| Influenza |
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| Disease Issues |
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How serious a problem is influenza in the
U.S.? |
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| Influenza is the
most frequent cause of death from a
vaccine-preventable disease in the United
States. Rates of infection from seasonal
influenza are highest among children, but the
risks for complications, hospitalizations, and deaths are higher among adults age 65 years
and older, children younger than 5 years,
pregnant women, and people of any age who have
medical conditions that place them at
increased risk for complications from
influenza. |
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| In a study of
influenza seasons from 1976–77 through
2006–07, the estimated number of annual
influenza-associated deaths from respiratory
and circulatory causes ranged from a low of
3,349 (1985–86 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 was also
responsible for more than 200,000
hospitalizations per year. |
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| A novel H1N1
virus was first detected in March 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 age 19–65
years, obese persons, and pregnant and
post-partum women. The pandemic virus has
continued to circulate. |
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| From the 2010–11
through the 2019–20 seasons, the annual
influenza-related disease burden has varied
from approximately 9–56 million illnesses,
4–26 million medical visits, 140,000–810,000
hospitalizations and 12,000–62,000 deaths per
year.* The number of influenza laboratory
confirmed deaths in children reported to CDC
has averaged 132 deaths (range 37–188) per
year. This is considered an underestimate of
actual pediatric deaths as some
influenza-related deaths are likely not
reported or recognized. For more information
on the health burden of influenza, see
www.cdc.gov/flu/about/burden/index.html. |
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| * Estimates from
2017–20 are preliminary. These estimates
include median estimates for all years except
for 2019–20 season where the 95% confidence
interval is included as the median estimate is
not yet published. |
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| What medical
conditions increase the risk of severe illness
from influenza? |
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| While even
healthy children and adults can get severe
influenza or die from influenza and its
complications, the risk of severe influenza is
higher for children younger than 5 years,
adults 50 years and older, pregnant women, Alaska Natives and American Indians, and
residents of nursing homes or other long-term
care facilities. Medical conditions that
increase a person's risk of severe influenza
include chronic pulmonary (including asthma), cardiovascular (excluding isolated
hypertension), renal, hepatic, neurologic,
hematologic, or metabolic disorders (including
diabetes mellitus); immunocompromising
conditions due to any cause (including but not
limited to immune suppression caused by
medications or HIV); extreme obesity (body
mass index of >40 for adults); and the chronic
use of aspirin- or salicylate-containing
medications in children through age 18 (due to
the risk of Reye syndrome after influenza
infection). |
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| How do risk
groups for severe illness from influenza and
SARS-CoV-2 compare to each other? |
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| People of all
ages are susceptible to illness from both
influenza and SARS-CoV-2, the virus that
causes COVID-19. High risk groups for severe
illness from influenza and SARS-CoV-2
substantially overlap. While we continue to learn more about COVID-19, currently CDC
identifies persons at increased risk of severe COVID
www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html
as older adults, with risk increasing as age
increases; and persons with cancer, chronic
kidney disease, COPD (chronic obstructive pulmonary disease), immunocompromised state
(weakened immune system) from solid organ
transplant, obesity (body mass index [BMI] of
30 or higher), serious heart conditions (such
as heart failure, coronary artery disease, or
cardiomyopathies), sickle cell disease, or
type 2 diabetes. |
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| Groups that might
be at an increased risk for severe illness
from COVID-19 include asthma (moderate to
severe), cerebrovascular disease, cystic
fibrosis, hypertension, immunocompromised due
to treatment or medical conditions, neurologic
conditions (such as dementia), liver disease,
pregnancy, pulmonary fibrosis (having damaged
or scarred lung tissues), smoking, thalassemia
(a type of blood disorder), and type 1
diabetes mellitus. |
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| More information
about risk factors for severe COVID-19 can be
found at:
www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html. |
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| Can influenza
viruses circulate at the same time as
SARS-CoV-2, the virus that causes COVID-19? |
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| Yes. Both viruses
co-circulated at the start of the COVID-19
pandemic and continue to circulate, although
the number of influenza viruses detected in
the U.S. decreased substantially in the spring
of 2020. The extent to which SARS-CoV-2 and
influenza viruses will co-circulate during
this upcoming influenza is unknown, however,
CDC anticipates that both viruses will
circulate during the 2020–21 influenza season. |
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| Where can I
get information on influenza and its
surveillance? |
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| Information
regarding influenza surveillance is available
year-round from CDC at
www.cdc.gov/flu/weekly/fluactivitysurv.htm.
The full FluView surveillance report is
published each Friday afternoon from October
through mid-May and an abbreviated FluView
report is published Mid-May through September.
In addition, periodic updates about influenza
are published in MMWR. |
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| State and local
health departments should be consulted
regarding availability of influenza vaccine,
access to vaccination programs, information
about state or local influenza activity, and
for reporting influenza outbreaks and
receiving advice regarding their control. |
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| What's new in
the 2020–21 influenza vaccine recommendations? |
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| The 2020–21 ACIP
influenza vaccine recommendations were
published on August 21, 2020, and are
available at
www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6908a1-H.pdf.
The updated guidance describes the vaccine composition for this season (a change in the
A/H3N2, A/H1N1, and B/Victoria lineage vaccine
components); discusses the availability of two
new vaccines for adults age 65 and older, Fluzone High-Dose Quadrivalent (Sanofi
Pasteur) and Fluad Quadrivalent (Seqirus);
updates recommended intervals between live
attenuated influenza vaccine (LAIV4, Flumist
Quadrivalent; AstraZeneca) and influenza
antiviral medications; updates contraindications for LAIV4 to include
cerebral spinal fluid leak, cochlear implant,
and anatomic or functional asplenia; and
updates guidance on vaccination of people with
severe allergic reaction to eggs to state that vaccination in a medical setting supervised by
a healthcare provider who is able to recognize
and manage severe allergic reaction is needed
only if administering a vaccine other than
cell culture-based quadrivalent influenza vaccine (Flucelvax Quadrivalent; Seqirus) or
recombinant hemagglutinin influenza vaccine (Flublok
Quadrivalent; Sanofi Pasteur). |
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| Who is
recommended to be vaccinated against
influenza? |
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| ACIP recommends
annual vaccination for all people ages 6
months and older who do not have a
contraindication to influenza vaccination. |
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| Which
influenza vaccines will be available during
the 2020–21 influenza season? |
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| Multiple
manufacturers are producing influenza vaccine
for the U.S. market for the 2020–21 season.
