Guidelines Section

Influenza Guidelines: Prevention and Control of Influenza CDC,MMRW2003;52:RR-8: The major changes in the influenza guidelines as applied to adults are the following: Optimal time to vaccinate: The optimal time is October and November, but there have been distribution delays in the past that have led to preferential vaccination for high-risk patients during October with others to be vaccinate in November. The high risk group includes persons >50 years or 6-23 months, persons 2-49 years with high risk medical conditions, children <9 years receiving the initial vaccine, health care workers and household contacts of persons at high risk. The 2003-04 trivalent inactivated vaccine includes A/Moscow/10/99 (H3N2), A/New Caledonia/20/99 (H1N1) and B/Hong Kong/330/2001. The US market will have vaccine available from two suppliers in 2003-04 compared to three in 2002-03. Comment: The reduction in suppliers represents the withdrawal of Wyeth, which is pursuing the intranasal influenza vaccine “FluMist” with Med Immune. The FDA approved this vaccine 6/17/03, but it is not mentioned in the CDC guidelines presumably due to timing. The FluMist indication is for healthy persons aged 5 to 49 years, the price is $46 per dose and the distribution system will include administration in pharmacies (Pink Sheet, June 5, 2003, p. 20). Updated Interim Surveillance Case Definition for Severe Acute Respiratory Syndrome (SARS)—United States, April 29, 2003 CDC MMWR 2003;52:392: The following represents the updated interim US surveillance case definition of SARS: Clinical criteria Asymptomatic or mild respiratory illness Moderate respiratory illness - temperature of >100.4°F (>38°C), and - one or more clinical findings of respiratory illness (e.g., cough, shortness of breath, difficulty breathing, or hypoxia). Severe respiratory illness - temperature of >100.4°F (>38°C), and - one or more clinical findings of respiratory illness (e.g., cough, shortness of breath, difficulty breathing, or hypoxia), and - radiographic evidence of pneumonia, or - respiratory distress syndrome, or - autopsy findings consistent with pneumonia or respiratory distress syndrome without an identifiable cause Epidemiologic criteria Travel (including transit in an airport) within 10 days of onset of symptoms to an area with current or recently documented or suspected community transmission of SARS (China, Hong Kong, Singapore, Taiwan, Toronto, Hanoi) Close contact (cared for or lived with) within 10 days of onset of symptoms with a person known or suspected to have SARS infection Laboratory criteria (EIA, IFA or RT-PCR) Confirmed - detection of antibody to SARS-CoV in specimens obtained during acute illness or >21 days after illness onset, or - detection of SARS-CoV RNA by RT-PCR confirmed by a second PCR assay, by using a second aliquot of the specimen and a different set of PCR primers or - isolation of SARS-CoV Negative - absence of antibody to SARS-CoV in convalescent serum obtained >21 days after symptom onset Undetermined: laboratory testing either not performed or incomplete Case classification Probable case; meets the clinical criteria for severe respiratory illness of unknown etiology with onset since February 1, 2003, and epidemiologic criteria; laboratory criteria confirmed, negative, or undermined Suspect case: meets the clinical criteria for moderate respiratory illness of unknown etiology with onset since February 1, 2003, and epidemiologic criteria; laboratory criteria confirmed, negative, or undetermined

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