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|
| Can we test patients who think they already had
H1N1 influenza to see if their infection was caused by H1N1? |
 |
| There is no test readily available that
can show whether a person had 2009 H1N1 influenza in the past. People
for whom the 2009 H1N1 influenza vaccine is recommended should receive
it, unless they can be certain they had 2009 H1N1 influenza based on a
reverse transcriptase polymerase chain reaction (RT-PCR) test. |
|
| If a patient has received the
seasonal influenza vaccine, do they need to receive the H1N1 influenza
vaccine? |
|
| If a patient is in a risk group to
receive H1N1 influenza vaccine, they should be vaccinated. Studies
suggest that vaccination with seasonal influenza vaccine will not
provide protection against the 2009 H1N1 influenza virus. |
|
| Should the 2009 H1N1 influenza
vaccine be given to someone who had an influenza-like illness between
April and now? |
|
| If an influenza-like illness (ILI) was
confirmed as H1N1 by reverse transcriptase polymerase chain reaction (RT-PCR),
then vaccination with H1N1 monovalent vaccine is not necessary for the
2009-2010 season. If the ILI was not confirmed by RT-PCR, then the
person should be vaccinated if indicated. There is no harm in
vaccinating a person who had 2009 H1N1 influenza in the past. |
|
|
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|
|
| What can I say to patients who think
the H1N1 influenza vaccines are "new" or experimental? |
|
| The 2009 H1N1 influenza vaccines are
being produced by the same companies using the same procedures used to
produce seasonal
influenza vaccines. The 2009 H1N1 vaccines are exactly the same as
seasonal influenza vaccines except for the strain of
influenza virus they contain. One way to approach this discussion is to
emphasize that the 2009 H1N1 vaccine is not a "new"
vaccine but rather is a change in the strains (just as is done in
preparing new vaccine for each influenza season). Each
year, experts look at the strains that are likely to be circulating
during the next influenza season, and put those into the
upcoming year's influenza vaccine. That's exactly what has been done in
this case.
Most of the seasonal influenza vaccines
distributed over the last decade have included H1N1-like strains. If the
timing had
been better, it is possible that the 2009 H1N1 strain could have been
included in the 2009-2010 seasonal influenza vaccine. |
|
| Do any of the H1N1 influenza vaccines
include an adjuvant? |
|
| None of the currently approved influenza
A 2009 (H1N1) monovalent vaccines or seasonal influenza vaccines
contains an adjuvant. (NOTE: An adjuvant is a substance that is
sometimes added to the vaccine to enhance the immune response, so that
smaller quantities of vaccine can be given.). |
|
| Do the H1N1 influenza vaccines use
thimerosal as a preservative? |
|
| IAll multidose vials of influenza
vaccine (both seasonal and H1N1) contain thimerosal as a preservative.
There is no evidence
that thimerosal is harmful. CDC recommends that pregnant women and
children may receive influenza vaccine with or without
thimerosal. However, because some pregnant women and parents are
concerned about exposure to thimerosal, manufacturers are
producing some preservative-free seasonal and 2009 H1N1 influenza
vaccines in single-dose syringes.
The live intranasal H1N1 influenza
vaccine is packaged in single doses so it does not use a preservative;
however, it
cannot be used for pregnant women or children younger than age 2 years. |
|
|
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|
|
| Who is targeted to receive the H1N1
vaccine? |
|
| On Aug. 28, 2009, CDC issued
recommendations for the use of the 2009 H1N1 influenza vaccine. The
recommendations identify 5 initial target groups for H1N1 influenza vaccination.
They are (1) pregnant women; (2) people who live with or provide care for
infants younger than age 6 months (e.g., parents, siblings, day care providers);
(3) healthcare and emergency medical services personnel; (4) children and young
adults ages 6 months through 24 years; and (5) people ages 25 through 64 years
who have medical conditions that put them at higher risk for influenza-related
complications. You can access the complete recommendations at www.cdc.gov/mmwr/pdf/rr/rr58e0821.pdf. |
|
| According to ACIP, individuals aged 25-64 years
with medical conditions that put them at higher risk for influenza-related
complications should be among those targeted to receive the first available H1N1
influenza vaccine. What exactly are these high-risk conditions? |
|
| A footnote on page 5 of the ACIP
recommendations for use of H1N1 influenza vaccine (www.cdc.gov/mmwr/PDF/rr/rr5810.pdf)
defines these medical conditions in a footnote, as follows: "Chronic
medical conditions that confer a higher risk for influenza-related
complications include chronic pulmonary (including asthma),
cardiovascular (except hypertension), renal, hepatic, cognitive,
neurologic/neuromuscular, hematologic, or metabolic disorders (including
diabetes mellitus) or immunosuppression (including immunosuppression
caused by medications or by human immunodeficiency virus)." |
|
| Are healthcare personnel among the
initial target groups for monovalent H1N1 vaccine? |
|
| Emphatically yes. Healthcare personnel
are among the highest priority groups for both monovalent H1N1 AND
seasonal influenza vaccine. HCP of all ages should be vaccinated as soon
as the vaccines become available. |
|
| Why are pregnant women prioritized
for vaccination? |
|
| Data from early 2009 H1N1 influenza
cases in the United States show that pregnant women account for a
disproportionate number of deaths, making them a high-priority group for
vaccination (see www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61304-0/abstract).
