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| How
serious a problem is influenza in the U.S.? |
|
Influenza is the most frequent cause
of death from a vaccine-preventable disease in the United States. From
1990 through 1999, an average of approximately 36,000
influenza-associated pulmonary and circulatory deaths occurred during
each influenza season. In addition to fatalities, seasonal influenza
is also responsible for more than 200,000 hospitalizations per year.
Rates of infection from seasonal influenza are highest among children,
but the risks for complications, hospitalizations, and deaths are
higher among adults ages 65 and older, children younger than 5 years,
and people of any age who have medical conditions that place them at
increased risk for complications from influenza.
|
A novel H1N1 virus was first detected in
March of 2009 and quickly spread to pandemic levels. In the U.S., it
is estimated that approximately 43-89 million persons became ill with
2009 pandemic H1N1 from April 2009 to April 2010. The virus also
resulted in significant hospitalizations and deaths among children,
adults 19-65 years, obese persons, and pregnant and post-partum women. |
|
| Where can I get information on
influenza and its surveillance? |
|
| Information regarding influenza
surveillance is available October through May from the CDC influenza
website at
www.cdc.gov/flu/weekly/fluactivity.htm.
In addition, periodic updates about
influenza are published in the MMWR. State and local health
departments should be consulted regarding availability of influenza
vaccine, access to vaccination programs, information about state or
local influenza activity, and for reporting influenza outbreaks and
receiving advice regarding their control. |
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| General information about influenza vaccination |
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| Who is recommended to get
vaccinated against influenza? |
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| Beginning with the 2010-11 vaccination
season, ACIP recommends annual vaccination for all people ages 6
months and older who do not have a contraindication to the vaccine. |
|
| We're glad that CDC has made a
universal influenza vaccination recommendation to vaccinate everyone 6
months and older. Would you tell us how this came about? |
|
| Prior to the 2010-11 vaccination
season, only children ages 6 months through 18 years and adults age 50
years and older were universally recommended for vaccination;
recommendations for adults ages 19 through 49 years were targeted to
people with specific risk factors, although other adults could be
vaccinated if they wanted protection. Collectively, these targeted
risk groups made up 85% of the U.S. population. During the 2009 H1N1
outbreak, additional risk groups were identified, such as obese
individuals. The recommendation made by ACIP in February 2010 for
universal vaccination simplifies previous recommendations, making it
easier for healthcare providers to determine whom to vaccinate. The
universal recommendation also makes it easier for patients to remember
to get vaccinated every year. |
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| When should influenza vaccine be
given? |
|
| You can begin offering vaccine as soon
as vaccine becomes available. Early vaccination of children younger
than age 9 years who are first time vaccinees can be helpful in
assuring routine second doses before the influenza season begins. |
|
| We have noticed that CDC recommends
that we begin vaccinating with seasonal influenza vaccine as early as
September or even earlier. Does protection from seasonal influenza
vaccine decline or wane within 3 or 4 months of vaccination? Should I
wait until October or November to vaccinate my elderly or medically
frail patients? |
|
| CDC recommends that seasonal influenza
vaccine be administered to all age groups as soon as it becomes
available. Antibody to seasonal inactivated influenza vaccine declines
in the months following vaccination. However, antibody level at a
point several months after vaccination does not necessarily correlate
with clinical vaccine effectiveness. There are no studies that compare
vaccine effectiveness according to the month when the vaccination was
given. The authors of a review on antibody declines among the elderly
after vaccination reported, "In conclusion, we found no compelling
evidence for more rapid decline of the influenza vaccine-induced
antibody response in the elderly, compared with young adults, or
evidence that seroprotection is lost at 4 months if it has been
initially achieved after immunization." (See Skowronski, et al., Rapid
Decline of Influenza Vaccine-Induced Antibody in the Elderly: Is it
Real, or Is It Relevant? Journal of Infectious Diseases
2008;197:490-502).In addition, there is a lack of evidence for
late-season outbreaks among vaccinated persons that can be attributed
to waning immunity. |
|
| How late in the season can I
vaccinate my patients with influenza vaccine? |
|
| Peak influenza activity does not
generally occur until February. Providers are encouraged to continue
vaccinating patients throughout the influenza season, including into
the spring months (e.g., through May), as long as they have vaccine in
the refrigerator and unvaccinated patients in their office.
