With flu-shot season upon us, clinicians should be aware that new CDC recommendations could bring many more vaccination recipients to their doors. The 2008 recommendations of the CDC’s Advisory Committee on Immunization Practices (ACIP) for the prevention and control of influenza now call for annual vaccination of all children between age 5 and their 19th birthday. In previous years, the shot was routinely recommended only for children aged 6 months to 59 months and for older children with conditions that place them at increased risk of flu complications. (Children younger than 6 months should not be vaccinated.) 

Immunization should begin as soon as the 2008-2009 vaccine is available. Children younger than 9 years receiving vaccine for the first time require two doses. By next year’s flu season, annual vaccination for all youths is expected to be firmly in place. As health-care providers transition to routine immunization of all children, they should continue to focus vaccination efforts on children and adolescents  at high risk for flu complications. The recommendations for flu vaccine in children appear in Morbidity and Mortality Weekly Report (2008;
57[No. RR-7]:1-60; available at www.cdc.gov/mmwr/PDF/rr/rr5707.pdf, accessed September 15, 2008).

The CDC also recommends vaccinating adults soon after the flu vaccine becomes available—by October if possible. Even if flu activity has already begun, vaccinations given in December or later are likely to be beneficial. In more than 80% of flu seasons since 1976, peak activity hasn’t occurred until January or later. In more than 60% of those seasons, the peak hit in February or later. Most adults have antibody protection within two weeks after vaccination; immunity lasts approximately one year.

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Pneumonia is a common complication of flu in older patients, but the risk was thought to be reduced in those who receive flu vaccine. However, in a recent study of 1,173 cases of community-acquired pneumonia, researchers found no reduced risk of pneumonia in people aged 64-90 who had received flu vaccine.
“These results could mean that influenza infection only causes a small proportion of the pneumonias in these people,” say Michael L. Jackson, PhD, and colleagues (Lancet. 2008;372:398-405). “Alternatively, these results could mean that the vaccine is not very effective in reducing the risk of influenza infection in elderly people at risk of pneumonia.”