Inactivated influenza vaccines will be
produced using egg-based, cell culture-based,
and recombinant technologies. Live attenuated
nasal spray vaccine (Flumist Quadrivalent;
AstraZeneca) will also be available. All but
one influenza vaccine will be quadrivalent
(containing four strains of influenza virus).
The only trivalent vaccine available is the MF-59 adjuvanted vaccine (Fluad; Seqirus),
however a quadrivalent MF-59 adjuvanted
vaccine is also available (Fluad Quadrivalent;
Seqirus). Both Fluad vaccines are indicated
for adults age 65 years and older. |
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| ACIP does not
state a preference for one influenza vaccine
over another for people for whom more than one vaccine is recommended for their age and
health condition. A complete listing of
influenza vaccine products is available at
www.immunize.org/catg.d/p4072.pdf. |
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| What are the
new influenza vaccines available for the
2020–21 influenza season? |
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| Fluzone High-Dose
Quadrivalent (HD-IIV4, Sanofi Pasteur) and
Fluad Quadrivalent (Seqirus), both for adults
65 years and older, are new for 2020–21. The
HD-IIV4 replaces Fluzone High-Dose
(trivalent). Both Fluad Quadrivalent and Fluad
(trivalent) will be available this season. |
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| HD-IIV4, Fluad
(trivalent), and Fluad Quadrivalent are
supplied as pre-filled syringes. A dose of
HD-IIV4 is 0.7 mL; the dose of both Fluad and
Fluad Quadrivalent vaccines is 0.5 mL. |
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| What are the
changes to vaccine viruses for the 2020–21
influenza season? |
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| Influenza
vaccines produced for the current season will
mostly be quadrivalent (four components).
Quadrivalent vaccines contain two A viruses
and two B viruses while trivalent vaccines
contain two A viruses and one B virus. |
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| For the 2020–21
season, U.S. egg-based influenza vaccines
(i.e., vaccines other than Flucelvax
Quadrivalent and Flublok Quadrivalent) will
contain hemagglutinin (HA) derived from an
influenza: |
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A/Guangdong-Maonan/SWL1536/2019
(H1N1)pdm09-like virus, |
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A/Hong Kong/2671/2019 (H3N2)-like virus, |
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B/Washington/02/2019 (Victoria
lineage)-like virus, and |
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B/Phuket/3073/2013 (Yamagata lineage)-like
virus (for quadrivalent vaccines). |
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| U.S. cell
culture-based (Flucelvax Quadrivalent) and
recombinant (Flublok Quadrivalent) influenza
vaccines will contain HA derived from an
influenza: |
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A/Hawaii/70/2019 (H1N1)pdm09-like virus, |
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A/Hong Kong/45/2019 (H3N2)-like virus, |
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B/Washington/02/2019 (Victoria
lineage)-like virus, and |
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B/Phuket/3073/2013 (Yamagata lineage)-like
virus. |
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| If
quadrivalent vaccines includes one additional
strain, why aren't they preferred for use over
trivalent vaccines? |
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| Two different
types of influenza B virus are likely to cause
disease during an influenza season, but
trivalent influenza vaccines contain only one
type of influenza B virus. The quadrivalent
vaccine includes both types of B virus. While
most vaccines are now quadrivalent, not all
types of vaccine are likely to be uniformly
available in any practice setting or locality.
Consequently, ACIP does not express a
preference for use of one type of influenza vaccine over another type (that is,
quadrivalent over trivalent) for those for
whom more than one type of vaccine is indicated and available. Vaccination should
not be delayed in order to obtain a specific
product when an appropriate one is already
available. |
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| Is it
acceptable to administer a dose of the
quadrivalent influenza vaccine to a patient
who has already received the trivalent
vaccine? We've had a few patients request
this. |
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| No. ACIP does not
recommend more than one dose of influenza
vaccine in a season, except for certain
children age 6 months through 8 years for whom
two doses are recommended. |
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| When should
influenza vaccines be given? |
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| CDC recommends
that vaccination should be offered by the end
of October. Vaccination should continue throughout the influenza season, including
into the spring months (for example, through
May), as long as influenza viruses are
circulating and providers have unexpired
vaccine. |
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| Children age 6
months to 8 years without two prior doses of
influenza vaccine need 2 doses. They should
get their first influenza vaccination as soon
as vaccine becomes available; the minimum
interval for the second dose is 28 days. |
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| For people who
need only 1 dose, early vaccination (i.e.,
July and August) can result in reduced immune protection towards the end of the influenza
season, particularly for older adults. |
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| To avoid missed
opportunities for vaccination, providers
should offer vaccination during routine
healthcare visits and hospitalizations. Early
vaccination of children younger than age 9
years who need 2 doses of vaccine can be helpful in assuring routine second doses are
given before the influenza season begins. |
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| We are unsure
about when to start our influenza vaccination
promotion, and when to ideally vaccinate our patients. Does protection from seasonal
influenza vaccine decline or wane during the
influenza season? Should I wait until later in
the year to vaccinate my elderly or medically
frail patients? |
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| Optimally,
vaccination should occur before onset of
influenza activity in the community. Because
the timing of the onset, peak, and decline of
influenza activity varies, the ideal time to
start vaccinating cannot be predicted each season. Local outbreaks can begin as early as
October, but CDC reports that 75% of influenza
seasons peak in January or later. |
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| CDC recommends
that vaccination should be offered by the end
of October. Children age 6 months to 8 years without two prior doses of flu vaccine need 2
doses and should get their first influenza
vaccination as soon as vaccine becomes
available to ensure they are fully vaccinated
before the onset of community outbreaks. |
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| Several studies
have reported decreases in vaccine
effectiveness over the influenza season.
However, waning effects have not been observed
consistently across age groups, virus
subtypes, and seasons. While delaying vaccination might permit greater immunity
later in the season, deferral could result in
missed opportunities to vaccinate, as well as
difficulties in vaccinating a large number of
people within a more limited time period. |
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| For people who
need only 1 dose, early vaccination (i.e.,
July and August) can result in reduced immune protection towards the end of the influenza
season, particularly for older adults. |
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| Should our
practice consider revaccinating our high risk
and older patients a second time during the
year due to concerns with waning immunity? |
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| For people who
have already been fully vaccinated,
revaccination later in the season is not
recommended. |
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| How late in
the season can I vaccinate my patients with
influenza vaccine? |
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| Peak influenza
activity generally occurs in the Northern
Hemisphere in January or February. Providers
should continue vaccinating patients
throughout the influenza season, including
into the spring months (for example, through
May), as long as they have unexpired vaccine
in stock and unvaccinated patients in their
office. |
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| 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 most injectable
influenza vaccine has a June 30 expiration
date. |
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| What types of
personal protective equipment do healthcare
personnel need for administering vaccines in light of COVID-19? |
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| CDC recommends
that healthcare personnel administering any
vaccines during COVID-19 wear surgical masks and eye protection (goggles or face shields).
