunized children between 6 months and 9 years of age should be given 2 doses of influenza vaccine, administered 1 month apart, beginning as soon as local availability permits during the influenza season.

Children in this cohort who received only 1 dose for the first time in the previous season should be given 2 doses in the current season, but this recommendation is only applicable to the influenza season that follows the first year that a child younger than 9 years receives influenza vaccine. Children who then also fail to receive 2 doses the next year should receive only 1 dose per year from that point on.

Even after influenza activity has been documented in a community, influenza vaccination should also continue to be offered throughout the influenza season. The influenza vaccine may change from year to year based on global surveillance of circulating virus strains. In the 2007-2008 vaccine, 1 of the 3 strains differs from that in the previous year's vaccine.

Plans to immunize all children for whom influenza vaccine is recommended require expanding outreach and infrastructure developed by all healthcare clinicians, influenza campaign organizers, and public health agencies. When vaccine supplies are delayed or limited, administration of influenza vaccine must take priority.

Immunization against influenza is recommended throughout late winter and early spring because the influenza season often continues into March. Because of widespread resistance of influenza A virus strains to amantadine or rimantadine, healthcare clinicians should not prescribe these antivirus medications for influenza treatment or chemoprophylaxis during the 2007-2008 season and most likely beyond. However, influenza A and B strains remain susceptible to oseltamivir and zanamivir, and these medications can still be prescribed for treatment or chemoprophylaxis.