 |
|
|
|
|
| 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. |
|
|
|
| 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 are first time vaccinees (or who failed to get their
second dose in the preceding season) 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; this will save them from
having to get 2 doses in the next vaccination season. 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. |
|
| 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. The vaccine
is effective in protecting 90% of healthy young adult vaccinees from
illness when the vaccine strain is similar to the circulating strain.
However, the vaccine is only 30%-40% effective in preventing illness
among frail elderly persons (although among elderly persons, the vaccine
is 20%-70% effective in preventing hospitalization and 80% effective in
preventing death). |
|
| 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). |
|
| 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." |
|
|
|
|
|
|
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 for 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, 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. |
|
| We have pre-ordered Afluria for the
2010-11 season but now need to find other vaccine for pediatric patients
ages 6 months through 8 years. What should we do? |
|
| There are several other products
licensed for use in children ages 6 months through 8 years which are
displayed on the a chart found at
www.immunize.org/catg.d/p4072.pdf. If you don't have a regular
supplier for influenza vaccine, you may want to check a listing of
influenza vaccine distributors that have vaccine in stock or on order by
going to
www.preventinfluenza.org/ivats/ivats_10_11.pdf. The National
Influenza Vaccine Summit maintains this list and updates it
periodically; check back weekly if you don't find a vaccine on the list
that you can use. |
|
| Which of our pediatric patients will
need 2 doses of influenza vaccine for the 2010-11 vaccination season? |
|
Whether you give injectable vaccine or
nasal-spray vaccine or one of each, give 2 doses separated by at least 4
weeks to all children ages 6 months through 8 years who (1) are
receiving influenza vaccine for the first time; (2) received their first
dose of seasonal vaccine during the 2009-10 season but failed to get
their second dose; or (3) failed to get at least 1 dose of 2009 H1N1
vaccine, regardless of their previous influenza vaccination history. If
there is uncertainty about the previous season's vaccination history,
give 2 doses this season to any child age 6 months through 8 years. CDC
has developed a flow chart to aid in making the decision based on the
child's previous vaccination history (see
www.cdc.gov/vaccines/ed/imzupdate/downloads/doses-algorithm.pdf).
The chart below provides a different format of the information in
the flow chart.
 |
|
| Children younger than age 9 years
need 2 doses of influenza vaccine. Should 2 doses be given each year
until the child turns 9? |
|
| No. Two doses should be administered to
children younger than age 9 years (i.e., 6 months through 8 years) the
FIRST time the vaccine is given. If the child fails to get the second
dose during that season, he should be given two doses in the subsequent
influenza vaccination season (i.e., the next chronological year). If he
isn't vaccinated in the subsequent season, he should only get one dose
per year from that point on. |
|
| 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. |
|
| It may be difficult to assure that
first-time vaccinees younger than 9 years old receive two doses of
influenza vaccine. Do you have any suggestions? |
|
| The ACIP has suggested these patients
may be given their first dose of vaccine as soon as vaccine becomes
available. |
|
| 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. |
|
|
|
| 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. |
|
| 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. |
|
| 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 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: |
|
| • |
|
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?s_cid=rr5502a1-e |
|
| 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. Starts 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). |
|
|
|
|
|
| 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 (such as egg protein)
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. |
|
| Which patients with egg allergy
should not receive influenza vaccine? |
|
| For those who claim egg allergy,
determine the nature of the allergy. If it is severe (anaphylaxis,
urticaria, bronchospasm), do not vaccinate. You might consider
consultation with an allergist. Protocols for desensitization have been
published. For allergies other than severe, give the vaccine. If a
person can eat eggs in any form, they may receive influenza vaccine
without prior testing. |
|
| 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. |
|
| For planned pregnancies, how long
should a woman wait after receiving nasal spray flu vaccines before
becoming pregnant? |
|
| There are no studies of live attenuated
influenza vaccine among women who are pregnant or who are planning to
become pregnant. However, the vaccine virus is cold-adapted and
replicates in the nasopharyngeal tissues rather than at core body
temperature. Consequently, infection of a fetus with live attenuated
influenza virus is very unlikely. It is not necessary to defer pregnancy
for a specific interval following receipt of live attenuated influenza
vaccine. |
|
| 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 during the 2010-11 influenza
vaccination season: 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) and
Agriflu (Novartis). You'll find a chart that lists all the available
influenza vaccines for the current vaccination season and simple
instructions for administering them at
www.immunize.org/catg.d/p4072.pdf. |
|
| 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 8/10 |
|
IAC Home