CDC panel urges flu vaccine for more children.

ATLANTA -- A Centers for Disease Control and Prevention advisory panel has recommended expanding the ages for annual influenza vaccination for children to include all who are 6 months to 18 years of age.

The Advisory Committee on Immunization Practices (ACIP) made the recommendation in a unanimous vote, adding approximately 30 million children in the 5- to 18-year age group. However, the panel was mixed about when the move should take effect.

Some ACIP members said the decision should become official in the 2009-2010 influenza season, giving practitioners time to prepare for implementation. Others sought immediate implementation. The compromise language, which is subject to revision, states that the recommendation should take effect "as soon as feasible, and no later than the 2009-2010 influenza season." The panel's advice routinely is adopted by the CDC, which then issues guidelines to physicians.

"We're very supportive of what happened, said Dr. Doug Campos-Outcalt, a liaison to ACIP from the American Academy of Family Physicians. "We do think it's going to take a year, just because of the timing. By the time the official recommendation comes out, it will be summer.... I think that giving a year's notice for full implementation" for children through age 18 years will be "very helpful in maintaining the credibility of ACIP with practitioners."

Dr. Joseph A. Bocchini Jr., a liaison from the American Academy of Pediatrics, agreed. "This is an important advance for children, because this age group has a high attack rate of influenza each year and may be important in spreading the infection to adults and other individuals who may be at risk for complications." He added that it is a "reasonable compromise, but it means we do have to work as quickly as possible to educate and look for ways to demonstrate the ability to do this, potentially in the office and more importantly in places outside of the office." Dr. Bocchini is professor of pediatrics and chairman of the department of pediatrics at Louisiana State University, Shreveport. He noted that the size of the added age group would make it "very difficult for many practices" to bring that many children into the office in a short period of time.

Studies have shown that healthy children bear a significant burden from influenza disease and are at increased risk of needing influenza-related medical care. There are few deaths or hospitalizations for influenza among school-age children compared with younger children, the elderly, or those with chronic conditions. However, school-age children make 5-7 outpatient visits per 100 annually, where they frequently receive antibiotics. About 10-30 influenza illnesses occur per 100 children, and frequently are associated with school absenteeism, according to Dr. Anthony Fiore of the influenza division of the CDC's National Center for Immunization and Respiratory Diseases.

The ACIP continues to recommend vaccination of all children who have certain chronic medical conditions, such as asthma, diabetes, kidney disease, or weakened immune systems. In addition, vaccinating those who are younger than 5 years of age should continue to be a priority since that population is at higher risk for more severe influenza complications.

Also at the meeting, results from a vaccine efficacy study among children aged 6-23 months were presented by Dr. David Shay, also of NCIRD's influenza division. The findings indicated vaccine efficacy of about 75% in preventing influenza hospitalizations among fully vaccinated children in this age group during the 2005-2006 and 2006-2007 seasons. In contrast, the study found that children who received only one dose of vaccine did not receive statistically significant protection. These data underscore the importance of the existing ACIP recommendation that children younger than 9 years of age who will be receiving the influenza vaccine for the first time need two doses.

The 2008-2009 influenza vaccine for the United States will include three new swains: an A/Brisbane/10/2007 (H3N2)--like virus, a B/Florida / 4 / 2006--like virus, and A / Brisbane / 59 / 2007 (H1N1)--like virus strain. Influenza vaccine manufacturers produced as many as 130 million doses of influenza vaccine for the 2007-2008 influenza season and have discussed expanding current production capacity in the coming years.

BY MIRIAM E. TUCKER

Senior Writer