Flu vaccine recommendations for the 2016 - 2017 season
There will be more shots given this flu season with the loss of the intranasal formulation of the influenza vaccine, according to the American Academy of Pediatrics (AAP).
The AAP recently released its updated recommendations on influenza vaccination for the 2016-2017 season, building upon an earlier announcement from the Centers for Disease Control and Prevention (CDC) that the intranasal flu vaccine would be pulled this year after it was found to be substantially less effective than the injectable formulation.
Although this might be the most noticeable change for the year, there are other updates in the recommendations, as well as reminders of vaccination protocols and practice goals.
Henry H Bernstein, DO, MHCM, FAAP, a pediatrician with Northwell Health in New Hyde Park, New York, helped draft the new recommendations and says that although the flu shot won’t ever be perfect, it’s better than remaining unprotected. He urges pediatricians to educate patients and their families, and promote vaccination in all children aged 6 months and older as well as their caregivers.
“People need to recognize that the influenza virus is totally unpredictable. We try to predict which strains will predominate in a given season and we do hope the strains included in the vaccine match those flu viruses that circulate in communities,” Bernstein says. “No vaccine is 100% perfect, but last year’s protection rate of more than 60% highlights an excellent track record and [is] certainly much better than not having received flu vaccine at all.”
Last year’s flu season was “moderate,” says the AAP, but peaked later—in March—than in previous seasons. The predominant strain last year was the influenza A (H1N1)pdm09 virus, with influenza A (H3N2) dominating the season from October through December, and influenza B viruses taking over from mid-April through mid-May.
Bernstein says there are thousands of deaths each year because of influenza, and pediatric deaths related to influenza average around 100 per year. Last year, there were 85.
The majority of pediatric deaths from influenza—80% to 85%—typically occur in unvaccinated children aged older than 6 months, the AAP notes. Most influenza hospitalizations among pediatric patients over the last decade occurred in children aged younger than 5 years, according to the association’s data.
“These deaths are preventable, and the vaccine certainly can help prevent infection and disease,” Bernstein says.
The updated guidelines highlight the fact that the AAP recommends that all children aged 6 months and older receive the flu vaccine, and intranasal is out.
Earlier this summer, the CDC’s Advisory Committee on Immunization Practices voted against using the live attenuated influenza vaccine—administered intranasally—for the upcoming flu season, based on data that showed poor effectiveness between 2013 and 2016.
According to data from the US Influenza Vaccine Effectiveness Network, the intranasal spray showed an estimated 3% effectiveness rate during the 2015-2016 season compared with a 63% effectiveness rate for the injectable vaccine.
Although the CDC gave no reason as to why the intranasal vaccine saw a drop in efficacy since it was introduced in 2003, both Bernstein and the CDC suspect it was due to a change in the formulation of the vaccine. The efficacy of the intranasal vaccine began to change 3 years ago when coverage was added against a fourth strain of the influenza virus, Bernstein says. Whether there is some kind of interference among the viruses making it less effective is uncertain, he adds.
“No matter how you slice the information, it appears that the inactivated flu vaccine shot always outperforms the intranasal, which was not necessarily the case 3 years prior when the intranasal product was a trivalent vaccine,” Bernstein explains.