|
| As appeared in the January 2010 issue of Needle Tips |
|
|
Click here for PDF version
|
|
|
|
| Seasonal & H1N1 influenza |
|
|
| Q: |
|
Can anyone who wants it now receive H1N1 influenza vaccine? |
|
|
|
| A: |
|
Currently, each state can determine which people can receive H1N1 vaccine. As of this writing, an increasing number of states have decided to give
the vaccine to whomever wants it. Check with your local or state health department to find out the people who are eligible to receive the H1N1 vaccine
in your region. |
|
| |
| Q: |
|
According to ACIP,
individuals ages 25-64 years with medical conditions that put them
at higher risk for influenza-related complications are among those
prioritized to receive H1N1 influenza vaccine. What exactly are
these high-risk conditions? |
|
|
|
| A: |
|
A footnote on page 5 of the ACIP
recommendations for use of H1N1 influenza vaccine (www.cdc.gov/mmwr/PDF/rr/rr5810.pdf)
defines these medical conditions as follows: "Chronic medical
conditions that confer a higher risk for influenza-related
complications include chronic pulmonary (including asthma),
cardiovascular (except hypertension), renal, hepatic, cognitive,
neurologic/neuromuscular, hematologic, or metabolic disorders
(including diabetes mellitus) or immunosuppression (including
immunosuppression caused by medications or by human
immunodeficiency virus)." |
|
| |
| Q: |
|
People 65 years and
older are not among CDC's initial target groups for H1N1 vaccine.
Our hospital is refusing to give H1N1 vaccine to healthcare
personnel who are 65 and older. Is this correct? |
|
|
|
| A: |
|
This is not correct. People 65
years or older who are healthcare personnel, or who live with or
care for an infant younger than age 6 months, are among those
prioritized to receive H1N1 vaccine. |
|
| |
| Q: |
|
Can we administer
both the seasonal and H1N1 influenza vaccines at the same visit? |
|
|
|
| A: |
|
|
You can in most
cases. See the points below. |
|
| • |
|
You can administer both
the inactivated seasonal and the inactivated H1N1
influenza vaccines at the same visit (using separate
syringes and sites). Also, you can administer them at any
time before or after each other. |
|
|
|
| • |
|
You can administer the
inactivated seasonal and the live H1N1 influenza vaccines
together or at any time before or after each other. |
|
|
|
| • |
|
You can administer the
live seasonal and the inactivated H1N1 influenza vaccines
together or at any time before or after each other. |
|
|
|
| • |
|
Administering both the
LIVE attenuated seasonal and the LIVE attenuated H1N1
influenza vaccines at the same visit is NOT recommended
because of concerns about competition between the two live
vaccine viruses. If you have only live seasonal influenza
vaccine and live H1N1 influenza vaccine available, you
should separate the doses of the two live vaccines by at
least 4 weeks. |
|
|
|
|
| |
| Q: |
|
If seasonal live
attenuated influenza vaccine (LAIV) and 2009 H1N1 LAIV are
mistakenly given during the same visit, do either or both doses
need to be repeated? |
|
|
|
| A: |
|
There are no data on the
administration of seasonal LAIV and 2009 H1N1 LAIV during the same
visit. ACIP recommends that seasonal LAIV and 2009 H1N1 LAIV not
be administered during the same visit. However, if both types of
LAIV are inadvertently administered during the same visit, neither
vaccine needs to be repeated. |
|
| |
| Q: |
|
What if seasonal LAIV
and 2009 H1N1 LAIV are given less than 28 days apart? |
|
|
|
| A: |
|
ACIP recommends a minimum interval
of 28 days (4 weeks) between use of a seasonal LAIV and a 2009
H1N1 LAIV because these are considered two different live
vaccines. Based on previous studies of LAIV replication and immune
response, however, a dosing interval as short as 14 days (2 weeks)
might be sufficient to allow for an appropriate immune response to
both vaccines. Therefore, an interval of 2 weeks or more between
these two live vaccines is considered acceptable. However, if a
dose of seasonal LAIV and a dose of H1N1 LAIV are administered
1-13 days apart, the LAIV vaccine that was given last should be
considered invalid and should be repeated 28 days after the
invalid dose. An interval of 14 days between administering the
invalid dose and the repeat dose is acceptable, however. See the
previous question for guidance about what to do if two doses of
LAIV are inadvertently given on the same day. |
|
| |
| Q: |
|
What is the
recommended spacing between doses for a child who requires 2 doses
of H1N1 influenza vaccine? |
|
|
|
| A: |
|
|
The first and second
doses of either the live or the inactivated H1N1 vaccine
should be separated by at least 28 days. See the paragraphs
below: |
|
| |
|
Spacing when giving 2
doses of live H1N1 vaccine to a child: If 2 doses of
live H1N1 influenza vaccine (nasal spray) are given less
than 28 days apart, but at least 14 days apart, count the
doses as valid. If 2 doses of live H1N1 influenza vaccine
are given 1-13 days apart, the second dose is invalid.
