| 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. In a study of influenza seasons from
1976–1977 through 2006–2007, the estimated
number of annual influenza-associated deaths
from respiratory and circulatory causes ranged
from a low of 3,349 (1985–1986 season) to a
high of 48,614 (2003–2004 season), with an
average of 23,607 influenza-associated deaths.
In addition to fatalities, seasonal influenza
is also responsible for more than 200,000
hospitalizations per year. Rates of infection
from seasonal influenza are highest among
children, but the risks for complications,
hospitalizations, and deaths are higher among
adults ages 65 years and older, children
younger than 5 years, and people of any age
who have medical conditions that place them at
increased risk for complications from
influenza. |
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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 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 2018–19 seasons, the annual
influenza-related disease burden has varied
from 9–49 million illnesses, 4–23 million
medical visits, 140,000–960,000 hospitalizations and 12,447–79,400
deaths per year. The number of influenza
laboratory confirmed deaths in children
reported to CDC has averaged 122 deaths
(range 37–187) 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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| 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 2019–20 influenza vaccine
recommendations? |
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The 2019–20 ACIP
influenza vaccine recommendations were
published on August 23, 2019, and are
available at
www.cdc.gov/mmwr/volumes/68/rr/pdfs/rr6803-H.pdf.
The updated guidance:
- describes the vaccine composition for
this season (a change in the H3N2 and H1N1
vaccine components);
- discusses
recent FDA labeling changes, including
expansion of the age indication for Afluria
Quadrivalent (Seqirus) to age 6 months and
older (previously
licensed for people age 5 years and older)
and expanding options for Fluzone
Quadrivalent (Sanofi Pasteur) dosing for
children age 6–35 months to allow either
0.25 mL
or 0.5 mL doses.
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| Which
influenza vaccines will be available during
the 2019–2020 influenza season? |
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| Multiple manufacturers are producing influenza
vaccine for the U.S. market for the 2019–2020
season. Inactivated vaccines will be produced
using egg-based, cell
culture-based, and recombinant technologies.
Most inactivated influenza vaccines will be
quadrivalent (containing four strains of
influenza virus). The only trivalent
vaccines are the high-dose inactivated vaccine
(Fluzone-HD, Sanofi) and the MF-59 adjuvanted
vaccine (Fluad, Seqirus), both of which are
indicated for adults age 65
years and older. The recombinant vaccine (Flublok,
Sanofi Pasteur) and live attenuated vaccine (Flumist
Quadrivalent, AstraZeneca) are both
quadrivalent. |
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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 and age and health
condition
appropriate. A complete listing of influenza
vaccine products is available at
www.immunize.org/catg.d/p4072.pdf. |
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| What are the
differences between trivalent and quadrivalent
influenza vaccines? |
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| Influenza
vaccines produced for the current season will
be either trivalent (three components) or
quadrivalent (four components). Both types of
vaccine contain two A
viruses and one B virus. The components of
2019–2020 trivalent vaccines are: |
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A/Brisbane/02/2018 (H1N1)pdm09-like
virus (new for the 2019–20 season) |
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A/Kansas/14/2017 (H3N2)-like virus (new
for the 2019–20 season) |
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B/Colorado/06/2017-like virus (Victoria
lineage). |
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| Quadrivalent
vaccines will contain these three viruses,
plus a B/Phuket/3073/2013–like virus (Yamagata
lineage). |
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| If
quadrivalent vaccine includes one additional
strain, why isn't it 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. 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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| 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 vaccine. |
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| When should
influenza vaccine be given? |
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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. Healthcare providers
should offer vaccination by the end of
October, if possible, and vaccination should
continue to be offered as long as influenza
viruses are circulating and unexpired vaccine
is available. 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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| No one can
predict when influenza disease will peak in a
given 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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| 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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| Balancing issues
regarding the difficulty in predicting when
influenza outbreaks will occur with concerns
about waning immunity during the flu season,
especially in older
adults, CDC recommends that vaccination should
be offered by the end of October. Vaccination
efforts should continue as long as influenza
viruses are circulating. |
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| Children age 6
months to 8 years without two prior doses of
flu 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 that
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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| 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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| 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 persons who require 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:
- 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.
- 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.
- 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.
- Influenza
vaccine is not 100% effective, especially in
older persons.
For more
information on this topic, go to:
www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm. |
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| When
administering influenza vaccine, is giving
patients a 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,
along with many translations. The influenza
VISs dated August 15, 2019 should be used
during the 2019–20 season. |
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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 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 (for example, visiting
nurses, 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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| Do statin
medications (taken to lower blood lipid
levels) affect the efficacy of influenza
vaccine? |
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| Two recent
studies raise the possibility that statin
medications may blunt the effectiveness of
influenza vaccines in seniors. Experts caution
that more research is needed to better
understand the issue. Because of their
benefit, seniors should not stop taking their
statin without consultation with their
healthcare provider. Influenza vaccine remains
the best protection we have against influenza,
and provides at least some protection in
people who take statins, so patients should
still receive an influenza vaccine to be
protected. There is no change to the ACIP
recommendation for influenza vaccine. |
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| Live
Attenuated Influenza Vaccine (LAIV)
Issues |
Back to top |
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| For whom is
LAIV approved? |
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| LAIV is currently
approved by the Food and Drug Administration
for use only for healthy non-pregnant persons
ages 2 through 49 years. |
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| How is LAIV
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 LAIV 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 LAIV? |
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| Breastfeeding is
not a contraindication for any routine
vaccination including LAIV. |
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| Can LAIV be
given to contacts of immunosuppressed
patients? |
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| 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
(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 LAIV 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 LAIV must they stay
away from a severely immunosuppressed person
(a person who is 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 LAIV. There are no restrictions on
being in contact with any other patients. |
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| Is LAIV
contraindicated for adults with asthma? |
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| Asthma is a
precaution for LAIV in people 5 years of age
and older. |
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| Can we give
LAIV 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 LAIV. If a person is taking
an influenza antiviral drug, you should not
administer LAIV until 48 hours after the
person took the last dose of the drug. If a
person takes antiviral drugs within 14 days of
getting the nasal-spray influenza vaccine, the
person should be revaccinated. However, you
can give inactivated influenza vaccine (IIV)
to a person who is taking an influenza
antiviral drug. |
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| One of our
young patients made it impossible to
administer the second part of the LAIV dose.