Also, guidance has been issued for clinicians to promptly treat pregnant
women who become infected with the 2009 H1N1 virus with antiviral drugs
(see www.cdc.gov/h1n1flu/clinician_pregnant.htm). |
|
| Why aren't adults age 65 years and
older included as a priority group for the 2009 H1N1 vaccination as they
are for seasonal influenza, where they are included as part of the
age-50-and-older priority group? |
|
| Adults age 65 years and older are
included as a priority group if they live with or care for infants
younger than age 6 months or are a healthcare or emergency services
provider. Current studies indicate that the risk of infection,
hospitalization, and death from the 2009 H1N1 influenza virus among
persons age 65 years and older is less than is the risk for younger age
groups. Studies suggest that there is some degree of preexisting
immunity to the 2009 H1N1 strains, especially among adults older than
age 60 years. One possible explanation is that some adults in this age
group have had previous exposure, either through infection or
vaccination, to an influenza A (H1N1) virus. |
| |
| Will H1N1 influenza vaccine be
available for healthy people age 25 years and older (who are not in
targeted groups)? |
|
| Once public health authorities at the
local level determine that the H1N1 influenza vaccine demand for the 5
target groups has been met, providers will be notified that they can
administer the vaccine to healthy people ages 25 through 64 years. Once
demand for H1N1 influenza vaccine among younger age groups is met,
vaccination should be expanded to all people age 65 and older. |
|
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|
| Will we be able to administer both
the seasonal and H1N1 influenza vaccines at the same visit? |
|
| You can in most cases. See the points
below. |
|
| • |
You can
administer both the inactivated seasonal and the inactivated H1N1
influenza vaccines at the same visit (using separate syringes and
sites) or at any time before or after each other. |
| • |
You can
administer the inactivated seasonal and live H1N1 influenza vaccines
together or at any time before or after each other. |
| • |
You can
administer the live seasonal and inactivated H1N1 influenza vaccines
together or at any time before or after each other. |
| • |
Administering both the live attenuated seasonal and the live
attenuated H1N1 influenza vaccines at the same visit is NOT
recommended because of concerns about competition between the 2
vaccine viruses. If you have only live vaccines for both seasonal
and H1N1 influenza available, you should separate the doses of the
live vaccines by at least 4 weeks. |
|
|
| In the package inserts, the age for
two doses in children is different for seasonal (6 months through 8
years) and 2009 H1N1 monovalent vaccine (6 months through 9 years). Does
CDC recommend that clinicians follow the recommendation in the package
inserts? |
|
| Yes, CDC recommends that clinicians
follow the guidance in the manufacturer package inserts. For 2009 H1N1
monovalent vaccines, that means that clinicians should administer two
doses of 2009 H1N1 monovalent vaccine to children ages 6 months through
9 years. Persons 10 years and older should receive one dose. |
|
| If a child needs two doses of either
seasonal or H1N1 influenza vaccine, can you give the child one dose of
inactivated vaccine and one dose of live vaccine? This may be an issue
because of supply fluctuation. |
|
| Yes. |
|
| Once H1N1 influenza vaccine becomes
available, should we stop administering seasonal influenza vaccine? |
|
| No. Providers should start administering
seasonal influenza vaccine as soon as it is available and continue to
administer it throughout influenza season, including during the winter
and spring months. |
|
| Can 2009 H1N1 vaccine be administered
at the same visit as other vaccines? |
|
| Inactivated 2009 H1N1 vaccine can be
administered at the same visit as any other vaccine, including
pneumococcal polysaccharide vaccine. Live (nasal-spray) 2009 H1N1
vaccine can be administered at the same visit as any other live or
inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine. |
|
| If seasonal LAIV and 2009 H1N1 LAIV
are given during the same visit, do either or both doses need to be
repeated, and if so, when? |
|
| There are no data on the administration
of seasonal and 2009 H1N1 LAIV during the same visit. ACIP recommends
that seasonal and 2009 H1N1 LAIV not be administered during the same
visit. However, if both types of LAIV are inadvertently administered
during the same visit, neither vaccine needs to be repeated. |
|
| What if seasonal or H1N1 LAIV is
given 2 weeks after a dose of varicella vaccine or MMR? Does the dose of
LAIV need to be repeated? |
|
| Yes. If two live virus vaccines are
administered less than 4 weeks apart and not on the same day (EXCEPTION:
live H1N1 and live seasonal influenza vaccines should not be given on
the same day), the vaccine given second should be considered invalid and
repeated. The repeat dose should be administered at least 4 weeks after
the invalid dose. If the repeat dose is inactivated influenza vaccine it
can be administered immediately. |
|
| What personal protective equipment is
recommended for healthcare workers who are giving the 2009 H1N1
nasal-spray vaccine? |
|
| Personal protective equipment (gloves
and masks) are not needed when administering nasal-spray vaccine,
including the 2009 H1N1 nasal-spray vaccine. |
|