N95 respirators are not recommended. Gloves
are recommended when giving intranasal or oral
vaccines because of the increased likelihood
of coming into contact with a patient's mucous
membranes and body fluids. Gloves are optional
for other vaccines. Importantly, hands should
be washed and gloves, when worn, should be
changed between each patient. See the CDC web
page Vaccination Guidance During a Pandemic
www.cdc.gov/vaccines/pandemic-guidance/index.html
for additional details. |
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| We are
considering co-locating our COVID-19
drive-through testing site and influenza
vaccination sites. Can we vaccinate someone
with suspected or confirmed COVID-19
infection? |
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| CDC recommends
deferring vaccination for people with
suspected or confirmed COVID-19 until they
have met criteria for no longer needing
quarantine or isolation to avoid exposing
healthcare personnel and other patients. When
scheduling or confirming appointments for
vaccination, patients should be screened for
COVID-19 symptoms and recent exposure. |
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| Which
travelers are recommended to be vaccinated? |
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| 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. |
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| If a patient
received a dose of influenza vaccine in June
(for example, for international travel), how
long should the patient wait before getting
vaccinated with the next season's flu vaccine? |
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| There should be a
minimum of 4 weeks between the doses in such
situations. |
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| If an
unvaccinated patient who has just recovered
from a laboratory confirmed case of influenza
comes into our clinic, should we vaccinate
him? |
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| Yes. Influenza
vaccine contains three or four influenza
vaccine virus strains; two A viruses and one
or two B viruses, 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 be exposed to
more than one type during a typical influenza
season. So, a person who has recently had
influenza will benefit from receipt of a
vaccine that contains additional influenza
virus strains. |
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| How long does
immunity from influenza vaccine last? |
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| Protection from
influenza vaccine is thought to persist for at
least 6 months. Protection declines over time
because of waning antibody levels and because
of changes in circulating influenza viruses
from year to year. For people who need only 1
dose of influenza vaccine for the season,
yearly vaccination (i.e. in July and August)
is likely to be associated with suboptimal
immunity before the end of the influenza
season, particularly among older adults. |
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| 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? |
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| There are several
reasons why this misconception persists: |
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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. |
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Protective immunity doesn't develop until
1–2 weeks after vaccination. Some people
who get vaccinated later in the season
(December or later) may be infected with
influenza virus 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. |
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For many people, "the flu" is any illness
with fever and cold symptoms or
gastrointestinal symptoms. If they get any
viral illness, they may blame it on flu
vaccine or think they got "the flu"
despite being vaccinated. Influenza vaccine only protects against certain
influenza viruses, not all viruses. |
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Influenza vaccination is our best
protection against influenza disease;
however, some people who are vaccinated will still contract influenza illness
despite vaccination. |
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| While vaccine
effectiveness (VE) can vary, recent studies
show that flu vaccination reduces the risk of
flu illness by between 40% and 60% among the
overall population during seasons when most
circulating flu viruses are well-matched to
the flu vaccine. VE is generally lower for
adults age 65 years and older. Influenza
vaccination has also been shown to reduce
influenza disease severity even if someone
does get sick after vaccination, and reduces
the risk of influenza hospitalization, and
deaths in children and adults. Influenza
vaccination also reduces the risk of acute
cardiac events, like heart attack and heart
failure, among people with heart disease. |
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| For more
information on this topic, go to:
www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm. |
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| When
administering influenza vaccine, is giving
patients a vaccine information statement (VIS) mandatory or is it only "recommended"? |
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| Giving patients
an influenza Vaccine Information Statement
(VIS) is mandatory under the National
Childhood Vaccine Injury Act of 1986. The VIS
must be given to all adults as well as to
parents or guardians of children prior to
vaccination. Two VISs are available, one for
live attenuated influenza vaccine (LAIV) and
one for inactivated influenza vaccine (IIV)
and recombinant vaccine (RIV). Each can be
found at www.immunize.org/vis/ in multiple languages. The latest influenza vaccine VISs
are dated August 15, 2019, and should be used
until updated VISs are available from CDC. CDC
allows providers to use VISs that they have
already printed when updates become available. |
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| The latest VIS
for all vaccines plus translations in multiple
languages are located on the IAC website
www.immunize.org/vis/. |
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| Are there
recommendations for the prevention of
institutional outbreaks of influenza? |
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| The most
important factor in preventing outbreaks is
annual vaccination of all residents and staff
who work at facilities such as nursing homes,
assisted living facilities, and other group
living situations. 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 (for example, visiting nurses, therapists, and volunteers). |
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| 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? |
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| 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 (and pneumococcal
polysaccharide) vaccination, patient
self-report of being vaccinated can be
accepted as evidence of vaccination. |
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| Live
Attenuated Influenza Vaccine (LAIV)
Issues |
Back to top |
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| For whom is
Flumist Quadrivalent approved? |
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| Flumist
Quadrivalent (LAIV4; AstraZeneca) is currently
approved by FDA only for use among healthy
non-pregnant persons age 2 through 49 years. |
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| Is
administering Flumist an aerosol-generating
procedure requiring airborne precautions
during the COVID-19 pandemic? |
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| No. Giving
Flumist is not considered an
aerosol-generating procedure. See the CDC web
page
Vaccination Guidance During a Pandemic for
additional details. |
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| How is Flumist
administered? |
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| 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. |
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| Can Flumist be
administered to persons with minor acute
illnesses, such as a mild upper respiratory infection (URI) with or without fever? |
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| Yes, unless
clinical judgment suggests nasal congestion is
present that might impede delivery of the
vaccine to the nasopharyngeal mucosa, in which
case deferral of administration should be
considered until the congestion resolves. |
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| Can a woman
who is breastfeeding receive Flumist? |
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| Breastfeeding is
not a contraindication for any routine
vaccination including Flumist. |
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| Can Flumist be
given to contacts of immunosuppressed
patients? |
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| Like other live
vaccines, Flumist 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
(for example, 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 (for
example, persons with diabetes, persons with asthma taking corticosteroids, or persons
infected with human immunodeficiency virus)
who are otherwise eligible for Flumist may
receive it. No special precautions need to be
taken by the vaccinated person. |
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| How long after
someone is vaccinated with Flumist must they
stay away from a severely immunosuppressed
person (a person who is hospitalized in
protective [reverse] isolation)? |
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| Persons should
avoid contact with any person who is severely
immunosuppressed for at least 7 days after receiving Flumist. There are no restrictions
on being in contact with any other patients. |
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| Is Flumist
contraindicated for adults with asthma? |
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| Asthma is a
precaution for Flumist in people 5 years of
age and older. |
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| Can we give
Flumist to a person who is taking an influenza
antiviral medication? |
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| An antiviral drug
active against influenza virus may reduce the
effectiveness of Flumist. ACIP has recommended different intervals between the last dose of
an antiviral medication and Flumist
administration, based upon the half-life of
the antiviral medication. The new
recommendations are as follows: |
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Oseltamivir
or zanamivir: wait at least 48 hours after
last dose before administering Flumist |
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Peramivir: wait at least 5 days before
administering Flumist |
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Baloxavir: wait at least 17 days before
administering Flumist |
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| If any influenza
antiviral medication must be given within 14
days of Flumist administration, the patient
should be revaccinated without delay with any
age-appropriate inactivated influenza vaccine.