Give the repeat dose at least 14 days (preferably 28 days)
after the invalid dose. |
|
|
|
| |
|
Spacing when giving 2
doses of inactivated H1N1 vaccine to a child: If 2
doses of inactivated H1N1 influenza vaccine are given less
than 28 days apart, but at least 21 days apart, count the
doses as valid. If 2 doses of inactivated H1N1 influenza
vaccine are given 1-20 days apart, the second dose is
invalid. Give the repeat dose at least 21 days (preferably
28 days) after the invalid dose. |
|
|
|
|
| |
| Q: |
|
Can a child who
requires 2 doses of a 2009 H1N1 influenza vaccine, and who was
given an inactivated H1N1 vaccine for the first dose, complete the
series with a live H1N1 vaccine? Or vice versa? |
|
|
|
| A: |
|
Data describing the immune
response to mixed schedules are limited. Therefore, when feasible,
the same type of vaccine (either live attenuated vaccine OR
inactivated vaccine) should be used in a 2-dose schedule. Mixed
schedules, however, are preferable to not completing the series. A
28-day interval between 2 doses of a mixed inactivated/live H1N1
vaccine series is recommended, but a 21-day interval is
acceptable. If the vaccines are separated by 1-20 days, the second
dose is invalid. Give the repeat dose 28 days (21 days acceptable)
after the invalid dose was given. |
|
| |
| Q: |
|
What if seasonal
LAIV or H1N1 LAIV is given 2 weeks after a dose of varicella
vaccine or MMR? Does the dose of LAIV need to be repeated? |
|
|
|
| A: |
|
Yes. The general rule for spacing
two live virus vaccines is that if two live virus vaccines are
administered less than 4 weeks apart and not on the same day, the
vaccine given second should be considered invalid and repeated.
The repeat dose should be administered at least 4 weeks after the
invalid dose. The two exceptions to this guidance are (1) that
live H1N1 and live seasonal influenza vaccines should not be given
on the same day and (2) that the minimum interval between seasonal
LAIV and H1N1 LAIV is 14 days. |
|
| |
| Q: |
|
Can a person with a
runny nose receive LAIV vaccine? |
|
|
|
| A: |
|
Yes. |
|
| |
| Q: |
|
Can 2009 H1N1
vaccine be administered at the same visit as other vaccines? |
|
|
|
| A: |
|
Inactivated 2009 H1N1 vaccine can
be administered at the same visit as any other vaccine, including
pneumococcal polysaccharide vaccine. Live 2009 H1N1 vaccine can be
administered at the same visit as any other live or inactivated
vaccine EXCEPT seasonal live attenuated influenza vaccine. |
|
| |
| Q: |
|
In the package
inserts, the age range for children who need 2 doses is different
for seasonal (6 months through 8 years) and 2009 H1N1 monovalent
vaccine (6 months through 9 years). Does CDC recommend that
clinicians follow the recommendation in the package inserts? |
|
|
|
| A: |
|
Yes, CDC recommends that
clinicians follow the guidance in the manufacturer package
inserts. For 2009 H1N1 monovalent vaccines, that means that
clinicians should administer 2 doses of 2009 H1N1 monovalent
vaccine to children ages 6 months through 9 years. Persons 10
years and older should receive 1 dose. |
|
| |
| Q: |
|
If a child receives
his first dose of H1N1 vaccine at age 9 years, but is 10 years old
when he comes back for the second dose, should the second dose be
given? |
|
|
|
| A: |
|
According to CDC recommendations,
if a child turns 10 years old between the first and second doses
of H1N1 vaccine, the second dose is not necessary. |
|
| |
| Q: |
|
Can the two types
of LAIV vaccine be given to close contacts of pregnant women? |
|
|
|
| A: |
|
Yes. A pregnant woman can be in
close contact with someone who has received LAIV vaccine for
either H1N1 or seasonal influenza. In addition, a pregnant
healthcare worker can administer both LAIV vaccines to patients.
