 |
|
|
|
|
| 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. In a
study of influenza seasons from 1976-1977 through 2006-2007, the
estimated number of annual influenza-associated deaths from
respiratory and circulatory causes ranged from a low of 3,349
(1985-1986 season) to a high of 48,614 (2003-2004 season), with an
average of 23,607 influenza-associated deaths. 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 years 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/fluactivitysurv.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. |
|
|
|
| General information
about influenza vaccination |
Back to top |
|
|
|
| Who is recommended to get
vaccinated against influenza? |
|
| 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. |
|
| 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 need 2 doses of vaccine 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 needed 2 doses of vaccine 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. |
|
| If a patient received a dose of
influenza vaccine in June (e.g., for international travel), how long
should the patient wait before getting vaccinated with the next
season's flu vaccine? |
|
| There should be a minimum of 4 weeks
between the doses in such situations. |
|
| 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. |
|
| Why do people who received
influenza vaccine in one year still need to get vaccinated in the next
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 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) only recommended or is it mandatory 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- isk persons (e.g., visiting nurses, volunteers). |
|
| What is the recommended interval
for receiving influenza vaccine after an allergy injection? |
|
| Vaccines can be administered at any
time before or after administration of an "allergy injection." |
|
| We are trying to provide influenza
vaccination to all eligible patients during their stay in our
hospital. If a patient does not remember if he or she has
already received the vaccine this season, should we go ahead and
vaccinate? |
|
| If a patient or family member cannot
remember if the patient received influenza vaccine this season and no
record is available, proceed with administering
influenza vaccine, even if it might mean an extra dose is given. When
a patient reports that they HAVE received influenza vaccine but does
not have written
documentation, ACIP states that in the specific case of influenza
vaccination, patient self-report of being vaccinated should be
accepted as evidence of
vaccination. |
|
|
|
|
|
| Which children should receive
influenza vaccine? |
|
| 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. |
|
|
Which children younger than age 9 years
will need 2 doses of influenza vaccine in the 2012–13 influenza
season? |
|
| Children age 6 months through 8 years
should receive a second dose 4 weeks or more after the first dose if
they (1) are receiving influenza vaccine for the
first time or (2) did not get at least 2 doses of seasonal influenza
vaccine since July 1, 2010.
CDC has developed an alternative approach that may be used with
children who have documented histories (e.g., maintained in
electronic registries) of
influenza vaccination. By this approach, children age 6 months
through 8 years need only 1 dose of vaccine in 2012–13 if they have
received any of the
following: (1) 2 or more doses of seasonal influenza vaccine since
July 1, 2010; (2) at least 2 doses of seasonal vaccine given before
July 1, 2010, and at
least 1 dose of monovalent 2009 H1N1 vaccine; or (3) at least 1 dose
of seasonal vaccine given before July 1, 2010, and at least 1 dose
of seasonal vaccine
since July 1, 2010.
For more details about the recommendations for which children need
two doses, see Prevention and Control of Influenza with Vaccines:
Recommendations of the
Advisory Committee on Immunization Practices (ACIP) — United States,
2012–13 Influenza Season found at
www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm
You may also find this information in one of the IAC's handouts –
"Guides for determining the number of doses of influenza vaccine to
give to children ages 6
months through 8 years" (see
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. |
|
| 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? |
|
| 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)? |
|
| 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. |
|
| Can a clinic vaccinate children
younger than age 3 years with a 0.25 mL dose of influenza vaccine
taken from a multidose vial of Fluzone (TIV; sanofi)? The
multi-dose vial contains thimerosal as a preservative. |
|
| Yes, Fluzone is the only inactivated
influenza vaccine licensed for use in children younger than age 3
years. Multidose vials of Fluzone contain a small
amount of thimerosal to prevent bacterial and fungal growth in the
vials. Thimerosal-containing vaccines are safe to use in children. No
scientific evidence
indicates that thimerosal in vaccines causes adverse events unless the
patient has a severe allergy to thimerosal. However, a few states have
enacted
legislation that restricts the use of thimerosal-containing vaccines
in children. To find out if your state has such restrictions, check
with your state
immunization program. |
|
|
|
| Influenza
vaccination of selected populations |
Back to top |
|
|
|
|
Is influenza vaccine
recommended for pregnant women? |
|
| 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. |
|
| Why do we vaccinate pregnant women
against influenza when it is not recommended to vaccinate infants
younger than age 6 months? |
|
| ACIP has recommended vaccinating
pregnant women with inactivated influenza vaccine (TIV) for a number
of years. Pregnant women are a high risk group for
complications, hospitalization, and even death from influenza because
of the increased physiologic strain of pregnancy on their heart,
lungs, and immune
system. Vaccination can occur in any trimester, including the first.
