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Stefanie Cole,
BSN, RN, MPH, Immunization Nurse Educator, Michigan Department of Health and
Human Services Division of Immunization
The 2017-18 influenza season (defined as October 1, 2017–May
19, 2018) was a high severity season for all age groups in the United States. Levels
of flu activity are measured using multiple surveillance systems including
laboratory data, outpatient visits due to influenza-like illness (ILI),
hospitalizations, and deaths. The U.S. experienced high levels of outpatient
clinic and emergency department visits due to ILI, high flu-related
hospitalization rates, and widespread flu activity across the country for an
extended period in 2017-18. Nationally, ILI began to increase in November 2017,
peaked at the end of January/beginning of February 2018, and did not return to
baseline levels until early April. Overall, 2017-18 was an influenza A(H3N2)-predominant
season, although influenza B viruses predominated from March onward (Garten, Blanton, Elal, et al., 2018).
Unfortunately, the 2017-18 flu season saw a record number of
influenza-associated pediatric deaths. As of June 1, 2018, 171 flu-associated
pediatric deaths were confirmed nationally. The ages of these children ranged
from 8 weeks to 17 years with an average age of 7 years. For those children whose
medical history was known (n=154), 51% had at least one underlying medical
condition that put them at higher risk for flu complications. The other half
were previously healthy kids. Among the 138 children who were at least 6 months
of age and for whom vaccination status was reported, only 22% received at least
one dose of 2017-18 flu vaccine before becoming ill (Garten, Blanton, Elal, et al., 2018).
Further, as of July 14, 2018, the number of flu-associated
pediatric deaths nationally increased to 178, two of which were Michigan
children (Centers for Disease Control, 2018b; Michigan Department of Health and Human Services, n.d.). Since influenza pediatric deaths became a reportable
condition in 2004, the only other flu season with more pediatric flu deaths
than this past season was the 2009 pandemic (Garten, Blanton, Elal, et al., 2018). The 2017-18 season
underscored the importance of ensuring children are vaccinated against
influenza, regardless of if they have underlying medical conditions. Some
children will need two doses of flu vaccine during the upcoming flu season. To
find out which children need two doses, visit the Michigan Department of Health and Human Services Flu Website and click on
the “Current Flu Season Vaccination Materials for Health Care Professionals” to
find this and other flu vaccine educational resources.
Estimates from November 2017 found that only about two in
every five children and adults in the U.S. had received flu vaccine. About 65%
of children who had received flu vaccine by November got it at a doctor’s
office. For adults, about 35% got flu vaccine at a doctor’s office and 28% were
vaccinated in a pharmacy or store. Because infants younger than 6 months are
too young to be vaccinated against flu, vaccinating pregnant women is an
important strategy to protect them. Unfortunately, as of November 2017, flu
vaccination coverage among pregnant women before and during pregnancy was only 35.6%.
All end-season flu vaccine coverage estimates for 2017-18, including
Michigan-specific estimates, will be published in September 2018 (Centers for Disease Control, 2017).
The Northern Hemisphere’s 2018-19 flu vaccine composition
includes an A/Michigan/45/2015 A(H1N1)pdm09-like virus, an
A/Singapore/INFIMH-16–0019/2016 A(H3N2)-like virus, and a
B/Colorado/06/2017-like (B/Victoria lineage) virus. Quadrivalent vaccines
include these three strains plus a B/Phuket/3073/2013-like (B/Yamagata lineage)
virus (Garten, Blanton, Elal, et al., 2018). In June 2018, the Advisory Committee on Immunization
Practices (ACIP) voted to continue the universal flu vaccine recommendation for
all persons aged 6 months and older for the 2018-19 season (Centers for Disease Control, 2018a). ACIP
does not recommend any flu vaccine over another, but recommends that any
age-appropriate, licensed flu vaccine may be used. After two years off the
market, live, attenuated influenza vaccine (LAIV4, FluMist®) was recommended by
ACIP in February 2018 as an option for flu vaccination of persons for whom it
is appropriate for the 2018–19 season (Grohskopf, Sokolow, Fry, Walter, & Jernigan, 2018). The complete 2018-19 flu
vaccine recommendations can be found at www.cdc.gov/mmwr.
Begin vaccinating all persons aged 6 months
and older as soon as flu vaccine is available. Vaccinate not only to
protect patients but also anyone they may encounter, including infants who
may be too young to receive flu vaccine themselves.
References:
Centers for Disease Control and Prevention (2017).
FluVaxView, 2017-18 Flu Season: https://www.cdc.gov/flu/fluvaxview/1718season.htm
Centers for Disease Control and Prevention
(2018a). Advisory Committee on Immunization Practices (ACIP): https://www.cdc.gov/vaccines/acip/meetings/meetings-info.html
Centers
for Disease Control and Prevention (2018b). Weekly U.S. Influenza Surveillance
Report: https://www.cdc.gov/flu/weekly/
Garten, R., Blanton, L., Elal, A.I., et al. (2018) Update:
Influenza Activity in the United States During the 2017–18 Season and
Composition of the 2018–19 Influenza Vaccine. MMWR Morb Mortal Wkly Rep. 67(22) 634–642. http://dx.doi.org/10.15585/mmwr.mm6722a4
Grohskopf, L.A.,
Sokolow, L.Z., Fry, A.M., Walter, E.B., Jernigan, D.B.(2018). Update: ACIP
Recommendations for the Use of Quadrivalent Live Attenuated Influenza Vaccine
(LAIV4) — United States, 2018–19 Influenza Season. MMWR Morb Mortal Wkly Rep 67(22):643–645. http://dx.doi.org/10.15585/mmwr.mm6722a5
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