Because the viruses in these vaccines are attenuated or weakened,
vaccine viruses are unlikely to cause any illness symptoms, even
if an unvaccinated person inadvertently gets vaccine viruses in
their nose. The LAIV vaccine for seasonal influenza viruses has
been used in millions of school children and healthy adults since
it was licensed, and there have been no reports of pregnant women
becoming ill after exposure to their vaccinated children or other
family members.
Although both LAIV vaccines can be given to contacts of pregnant
women, pregnant women should not receive either of the LAIV
vaccines. |
|
| |
| Q: |
|
Are there any
contraindications to giving breastfeeding mothers the 2009 H1N1
vaccine? |
|
|
|
| A: |
|
Breastfeeding mothers can get
either live or inactivated H1N1 influenza vaccine. They can also
receive either live or inactivated seasonal influenza vaccine. As
noted elsewhere, seasonal and H1N1 LAIV vaccines should not both
be given at the same visit. |
|
| |
| Q: |
|
What can I say to
patients who think the H1N1 influenza vaccines are "new" or
experimental? |
|
|
|
| A: |
|
The 2009 H1N1 influenza vaccines
are being produced by the same companies using the same procedures
used to produce seasonal influenza vaccines. The 2009 H1N1
vaccines are exactly the same as seasonal influenza vaccines
except for the strain of influenza virus they contain. One way to
approach this discussion is to emphasize that the 2009 H1N1
vaccine is not a "new" vaccine but rather is a change in the
strains (just as there is a change in the strains used to prepare
a new vaccine for each influenza season). Each year, experts look
at the strains that are likely to be circulating during the next
influenza season and put those into the upcoming year's influenza
vaccine. That's exactly what has been done in preparing the H1N1
vaccine.
Most of the seasonal influenza vaccines distributed over the last
decade have included H1N1-like strains. If the timing had been
better, it is possible that the 2009 H1N1 strain could have been
included in the 2009-10 seasonal influenza vaccine. |
|
| |
| Q: |
|
Do any of the H1N1
influenza vaccines include an adjuvant? |
|
|
|
| A: |
|
None of the currently approved
H1N1 influenza vaccines or seasonal influenza vaccines contains an
adjuvant. (NOTE: An adjuvant is a substance that is sometimes
added to a vaccine to enhance the immune response, so that smaller
quantities of vaccine can be given.) Most childhood vaccines
contain an adjuvant. |
|
| |
| Q: |
|
Do the H1N1
influenza vaccines use thimerosal as a preservative? |
|
|
|
| A: |
|
All multidose vials of influenza
vaccine (both seasonal and H1N1) contain thimerosal as a
preservative. There is no evidence that thimerosal is harmful. CDC
recommends that pregnant women and children may receive influenza
vaccine with or without thimerosal. However, because some pregnant
women and parents are concerned about exposure to thimerosal,
manufacturers are producing some preservative-free seasonal and
H1N1 influenza vaccines in single-dose syringes.