Because influenza occurs in many areas
of the world during April through September, vaccine should be given
to travelers who missed vaccination in the preceding fall and winter.
Another late season use of vaccine is for children younger than age 9
years who were vaccinated for the first time in the current
vaccination season but failed to get their second dose. For each of
these situations, vaccine can be given through the month of June since
injectable influenza vaccine customarily has a June 30 expiration
date. |
|
| Which travelers are recommended to
be vaccinated? |
|
| Healthcare providers should vaccinate
any person who failed to get vaccinated in the previous vaccination
season and who wants to reduce their risk of acquiring influenza
during their upcoming travel, particularly if they are at high risk
for influenza-related complications. This includes persons who are
traveling to the tropics, traveling with organized tourist groups at
any time of year, or traveling to the Southern Hemisphere during
April-September. |
|
| We are always concerned that there
won't be enough vaccine to vaccinate our patients in the fall. What
can we do to be assured that we've done all that we possibly can to
avoid this type of situation? |
|
| It is never too early to begin
planning for the coming fall's influenza vaccination program. The most
important thing you can do initially is to place your order for
vaccine from your usual source. Some manufacturers often stop taking
pre-orders in mid-May. Be sure to include vaccine for pediatric
patients needing two doses and also for your facility's healthcare
workers as part of your overall campaign. |
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| Why do people who received
influenza vaccine last year still need to get vaccinated this year
when the viruses haven't changed? |
|
| Although the strains may sometimes be
the same as in the previous year's vaccine, you should NOT use the
previous season's vaccine you might still have in your refrigerator.
Influenza vaccine distributed in the northern hemisphere expires on
June 30 after each season; expired vaccine should NEVER be
administered. Secondly, antibody titers that persons might have
achieved from the previous year's vaccination will have waned and need
to be boosted with a dose of the current year's vaccine. |
|
| If an unvaccinated patient who has
just recovered from a diagnosed case of influenza comes into our
clinic, should we vaccinate him? |
|
| Yes. Influenza vaccine commonly
contains three influenza vaccine virus strains; two for A viruses and
one for a B virus which are prepared based on circulating viruses from
the previous influenza season. Infection from one virus type does not
confer immunity to other types and it would not be unusual to have
exposure to more than one type during a typical influenza season. By
all means, vaccinate this person! |
|
| How long does immunity from
influenza vaccine last? |
|
| Protection from influenza vaccine is
thought to persist for a year or less because of waning antibody and
because of changes in the circulating influenza virus from year to
year. |
|
| Some of my patients refuse
influenza vaccination because they insist they "got the flu" after
receiving the injectable vaccine in the past. What can I tell them? |
|
| There are several reasons why this
misconception persists: (1) Less than 1% of people who are vaccinated
with the injectable vaccine develop flu-like symptoms, such as mild
fever and muscle aches, after vaccination. These side effects are not
the same as having influenza, but people confuse the symptoms. (2)
Protective immunity doesn't develop until 1–2 weeks after vaccination.
Some people who get vaccinated later in the season (December or later)
may get influenza shortly afterward. These late vaccinees develop
influenza because they were exposed to someone with the virus before
they became immune. It is not the result of the vaccination. (3) To
many people "the flu" is any illness with fever and cold symptoms. If
they get any viral illness, they may blame it on the flu shot or think
they got "the flu" despite being vaccinated. Influenza vaccine only
protects against certain influenza viruses, not all viruses. (4) The
influenza vaccine is not 100% effective, especially in older persons.
