CDC committee: LAIV safe for those with egg allergy

Children with an egg allergy could receive any age-appropriate influenza vaccine under a new recommendation for the 2016-’17 influenza season from a Centers for Disease Control and Prevention (CDC) committee.

Live attenuated influenza vaccine (LAIV) “appears to be a low risk similar to that of inactivated vaccine and for these purposes … (should) not be treated differently from other vaccines,” said Lisa Grohskopf, M.D., a CDC medical officer.

The CDC Advisory Committee on Immunization Practices (ACIP) previously recommended using only inactivated influenza vaccines or recombinant influenza vaccine for those with egg allergies. However, recent studies have found that children with egg allergies did not have reactions to LAIV, likely due to levels of egg protein in the vaccine being extremely low, according to John Kelso, M.D., an allergist with Scripps Health.

For the 2016-’17 influenza season, ACIP members agreed to recommend that any age-appropriate vaccine could be given to someone with an egg allergy of any severity and to eliminate an algorithm regarding vaccinating such patients. Some members said the algorithm deters some providers from vaccinating patients with egg allergies.

“I think these changes are wonderful and will make implementation programmatically much easier,” said ACIP member Kelly Moore, M.D., M.P.H., director of the Tennessee Immunization Program at the Tennessee Department of Health.

In addition, the committee called for removal of a 30-minute post-vaccination observation period for patients with egg allergies, saying the standard 15-minute period is sufficient.

However, the group said those with severe egg allergies still should be vaccinated in a setting with a health care provider trained to manage severe allergic conditions. After extensive debate, members did not finalize exact wording on how that provider should be defined.

ACIP continues to call for all people 6 months and older to be vaccinated against influenza. Vaccination by the end of October is preferable but should be offered as long as the virus is circulating and unexpired vaccines are available. A previous severe allergic reaction to influenza vaccine remains a contraindication to receiving the vaccine.

This year’s flu season has been relatively mild compared to the last three, and overall vaccine effectiveness is about 59%, officials said.

ACIP’s recommendations must be approved by the CDC director and, if adopted, are published as official recommendations in Morbidity and Mortality Weekly Report. The Academy will review the CDC’s changes and make official policy recommendations of its own.