Update: influenza vaccine supply and recommendations for prioritization during the 2005-06 influenza season

Influenza vaccine distribution delays or vaccine supply shortages have occurred in the United States in three of the last five influenza seasons. In response, prioritization has been implemented in previous years to ensure that enough vaccine is available for those at the highest risk for complications from influenza. The information in this report updates projections of influenza vaccine supply and previous recommendations for priority use of trivalent inactivated influenza vaccine (TIV) during the 2005-06 influenza season.     

Influenza vaccine prebooking and distribution strategies for the 2005-06 influenza season

For the 2004-05 influenza season, CDC, in coordination with the Advisory Committee on Immunization Practices (ACIP), issued interim influenza vaccine use recommendations after Chiron Corporation announced that none of its inactivated influenza vaccine (Fluvirin) would be available in the United States. To plan for the upcoming 2005-06 influenza season, CDC has met with influenza vaccine manufacturers, including those intending to apply for approval to sell in the United States, to develop supply projections and distribution strategies, including prebooking (i.e., advance ordering of vaccine) and partial shipment of orders to those customers who prebook. As of March 25, 2005, the supply of inactivated influenza vaccine projected for the 2005-06 season appeared adequate to meet the historical demand from persons in the priority groups established by ACIP during the 2004-05 season. If more vaccine becomes available, additional groups can also be targeted for vaccination.     

Update: influenza activity--United States and worldwide, 2005-06 season, and composition of the 2006-07 influenza vaccine

During the 2005-06 influenza season, influenza A (H1N1), A (H3N2), and B viruses cocirculated worldwide. In the United States, influenza A (H3N2) viruses predominated overall, but influenza B viruses were isolated more frequently than influenza A viruses late in the season. Influenza activity in the United States peaked in early March, and the number of pneumonia and influenza deaths did not exceed the epidemic threshold. Worldwide, influenza B viruses were the most commonly reported influenza type in Europe; influenza A (H1N1) and influenza B viruses predominated in Asia. Through June 13, 2006, outbreaks of influenza A (H5N1) viruses (avian influenza) among migratory birds and poultry flocks were associated with severe human illness or death in 10 countries (Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Thailand, Turkey, and Vietnam). This report summarizes influenza activity in the United States and worldwide during the 2005-06 influenza season and describes composition of the 2006-07 influenza vaccine.     

Influenza vaccination coverage among persons with asthma--United States, 2005-06 influenza season

During 2006, approximately 6.8 million (9.3%) U.S. children and 16.1 million (7.3%) U.S. adults were reported to have asthma. Since 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination of all persons with asthma because of the higher risk for medical complications from influenza for those persons. Influenza vaccination coverage of persons with asthma varies by age group and remains below Healthy People 2010 targets of 60% coverage of persons aged 18--64 years with high-risk conditions (14-29 c) and 90% of all persons aged > or =65 years (14-29 a). Influenza vaccination rates of children and older adults with asthma have not been well studied. Using 2006 National Health Interview Survey (NHIS) data, this report provides the first examination of influenza vaccination rates and related factors across a national sample of persons with asthma aged > or =2 years. The results indicated that 36.2% received influenza vaccination during the 2005--06 influenza season. Vaccination rates remained below target levels among all subgroups examined, including those reporting the greatest number of health-care visits in the past 12 months. The results of this study indicate that influenza vaccination coverage of all persons with asthma can be improved by increasing access to health care and using opportunities for vaccination during health-care visits.     