For more information on this topic, go to:
www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm |
|
| Is a Vaccine Information Statement
(VIS) mandatory or is it only recommended when administering influenza
vaccine? |
|
| As of January 1, 2006, the use of a
VIS for influenza vaccine given to a child or an adult became
mandatory under the National Vaccine Injury Compensation Program. Two
VISs are published annually, one for LAIV and one for TIV. Each can be
found at
www.immunize.org/vis along with many translations. |
|
| Are there recommendations for the
prevention of institutional outbreaks of influenza? |
|
| The most important factor in
preventing outbreaks is annual vaccination of all occupants of the
facility, and all persons in the facility who share the same air as
the high-risk occupants. Groups that should be targeted include
physicians, nurses, and other personnel in hospitals and outpatient
settings who have contact with high-risk patients in all age groups,
and providers of home care to high-risk persons (e.g., visiting
nurses, volunteers). |
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| What is the recommended interval
for receiving influenza vaccine after an allergy injection? |
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| Vaccines can be administered at any
time before or after administration of an "allergy injection." |
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| Which children should receive
influenza vaccine? |
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| ACIP recommends annual influenza
vaccination for all children age 6 months and older who do not have a
contraindication to the vaccine. |
|
| Which influenza vaccines can we
give to children? |
|
| There are several vaccines that can be
given to children. You can find information on all influenza vaccines
available in the U.S. for the current season and the age groups
approved by FDA by going to
www.immunize.org/catg.d/p4072.pdf. |
|
| We've heard that ACIP has limited
the use of one of the influenza vaccine products for children
beginning with the 2010-11 vaccination season. Is that true? |
|
| Yes. You are referring to Afluria,
which is manufactured in Australia by CSL Laboratories for the U.S.
market. CSL's 2010 Southern Hemisphere influenza vaccine (Fluvax and
Fluvax Junior) has been associated with increased post-marketing
reports of fever and febrile seizures in children predominantly
younger than age 5 years as compared to previous years. For this
reason, on August 5, 2010, ACIP recommended that Afluria, 0.5 mL,
licensed for use in people age 36 months and older, not be used in
children younger than age 9 years. ACIP further recommended that
Afluria could be administered to children ages 5 through 8 years who
are at high risk for influenza complications if there is no other
age-appropriate TIV available, after risks and benefits of using this
vaccine in this age group have been discussed with the parent or
guardian. The vaccine should not be given to children younger than age
5 years. For detailed information, go to
www.cdc.gov/media/pressrel/2010/s100806.htm. |
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|
Which of our pediatric patients
will need 2 doses of influenza vaccine for the 2011–12 vaccination
season? |
|
| ACIP's influenza recommendations for
children age 6 months through 8 years have changed for the 2011–12
season. According to
the new algorithm, certain children need 2 doses of influenza vaccine
this influenza season, separated by at least 4 weeks.
Here is a summary: |
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| • |
|
Children age 6 months through 8
years who did not receive AT LEAST 1 dose of the 2010–11 vaccine
should receive 2 doses, separated by at least 4 weeks, REGARDLESS of
their previous influenza vaccination history. |
| • |
|
Children age 6 months through 8
years whose influenza vaccination status from the previous season is
not known should also receive 2 doses at least 4 weeks apart. |
| • |
|
Children age 6 months through 8
years who received 1 dose of seasonal influenza vaccine during the
2010–11 season need ONLY 1 dose this season. This is because the
vaccine strains are the same this season as last season. |
|
|
| You may find this Immunization Action
Coalition handout helpful:
www.immunize.org/catg.d/p3093.pdf. |
|
| When a child needs 2 doses of
influenza vaccine, can I give 1 dose of each type (injectable and
nasal spray)? |
|
| Yes. As long as a child is eligible to
receive nasal spray vaccine (i.e., is in the proper age range and
health status), it is acceptable to give 1 dose of each type of
influenza vaccine. The doses should be spaced at least 4 weeks apart. |
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| If a child receives influenza
vaccine at age 34 or 35 months for the first time (0.25 mL dose) and
then returns for the second dose at age 37 months, should we give
another 0.25 mL dose or should we give the 0.5 mL dose that is
indicated for ages 3 and older? |
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| The child should always receive the
dose appropriate for his or her age at the time of the clinic visit;
at age 37 months that would be 0.5 mL. |
|
| A five-year-old child received her
second MMR a week ago. How long should she wait before receiving live
attenuated influenza vaccine (LAIV)? |
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| LAIV can be administered
simultaneously with another live vaccine (e.g., MMR, varicella), but
if not given at the same time, ACIP recommends waiting four weeks
before administering the second live vaccine. |
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| Influenza vaccination of selected populations |
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| Is influenza vaccine recommended
for pregnant women? |
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| Yes. It is especially important to
vaccinate pregnant women because of their increased risk for
influenza-related complications. An increased risk of severe influenza
infection was also observed in postpartum women (those delivered
within the previous 2 weeks) during the 2009–2010 H1N1 pandemic.