| Do providers working at a large-scale
influenza vaccination event have to wash their hands between each
patient? |
|
| Hands should be washed thoroughly with
soap and water or cleansed with an alcohol-based waterless antiseptic
between patients. The Department of Health and Human Services has
provided the following guidance in its Pandemic Influenza Plan: |
|
| • |
If hands
are visibly soiled or contaminated with respiratory secretions, wash
hands with soap (either non-antimicrobial or
antimicrobial) and water. |
| • |
In the
absence of visible soiling of hands, approved alcohol-based products
for hand disinfection are preferred over antimicrobial soap and
water or plain soap and water because of their superior
microbiocidal activity, reduced drying of the skin, and convenience. |
|
|
| For more information, go to: www.cdc.gov/handhygiene |
|
| Though I know it is not necessary to
wear gloves when providing injections, if a nurse chooses to wear
gloves, should the nurse change gloves after administering each
vaccination during a busy flu clinic? |
|
| Yes. Persons who administer vaccines
should either wash their hands with soap and water, use alcohol-based
hand sanitizer, or change their gloves between individual patient
encounters. |
|
|
|
|
|
| Can patients on influenza antiviral
prophylaxis (e.g., Tamiflu) receive seasonal and/or H1N1 influenza
vaccine? |
|
| Such patients can receive inactivated
seasonal or inactivated H1N1 influenza vaccine. A person taking an
influenza antiviral drug (including Tamiflu or Relenza) should not be
given the nasal-spray influenza vaccine until 48 hours after the last
dose of the influenza antiviral medication was given. If LAIV is
administered less than 48 hours after a dose of antiviral medication, or
if antivirals are administered less than 2 weeks after LAIV is
administered, then the LAIV dose should not be counted as valid. |
|
| Can a person with a runny nose
receive nasal-spray influenza vaccine? |
|
| Yes. |
|
| Can the live nasal-spray influenza
vaccines be given to close contacts of pregnant women? |
|
| Yes. A pregnant woman can be in close
contact with someone who has gotten the nasal-spray (live) vaccine for
either H1N1 or
seasonal influenza. A pregnant healthcare worker can also administer
nasal-spray influenza vaccines to patients. Because the
viruses in the nasal-spray vaccines are attenuated or weakened, vaccine
viruses are unlikely to cause any illness symptoms,
even if an unvaccinated person inadvertently gets vaccine viruses in
their nose. The nasal-spray vaccine against seasonal
influenza viruses has been used in millions of school children and
healthy adults since it was licensed, and there have been
no reports of pregnant women becoming ill after exposure to their
vaccinated children or other family members.
Although the live nasal-spray influenza vaccines can be given to
contacts of pregnant women, they should not be administered
to pregnant women. |
|
| Are there any contraindications to
giving breastfeeding mothers the 2009 H1N1 vaccine? |
|
| Breastfeeding mothers can get either
live or inactivated H1N1 influenza vaccine. They can also receive either
live or inactivated seasonal influenza vaccine. As noted elsewhere,
seasonal and H1N1 live (nasal-spray) vaccines should not both be given
at the same visit. |
|
| Can healthcare workers who cannot
receive the nasal-spray vaccine (e.g., pregnant women, older adults,
persons with chronic medical conditions) administer this vaccine to
others? |
|
| Yes. Healthcare workers who cannot get
the nasal-spray vaccine themselves can administer the vaccine to others. |
|
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|
|
| Can we use the same influenza VISs
that have been issued from CDC for seasonal influenza vaccine when we
give the 2009 H1N1 influenza vaccine? |
|
| No. You should use the separate VISs for
the monovalent 2009 H1N1 vaccine only to the 2009 H1N1 vaccine. You will
find them posted at www.immunize.org/vis. |
|
| Where can I find VISs for seasonal
and H1N1 influenza vaccines? |
|
| IAC posts the English-language VISs
developed by CDC and all available translations on its website as soon
as they become available. Please note that all VIS translations are
graciously donated, so IAC is unable to guarantee specific delivery
dates. |
|
|
|
| What if our organization needs a VIS
translation before it is available from IAC's website, or needs VISs in
a language that is unlikely to be donated by others? Is it legal to
translate CDC's English-language VIS ourselves? |
|
| Permission is not required to translate
a VIS. However, providers should not change the text of a VIS or write
their own VISs. It is permissible to add a practice's name, address, or
phone number to an existing VIS.
If your organization decides to have some
VISs translated, consider sharing the translations with IAC for possible
posting to our website. You can access our guidelines for translations
at www.immunize.org/printmaterials/print_translate.asp |
|
| Do you have any other resources that
would make this difficult influenza season easier for those of us
providing vaccines? |
|
| IAC has developed standing orders for
both seasonal and H1N1 influenza vaccination and has revised its
influenza screening questionnaires to be suitable for both seasonal and
H1N1 influenza vaccines. |
|
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| Reviewed on 11/09 |
|
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