All inactivated influenza vaccines and
recombinant influenza vaccine (Flublok) may be
administered at any time relative to antiviral medication. |
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| One of our
young patients made it impossible to
administer the second part of the Flumist
dose. What should we do? |
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| A half dose of
Flumist (or any other vaccine) is a
non-standard dose and should not be counted.
If you were unable to give the second half of
the vaccine at that same appointment, you will
have to provide another full dose of influenza
vaccine at another time. Alternatively, you
can give inactivated influenza vaccine any
time after this partial dose. If you want to
give Flumist again, you should wait four
weeks, as it is a live vaccine. |
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| Which children
should receive influenza vaccine? |
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| ACIP recommends
annual influenza vaccination for all children
age 6 months and older who do not have a contraindication to the vaccine. |
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| Which
influenza vaccines can we give to children? |
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| Four injectable
inactivated influenza vaccines are now
approved by FDA for children age 6 months and
older. |
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Fluzone
Quadrivalent (Sanofi Pasteur), |
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FluLaval
Quadrivalent (GSK), |
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Fluarix
Quadrivalent (GSK), and |
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Afluria
Quadrivalent (Seqirus). |
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| The inactivated
cell culture-based influenza vaccine Flucelvax
(Seqirus) is approved for people age 4 years
and older. |
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| The nasal spray
live attenuated influenza vaccine, Flumist
Quadrivalent (AstraZeneca), is approved for
healthy people age 2–49 years who are not
pregnant. Information about all influenza
vaccines available in the U.S., including
product billing codes, is available in IAC's
handout titled "Influenza Vaccine Products for
the 2020–2021 Influenza Season" at
www.immunize.org/catg.d/p4072.pdf. Information
on vaccine products for the U.S. is also
available on CDC's website at
www.cdc.gov/flu/professionals/vaccines.htm. |
|
| Please provide
details about the use of inactivated influenza
vaccine in children younger than 3 years. |
|
| Afluria
Quadrivalent (Seqirus) dosing is 0.25 mL given
IM for children age 6–35 months and 0.5 mL for
children age 3 years and older. |
|
| The dosing for
FluLaval Quadrivalent (GSK) and Fluarix
Quadrivalent (GSK) vaccines is 0.5 mL for
children age 6 months and older. |
|
| For Fluzone
Quadrivalent (Sanofi Pasteur), either 0.25 mL
or 0.5 mL doses can be given to children age
6–35 months. For children age 3 years and
older, the dose is 0.5 mL. |
|
| Flucelvax
Quadrivalent (Seqirus) is recommended
beginning at age 4 years at 0.5 mL dose, but
should not be used for children younger than
age 4 years. |
|
| Which children
younger than age 9 years will need 2 doses of
influenza vaccine in this influenza season? |
|
| Children age 6
months through 8 years should receive a second
dose 4 weeks or more after the first dose 1)
if they are receiving influenza vaccine for
the first time, 2) if they did not receive a
total of at least two doses of any seasonal
influenza vaccine before July 1 of the current
year, or 3) if their vaccination history is
unknown. The two previous doses need not have
been received during the same season or
consecutive seasons. |
|
| IAC's handout
titled "Guide for Determining the Number of
Doses of Influenza Vaccine to Give to Children
Ages 6 Months Through 8 Years" provides
guidance on this issue; it is available at
www.immunize.org/catg.d/p3093.pdf. |
|
| When
determining whether a child age 2 through 8
years needs one or two doses of influenza
vaccine this season, can we count doses of Flumist administered in past years? |
|
| CDC advises that
doses of Flumist administered in past seasons
can be counted. |
|
| If a child age
8 years or younger has had one dose of
trivalent and one dose of quadrivalent
influenza vaccine in the past, do they need
one or two doses for the upcoming season? |
|
| They need just
one dose of any age and health
condition-appropriate influenza vaccine
annually. |
|
| Can a child
age 6–35 months who needs 2 doses of influenza
vaccine this season receive a combination of Afluria, Fluzone, FluLaval, Fluarix, or
Flumist vaccine? |
|
| Yes. The two
doses do not have to be the same brand.
Afluria Quadrivalent (0.25 mL per dose),
Fluzone Quadrivalent (0.25 mL or 0.5 mL per
dose), FluLaval Quadrivalent (0.5 mL per
dose), and Fluarix Quadrivalent (0.5 mL per
dose) are approved by the FDA for use in
children age 6–35 months. If a child is age 2
years or older, Flumist Quadrivalent may also
be used when age and health condition are
appropriate. |
|
| Can a child 36
months through 8 years of age who needs 2
doses of influenza vaccine this season receive
a combination of Fluzone, FluLaval, Fluarix or
Afluria vaccine? |
|
| Yes. The two
doses do not have to be the same brand.
Fluzone Quadrivalent (0.5 mL dose), FluLaval
Quadrivalent (0.5 mL dose), Fluarix
Quadrivalent (0.5 mL dose) and Afluria
Quadrivalent (0.5 mL dose) are approved by the FDA for use in children age 3 years and older. |
|
| If a child
receives Fluzone Quadrivalent vaccine (0.25 mL)
at age 34 or 35 months for the first time and then returns for the second dose at age 37
months, should we give another 0.25 mL dose of
Fluzone Quadrivalent or should we give the 0.5
mL dose that is indicated for age 3 years 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. |
|
| Can a clinic
vaccinate children younger than age 3 years
with influenza vaccine taken from a multi-dose vial of influenza vaccine? The multi-dose
vials contain thimerosal as a preservative. |
|
| Yes. Multi-dose
vials of inactivated influenza vaccine contain
a small amount of thimerosal to prevent
bacterial and fungal growth in the vial.