2005-2007年珠海市流感监测分析

目的 分析珠海市2005-2007年流感流行特征.方法 采集监测医院和疑似流感疫情的流感样病例咽拭子标本,用狗肾传代细胞(MDCK)进行流感病毒分离培养,采用血凝抑制试验(HI)进行流感病毒型别鉴定.结果 2005-2007年共检测疑似流感样病例标本2 446份,分离到流感病毒311株,分离率为12.7%,其中H1N1亚型108株、H3N2亚型117株、B型86株,分别占34.7% 、37.6%和27.7%.2005年、2006年流感病毒的分离率均高于2007年流感病毒的分离率(均P<0.01);2005年、2006年为H1N1、H3N2和B型同时流行; 2007年未分离到HlN1亚型,为H3N2与B型同时流行.结论 珠海市2005年和2006年流感病毒较活跃,2007年较平稳;2007年的流行优势毒株由2006年的H1N1亚型变为H3N2亚型.3-7月份为流感疫情高发期,应加强此期的流感监测.     

Influenza vaccination coverage among children aged 6-23 months--United States, 2005-06 influenza season

Children aged <2 years are at increased risk for influenza-related hospitalizations, and those aged <5 years have more influenza-related health-care visits than older children. In 2004, the Advisory Committee on Immunization Practices (ACIP) recommended annual influenza vaccination of children aged 6-23 months. Two doses, at least 4 weeks apart, were recommended to fully vaccinate children aged <9 years who were receiving influenza vaccination for the first time. To assess influenza vaccination coverage among children aged 6-23 months during the 2005-06 influenza season, data from the 2006 National Immunization Survey (NIS) were analyzed. This report describes the results of that analysis, which indicated that 31.9% of children in this age group received at least 1 dose of influenza vaccine and 20.6% were fully vaccinated according to ACIP recommendations; however, results varied substantially among states. The results underscore the need to continue to monitor influenza vaccination coverage among young children, develop systems to provide childhood influenza vaccination services more efficiently, and increase awareness among health-care providers and caregivers about the effectiveness of influenza vaccination among young children.     

High levels of adamantane resistance among influenza A (H3N2) viruses and interim guidelines for use of antiviral agents--United States, 2005-06 influenza season

An estimated 200,000 persons are hospitalized each year and 36,000 persons die from complications of influenza in the United States. The cornerstone of influenza prevention is annual vaccination. However, antiviral drugs are an important adjunct to vaccination for influenza prevention and control. Two classes of antiviral medications are available currently: adamantanes or M2 ion channel inhibitors (i.e., amantadine and rimantadine) and neuraminidase inhibitors (i.e., oseltamivir and zanamivir). The adamantanes are active against only influenza A viruses and are used for both treatment and chemoprophylaxis of influenza A, whereas the neuraminidase inhibitors are active against both influenza A and B viruses. Zanamivir is not approved for chemoprophylaxis of influenza in the United States. This report describes new findings regarding the resistance to adamantanes of influenza A viruses currently circulating in the United States and provides interim recommendations that these drugs not be used during the remainder of the 2005-06 influenza season. Amantadine also is used to treat symptoms of Parkinson disease and may continue to be used for this indication.     

2005—2012年无锡市流感流行特征分析

目的掌握2005-2012年无锡市流感流行规律和流感病毒优势株的变化。方法分别采用实时荧光聚合酶链反应（Real-time polymerase chain reaction,Real-time PCR）方法和狗肾传代细胞（Madin-Darby canine kid-ney,MDCK）细胞培养法进行流感病毒检测和流感病毒分离。结果 2005年10月～2012年12月,无锡市流感样病例（influenza like illness,ILI）年龄构成以0～5岁为主（62.31%）,流感病毒分离平均阳性率为19.29%,其中季节性A（H1N1）占11.99%,季节性A（H3N2）占28.15%,B型占34.17%,甲型H1N1占25.70%。各年龄组人群感染流感毒株型别不同（2=250.60,P〈0.001）。总阳性率每隔2年升高一次,ILI与流感病毒活动度之间呈正相关（r=0.241,P=0.024）。ILI暴发疫情主要集中在2006年3～4月份和2009年9月份,主要由B型和甲型H1N1引起。结论 ILI、ILI%和流感病毒阳性率三者的高峰基本吻合,并与流感优势毒株交替变化一致,上述验证了流感哨点监测在预警预测流感流行趋势和暴发疫情中的实际作用。     