The live intranasal H1N1 influenza
vaccine is packaged in single doses so it does not use a
preservative; however, it cannot be used for pregnant women or
children younger than age 2 years. |
|
| |
| Q: |
|
Can the H1N1
influenza vaccine be given to someone who had an influenza-like
illness between April and now? |
|
|
|
| A: |
|
If an influenza-like illness (ILI)
was confirmed as H1N1 by reverse transcriptase polymerase chain
reaction (RT-PCR), then vaccination with H1N1 monovalent vaccine
is not necessary for the 2009-10 season. If the ILI was not
confirmed by RT-PCR, then the person should be vaccinated if
indicated. There is no harm in vaccinating a person who had H1N1
influenza in the past. |
|
| |
| Q: |
|
Can we test
patients who think they already had H1N1 influenza to see if their
infection was caused by H1N1? |
|
|
|
| A: |
|
There is no test readily available
that can show whether a person had 2009 H1N1 influenza in the
past. People for whom the 2009 H1N1 influenza vaccine is
recommended should receive it, unless they can be certain they had
2009 H1N1 influenza based on a reverse transcriptase polymerase
chain reaction (RT-PCR) test. |
|
| |
| Q: |
|
Can patients on
influenza antiviral prophylaxis (e.g., Tamiflu) receive seasonal
and/or H1N1 influenza vaccine? |
|
|
|
| A: |
|
Such patients can receive
inactivated seasonal or inactivated H1N1 influenza vaccine. A
person taking an influenza antiviral drug (including Tamiflu or
Relenza) should not be given the nasal-spray influenza vaccine
until 48 hours after the last dose of the influenza antiviral
medication was given. If LAIV is administered less than 48 hours
after a dose of antiviral medication, or if antivirals are
administered less than 2 weeks after LAIV is administered, then
the LAIV dose should not be counted as valid. |
|
| |
| Q: |
|
Why is there an
increased emphasis on giving pneumococcal polysaccharide vaccine
(PPSV) this influenza season? |
|
|
|
| A: |
|
The reason is that CDC is
receiving reports of greater-than-expected numbers of cases of
invasive pneumococcal disease concurrent with increases in
influenza-associated hospitalizations. Healthcare providers should
give PPSV to all people for whom it is recommended. This includes
previously unvaccinated adults age 65 years and older and people
ages 2-64 years with certain high-risk medical conditions. For an
explanation about the importance of using pneumococcal vaccine
during influenza season, read CDC's Health Advisory titled
"Pneumococcal Vaccination Recommended to Help Prevent Secondary
Infections" at
www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00301. |
|
| |
| Q: |
|
What personal
protective equipment is recommended for healthcare workers who are
administering LAIV vaccines? |
|
|
|
| A: |
|
Personal protective equipment
(gloves and masks) are not needed when administering LAIV vaccines
for seasonal or 2009 H1N1 influenza virus. |
|
| |
| Q: |
|
Do providers
working at a large-scale influenza vaccination event have to wash
their hands between each patient? |
|
|
|
| A: |
|
|
Yes. Hands should be
washed thoroughly with soap and water or cleansed with an
alcohol-based waterless antiseptic between patients. The
Department of Health and Human Services has provided the
following guidance in its Pandemic Influenza Plan: |
|
| • |
|
If hands are visibly
soiled or contaminated with respiratory secretions, wash
hands with soap (either non-antimicrobial or
antimicrobial) and water. |
|
|
|
| • |
|
In the absence of visible
soiling of hands, approved alcohol-based products for hand
disinfection are preferred over antimicrobial soap and
water or plain soap and water because of their superior
microbiocidal activity, reduced drying of the skin, and
convenience. |
|
|
|
|
For more information, go to:
www.cdc.gov/handhygiene. |
|
|
|
|
| |
| Q: |
|
Though I know it is
not necessary to wear gloves when providing injections, if a nurse
chooses to wear gloves, should the nurse change gloves after
administering each vaccination during a busy flu clinic? |
|
|
|
| A: |
|
Yes. Persons who administer
vaccines should either wash their hands with soap and water, use
alcohol-based hand sanitizer, or change their gloves between
individual patient encounters. |
|
| |
| Q: |
|
Where can I find
VISs for seasonal and H1N1 influenza vaccines? |
|
|
|
| A: |
|
IAC posts the English-language
VISs developed by CDC and all available translations on its
website as soon as they become available. There are more than 40
translations of certain VISs. Please note that all VIS
translations are graciously donated. To access all VISs and their
translations, go to
www.immunize.org/vis. |
|
|
|
Click here for PDF version
|
A-Z
IAC Home