Vaccination can occur in any trimester, including the first. Only
inactivated (injectable or TIV) vaccine should be given to pregnant
women. |
|
| Can thimerosal-containing vaccine
be given to pregnant women? |
|
| Yes, unless you live in a state that
has enacted legislation restricting use in pregnant women. There is no
scientific evidence that thimerosal in vaccines, including influenza
vaccines, is a cause of adverse events, unless the patient has a
systemic allergy to thimerosal. |
|
| A co-worker of mine says we are
supposed to give infants preservative-free influenza vaccine. Is this
true? |
|
| No. CDC and ACIP express no preference
for preservative-free vaccine for infants or any other group of
vaccine recipients. See page 22 of the 2010–11 ACIP influenza
recommendations:
www.cdc.gov/mmwr/pdf/rr/rr5908.pdf.
No scientific evidence exists that
thimerosal in vaccines, including influenza vaccines, is a cause of
adverse events, unless the patient has a systemic allergy to
thimerosal. However, some states have enacted legislation that
restricts the use of thimerosal-containing vaccines. Check with your
state immunization manager to see if your state is one of them (www.immunize.org/coordinators). |
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|
Do diabetics who control
their disease with diet need influenza vaccine? |
|
| People with a metabolic disease,
including diabetes, should receive annual influenza vaccination with
the inactivated vaccine. |
|
| Is influenza vaccine safe to
administer to patients with multiple sclerosis? |
|
| Yes. Multiple sclerosis is not a
contraindication to any vaccine, including influenza and pneumococcal
vaccines. However, these patients should receive inactivated influenza
vaccine and not the live, intranasal vaccine. |
|
| Does influenza vaccine increase the
HIV titer in the blood of people with HIV infection? |
|
| Although some studies have
demonstrated a transient increase in replication of HIV following
inactivated influenza vaccine, other studies have not found this. This
temporary increase in HIV titer has not been associated with
deterioration in either T-lymphocyte counts or clinical condition.
ACIP believes that annual influenza vaccination with inactivated
vaccine will benefit many HIV-infected persons. |
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| Influenza vaccination issues for healthcare workers |
Back to top |
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| Which healthcare personnel should
be vaccinated against influenza? |
|
| It is important to vaccinate ALL
hospital and outpatient-care personnel, especially those that have
direct contact with patients. In addition to physicians and nurses,
vaccination in a hospital setting also includes full-time and
part-time employees in radiology, laboratories, pharmacy, human
resources, facilities management (housekeeping), food services, or
laundry. Vaccinate volunteers as well. Others that should be
vaccinated are emergency response workers, employees of nursing homes
and assisted living programs, and providers of home care. |
|
| Which employees of chronic care
facilities and nursing homes should be vaccinated against influenza? |
|
| All employees of long term care
facilities who have any patient contact and do not have a valid
contraindication should receive annual influenza vaccination. |
|
| What are the ACIP recommendations
for influenza vaccination of healthcare personnel? |
|
| Because healthcare personnel (HCP)
provide care to patients at high risk for complications of influenza,
HCP should be considered a high-priority group for receiving
vaccination. Achieving high rates of vaccination among HCP will
protect staff and their patients, and reduce disease burden and
healthcare costs. Vaccination rates of HCP are shamefully low; the
2008 National Health Interview Survey revealed only about half (49%)
had been vaccinated.
