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Influenza is most prevalent in the winter months from December through March and is responsible for about 36,000 deaths per years in the U.S.1 Children experience one of the highest rates of influenza infection.2 Influenza infections include influenza A and influenza B viruses. Influenza A is divided into subgroups on the basis of surface antigens, hemagglutinin (H) and neuraminidase (N). Mutations known as antigenic drifts make previously acquired influenza immunity only partially affective against new strains.3 On July 28, 2006, the Center for Disease Control and Prevention (CDC) published the 2006 guidelines for influenza vaccination, which remain the most effective approach to reducing influenza epidemics.4 These recommendations point to a need to improve vaccination levels particularly in children 6 to 23 months, in adults older than age 65, in patients with other medical conditions and in caregivers of susceptible children.4 The Advisory Committee on Immunization Practices (ACIP) recommends two doses of vaccination for children with live attenuated influenza vaccine 6 to 10 weeks apart.4 Successful vaccination programs have a plan to reach optimal immunization levels and the cornerstone of these programs is education. Vindico Medical Education recognizes a clear need to educate all healthcare providers who treat children and care for children about the new guidelines for influenza immunization.
Evidence–based data of 5000 children retrospectively analyzed for influenza immunity found no protection with one vaccination dose and a 49% effectiveness after a second vaccination.5 This study combined with several similar studies determined the influenza vaccination schedule. Another report by Emmanuel Walter, MD, director of the Duke Vaccine and Infectious Diseases Epidemiology Unit compared Spring-Fall vaccination to Fall-Fall vaccination and found that for Influenza A H1N1 the Spring vs. Fall initial vaccination was comparable and for Influenza A H3N2 and Influenza B, the Fall-Fall immunization was superior.6 He also concluded that whenever the first dose is given, two vaccination doses are always preferable to one dose. The safety profile of live attenuated influenza vaccine was evaluated in a randomized, double-blind, placebo controlled trial of 4000 healthy children 5 to 17 years of age and 2000 healthy adults over the age of 18 and the results found no statistically significant difference in adverse effects when compared to placebo.7 An educational program concerning influenza vaccination is important for healthcare providers to optimally manage patient selection, dosing, and compliance. Recently, the U.S Department of Health and Human Services published an influenza national health objective to immunize 90% of the targeted population by the years 2010.8 This reports recommends a vigorous educational campaign to achieve their goal.
Recent data on the phase 3 trial of the next generation investigational influenza vaccine was released in May 2006 and the cold adapted influenza vaccine, trivalent (CAIV-T) is 55% more effective than the trivalent injectable inactivated influenza vaccine (TIV) in reducing influenza illness.9 Effective continuing medical education not only covers current immunization guidelines but also informs healthcare professionals about vaccine research of formulas soon to be released. To emphasize the importance of influenza immunization education, the CDC has combined efforts with Metrixx, the Knowledge Factor, to perform outcome studies on the effectiveness of on line education for thousands of healthcare professionals. Through immediate feedback, knowledge will be tracked from uninformed to misinformed to fully informed.10 The CDC is concerned about healthcare professionals access to effective education to become fully informed.
The new CDC influenza recommendations include annual vaccination for all healthy children from 6 months of age and older and in particular those children who have not previously experienced influenza vaccination. In addition, all adults who live with or care for these children should be included in the vaccination program. Vindico Medical Education suggests a continuing medical education program to help close the gap of guideline recommendations and immunization initiatives to daily treatment in clinical practice. A thorough understanding of current influenza vaccination can have a major impact on the health of millions of patients (and in particular children), lost time in schools and work, and the healthcare cost of treating influenza patients.
References
1. Thompson W, Shay D, Weintraub E. et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003; 289:179-186.
2. Glezen W, Greenberg S, Atmar R, et al. Impact of respiratory virus infections on persons with underlying chronic conditions. JAMA. 2000;283: 499-505.
3. Cox N, Subbarao K. Influenza. Lancet. 1999;354:1277-1288.
4. Smith N, Bresee J, Shay D. Prevention and control of influenza. MMWR July 28, 2006; 55:1-42.
5. Ritzwollar D, Bridges C, Sheetterly S, et al. Effectiveness of the 2003-2004 influenza vaccine among children 6 months to 8 years for I versus 2 doses. Pediatrics. 2005;116:153-159.
6. Walter EB. Study probes another strategy to prime children in the fight against influenza. Infectious Diseases in Children. January 2006.
7. Nolan T, Lee M, Cordova J, et al. Safety and immunigenicity of a live attenuated influenza vaccine blended and filled at two manufacturing facilities. Vaccine. 2003; 21:1224-1231.
8. US Department of Health and Human Services. Healthy People 2010
Washington DC 2000.
9. Press Release MedImmune May 1, 2006 Phase 3 study results of MedImmune’s next-generation influenza vaccine suggest better relative efficacy against matched and mismatched strains compared to the flu shot in children.
10. The Metrixx Monitor. United States Centers for Disease Control chooses Metrixx for infectious threat education and outcomes. The Metrixx Monitor. Summer, 2006;1-4.
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