March 1, 2008


ACIP Makes New Recommendations on Flu, MMRV Vaccines


The federal Advisory Committee on Immunization Practices (ACIP) made new recommendations on key vaccines at its February meeting in Atlanta, according to IDSA’s ACIP liaison, Samuel Katz, MD, FIDSA.

Expand Influenza Vaccine: ACIP voted to extend routine influenza virus vaccination to all healthy children ages 6 months to 18 years. (The previous recommendation was for vaccination of children from 6 months to 59 months, children with certain chronic conditions, and household contacts of children under 6 months.) The expanded recommendation could be implemented by the 2009-2010 flu season, but can be initiated in 2008-2009 when desired and feasible. The new recommendation would increase the number of children recommended for influenza vaccination by about 30 million.

Reports from the vaccine producers indicate that supply will not be a problem. The recommendation represents another step forward by those who seek universal flu vaccination for the entire population, said Dr. Katz. There was discussion of the problems this year with mismatch of vaccine strains versus the circulating ones. The 2008-2009 flu vaccine for the United States will include three new strains: an A/Brisbane/10/2007 (H3N2)-like virus, A/Brisbane/59/2007 (H1N1)-like virus strain, and a B/Florida/4/2006-like virus.

MMRV No Longer Vaccine of Choice: ACIP voted to withdraw the preferential recommendation for the measles, mumps, rubella, and varicella vaccine (MMRV, marketed by Merck & Co., Inc. as ProQuad) as the vaccine of choice for initial vaccination of infants. Preliminary findings suggest that about one additional febrile seizure would be expected to occur in the 7-10 day postvaccination period for every 2,000 children aged 12-23 months who receive MMRV vaccine, compared with MMR vaccine and varicella vaccine at the same visit. Officials continue to evaluate the preliminary findings. The updated recommendations have been published in Morbidity and Mortality Weekly Report (MMWR), http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5710a3.htm.

No Change on MCV4: A proposal to extend the recommendation for meningococcal conjugate vaccine (MCV4) to include healthy 2-10 year olds was voted down. The recommendation remains to administer the vaccine only to high-risk children in that age group (e.g., those with terminal complement deficiency, sickle cell disease, or other splenic dysfunctions), all children 11-18 years old, and adults at high risk who are 19-55 years old. For people age 2-55 years, MCV4 is preferred; the meningococcal polysaccharide vaccination (MPSV) is an acceptable alternative if MCV4 is not available. Adults age 56 and older at high risk should receive MPSV.

ACIP recommendations become official once approved by the Centers for Disease Control and Prevention and published in MMWR. For more information, see: http://www.cdc.gov/vaccines/recs/acip/.

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