On February 24, 2006, CDC devoted an
entire MMWR Recommendations and Reports to influenza vaccination of
HCP. These recommendations are summarized in the following points: |
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| • |
|
All HCP should be educated
regarding the benefits of influenza vaccination. |
| • |
|
Influenza vaccine should be
offered annually to all eligible HCP. |
| • |
|
Obtain a signed declination from
HCP who decline influenza vaccination. |
| • |
|
Monitor HCP
influenza vaccination coverage and declination at regular
intervals. |
| • |
|
Use the level of HCP
vaccination coverage as one measure of a patient-safety quality
program. |
|
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| To obtain a copy of these CDC
recommendations for healthcare personnel, go to
www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm?s_cid=rr5502a1-e |
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| What is the Joint Commission's
recommendation on vaccinating healthcare workers against influenza? |
|
| In January 2007, a new infection
control standard of the Joint Commission became effective that
requires accredited organizations to offer annual influenza
vaccination to staff, volunteers, and licensed independent
practitioners who have close patient contact. |
|
| What are the ACIP recommendations
for use of the intranasal live attenuated influenza vaccine (LAIV) in
healthcare personnel (HCP)? |
|
| ACIP recommends that HCP for whom LAIV
is not contraindicated be allowed to receive it, with the exception of
those who are in contact with patients who are severely
immunosuppressed during periods when they require a protective
environment (e.g., persons with bone marrow transplants who are
hospitalized and in protective isolation). These HCP should receive
trivalent inactivated influenza vaccine (TIV) instead. HCP who have
close contact with persons having lesser degrees of immunosuppression
(e.g., persons with diabetes, persons with asthma taking
corticosteroids, or persons infected with HIV) are especially
encouraged to receive LAIV if they themselves are healthy, not
pregnant, and are younger than age 50 years. HCP use of LAIV might
also increase availability of inactivated influenza vaccine for
persons at high risk. |
|
| Please review which healthcare
workers (HCWs) can be given the intranasal live attenuated influenza
vaccine (LAIV) and which cannot. |
|
|
LAIV can be administered to
all HCWs for whom it is indicated based on age and health
history--except to those who care for severely immunocompromised
patients in a protected (reverse air flow) environment. Despite the
clarity of this strong recommendation, we have heard that some
healthcare facilities erroneously take extreme measures to protect all
patients from exposure to someone recently vaccinated with LAIV. Some
even restrict visitors from seeing hospitalized patients, allowing
only people vaccinated with injectable trivalent inactivated influenza
vaccine (TIV) to visit. CDC addressed this issue in the
recommendations for use of the 2010-11 influenza vaccine as follows:
"Concerns about the theoretic risk posed by transmission of live
attenuated vaccine viruses contained in LAIV to patients should not be
used to justify preferential use of TIV in health-care settings other
than inpatient units that house severely immunocompromised patients
requiring protected environments. Some health-care facilities might
choose to not restrict use of LAIV in close contacts of severely
immunocompromised persons, based on the lack of evidence for
transmission in health-care settings since (LAIV's) licensure in
2004." To read more on this topic, see the discussion under the
section titled Persons Who Live With or Care for Persons at Higher
Risk for Influenza-Related Complications in "Prevention and Control of
Influenza with Vaccines: Recommendations of the Advisory Committee on
Immunization Practices (ACIP) at
www.cdc.gov/vaccines/pubs/ACIP-list.htm. |
|
| Why is influenza vaccination
important for healthcare workers? We already encourage them to stay
home from work when they are sick. |
|
| Unfortunately, by the time a
healthcare worker has symptoms of influenza, they will have already
exposed many patients since the virus is shed for 1-2 days before
symptoms begin. Do the right thing. Start planning early to make sure
all employees in your work setting receive annual influenza
vaccination before the influenza season begins. |
|
| I would like to help establish a
policy of mandatory influenza vaccination for healthcare workers in
our facility and would like to learn from others. Can you help? |
|
| You will be happy to know that more
and more healthcare facilities are adopting mandatory vaccination
policies for their employees. IAC has included many of these on its
Honor Roll for Patient Safety, which gives special recognition to