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
(see
www.immunize.org/coordinators for contact
information). |
|
| Do any
children age 9 years and older need two total
doses during an influenza season? |
|
| Yes. A 9-year-old
should receive a dose of influenza vaccine if
they turned 9 years old during the current
season and already received one dose during
the current season when they were 8 years old,
AND they did not receive a total of at least
two prior doses of influenza vaccine before
July 1 of the current year, or if their
vaccination history is unknown before July 1
of the current year. |
|
| There is a
debate within my clinical department about not
allowing influenza vaccine to be given with DTaP and PCV13. Are there data that state
these should not be given concomitantly? |
|
| A CDC study has
shown a small increased risk for febrile
seizures during the 24 hours after a child
receives the inactivated influenza vaccine at
the same time as the PCV13 vaccine or DTaP
vaccine. However, the risk of febrile seizure
with any combination of these vaccines is
small and ACIP recommends giving these
vaccines at the same visit if indicated. See
www.cdc.gov/vaccinesafety/concerns/febrile-seizures.html
for more information. |
|
|
|
|
|
| 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 and their
baby's increased risk of influenza-related
illness and hospitalizations during the first
6 months of life. |
|
| Influenza
vaccination during pregnancy reduces mothers'
risk of influenza illness, preterm labor, and
their infants' risk of influenza and
influenza-related hospitalization in the first
6 months of life. |
|
| Most studies of
influenza vaccination in pregnant women have
administered vaccine in the second or third trimester using inactivated influenza vaccine. |
|
| Vaccination can
occur in any trimester, including the first.
Only inactivated or recombinant influenza
vaccines can be given to pregnant women. Flumist, a live vaccine, should not be used in
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 since 1997.
Pregnant women are at increased risk 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. However, vaccinating during
pregnancy provides maternal antibodies to the
fetus; this helps protect the young infant
against influenza during the first 6 months of
life. Vaccinating pregnant women protects
women, their unborn babies, and their babies
after birth. |
|
| Does ACIP
recommend one influenza product over another
for pregnant women? |
|
| Pregnant women
can receive any inactivated or recombinant
influenza vaccine. They should not be given
Flumist Quadrivalent. |
|
| 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. |
|
|
If a patient was vaccinated earlier in the
influenza season and later becomes pregnant
during the same season, should she be
revaccinated due to her pregnancy? |
|
| No. The Advisory
Committee on Immunization Practices (ACIP)
does not recommend more than one dose of influenza vaccine per season, except for
certain children being vaccinated for the
first time. |
|
| I heard that a
study suggested an increase in miscarriage
among women who received inactivated influenza
vaccine. Please provide details. |
|
| A CDC-funded
study found that women who had been vaccinated
early in pregnancy with an influenza vaccine containing the pandemic H1N1 (H1N1pdm09)
component and who also had been vaccinated the
prior season with an H1N1pdm09-containing
influenza vaccine had an increased risk of
spontaneous abortion (miscarriage) in the 28
days after vaccination. This study did not
quantify the risk of miscarriage and did not
prove that influenza vaccine was the cause of
the miscarriage. Earlier studies have not
found a link between influenza vaccination and miscarriage. A larger follow-up study also
funded by CDC which included 3 more years of
data found no association between early
miscarriage and influenza vaccination
regardless of previous influenza season vaccination. These results are reassuring
regarding the safety of influenza vaccination
of pregnant women. |
|
| CDC, ACIP, and
the American College of Obstetricians and
Gynecologists (ACOG) have not changed the recommendation for influenza vaccination of
pregnant women. It is recommended that
pregnant women receive influenza vaccine
during any trimester of their pregnancy
because influenza poses a danger to pregnant
women and the vaccine can prevent influenza in
pregnant women and their infants. |
|
| 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. |
|
| 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 people with
diabetes who control their disease with diet
need influenza vaccine? |
|
| People with a
metabolic disease, including diabetes, should
receive annual influenza vaccination with an inactivated or recombinant influenza 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. |
|
| 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. |
|
| Please tell me
about Fluad, one of the influenza vaccines for
people age 65 years and older. |
|
| In November 2015,
FDA licensed Fluad (aIIV3, Seqirus), a
trivalent, MF59-adjuvanted inactivated
influenza vaccine, for people age 65 years and
older. Fluad is the first adjuvanted influenza
vaccine marketed in the U.S. An adjuvant is a
substance added to a vaccine to increase its immunogenicity. The MF59 adjuvant is based on squalene, an oil that occurs naturally in many
plants and animals. Fluad has been used in
Europe since 1997 and is approved in 38 other
countries. Fluad is available as a trivalent
and quadrivalent formulation. In contrast to Fluzone High-Dose Quadrivalent (Sanofi
Pasteur), Fluad is a standard-dose vaccine,
containing 15 mcg of hemagglutinin per virus
per dose. In a small observational study among
adults age 65 years and older Fluad was about
63% more effective than unadjuvanted trivalent
standard dose inactivated influenza vaccine.
ACIP has not stated a preference for any
specific licensed influenza vaccine for people
age 65 years and older. |
|
| A study
published in 2014 found that the injectable
vaccine Fluzone High-Dose protected people 65
years and older better than standard-dose Fluzone. Does ACIP preferentially recommend
use of Fluzone High-Dose for all people age 65
years and older? |
|
| Aging decreases
the body's ability to develop a good immune
response after getting influenza vaccine,
which places older people at greater risk of
severe illness from influenza. A higher dose
of antigen in the vaccine should give older
people a better immune response and therefore
provide better protection against influenza.