2005-2012年无锡市流感流行特征分析

目的掌握2005-2012年无锡市流感流行规律和流感病毒优势株的变化。方法分别采用实时荧光聚合酶链反应（Real-time polymerase chain reaction,Real-time PCR）方法和狗肾传代细胞（Madin-Darby canine kid-ney,MDCK）细胞培养法进行流感病毒检测和流感病毒分离。结果 2005年10月～2012年12月,无锡市流感样病例（influenza like illness,ILI）年龄构成以0～5岁为主（62.31%）,流感病毒分离平均阳性率为19.29%,其中季节性A（H1N1）占11.99%,季节性A（H3N2）占28.15%,B型占34.17%,甲型H1N1占25.70%。各年龄组人群感染流感毒株型别不同（2=250.60,P<0.001）。总阳性率每隔2年升高一次,ILI与流感病毒活动度之间呈正相关（r=0.241,P=0.024）。ILI暴发疫情主要集中在2006年3～4月份和2009年9月份,主要由B型和甲型H1N1引起。结论 ILI、ILI%和流感病毒阳性率三者的高峰基本吻合,并与流感优势毒株交替变化一致...     

False-positive oral fluid rapid HIV tests--New York City, 2005-2008

The New York City Department of Health and Mental Hygiene (NYC DOHMH) operates 10 sexually transmitted disease (STD) walk-in clinics offering various free services, including confidential or anonymous testing for human immunodeficiency virus (HIV). In January 2004, the STD clinics introduced on-site rapid HIV testing of finger-stick whole-blood specimens using the OraQuick(R) brand test (OraSure Technologies, Bethlehem, Pennsylvania). In March 2005, the clinics replaced finger-stick whole-blood testing with oral fluid testing with the OraQuick Advance Rapid HIV-1/2 Antibody Test. The clinics use Western blot confirmatory tests on serum to confirm all whole-blood or oral fluid reactive (i.e., preliminary positive) rapid tests. In late 2005, an unexpected increase in the number of false-positive oral fluid tests occurred, but the increase subsided after several months. In December 2005, while the cluster of false-positive oral fluid test results was being investigated, the NYC DOHMH Bureau of STD Control suspended oral fluid testing in the clinics for 3 weeks and replaced it with finger-stick whole-blood rapid testing, which produced no false-positive test results. On December 21, 2005, NYC DOHMH resumed oral fluid rapid testing but also introduced the use of immediate follow-up finger-stick whole-blood testing, using a second OraQuick test, after any reactive oral fluid test result. In late 2007, another larger increase in the incidence of false-positive oral fluid rapid test results was observed. The cause for the episodic increases in false-positive oral fluid tests has not yet been determined. NYC DOHMH has again suspended the use of oral fluid testing in STD clinics, and finger-stick whole-blood testing is the only rapid HIV test being used in this setting. These findings underscore the importance of confirming all reactive HIV tests, both from oral fluid and whole-blood specimens. In addition, the results suggest that the NYC DOHMH strategy of following up reactive oral fluid test results with an immediate finger-stick whole-blood test reduced the number of apparent false-positive oral fluid test results and might be a useful strategy in other settings and locations.     

State-specific influenza vaccination coverage among adults aged > or =18 years--United States, 2003-04 and 2005-06 influenza seasons