institutions that enforce mandatory vaccination for all personnel who
are in the vicinity of a patient (e.g., including volunteers,
housekeeping staff). To read about the policies of the various
facilities included in the Honor Roll, go to
www.immunize.org/laws/influenzahcw.asp. We hope reviewing these
policies will give you the information you need to assist in
developing a policy for your facility. |
|
| We have a mandatory vaccination
policy in our facility; however, we allow employees to choose not to
be vaccinated after filling out and signing an informed declination
form. What can we do to achieve assurances that patient safety is
still maintained? |
|
| Though vaccination is the most
effective means of protecting your patients from influenza, there may
be instances where employees are not vaccinated for medical or
personal reasons. In these instances, you may want to consider
reassigning unvaccinated workers to non-patient areas or requiring
that they wear masks throughout the influenza season. |
|
| I heard about a hospital where more
than 95% of employees received influenza vaccine last year. How did
they achieve such a high level of vaccination? |
|
|
Virginia Mason Medical Center
in Seattle, WA, completed 2 years of mandatory employee influenza
vaccination, achieving 98% compliance in the 2006-07 year. Toolkits,
as well as other materials from a variety of organizations and the
presentation on the Virginia Mason program given at the 2007 National
Influenza Vaccine Summit, are available to you at
www.preventinfluenza.org/profs_workers.asp. A report covering the
first five years of their program was also published in the September
2010 issue of Infection Control and Hospital Epidemiology. An abstract
of the report can be found here
www.ncbi.nlm.nih.gov/pubmed/20653445. |
|
| We recommend our healthcare
personnel receive LAIV, but question whether NICU staff can receive
this vaccine without compromising our neonates. |
|
| Neonates in an NICU are not considered
severely immunocompromised. NICU personnel may receive LAIV if
otherwise eligible (younger than 50 years, healthy, and not pregnant). |
|
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|
|
| For who is influenza vaccine
contraindicated? |
|
| Persons who have experienced a severe
allergic reaction to a prior dose of influenza vaccine, or who are
known to have a severe allergy to a vaccine component should not be
vaccinated. Vaccination should be deferred for a person with moderate
or severe acute illness until his/her condition improves. The use of
live attenuated influenza vaccine (LAIV) is contraindicated in persons
with a chronic disease that constitutes an increased risk when exposed
to wild influenza virus (e.g., asthma, heart and renal disease,
diabetes), pregnant women, immunosuppressed persons, children younger
than age 2 years, and adults older than age 49 years. A history of
Guillain-Barrè syndrome occurring within 6 weeks of previous influenza
vaccine is a precaution for TIV and LAIV. |
|
| Can you explain the newest
recommendation for vaccinating people with egg allergies? |
|
| Any allergic reaction to eggs severe
enough to cause hives is a contraindication for LAIV; however, it is
only a precaution for receipt of TIV. If the reaction consists of
hives only, the person should be given TIV by a healthcare provider
who is familiar with the potential manifestations of egg allergy. The
person should also be observed for at least 30 minutes after being
vaccinated. If the reaction includes more severe symptoms, including
but not limited to swelling of the lips and throat, angioedema,
lightheadedness, cardiovascular symptoms (e.g., hypotension),
respiratory symptoms (e.g., wheezing), gastrointestinal symptoms
(e.g., nausea, vomiting), a history of required use of epinephrine
following egg ingestion, or a history of required emergency medical
intervention, then the patient should be referred to a physician
familiar with the management of allergic conditions. |
|
| How do you suggest we screen
patients for potential egg allergy in our busy clinic? |
|
| People who indicate that they can eat
lightly cooked eggs (e.g., scrambled eggs) without reaction are
unlikely to have an egg allergy. Don't rely on their ability to eat
eggs in baked products (e.g., cakes, breads), however, since the
baking might denature the protein and mask an intrinsic anaphylactic
allergy to eggs. Also a history of tolerance to baked products that do
not contain eggs may be misinterpreted as egg tolerance. |
|
| The 2011–12 Influenza VIS states
that giving pneumococcal conjugate vaccine (PCV13) and inactivated
influenza vaccine simultaneously may increase febrile seizures. Can we
continue to give these two vaccines at the same time? |
|
| Yes, you can. Increased rates of
febrile seizures have been reported among children, especially those
