The 2010-2011 Influenza Update
According to the CDC, the official beginning of the 2010-2011 flu season begins on October 3, 2010. Around this time last year, H1N1 influenza was making the rounds in the northern hemisphere and was considered to be pandemic. Despite the rush to manufacture vaccine, supplies were still limited. And, due to the vaccine shortage, high- risk groups were triaged to receive H1N1 vaccine resulting in a great deal of concern and anxiety. This year, however, there has been an unprecedented amount of vaccine manufactured that should be available to all groups.
The World Health Organization announced in August 2010 that the 2009 H1N1 influenza strain was no longer considered to be pandemic, but rather was now seasonal, thereby noting that the H1N1 strain would be circulating with the other established seasonal strains. Of most importance is that all influenza strains that have been evaluated are antigenically similar to this season's manufactured vaccine strains. In addition, no changes in antiviral resistance trends have been observed.
In a recent letter to health care providers from the Maryland Department of Health and Mental Hygiene, The Advisory Committee on Immunization Practices (ACIP) now recommends influenza vaccinations for all individuals greater than or equal to 6 months of age. Our department of health (as would be expected throughout the United States) encourages vaccination for those at highest risk of complications (chronic lung, heart, and liver disease, extremes of age, diabetes, those who are immunosuppressed, and pregnant women), as well as healthcare workers and care providers.
A few words are in order about high- risk groups. People with diabetes are considered to be a high-risk group due to the consequences of becoming ill with any infection. In people with type 1 diabetes (and in some with ketosis prone type 2 diabetes as well), hyperglycemia, diabetic ketoacidosis, hypoglycemia, and dehydration are acute complications that may very well require hospitalization and further medical support. Thus, if one can protect oneself from infection with any offending organism, it is an excellent intervention. Of course, it is more obvious that those people with diabetes who have other medical conditions with/without long-term diabetes complications are at high risk as well and clearly need influenza vaccine. People with diabetes (especially healthy individuals) are NOT necessarily immuno-compromised; they are just in another high- risk group due to the explanations provided above.
Specific instructions in regard to pediatric patients:
- Those children under 9 years of age who are vaccinated with seasonal influenza for the first time require a seasonal influenza booster at a minimum of 4 weeks after initial dosing.
- Those children under 9 years of age who received a booster of H1N1 vaccine last year; but have never had a seasonal booster vaccine will require a booster of seasonal vaccine this year.
- Live attenuated influenza vaccines (nasal spray) are available for healthy people under 50 years of age. However, various diabetes organizations recommend that people with diabetes receive the injected vaccine. (As I discussed last year, many of my patients did receive the nasal attenuated influenza vaccine last year without any problems. And, due to the supply shortage, many used the live vaccine. I have not seen anything in the medical literature indicating major issues using the nasal vaccine in healthy children and teens with diabetes. Discuss the pros and cons of the nasal vs. injected vaccine with your pediatrician and diabetes team.)
- Please discuss in advance with your diabetes team (and pediatrician) sick day management (even if your child receives H1N1 vaccine, there are other nasty viruses in the environment). Be prepared. Have appropriate fluids available including sugar/sugar-free liquids. Make certain that your Glucagon kit has not expired! Refill ketostix to have the ability to check for ketones. Have acetaminophen and other pain relievers on hand. And lastly, have your diabetes care team emergency phone numbers readily available. (Please see recent blog on "Sick Day Management").
The CDC has indicated that the overall projected estimate for production capacity of influenza vaccine is @ 160-165 million doses, representing more doses of seasonal influenza vaccine that has ever been distributed or available for distribution in the United States in any single flu season. Fortunately, will not have a repeat of the 2009-2010 season!