Influenza vaccine is not recommended for children younger than age 6
months because it is not approved for this age group. In addition,
there are data that
indicate that vaccinated pregnant women pass maternal antibodies to
the fetus in the last few weeks of pregnancy; this helps protect the
young infant against
influenza. Vaccinating pregnant women thus protects women, their
unborn babies, and their babies after birth. |
|
| 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 Prevention and
Control of Influenza with Vaccines: Recommendations of the Advisory
Committee on Immunization Practices (ACIP) — United States, 2010–11
Influenza Season
found at
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). |
|
| 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. |
|
|
|
| Influenza
vaccination issues for healthcare workers |
Back to top |
|
|
|
| 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 still too low; CDC conducted an Internet
panel survey with 2,348 HCP during April 2–20, 2012, which found that,
overall, 66.9%
of HCP reported having had an influenza vaccination for the 2011–12
season.
On February 24, 2006, CDC devoted an
entire issue of MMWR Recommendations and Reports to influenza
vaccination of HCP. These recommendations are summarized
in the following points: |
|
| • |
|
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. |
|
|
|
To obtain a copy of these CDC
recommendations for healthcare personnel, go to
www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm In addition, in 2011, ACIP
published "Immunization of Health-Care Personnel" which includes
information about all recommended vaccines (see
www.cdc.gov/mmwr/pdf/rr/rr6007.pdf). |
|
| 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. |
|
| 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 pages 35–37 in Prevention and Control of
Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices
(ACIP) — United States, 2010–11 Influenza Season found at
www.cdc.gov/mmwr/pdf/rr/rr5908.pdf. |
|
| 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/honor-roll/influenza-mandates.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? |
|
| There are a number of hospitals that
have implemented successful programs to vaccinate their healthcare
workers. One example is the Virginia Mason Medical
Center in Seattle, WA that has consistently achieved high levels of
vaccination among their employees and volunteers. 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. IAC has developed an online
Honor Roll for Patient Safety that recognizes hospitals, medical
practices, professional
organizations, and government entities that have taken a stand for
patient safety by adopting policies endorsing mandatory influenza
vaccination or by
implementing mandatory influenza vaccination policies for all
employees. To view the current listing of policies and position
statements from leading
organizations in medicine, pediatrics, pharmacy, public health,
infectious diseases, and hospital administration, visit IAC's Honor
Roll at
www.immunize.org/honor-roll. |
|
|
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). |
|
| Does the federal law that requires
providing patients with VISs apply when administering influenza
vaccine to employees and volunteers in hospitals or other
workplaces? |
|
|
If a vaccine is covered under the National
Childhood Vaccine Injury Act—and almost all vaccines routinely
administered to adults are (with the exception of
PPSV and zoster)–it is mandatory under federal law to give the VIS for
that vaccine to the vaccinee. Therefore, when you give influenza
vaccine to employees
and staff, you are required by law to provide them with a VIS. |
|
| Why is it so important to vaccinate
healthcare personnel against influenza? |
|
| Because HCP provide care to patients
at high risk for complications of influenza, achieving high rates of
vaccination among HCP will reduce disease burden
and healthcare costs.