age 12 through 23 months, who received simultaneous vaccination with
TIV and PCV13, when compared with children who received these vaccines
separately. However, because of the risks associated with delaying
either of these vaccines, ACIP does not recommend administering them
at separate visits or deviating from the recommended vaccine schedule
in any way. |
|
Febrile seizures are not uncommon,
occurring in 2% to 5% of all children; and they are generally
benign. Healthcare providers should be prepared to discuss parents'
questions about this issue, including questions about fever and
febrile seizures. |
|
| The 2011–12 inactivated influenza
vaccine VIS states: "young children who get inactivated flu vaccine
and pneumococcal vaccine (PCV13) at the same time appear to be at
increased risk for seizures caused by fever." ACIP chose to include
this statement on the VIS to inform parents of this potential risk. |
|
| For more information, see these CDC
resources:
www.cdc.gov/vaccinesafety/Concerns/FebrileSeizures.html and
www.cdc.gov/vaccines/pubs/vis/tiv-pcv-note.htm. |
|
| We usually instruct our patients
that they should separate vaccinations and allergy shots by at least
24 hours because if there were a reaction to one or the other, it
wouldn't be possible to determine which was the cause. This becomes
problematic during influenza vaccination season. What should we do? |
|
| The probability of a serious allergic
reaction following any vaccine is extremely low if the person is
properly screened. ACIP has not issued a recommendation that
desensitization injections and vaccines be separated by any specific
time period; consequently, we feel that you should take the
opportunity to vaccinate. |
|
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|
| For whom can the intranasal
influenza vaccine be used? |
|
| The live attenuated influenza vaccine
(LAIV), FluMist is currently approved for use only for healthy
non-pregnant persons ages 2 through 49 years. Many of these persons
are among the groups that are targeted for vaccination, including
healthcare personnel (excluding those in close contact with severely
immunosuppressed persons during periods when the immunocompromised
person requires a protective environment) and other persons in close
contact with high-risk groups, including household contacts of
high-risk persons, contacts of children from birth through age 59
months, and contacts of adults age 50 years and older. In addition,
any healthy, nonpregnant person between the ages 2 through 49 years
who wants to reduce their risk of influenza or of transmitting it to
others can by vaccinated with FluMist. |
|
| Can LAIV be administered to persons
with minor acute illnesses, such as a mild upper respiratory infection
(URI) with or without fever? |
|
| Yes, however, if clinical judgment
suggests nasal congestion is present that might impede delivery of the
vaccine to the nasopharyngeal mucosa, deferral of administration
should be considered until the congestion resolves. |
|
| Can a woman who is breastfeeding
receive live attenuated influenza vaccine (LAIV)? |
|
| Yes. Breastfeeding is not a
contraindication for routine vaccination of breastfeeding women,
including LAIV. |
|
| Can LAIV be given to contacts of
immunosuppressed patients? |
|
| Like other live vaccines, LAIV should
not be administered to immunosuppressed persons. ACIP has stated a
preference for using inactivated influenza vaccine for household
members, healthcare personnel, and others who have close contact with
severely immunosuppressed individuals (e.g., patients with
hematopoietic stem cell transplants) during those periods in which the
immunosuppressed person requires care in a protective environment
because of the theoretical risk that the live attenuated vaccine virus
could be transmitted to the severely immunosuppressed individual and
cause disease. Healthcare personnel or other persons who have close
contact with persons with lesser degrees of immunosuppression (e.g.,
persons with diabetes, persons with asthma taking corticosteroids, or
persons infected with human immunodeficiency virus) who are otherwise
eligible for LAIV may receive it. No special precautions need to be
taken by the vaccinated person. |
|
| How long after someone is
vaccinated with seasonal live attenuated influenza vaccine (LAIV) must
they stay away from a severely immunosuppressed person (a person who
is in protective [reverse] isolation)? |
|
| Persons vaccinated with LAIV should
avoid contact with any person who is severely immunosuppressed for at
least 7 days after receiving LAIV. There are no restrictions on being
in contact with any other patients. |
|
| Is LAIV contraindicated for
asthmatics? |
|
| Persons with asthma should not receive
LAIV. Persons with asthma and other chronic respiratory conditions
should receive inactivated influenza vaccine. |
|
|
|
|
|
| Which influenza vaccine products
