CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) met July 29 to make recommendations for use of vaccine against novel influenza A (H1N1).

The committee met to develop recommendations on who should receive vaccine against novel influenza A (H1N1) when it becomes available, and to determine which groups of the population should be prioritized if the vaccine is initially available in extremely limited quantities.

The committee recommended the vaccination efforts focus on five key populations. Vaccination efforts are designed to help reduce the impact and spread of novel H1N1. The key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect young infants. When vaccine is first available, the committee recommended that programs and providers try to vaccinate:

pregnant women,
people who live with or care for children younger than 6 months of age,
health care and emergency services personnel,
persons between the ages of 6 months through 24 years of age, and
people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.
The groups listed above total approximately 159 million people in the United States.

The committee does not expect that there will be a shortage of novel H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others:

pregnant women,
people who live with or care for children younger than 6 months of age,
health care and emergency services personnel with direct patient contact,
children 6 months through 4 years of age, and
children 5 through 18 years of age who have chronic medical conditions.

The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these prioritized groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.

The committee also stressed that people over the age of 65 receive the seasonal vaccine as soon as it is available. Even if novel H1N1 vaccine is initially only available in limited quantities, supply and availability will continue, so the committee stressed that programs and providers continue to vaccinate unimmunized patients and not keep vaccine in reserve for later administration of the second dose.

The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine. It is intended to be used alongside seasonal flu vaccine to protect people. Seasonal flu and novel H1N1 vaccines may be administered on the same day.

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Nation's Teen Vaccination Coverage Increasing, But Below 2010 Goals

The nation's immunization coverage rates for preteens and teens are increasing for routinely recommended vaccines, but most still do not have all of the recommended immunizations, according to 2007 estimates released today by the Centers for Disease Control and Prevention (CDC).

"The overall trends are good news," said Dr. Lance Rodewald, director of the Division of Immunization Services at the CDC's National Center for Immunization and Respiratory Diseases. "We are seeing more preteens and teenagers being protected against serious, sometimes deadly diseases. But we remain short of our goals -- for almost all of these vaccines we want at least 90 percent of adolescents to be fully immunized. As such, we have much work to do to get many more adolescents protected."

The survey provides estimates for three vaccines recommended at 11 or 12 years of age: the tetanus-diphtheria-acellular pertussis (Tdap) vaccine, the meningococcal conjugate vaccine (MCV4), and the human papillomavirus (HPV4) vaccine for girls and young women. It also includes estimates of the percentage of 13- through 17-year-old teens who should have received the recommended immunizations for measles, mumps and rubella vaccine (MMR), hepatitis B (HepB) vaccine, and varicella vaccine (VAR) earlier in life.

According to Rodewald, the nation's Healthy People 2010 goals for preteens and teens ages 13-15 years are not being met for any of the vaccines for which goals were set. The Healthy People 2010 goals are for 90 percent coverage for preteens and teens 13 to 15 years of age with three doses of hepatitis B vaccine, two doses of measles, mumps and rubella vaccine, one dose of either tetanus-diphtheria or tetanus, diphtheria and acellular pertussis vaccine, and one dose of varicella vaccine for those who have not previously had chickenpox. There is not a Healthy People 2010 goal for HPV vaccination, which was first licensed and recommended in 2006.

The survey found that, compared to 2006, there was a substantial increase in the percentage of preteens and teens who had received the recommended vaccinations. Specific findings included:

-- Vaccination coverage levels for three or more doses of hepatitis B
(HepB) and two or more doses of measles, mumps and rubella vaccine
(MMR) were over 80 percent;
-- Coverage with one dose of varicella vaccine (VAR) was high at 75.7
percent but coverage with two doses was low at 18.8 percent among
preteens and teens without a previous history of disease;
-- 32.4 percent of preteens and teens surveyed had received MCV4
vaccination, up from 11.7 percent in 2006 (a 20.7 percentage point
increase);
-- 30.4 percent had received Tdap vaccination, up from 10.8 percent in
2006 (a 19.6 percentage point increase);
-- 25.1 percent of adolescent females had received at least one dose of
HPV vaccine

Rodewald encourages parents to take their preteens and teenagers for routine medical checkups as a way to ensure they receive the recommended vaccinations.

Additional Background Information

The meningococcal conjugate vaccine (MCV4) vaccine protects against meningococcal meningitis, the tetanus-diphtheria-acellular pertussis (Tdap) vaccine protects against pertussis, also known as whooping cough, and the human papillomavirus (HPV) vaccine protects girls against cervical cancer. The recommended series consists of one dose of Tdap vaccine, one dose of the MCV4 vaccine, and three doses of the HPV4 vaccine.

CDC has conducted the National Immunization Survey for teens since 2006. It is similar to the standard NIS which began in 1994, that collects immunization information among children 19 through 35 months old. It is a random digit-dialed telephone survey.

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