There is published evidence of better
protection from Fluzone High-Dose when
compared to standard-dose Fluzone (N Engl J
Med 2014; 371:635–45); however, ACIP has not
stated a preference for any specific licensed
influenza vaccine for people age 65 years and
older. |
|
| Should Fluzone
High-Dose Quadrivalent, Fluad, or Fluad
Quadrivalent be administered to patients younger than age 65 years? |
|
| No. These three
vaccines are licensed only for people age 65
years and older and are not recommended for younger people. |
|
| Sometimes
patients age 65 years and older who have
received the standard-dose influenza vaccine
hear about the high-dose (Fluzone High-Dose
Quadrivalent) or adjuvanted vaccine (Fluad or
Fluad Quadrivalent) and want to receive that,
too. Is this okay to administer? |
|
| No. ACIP does not
recommend that anyone receive more than one
dose of influenza vaccine in a season except
for certain children age 6 months through 8
years for whom two doses are recommended. |
|
| Would giving
an older patient 2 doses of standard-dose
influenza vaccine be the same as administering
the high-dose product? |
|
| No, and this is
not recommended. |
|
| If a patient
is undergoing treatment for cancer, is it safe
to vaccinate her or him against influenza? |
|
|
People with cancer need to be protected from
influenza, and they can and should receive
inactivated or recombinant influenza vaccine
(but not live nasal spray vaccine [Flumist])
even if they are immunosuppressed. Cancer
patients and survivors are at higher risk for
complications from influenza, including
hospitalization and death. Here is a helpful
CDC web page on cancer and influenza for
patients:
www.cdc.gov/cancer/flu. |
|
| How soon after
bone marrow transplant do we start to
vaccinate our patients against influenza? |
|
|
Inactivated influenza vaccine or recombinant
influenza vaccine should be administered
beginning at least 6 months after bone marrow
transplant and annually thereafter for the
life of the patient. A dose of vaccine can be
given as early as 4 months after transplant,
but a second dose should be considered in this
situation. A second dose is recommended
routinely for all children younger than 9
years receiving influenza vaccine for the
first time. |
|
|
|
|
|
| Why is
influenza vaccination important for HCP? We
already encourage them to stay home from work
when they are sick. |
|
| Unfortunately, by
the time a HCP has symptoms of influenza, they
may have already exposed many patients since
the virus is shed for 1–2 days before symptoms
begin. Further, many studies show that HCP
often go to work while they are sick and may
be infectious to others. Start planning early
to make sure all employees in your work
setting receive annual influenza vaccination
before the influenza season begins. |
|
| What are the
ACIP recommendations for influenza vaccination
of HCP? |
|
| Because HCP
provide care to patients at high risk for
complications of influenza, they 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; overall only 81% of HCP report
influenza vaccination during the 2018–19
season. |
|
| Influenza
vaccination key points for HCP include: |
|
| • |
|
All HCP should be educated regarding the
benefits of influenza vaccination. |
|
|
|
| • |
|
Influenza
vaccine should be administered annually to
all eligible HCP. |
|
|
|
| • |
|
A signed
declination should be obtained from HCP
who decline influenza vaccination. |
|
|
|
| • |
|
Healthcare facilities should monitor HCP
influenza vaccination coverage and
declination at regular intervals. |
|
|
|
| • |
|
HCP vaccination coverage should be used as
one measure of a patient-safety quality
program. |
|
|
| In 2011, ACIP
published "Immunization of Health-Care
Personnel," includes information about all
recommended vaccines (see
www.cdc.gov/mmwr/pdf/rr/rr6007.pdf). |
|
| Which health
care personnel should be vaccinated against
influenza? |
|
| It is important
to vaccinate all healthcare personnel,
including paid and unpaid workers who may be
exposed to patients or infectious materials.
This includes direct patient care staff (e.g.,
physicians, nurses, and therapists), and staff
and volunteers in pharmacy, radiology,
laboratory, human resources, facilities
management (housekeeping), food services, and
laundry. Vaccination should include healthcare
staff in all settings, such as hospitals,
outpatient clinics, pharmacies, emergency
response, nursing homes and assisted living
facilities, and home care. |
|
| Which
employees of congregate living facilities,
such as assisted living facilities and nursing
homes, should be vaccinated against influenza? |
|
| All persons
working in long-term care facilities who do
not have a valid contraindication should
receive annual influenza vaccination. |
|
| 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. |
|
| I would like
to help establish a policy of mandatory
influenza vaccination for HCP in our facility
and would like to learn from others. Can you
help? |
|
| Every year 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 (for example,
volunteers and 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/honorees.asp.
In addition, the National Adult and Influenza Immunization Summit has developed tools to
assist post-acute and long-term care
facilities that plan to implement influenza
vaccination requirements for HCP at
www.izsummitpartners.org/naiis-workgroups/influenza-workgroup/tools-for-ltcf/.
We hope reviewing these policies and tools
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? |
|
| Many hospitals
across the U.S. have implemented successful
influenza vaccination programs for 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 5
years of their program was published in the
September 2010 issue of Infection Control and
Hospital Epidemiology; an abstract of the report is available online at
www.ncbi.nlm.nih.gov/pubmed/20653445. |
|
| 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 does CDC
recommend that we consider obtaining a signed
declination from HCP 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 form for
healthcare workers at
www.immunize.org/catg.d/p4068.pdf. |
|
| Please tell me
which professional associations have endorsed
mandatory influenza vaccination for HCP 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 500 healthcare
settings that have implemented mandatory
vaccination programs on IAC's website at IAC's
Influenza Vaccination Honor Roll web section
at
www.immunize.org/honor-roll/influenza-mandates/. |
|
|
|
|
|
| What are
contraindications and precautions for
inactivated influenza vaccines? |
|
| Contraindications
to inactivated influenza vaccines are a severe
allergic reaction to a prior dose of influenza vaccine or a severe allergy to an influenza
vaccine component (except egg). |
|
| Precautions to
inactivated influenza vaccine include moderate
or severe acute illness, and history of
Guillain-Barré syndrome within 6 weeks after a