can we use in children and which in adults? |
|
|
Many influenza vaccine
products are available for vaccinating children; however, the minimum
age varies. These include Afluria (CSL Laboratories, distributed by
Merck); Fluarix (GlaxoSmithKline [GSK]); FluMist (MedImmune); Fluvirin
(Novartis); and Fluzone (sanofi pasteur). You can use any of these
vaccines in adults, as well as FluLaval (ID Biomedical Corp,
distributed by GSK). You'll find a chart that lists all the available
influenza vaccines for the current vaccination season, the approved
age ranges, and simple instructions for administering them at
www.immunize.org/catg.d/p4072.pdf. |
|
| Has ACIP recommended the use of
high-dose and intradermal influenza vaccines? |
|
| Yes, ACIP has recommended the use of
high-dose and intradermal influenza vaccines, along with all other
FDA-approved trivalent inactivated influenza vaccines (TIV). ACIP has
not stated a preference for any TIV product over another. The
formulation or presentation a provider uses is the provider's choice
as long as an age-appropriate product is used and is administered
correctly. Providers need to choose the type of vaccine most
appropriate for their patient population. The Immunization Action
Coalition (IAC) website has manufacturers' package inserts for every
influenza vaccine product licensed for use in the U.S. Go to,
www.immunize.org/packageinserts/pi_influenza.asp. |
|
| How is the intranasal vaccine (LAIV)
administered? |
|
| The vaccine dose (0.2 mL) comes inside
a special sprayer device. A plastic clip on the plunger divides the
dose into two equal parts. The patient is seated in an upright
position with head tilted back. Half of the contents of the sprayer
(0.1 mL) is sprayed into each nostril. |
|
| Some injectable influenza vaccine
comes with a 5/8" needle attached. I thought we were supposed to use a
1-1 1/2" needle for this IM vaccine in adults. |
|
| You're right. For intramuscular
injection ACIP generally recommends the use of at least a 1" needle in
adults. Some experts feel that a shorter needle can be used in adults
weighing less than 60 kg, but ONLY if administration is in the deltoid
and ONLY if the skin is stretched tight and the needle is placed at a
90 degree angle to the skin. |
|
|
Should staff at
drive-through influenza vaccination clinics encourage drivers to park
and wait for 15 minutes after vaccination to make sure they don't have
a vaccination reaction or syncopal (i.e., fainting) episode? |
|
| Yes. Syncope has been reported
following vaccination in the past. |
|
| Is it okay to draw up vaccine into
syringes at the beginning of the day? If it isn't, how much in advance
can this be done? |
|
| CDC discourages the practice of
prefilling vaccine into syringes for several reasons, including |
|
| • |
|
the increased possibility of
administration and dosing errors, |
| • |
|
the increased risk of
inappropriate storage, |
| • |
|
the probability of bacterial
contamination since the syringe will not contain a
bacteriostatic agent, and |
| • |
|
the probability of
reducing the vaccine's potency over time because of its
interaction with the plastic syringe components. |
|
|
| Prefilling vaccine into syringes also
violates basic medication administration guidelines, which state that
an individual should administer only those medications he or she has
prepared and drawn up.
Although pre-drawing vaccine is
discouraged, a limited amount of vaccine may be pre-drawn in a
mass-immunization clinic setting under the following conditions: |
|
| • |
|
only a single type of vaccine
(e.g., influenza) is administered at the mass-immunization
clinic setting, |
| • |
|
vaccine is not drawn up in
advance of its arrival at the mass-vaccination clinic site, |
| • |
|
these pre-drawn syringes are
stored at temperatures appropriate for the vaccine they hold, |
| • |
|
no more than 1 vial
or 10 doses (whichever is greater) is drawn into syringes, and |
| • |
|
clinic staff monitor
patient flow carefully and avoid drawing up unnecessary doses or
delaying administration of pre-drawn doses. |
|
|
| At the end of the clinic day, any
remaining vaccine in syringes prefilled by staff should be discarded. |
|
| Sometimes I am unable to get 10
doses of influenza vaccine out of a 5.0 mL (10-dose) vial. Do you have
any suggestions? |
|
| Certain vaccine syringes have small
hubs where a volume of the vaccine that is withdrawn from the vial
collects and is not available to be injected. Syringes without a hub
are available; their use results in less vaccine wastage. |
|
|
|
|
|
| How should LAIV and TIV be stored? |
|
| Both the trivalent (injectable)
influenza vaccine (TIV) and the live attenuated influenza vaccine (LAIV)
should be refrigerated at temperatures between 35°F (2°C) and 46°F
(8°C). |
|
| Reviewed on 10/11 |
|
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