ACIP: 2012-13 influenza vaccination recommendations

Recommendations for the 2012-2013 influenza season were recently published by the Advisory Committee on Immunization Practices (ACIP). The recommendations, which include an updated vaccination schedule for children and information on virus strains, seizures, and egg allergy, appear in the August 17 issue of the Morbidity and Mortality Weekly Report.

Virus strains
U.S. influenza vaccines for 2012-2013 will contain A/California/7/2009 (H1N1)-like, A/Victoria/361/2011 (H3N2)-like, and B/Wisconsin/1/2010-like (Yamagata lineage) antigens. The influenza A(H3N2) and B antigens differ from those included in the 2010-2011 and 2011-2012 seasonal vaccine antigens, while the influenza A(H1N1) vaccine virus strain was included in the 2009(H1N1) monovalent pandemic vaccine and the 2010-2011 and 2011-2012 seasonal vaccines, according to the authors.

Vaccination schedule for children
Children aged 6 months through 8 years require 2 doses of influenza vaccine (administered a minimum of 4 weeks apart) during their first season of vaccination.

Children aged 6 months through 8 years need only 1 dose of vaccine in 2012-2013 if they received a total of 2 or more doses of seasonal vaccine since July 1, 2010. Children who did not receive a total of 2 or more doses of seasonal vaccine since July 1, 2010, require 2 doses in 2012-2013, since they may not have received a vaccine containing 2009(H1N1) antigen.

Febrile seizures
Due to reports of an increased risk for fever and febrile seizures in young children in Australia associated with a 2010 Southern Hemisphere vaccine that was produced by CSL Biotherapies, ACIP does not recommend the U.S.-licensed CSL Biotherapies' TIV, Afluria, for children aged <9 years.

Egg allergy
For the 2012-2013 influenza season, ACIP recommends that individuals with a history of egg allergy who have experienced only hives after exposure to egg should receive influenza vaccine. However, TIV rather than LAIV should be used; and recipients should be observed for at least 30 minutes for signs of a reaction after administration of each dose. Individuals who report having had reactions to egg involving such symptoms as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, particularly those that occurred immediately or within a short time (minutes to hours) after egg exposure, should be referred to a physician with expertise in the management of allergic conditions for further risk assessment.

The authors note that FDA approved a new seasonal quadrivalent vaccine in February 2012, called LAIV, FluMist Quadrivalent (MedImmune). However, it is not anticipated to be available until the 2013-2014 influenza season.