Influenza is readily transmitted for 24 hours before a person develops
influenza symptoms. That means symptom-free unvaccinated HCP can
transmit influenza
virus to patients before developing symptoms and electing to stay home
as a way to prevent transmission. |
|
| Why does CDC recommend that we
consider obtaining a signed declination from healthcare personnel who
refuse influenza vaccination? |
|
| Some studies have shown an increase in
HCP influenza vaccine acceptance when decliners are required to sign
such a statement. In addition, such statements
can help a vaccination program assess the reasons for declination and
plan future educational efforts. IAC has posted the following
suggested declination forms for healthcare workers: |
|
| Please tell me which professional
associations have endorsed mandatory influenza vaccination for
healthcare workers and have created policy statements. |
|
| There are many professional
associations that have issued policy statements supporting mandatory
healthcare worker influenza vaccination. You can find
information about these organizations as well as a list of more than
200 healthcare settings that have implemented mandatory vaccination
programs on IAC's
website at IAC's Honor Roll for Patient Safety web section at
www.immunize.org/honor-roll. |
|
|
|
|
|
| For whom 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-Barré syndrome
occurring within 6 weeks of previous influenza vaccine is a precaution
for TIV and LAIV. |
|
| What is the latest ACIP guidance on
influenza vaccination and egg allergy? |
|
People who have experienced a serious
systemic or anaphylactic reaction (e.g., hives, swelling of the lips
or tongue, acute respiratory distress, or
collapse) after eating eggs should consult a specialist for
appropriate evaluation to help determine if vaccine should be
administered.
A previous severe allergic reaction to influenza vaccine, regardless
of the component suspected to be responsible for the reaction, is a
contraindication to
future receipt of the vaccine.
People who have documented immunoglobulin E (IgE)-mediated
hypersensitivity to eggs, including those who have had occupational
asthma or other allergic
responses to egg protein, might also be at increased risk for allergic
reactions to influenza vaccine. Protocols have been published for
safely administering
influenza vaccine to people with egg allergies.
Some people who report allergy to egg might not be egg allergic. If a
person can eat lightly cooked eggs (e.g., scrambled eggs), they are
unlikely to have an
egg allergy. However, people who can tolerate egg in baked products
(e.g., cake) might still have an egg allergy. If the person develops
hives only after
ingesting eggs, CDC recommends (1) they receive TIV (not LAIV), (2)
the vaccine be administered by a healthcare provider familiar with the
potential
manifestations of egg allergy, and (3) the vaccine recipient be
observed for at least 30 minutes after receipt of the vaccine for
signs of a reaction.
|
For more details about giving influenza vaccine to people with a
history of egg allergy, see Prevention and Control of Influenza with
Vaccines:
Recommendations of the Advisory Committee on Immunization Practices
(ACIP)—United States, 2012–13:
www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm
You may find the IAC handout "Influenza Vaccination of People with a
History of Egg Allergy" helpful (see
www.immunize.org/catg.d/p3094.pdf). |
|
| The 2011–12 and 2012–13 Influenza
VISs state 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 2012–13 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. Ask your
doctor for more information.." 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. |
|
|
|
|
|
| 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. |
|
| Can we give live attenuated
influenza vaccine (LAIV; FluMist; MedImmune) to a person who is taking
an influenza antiviral medication? |
|
| If a person is taking an influenza
antiviral drug, you should not administer nasal-spray flu vaccine
until 48 hours after the person took the last dose of
the influenza antiviral medication. If a person takes antiviral drugs
within 2 weeks of getting the nasal-spray flu vaccine, the person
should get
revaccinated. (The antiviral drugs will have killed the vaccine
viruses that are supposed to cause the immune response against those
viruses.) However, you
can give inactivated influenza vaccine (TIV) to a person who is taking
an antiviral influenza drugs. |
|
|
|
|
|
| Which formulations of influenza
vaccines (i.e., nasal spray, intradermal, injectable high-dose, and
injectable standard-dose) are licensed for various age
groups? |
|
|
There are multiple manufacturers of
influenza vaccine and each may have differences in their product line
(e.g., licensed age group, mode of administration,
etc.). IAC has developed a handout that summarizes each of the
products available for the coming influenza vaccination season that
can be found 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.Sthat can be
found at
www.immunize.org/packageinserts/pi_influenza.asp. |
|
| In recommending influenza
vaccination for people age 65 and older, does CDC prefer that
healthcare professionals administer high-dose influenza vaccine or
standard-dose influenza vaccine? |
|
| CDC has no preference. CDC stresses
that vaccination is the first and most important step in protecting
against influenza. |
|
| 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 10/12 |
|
A-Z
IAC Home