This is the current release of the guideline.

Recommended Use of Influenza A (H1N1) 2009 Monovalent Vaccine

The Advisory Committee on Immunization Practices (ACIP) recommends that vaccination efforts should focus initially on persons in five target groups (see Box below) whose members are at higher risk for influenza or influenza-related complications, are likely to come in contact with influenza viruses as part of their occupation and could transmit influenza viruses to others in medical care settings, or are close contacts of infants aged <6 months (who are too young to be vaccinated). In the event that vaccine availability is unable to meet initial demand, priority should be given to a subset of the five target groups (see Box below).

Initial Target Groups

When vaccine is first available, ACIP recommends that programs and providers administer vaccine to persons in the following five target groups (order of target groups does not indicate priority):

• Pregnant women
• Persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers)
• Health-care and emergency medical services personnel*
• Persons aged 6 months–24 years
• Persons aged 25–64 years who have medical conditions that put them at higher risk for influenza-related complications**

These five target groups comprise an estimated 159 million persons in the United States. This estimate does not accurately account for persons who might be included in more than one category (e.g., a health-care worker with a high-risk condition). Vaccination programs and providers should begin vaccination of persons in all these groups as soon as vaccine is available.

*Health-care personnel (HCP) include all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza, infectious materials, including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP. The recommendations in this report apply to HCP in acute-care hospitals, nursing homes, skilled nursing facilities, physicians' offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. Emergency medical services personnel might include persons in an occupation (e.g., emergency medical technicians and fire fighters) who provide emergency medical care as part of their normal job duties.

**Medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) and immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).

Subset of Target Groups During Limited Vaccine Availability

Current projections of initial vaccine supply indicate that establishment of a subset of the five initial target groups will not be necessary in most areas. However, demand for vaccination and initial supply might vary considerably across geographic areas. If the supply of the vaccine initially available is not adequate to meet demand for vaccination among the five target groups listed above, ACIP recommends that the following subset of the initial target groups receive priority for vaccination until vaccine availability increases (order of target groups does not indicate priority):

• Pregnant women
• Persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers)
• Health-care and emergency medical services personnel who have direct contact with patients or infectious material
• Children aged 6 months–4 years
• Children and adolescents aged 5–18 years who have medical conditions that put them at higher risk for influenza-related complications

This subset of the five target groups comprises approximately 42 million persons in the United States. Vaccination programs and providers should give priority to this subset of the five target groups only if vaccine availability is too limited to initiate vaccination for all persons in the five initial target groups.

Expanding Vaccination Efforts Beyond Initial Target Groups

Decisions about expanding vaccination to include additional populations beyond the five initial target groups should be made at the local level because vaccine availability and demand might vary considerably by area. Once vaccination programs and providers are meeting the demand for vaccine among the persons in the five initial target groups, vaccination should be expanded to all persons aged 25–64 years. Decisions about expanding or establishing priorities for vaccination should be made in accordance with local circumstances based on the judgment of state and local health officials and health-care providers. CDC and other public health agencies will assess the vaccine supply on a continuing basis throughout the manufacturing period. CDC and state and local health authorities will inform providers and the general public if any indication exists of a substantial delay or an inadequate supply.

BOX. Initial target groups for novel influenza A (H1N1) vaccination programs and a subset of these target groups to receive vaccine if initial vaccine availability is not sufficient to meet demand*

* Priority should be given to persons in the subset of the five target groups only if initial vaccine availability is not sufficient to meet demand for all persons in the five target groups. As vaccine availability increases, vaccination programs should be expanded to include all members of the initial target groups. Vaccination of other adult populations is recommended as vaccine availability increases.

**HCP include all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza, infectious materials, including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP. The recommendations in this report apply to HCP in acute-care hospitals, nursing homes, skilled nursing facilities, physicians' offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. Emergency medical services personnel might include persons in an occupation (e.g., emergency medical technicians and fire fighters) who provide emergency medical care as part of their normal job duties.

***Medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) and immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).

