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source: Washington Post
by: Mike Stobbe
ATLANTA -- A government panel is now recommending that virtually all Americans get a flu shot each year, starting this fall.
The Advisory Committee on Immunization Practices had gradually been expanding its recommendation for flu shots - 85 percent of Americans were already included.
On Wednesday, the panel voted to recommend a seasonal flu vaccination for everyone except babies younger than 6 months and those with egg allergies or other unusual conditions.
The panel's recommendation now goes to the Centers for Disease Control and Prevention. The CDC usually follows the panel's advice and spreads the message to doctors and hospitals across the country.
"Now no one should say 'Should I or shouldn't I?'" said Dr. Anthony Fiore, a CDC flu specialist.
CDC vaccination recommendations tend to be influential with the doctors who give the shots and the health insurers who pay for them.
Flu shots are already recommended for 85 percent of the U.S. public, including pregnant women, children older than 6 months, adults 50 and older, people with certain chronic health conditions, health care workers and those who take care of people in a recommended group. The only people who weren't specifically included were healthy people ages 19 to 49 who don't have close contact with anyone at risk of flu and its complications.
But only about 33 percent of Americans actually get a flu shot, and unusually millions and millions of doses get thrown away annually.
The swine flu pandemic that hit last year caused a new momentum for flu vaccinations. Virtually all the 114 million doses of seasonal flu vaccine doses made were distributed, and more young adults and children got the swine flu vaccine than usually come out for seasonal flu.
The panel voted 11 to 0 - with one abstention - for the recommendation, prompting a short round of applause in the CDC auditorium where the meeting was held. Some public health experts and physicians had been pushing for a universal flu vaccination recommendation for more than 10 years.
Also on Wednesday, the panel gave its nod to a proposed formulation of next year's seasonal flu vaccine. The vaccine will be built to protect against three strains of flu scientists think will be circulating next fall and winter. Swine flu is to be one of the strains incorporated into the vaccine.
At past meetings, the panel stopped short of recommending flu shots for everyone. Panel members were mindful of a history of temporary flu vaccine shortages in the United States. They worried a universal recommendation might cause demand to far surpass supply and endanger those at the highest risk of life-threatening flu complications.
"Yet every year we wasted millions and millions of doses," said Dr. Gregory Poland, a Mayo Clinic infectious diseases expert who for years has passionately pushed the panel to recommend flu shots for all.
The swine flu vaccine campaign appears to be ending the same way. Doses were scarce when the swine flu vaccine first became available in early October, but now roughly 90 million people have been vaccinated, demand is dying and millions of doses are unused.
Swine flu provided another argument for universal vaccination. The new virus proved to be unusually dangerous to young adults, and also took a surprising toll on Native Americans and obese people. Many of those hospitalized and killed by swine flu were not in groups previously recommended for annual flu shots, and that fact was another reason to expand the vaccination recommendation, experts said.
There are a few exceptions to the universal recommendation. Children under 6 months of age, who have undeveloped immune systems, will continue to be exempt. So too will people who have egg allergies (the vaccine is made using eggs) and those who have had certain severe reactions to flu shots in the past.
The panel also decided that elderly people can consider a new, revved-up version of the seasonal flu shot. It's a Sanofi Pasteur vaccine for adults 65 and older.
In years when the flu shot is well matched to circulating flu viruses, vaccine is 70 to 90 percent effective in people younger than 65, the CDC estimates. But it tends to be only 30 to 70 percent effective in those who are older because they generally have weakened immune systems.
The Sanofi vaccine - called Fluzone High-Dose - has four times as much immunity-building antibodies as a standard dose. The U.S. Food and Drug Administration approved the vaccine in December, and it should be available for the 2010-2011 flu season. It would cost about $25 a shot, or about twice the standard version.
The panel did not state a preference for the vaccine, however. The U.S. Food and Drug Administration approved the vaccine through an accelerated process, and Sanofi is to do further studies to show the shot reduces flu illnesses.
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