dose
of influenza vaccine. |
|
| What are
contraindications and precautions for the
recombinant influenza vaccine (Flublok)? |
|
|
Contraindications to Flublok include history
of severe allergic reaction to any component
of the vaccine. |
|
|
Precautions include moderate or severe acute
illness, and history of Guillain-Barré
syndrome within 6 weeks after a dose of
influenza vaccine. |
|
| What are the
contraindications and precautions for Flumist? |
|
|
Contraindications are: |
|
| • |
|
a history of severe allergic reaction to a
vaccine component (except egg—see next
question) or after a previous dose of any
influenza vaccine |
|
|
|
| • |
|
concomitant
aspirin or salicylate-containing therapy
in children and adolescents because of the
risk of Reye syndrome |
|
|
|
| • |
|
children age
2 through 4 years who have received a
diagnosis of asthma or whose parents or
caregivers report that a healthcare
provider has
told them during the preceding 12 months
that their child had wheezing or asthma or
whose medical record indicates a wheezing
episode during the
preceding 12 months |
|
|
|
| • |
|
immunosuppression due to any cause
including medications or HIV infection |
|
|
|
| • |
|
cerebral spinal fluid (CSF) leak, cochlear
implant, or anatomic asplenia or
functional asplenia (e.g., due to sickle
cell anemia) |
|
|
|
| • |
|
close contacts and caregivers of severely
immunosuppressed persons who require a
protected environment (e.g., reverse
isolation in a hospital) |
|
|
|
| • |
|
pregnancy |
|
|
|
| • |
|
receipt of influenza antiviral medication
within the previous 48 hours for
oseltamivir and zanamivir, previous 5 days
for peramivir, and previous 17
days for baloxavir |
|
|
| Precautions are: |
|
| • |
|
moderate or severe acute illness with or
without fever |
|
|
|
| • |
|
history of
Guillain-Barré syndrome within 6 weeks
after a dose of influenza vaccine |
|
|
|
| • |
|
asthma in a
person age 5 years or older |
|
|
|
| • |
|
underlying medical conditions that might
predispose to complications after
influenza virus infection, such as chronic
pulmonary, cardiovascular
(except isolated hypertension), renal,
hepatic, neurologic, hematologic, or metabolic disorders including diabetes
mellitus |
|
|
| What is the
latest ACIP guidance on influenza vaccination
and egg allergy? |
|
| ACIP recommends
that people with a history of egg allergy who
have experienced only hives after exposure to egg should receive influenza vaccine
without specific precautions (except a
15-minute observation period for syncope). Any
age-appropriate vaccine may be used. For
people who report
having had an anaphylactic reaction to egg
(more severe than hives), if a vaccine other
than Flucelvax Quadrivalent (ccIIV, Seqirus)
or Flublok
Quadrivalent (RIV4, Sanofi Pasteur) is given,
the vaccine should be administered in an
inpatient or outpatient medical setting
supervised by a healthcare
provider who is able to recognize and manage
severe allergic conditions. Although not
specifically recommended by ACIP, providers
may prefer
administering an age-appropriate egg-free
vaccine (ccIIV4 or RIV4) for patients with
severe egg allergy. |
|
| 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. For a complete
list of vaccine components (i.e., excipients
and culture media) used in the production of
the vaccine, check
the package insert (available at
www.immunize.org/fda) or go to
www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf. |
|
| For more details
about giving influenza vaccine to people with
a history of egg allergy, see the ACIP
guidance at
www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6908a1-H.pdf.
You also may find the IAC handout "Influenza Vaccination of People with a History of Egg
Allergy"
helpful (see
www.immunize.org/catg.d/p3094.pdf). |
|
| Is allergy to
chicken or duck feathers a contraindication to
receipt of an egg-based influenza vaccine? |
|
| No. |
|
| The influenza
VIS states that giving pneumococcal conjugate
vaccine and inactivated influenza vaccine simultaneously to young children may increase
the
risk of febrile seizures. Can we continue to
give these two vaccines at the same time? |
|
| Yes, you can.
Some, but not all studies, have reported
increased rates of febrile seizures among
children, especially those age 12 through 23
months, who
received simultaneous vaccination with IIV and
pneumococcal conjugate vaccine (PCV13, Pfizer)
or DTaP vaccine (Daptacel, Infanrix, Pediarix,
Pentacel), 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,
occurring in 2% to 5%, of all children, are
not uncommon, and they are generally benign. Healthcare providers should be prepared to
answer parents' questions about febrile
seizures and fever when discussing
vaccinations. Here is a helpful CDC resource:
www.cdc.gov/vaccinesafety/Concerns/FebrileSeizures.html. |
|
| 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. |
|
| When I was 5
years old, I had Guillain-Barré syndrome (GBS)
unrelated to vaccination. I am now 35 with no
residual effects of the GBS. I am a nurse and
my facility requires employees to receive
influenza vaccine. Is it safe for me to be
vaccinated? |
|
| Yes. A history of
GBS unrelated to influenza vaccine is not a
contraindication or precaution to influenza
vaccination. GBS within 6 weeks following a
previous dose of influenza vaccine is
considered a precaution for use of influenza vaccines. |
|
|
|
|
|
| Is there any
plan to change the Influenza Vaccine
Information Statement (VIS) for the 2020–21
influenza season? |
|
| Not at this time.
Both the inactivated and the live influenza
vaccine VISs (dated August 15, 2019) should be
used for the 2020–21 influenza season. |
|
| Which
formulations of influenza vaccines are
licensed for various age groups? |
|
| Influenza
vaccines differ with regard to age group
indications. IAC has a handout that summarizes
each of the products available for the current
influenza
vaccination season at
www.immunize.org/catg.d/p4072.pdf.
ACIP does not state a preference for one
influenza vaccine over another for persons for
whom
more than one vaccine is recommended and is
age- and health condition-appropriate. |
|
| When does CDC
recommend starting influenza vaccination? |
|
|
CDC recommends that
vaccination should be offered by the end of
October. Vaccination should continue throughout the influenza season, including
into
the spring months (for example, through May),
as long as influenza viruses are circulating
and providers have unexpired vaccine. |
|
| Children age 6
months to 8 years without two prior doses of
influenza vaccine need 2 doses. They should
get their first influenza vaccination as soon
as
vaccine becomes available to ensure they are
fully vaccinated before the influenza season
begins; the minimum interval for the second
dose is 28 days. |
|
| To avoid missed
opportunities for vaccination, providers
should offer vaccination during routine
healthcare visits and hospitalizations.