Current studies indicate the risk for infection among persons aged >65 years is less than the risk for persons in younger age groups. Expanding vaccination recommendations to include adults aged >65 years is recommended only after assessment of vaccine availability and demand at the local level. Once demand for vaccine among younger age groups is being met, vaccination should be expanded to all persons aged >65 years. This recommendation might need to be reassessed as new epidemiologic, immunologic, or clinical trial data warrant and in the context of global need for vaccine.

ACIP makes the following additional recommendations about use of influenza A (H1N1) 2009 monovalent vaccine:

• The number of doses of vaccine required for immunization against novel influenza A (H1N1) has not been established. Because vaccine availability is expected to increase over time, vaccine should not be held in reserve for patients who already have received 1 dose but might require a second dose.
• Simultaneous administration of inactivated vaccines against seasonal and novel influenza A (H1N1) viruses is permissible if different anatomic sites are used. However, simultaneous administration of live, attenuated vaccines against seasonal and novel influenza A (H1N1) virus is not recommended.
• All persons currently recommended for seasonal influenza vaccine, including those aged >65 years, should receive the seasonal vaccine as soon as it is available. Recommendations for use of the 2009–10 seasonal influenza vaccine have been published previously.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Not applicable: The guideline was not adapted from another source.

2009 Aug 28

Centers for Disease Control and Prevention - Federal Government Agency [U.S.]

United States Government

Advisory Committee on Immunization Practices (ACIP)

ACIP Influenza Working Group

Advisory Committee on Immunization Practices

Membership List, February 2009

Chair: Dale Morse, MD, New York State Department of Health, Albany, New York

Executive Secretary: Larry Pickering, MD, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia

Members: Carol Baker, MD Baylor College of Medicine, Houston, Texas; Robert Beck, JD, Consumer Representative, Palmyra, Virginia; Lance Chilton, MD, University of New Mexico, Albuquerque, New Mexico; Paul Cieslak, MD, Oregon Public Health Division, Portland, Oregon; Kristen Ehresmann, St. Paul, Minnesota; Janet Englund, MD, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington; Franklyn Judson, MD, Denver, Colorado; Susan Lett, MD, Massachusetts Department of Public Health, Boston, Massachusetts; Michael Marcy, MD, Torrance, California; Cody Meissner, MD, Boston, Massachusetts; Kathleen Neuzil, MD, University of Washington; Seattle, Washington; Mark Sawyer, MD, San Diego, California; Ciro Valent Sumaya, MD, Texas A&M University System Health Science Center, Bryan-College Station, Texas; Jonathan Temte, MD, Madison, Wisconsin

Ex-Officio Members: James E. Cheek, MD, Indian Health Service, Albuquerque, New Mexico; Wayne Hachey, DO, Department of Defense, Falls Church, Virginia; Geoffrey S. Evans, MD, Health Resources and Services Administration, Rockville, Maryland; Bruce Gellin, MD, National Vaccine Program Office, Washington, District of Columbia; Linda Murphy, Centers for Medicare and Medicaid Services, Baltimore, Maryland; George T. Curlin, MD, National Institutes of Health, Bethesda, Maryland; Norman Baylor, MD, Food and Drug Administration, Bethesda, Maryland; Linda Kinsinger, MD, Department of Veterans Affairs, Durham, North Carolina

