Epidemiologic Notes and Reports Prevention and Control of
Influenza
Influenza viruses have continually demonstrated the ability to
cause major epidemics of respiratory disease and frequently infect
individuals who, because of their advanced ages and/or chronic
underlying health conditions, are poorly able to cope with the
disease. Excess deaths attributable to pneumonia and influenza are
often documented during epidemics, and over 80% of these deaths
occur
among persons 65 years of age or older. Although annual influenza
vaccination has long been considered the single most important
measure
in the prevention or attenuation of influenza virus infections,
immunization surveys have repeatedly demonstrated that only about
20%
of persons at high risk for influenza-related complications are
vaccinated in any given year (1). In view of this observation, the
Immunization Practices Advisory Committee (ACIP) recently
reclassified
the broadly defined high-risk group on the basis of priority, so
that
special efforts can be directed at providing influenza vaccine to
persons who would derive the greatest benefit (2). These groups,
in
order of priority, are:
Adults and children with chronic disorders of the
cardiovascular or pulmonary systems that are severe enough
to
have required regular medical follow-ups or
hospitalization
during the preceding year; and residents of nursing homes
and
other chronic-care facilities.
Physicians, nurses, and other personnel who have extensive
contact with high-risk patients.
Otherwise healthy individuals over 65 years of age; and
adults and children with chronic metabolic diseases
(including diabetes mellitus), renal dysfunction, anemia,
immunosuppression, or asthma severe enough to require
regular
medical follow-up or hospitalization during the preceding
year.
Since there is considerable overlap in the target groups for
influenza and pneumococcal vaccination, physicians should consider
giving both vaccines simultaneously at separate anatomical sites.
However, in contrast to influenza vaccine, which should be
administered annually, pneumococcal vaccine should be given only
once
(3). Providing detailed immunization records to each patient would
help ensure that additional doses of pneumococcal vaccine are not
given.
The ACIP also encourages physicians to administer vaccine to
any
persons in their practices who wish to reduce their chances of
acquiring influenza infection and has also recommended amantadine
hydrochloride prophylaxis and therapy when appropriate
circumstances
arise. Details concerning these and other aspects of influenza
control have been published elsewhere (2).
Reported by Div of Immunization, Center for Prevention Svcs,
Influenza
Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Effective influenza vaccination programs require
planning well in advance and should be completed, whenever
possible,
before the beginning of the influenza season. Although the
earliest
laboratory-confirmed cases of influenza are often documented in
October, in recent years, peak activity has only rarely occurred
before January. In most years, therefore, influenza vaccine can be
administered from mid-October through December; if it is given much
earlier, protection may be waning when there is still widespread
influenza activity. It should also be emphasized, however, that
the
vaccine can be given until the time influenza viruses are isolated
from patients in the local community, and thereafter, although
temporary chemoprophylaxis with amantadine may be indicated (2).
Twenty-one states and Chicago, New York City, and the District
of
Columbia are providing influenza vaccine to high-risk groups on an
annual basis. Funding sources for these activities vary
considerably,
ranging from fee systems to special appropriations by the state
legislature. To supplement these efforts, CDC has expanded its
activities to improve vaccination rates among adults, especially in
those targeted to receive influenza and pneumococcal polysaccharide
vaccines. These CDC activities will include educational programs
for
patients and medical-care personnel, surveillance activities, and
evaluations of the organization, implementation, and outcome of
vaccination programs in hospitals and other settings.
References
CDC. U.S. immunization surveys (annual).
ACIP. Prevention and control of influenza. MMWR
1985;34:261-8,
273-5.
ACIP. Update: pneumococcal polysaccharide vaccine
usage--United
States. MMWR 1984;33:273-6, 281.
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