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The CDC's Recommendations for Influenza A (H1N1) 2009 Vaccine

Target groups for initial vaccine supplies include pregnant women as well as children and young adults.

The CDC has released its recommendations for use of influenza A (H1N1) 2009 monovalent vaccine. Although the vaccines are not licensed yet, the target date for the first available supply is mid-October 2009. State and local health officials will distribute vaccines, depending on local conditions.

The CDC recommends that the following five target groups (about 159 million people in the U.S.) receive priority for vaccination: pregnant women, people living with or caring for infants younger than 6 months, healthcare and emergency-response personnel, children and young adults (age range 6 months–24 years), and other adults (age range, 25–64) who have medical conditions that put them at high risk for complications associated with seasonal influenza. If the vaccine supply is not adequate for the target groups, the CDC has defined a subset for initial vaccination. If the supply is adequate, vaccination should be made available to all adults aged 25 to 64. Given that older adults (age, 65) have exhibited lower risk for infection, vaccination in this older group is recommended only after demand is met in all younger groups. If the vaccine requires two doses (likely, but not known until licensure), vaccine supplies should not be stockpiled for patients who received first doses and might require another dose. Two inactivated influenza vaccines or one inactivated and one live vaccine can be administered during the same visit; two live influenza vaccines cannot be administered during the same visit.

Comment: As the vaccine becomes available, clinics, hospitals, and office-based practices must adjust usual vaccination programs to accommodate delivery systems (e.g., health department clinics, school programs) initiated by local health departments. The recommendations for standard seasonal influenza vaccine are unchanged, so vaccine administration will require more time. Both thimerosal-free vaccine (for young children and pregnant women) and inactivated and live attenuated vaccines are expected to be available.

— Peggy Sue Weintrub, MD

Dr. Weintrub is on the Speakers' Bureau for Sanofi-Aventis and MedImmune (manufacturers of inactivated and live-attenuated vaccines, respectively).

Published in Journal Watch Pediatrics and Adolescent Medicine September 9, 2009

Citation(s):

Centers for Disease Control and Prevention (CDC). Use of influenza A (H1N1) 2009 monovalent vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 2009 Aug 28; 58:1. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm)

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Reader Remarks:

Review and add to remarks on this article

• swine flu vaccine
  Biplab Roy Chowdhury, hospital in govt . set up, 11 Sep 2009 12:16 PM EST
  is it relevant to use the vaccines for those who have been positive for H1N1 virus?
• Response from Journal Watch author: H1N1 immunity
  Peggy Sue Weintrub, MD, Journal Watch Pediatrics and Adolescent Medicine Associate Editor, 11 Sep 2009 3:29 PM EST
  Excellent question. If someone had documented H1N1, they are probably immune (though this is not a data driven answer). If... [more]
• Distribution of Vaccine
  David Siegler, Private Pediatrician, 14 Sep 2009 1:03 PM EST
  Would it not be intelligent planning to define how the vaccine will be distributed and administered? Our local DOH has... [more]
• deaths due to h1n1
  m j schaffield, 14 Sep 2009 1:03 PM EST
  why is it that the few deaths that have occurred "due to N1H1" are so mysterious? What are these "underlying... [more]
• Pregnant women
  Mario Castaneda, 29 Sep 2009 1:49 PM EST
  1). Does H1N1 vaccination include women with 1st. trimester pregnancies? 2). And on these cases, are there reports of abortions... [more]
• cross reactive antibody response
  A Täler, Teaching Hospital, 29 Sep 2009 1:49 PM EST
  Does the seasonal influenza vaccine induce any kind of protective cross-reactive antibody response to the pandemic influenza virus?
• vaccination in patients on anticoagulation
  Reshika Dhakal, 29 Sep 2009 1:49 PM EST
  Can inactivated H1N1 vaccine be administered safely via intramuscular route in patients on anticoagulation? Are there any data on other... [more]

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