Influenza epidemics occur seasonally and result in substantial morbidity and mortality among adults in the United States. Adult groups included in the 2007 Advisory Committee on Immunization Practices (ACIP) recommendation for annual influenza vaccination are persons aged 18-49 years with high-risk conditions (i.e., conditions associated with an increased risk for complications from influenza), persons aged > or =50 years, health-care personnel, and others who are household contacts or caregivers of persons at high risk (e.g., persons with high-risk conditions or children aged < or =59 months). In addition, adults who want to reduce the risk for becoming ill with influenza or of transmitting influenza to others should be vaccinated. Healthy People 2010 (HP2010) objectives include increasing vaccination levels to 90% for adults aged > or =65 years (objective 14-29a) and 60% for persons aged 18-64 years who have one or more high-risk conditions (objective 14-29c). From the 1992-93 through 2003-04 influenza seasons, seasonal influenza vaccination coverage estimates (based on Behavioral Risk Factor Surveillance System [BRFSS] data) among adults aged > or =65 years trended upward, except for three seasons (1997-98, 1999-00, and 2000-01) when no increases occurred (Figure). To evaluate recent state-specific progress toward the HP2010 objectives, CDC compared data from the 2004 and 2006 BRFSS surveys, which reflected vaccinations received during the 2003-04 and 2005-06 influenza seasons; data from the 2004-05 influenza season, which have been published previously, were not included in this comparison because that season was marked by a substantial shortage of influenza vaccine. This report describes the results of the analysis, which indicated that influenza vaccination coverage for the 2005-06 season did not return to levels observed before the vaccine shortage of 2004-05 and remained substantially below HP2010 targets. Comprehensive measures are needed to improve influenza vaccination coverage among adult populations in the United States, including increasing adoption of recommended adult immunization practices by health-care providers, raising public awareness about influenza vaccination, vaccinating throughout the influenza season, and ensuring stable supplies of readily available vaccine.     

Update: influenza activity--United States and worldwide, May 22-September 3, 2005, and 2005-06 season vaccination recommendations

Influenza A (H3N2) viruses circulated worldwide, and Influenza A (H1) and B viruses were reported less frequently during May 22-September 3, 2005. In North America, isolates of influenza A (H3N2), A (H1), and influenza B were identified sporadically. This report summarizes influenza activity in the United States and worldwide since the last MMWR update.     

Influenza vaccination coverage among children aged 6-23 months - six immunization information system sentinel sites, United States, 2005-06 influenza season

Beginning with the 2004-05 influenza season, the Advisory Committee on Immunization Practices (ACIP) recommended that all children aged 6-23 months receive influenza vaccinations annually. Other children recommended to receive influenza vaccinations include those aged 6 months-18 years who have certain high-risk medical conditions, those on chronic aspirin therapy, those who are household contacts of persons at high risk for influenza complications, and, since 2006, all children aged 24-59 months. Previously unvaccinated children aged <9 years need 2 doses administered at least 1 month apart to be considered fully vaccinated. This report assesses influenza vaccination coverage among children aged 6-23 months during the 2005-06 influenza season by using data from six immunization information system (IIS) sentinel sites. The findings demonstrate that vaccination coverage with 1 or more doses varied widely (range: 6.6% to 60.4%) among sites, with coverage increasing from the preceding influenza season in four of the six sites. However, <23% of children in five of the sites were fully vaccinated, underscoring the need for increased measures to improve the proportion of children who are fully vaccinated.     

2005—2012年徐州市流感病原学监测结果分析

目的了解2005—2012年徐州市流感病原学特点及流行特征。方法在徐州市选取3家哨点医院采集门诊疑似流感病人的咽拭子标本,用荧光定量PCR法、MDCK细胞培养法进行流感病毒的分离鉴定,用红细胞凝集及红细胞凝集抑制试验进行流感病毒的分型鉴定。结果 2005年10月到2012年9月底3家哨点医院共采集到咽拭子标本9 700份,分离到各型流感病毒999株,检出率为10.30%,其中669例为A型流感病毒阳性,占阳性标本的66.97%;330例为B型流感病毒阳性,占阳性标本的33.03%。结论近年来,徐州市流感除2006年以A/H1N1型为主要流行株、2009年以新A/H1N1为主要流行株外,其他年份均以A/H3N2型为流行优势株,同时也有B型毒株的存在。徐州市1年中有2个流行季节,即12月到次年的2月及8—9月。