Liaison Representatives: American Academy of Family Physicians, Doug Campos-Outcalt, MD, Phoenix, Arizona; American Academy of Pediatrics, Joseph Bocchini, MD, Shreveport, Louisiana, David Kimberlin, MD, Birmingham, Alabama; Keith Powell, MD; American Association of Health Plans, Andrea Gelzer, MD, Hartford, Connecticut; American College Health Association, James C. Turner, MD, Charlottesville, Virginia; American College of Obstetricians and Gynecologists, Stanley Gall, MD, Louisville, Kentucky; American College of Physicians, Gregory Poland, Rochester, Minnesota; American Medical Association, Litjen Tan, PhD, Chicago, Illinois; American Osteopathic Association, Stanley Grogg, DO, Tulsa, Oklahoma; American Pharmacists Association, Stephan L. Foster, PharmD, Memphis, Tennessee; America's Health Insurance Plans, Tamara Lewis, MD, Salt Lake City, Utah; Association of Teachers of Preventive Medicine, W. Paul McKinney, MD, Louisville, Kentucky; Biotechnology Industry Organization, Clement Lewin, PhD, Cambridge, Massachusetts; Canadian National Advisory Committee on Immunization, Monica Naus, MD, Vancouver, British Columbia; Healthcare Infection Control Practices Advisory Committee, Steve Gordon, MD, Cleveland, Ohio; Infectious Diseases Society of America, Samuel L. Katz, MD, Durham, North Carolina, London Department of Health, David M. Salisbury, MD, London, United Kingdom; National Association of County and City Health Officials, Nancy Bennett, MD, Rochester, New York, Jeff Duchin, MD, Seattle, Washington; National Coalition for Adult Immunization, David A. Neumann, PhD, Bethesda, Maryland; National Foundation for Infectious Diseases, William Schaffner, MD, Nashville, Tennessee; National Immunization Council and Child Health Program, Mexico, Vesta Richardson, MD, Mexico City, Mexico; National Medical Association, Patricia Whitley-Williams, MD, New Brunswick, New Jersey; National Vaccine Advisory Committee, Gary Freed, MD, Ann Arbor, Michigan; Pharmaceutical Research and Manufacturers of America, Damian A. Braga, Swiftwater, Pennsylvania, Peter Paradiso, PhD, Collegeville, Pennsylvania; Society for Adolescent Medicine, Amy Middleman, MD, Houston, Texas; Society for Health-Care Epidemiology of America, Harry Keyserling, MD, Atlanta, Georgia

ACIP Influenza Working Group

Chair: Kathleen Neuzil, MD, Seattle, Washington

Members: Beth Bell, MD, Atlanta, Georgia; Nancy Bennett, MD, Rochester, New York; Henry Bernstein, DO, Lebanon, New Hampshire; Joseph Bresee, MD, Atlanta, Georgia; Carolyn Bridges, MD, Atlanta, Georgia; Karen Broder, MD, Atlanta, Georgia; Jay Butler, MD, Anchorage, Alaska; Doug Campos-Outcalt, MD, Phoenix, Arizona; Lance Chilton, MD, Albuquerque, New Mexico; David Cho, MD, Rockville, Maryland; Nancy Cox, PhD, Atlanta, Georgia; Therese Cvetkovich, MD, Rockville, Maryland; David Delozier, MD, Atlanta, Georgia; Jeff Duchin, MD, Seattle, Washington; Janet Englund, MD, Seattle, Washington; Anthony Fiore, MD, Atlanta, Georgia; Sandra Fryhofer, MD, Atlanta, Georgia; Stanley Gall, MD, Louisville, Kentucky; Paul Gargiullo, PhD, Atlanta, Georgia; Steven Gordon, MD, Cleveland, Ohio; Penina Haber, PhD, Atlanta, Georgia; Wayne Hachey, DO, Falls Church, Virginia; John Iskander, MD, Atlanta, Georgia; Elyse Olshen Kharbanda, MD, New York, New York; Susan Lett, MD, Boston, Massachusetts; Tamara Lewis, MD, Salt Lake City, Utah; Cynthia Nolletti, MD, Rockville, Maryland; Gregory Poland, MD, Rochester, Minnesota; William Schaffner, MD, Nashville, Tennessee; Robert Schechter, MD, Sacramento, California; Kenneth Schmader, MD, Durham, North Carolina; David Shay, MD, Atlanta, Georgia; Danuta Skowronski, MD, Vancouver, British Columbia, Canada; Patricia Stinchfield, St. Paul, Minnesota; Ray Strikas, MD, Washington, District of Columbia; Litjen Tan, PhD, Chicago, Illinois; Mary Vernon-Smiley, MD, Atlanta, Georgia; Pascale Wortley, MD, Atlanta, Georgia; Timothy Uyeki, MD, Atlanta, Georgia

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI Institute on September 25, 2009.

No copyright restrictions apply.