However, for people
who need only 1 dose, early vaccination (i.e.,
July and August) can result in reduced immune
protection towards the end of the influenza
season,
particularly for older adults. |
|
| We are
considering co-locating our COVID-19
drive-through testing site and influenza
vaccination sites. Can we vaccinate someone
with suspected or
confirmed COVID-19 infection? |
|
| CDC recommends
deferring vaccination for people with
suspected or confirmed COVID-19 until they
have met criteria for no longer needing
quarantine or
isolation to avoid exposing healthcare
personnel and other patients. When scheduling
or confirming appointments for vaccination,
patients should be
screened for COVID-19 symptoms and recent
exposure. |
|
| Does ACIP
prefer that healthcare professionals
administer high-dose or adjuvanted influenza
vaccine to people age 65 years and older, or
is standard-dose influenza vaccine acceptable? |
|
| ACIP has no
preference. |
|
| The
pneumococcal conjugate vaccine (PCV13) package
insert says that in adults, antibody responses
to PCV13 were diminished when given with
inactivated influenza vaccine. Does this mean
we should not give PCV13 and influenza vaccine
at the same visit? |
|
| The available
data have been interpreted that any changes in
antibody response to either of the vaccines' components were clinically insignificant. The
antibody response was only lowered for three
components, and ONLY in patients younger than
65 years of age. In this age group, if PCV13
is
recommended, it means there is a high-risk of
invasive pneumococcal disease for those
unvaccinated. If PCV13 and influenza vaccine
are both indicated
and recommended, they should be administered
at the same visit. See the PCV13 ACIP recommendations at
www.cdc.gov/mmwr/pdf/wk/mm6337.pdf,
page 824. |
|
| We have had
three employees who have tested positive for
influenza by nasal swab within 2 weeks of receiving Fluarix Quadrivalent
(GlaxoSmithKline)
vaccine. Is there a time period after
receiving influenza vaccine that a nasal swab
can give a false positive result? |
|
| Inactivated
influenza vaccines, including Fluarix, are not
known to cause false positive nasal swab
tests. However, false positive test results
are possible
with rapid tests, and these are more likely to
occur when influenza prevalence in the area is
low. For more information regarding
interpretation of rapid
influenza tests see
www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm. |
|
| What is the
preferred anatomic site for administration of
inactivated influenza vaccine (IIV) and
recombinant influenza vaccine? |
|
| IIV should be
administered in the anterolateral thigh muscle
of an infant or young child. IIV and RIV
(approved for persons age 18 years and older)
should
be administered in the deltoid muscle of an
older child, adolescent, or adult. The
anterolateral thigh muscle can also be used
for an older child, adolescent,
or adult if necessary. It is critical that
intramuscular influenza vaccine be injected
into a muscle. Influenza vaccination season is
an opportune time to
review proper intramuscular injection
techniques with your staff. IAC has prepared a
handout on how to administer intramuscular
vaccine injections
(available at
www.immunize.org/catg.d/p2020.pdf)
that can be used as a staff training tool. |
|
| Some of our
patients believe that they have had reactions
to influenza vaccine in the past and request
the dose to be split into 2 doses administered
on
different days. Is this an acceptable
practice? |
|
| This is
definitely not an acceptable practice. Doses
of influenza vaccine (or any other vaccine)
should never be split into "half doses." If a
"half dose" is
administered, it should not be accepted as a
valid dose and should be repeated as soon as
possible with a full age-appropriate dose. |
|
| 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 syncopal (fainting) episode? |
|
| Yes. Syncope has
been reported following vaccination. It is
prudent for all persons to be observed for
syncope for at least 15 minutes after
vaccination. |
|
| Is it
acceptable 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 temperature, |
|
|
|
| • |
|
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 (for
example, 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. |
|
| When removing
both pediatric (0.25 mL) and adult (0.5 mL)
doses from a multi-dose vial of Fluzone
Quadrivalent, we can get more than 10 doses
from the
5.0 mL vial. Can we continue to remove doses
from the vial until it is empty? |
|
| No. Only the
number of doses indicated in the
manufacturer's package insert should be
withdrawn from the vial. For a 5.0 mL vial of
Fluzone Quadrivalent
this is 10 doses. For Afluria Quadrivalent 5.0
mL multi-dose vial, the package insert states
that the stopper can be punctured up to 20
times, allowing up to
20 doses of 0.25 mL dose for children age 6–35
months old. After the maximum number of doses
has been withdrawn or number of punctures of the
stopper has met the FDA-recommended limit, the
vial should be discarded, even if there is
vaccine remaining in the vial and the
expiration date has not
been reached. |
|
| We
inadvertently administered a 0.5 mL dose of
Flucelvax (Seqirus) to a 2-year-old child
before realizing that the vaccine is only
licensed for use in
people age 4 years and older. Do we need to
repeat the dose with an age-appropriate
product? |
|
|
No, the dose does not
need to be repeated. However, this is a
vaccine administration error as this
formulation is not recommended for children
younger
than age 4 years. Clinicians should carefully
select an influenza vaccine that is licensed
for the age group of the person being
vaccinated. Currently
Fluzone Quadrivalent 0.25 mL or 0.5 mL (Sanofi
Pasteur), FluLaval Quadrivalent 0.5 mL (GSK),
Fluarix Quadrivalent 0.5 mL (GSK), and Afluria
Quadrivalent 0.25 mL (Seqirus) are the only
inactivated influenza vaccines approved for
use in children age 6 months through 35
months. Flumist
(AstraZeneca) is approved for persons age 2
through 49 years. |
|
| If the child
needs a second dose of influenza vaccine, an
age-appropriate vaccine should be selected.
IAC's educational piece "Influenza Vaccine
Products for the 2020–21 Influenza Season"
(available at
www.immunize.org/catg.d/p4072.pdf)
provides helpful information on the wide
variety of influenza
vaccines in use this season. |
|
| If the
recombinant influenza vaccine (RIV4, Flublok
Quadrivalent) was given inadvertently to a
person younger than 18 years, can it be
counted? Would
there be any adverse side effects from this
error? |
|
| Flublok
Quadrivalent is not licensed for persons
younger than 18 years of age, so there are no
data regarding safety and efficacy in this age
group.
However, no serious side effects would be
expected. The dose does not need to be
repeated. Even if no adverse reaction occurs,
we request that vaccine
administration errors like this be reported to
the Vaccine Adverse Events Reporting System at
www.vaers.hhs.gov. |
|
| A 1-year-old
was inadvertently given a 0.25 mL dose of
FluLaval (or Fluarix) rather than the
recommended 0.5 mL dose. What should we do? |
|
| If the error is
discovered on the same clinic day you can
administer the other "half" of the FluLaval
Quadrivalent (or Fluarix Quadrivalent) dose.
If the error
is discovered the next day or later, the dose
should not be counted. The child should be
recalled to the office as soon as possible and
given a full age-appropriate repeat dose, either a 0.5 mL dose
of FluLaval Quadrivalent, a 0.5 mL dose of
Fluarix Quadrivalent, a 0.25 or 0.5 mL dose of
Fluzone
Quadrivalent, or a 0.25 mL dose of Afluria
Quadrivalent. |
|
|
|
|
|
| How should
influenza vaccines be stored? |
|
| All influenza
vaccines (inactivated, recombinant, and live
attenuated vaccines) should be stored at
refrigerator temperature of 2° through 8°C
(36° through
46°F). No influenza vaccine should be frozen.
Influenza vaccine exposed to freezing
temperature should not be used. |
|
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ACIP Recommendations
Vaccine Information Statements 