What should we do? |
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| A half dose of
LAIV (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 LAIV
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 as young as 6
months: |
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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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| Inactivated cell
culture-based influenza vaccine Flucelvax
Quadrivalent (Seqirus) is approved for people
age 4 years and older. |
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| The nasal spray
live attenuated influenza vaccine (LAIV,
FluMist, 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 2019–2020 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. |
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| Please provide
details about the use of inactivated influenza
vaccine in children younger than 3 years. |
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| 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. |
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| The dosing for
FluLaval Quadrivalent (GSK) and Fluarix
Quadrivalent (GSK) vaccines is 0.5 mL for
children age 6 months and older. |
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| For Fluzone
Quadrivalent (Sanofi), 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. |
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| Flucelvax
Quadrivalent (Seqirus) is recommended
beginning at age 4 years at 0.5 mL dose, but
cannot be used for children younger than age 4
years. |
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| Which children
younger than age 9 years will need 2 doses of
influenza vaccine in this influenza season? |
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| 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 trivalent or
quadrivalent influenza vaccine before July 1
of the current year or 3) if their vaccination
history is unknown. The two 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. |
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| 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
LAIV administered in past years? |
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| CDC advises that
doses of LAIV administered in past seasons can
be counted. |
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| Can a child
who needs 2 doses of influenza receive 1 dose
of quadrivalent vaccine and 1 dose of
trivalent vaccine? |
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| Yes. You can give
these two vaccines, as long as the 2 doses are
appropriately spaced. |
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| 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? |
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| Yes. Afluria
(0.25 mL per dose), Fluzone (0.25 mL or 0.5 mL
per dose), FluLaval (0.5 mL per dose), and
Fluarix (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 may
also be used when age and health condition are
appropriate. |
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| 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? |
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| Yes. Fluzone (0.5
mL dose), FluLaval (0.5 mL dose), Fluarix (0.5
mL dose) and Afluria (0.5 mL dose) are
approved by the FDA for use in children age 3
years and older. |
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| 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? |
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| The child should
always receive the dose appropriate for his or
her age at the time of the clinic visit; at
age 37 months that would be 0.5 mL. |
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| Can a clinic
vaccinate children younger than age 3 years
with influenza vaccine taken from a multi-dose
vial of Fluzone, FluLaval or Afluria? The
multi-dose vials contain thimerosal as a
preservative. |
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| Yes. Multi-dose
vials of Fluzone, FluLaval and Afluria 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 cause 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 phone
numbers). |
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| Do any
children age 9 years and older need two total
doses during an influenza season? |
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| 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 trivalent or quadrivalent influenza
vaccine before July 1 of the current
year, or if their vaccination history is
unknown before July 1 of the current year. |
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| 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? |
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| 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. |
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| Is influenza
vaccine recommended for pregnant women? |
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| Yes. It is
especially important to vaccinate pregnant
women because of their increased risk for
influenza-related complications and their
baby's increased risk of
influenza-related illness and hospitalizations
during the first 6 months of life. |
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| 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. |
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| Most studies of
influenza vaccination in pregnant women have
administered vaccine in the second or third
trimester using inactivated influenza vaccine. |
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| Vaccination can
occur in any trimester, including the first.
Only inactivated vaccine or recombinant
influenza can be given to pregnant women. LAIV
should not be used
in pregnant women. |
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| Why do we
vaccinate pregnant women against influenza
when it is not recommended to vaccinate
infants younger than age 6 months? |
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| 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. |
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| Influenza vaccine
is not recommended for children younger than
age 6 months because it is not approved for
this age group. In addition, there are data
that indicate that vaccinated pregnant women
pass maternal antibodies to the fetus in the
last few weeks of pregnancy; this helps
protect the young infant against influenza.
Vaccinating pregnant women protects women,
their unborn babies, and their babies after
birth. |
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| Does ACIP
recommend one influenza product over another
for pregnant women? |
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| Pregnant women
can receive any inactivated or recombinant
influenza vaccine. They should not be given
LAIV (FluMist). |
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| Can
thimerosal-containing vaccine be given to
pregnant women? |
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| 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
recent 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 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. |
|
| 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 (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. In contrast to Fluzone High-Dose
(Sanofi Pasteur), Fluad is a standard-dose
vaccine, containing 15 mcg of hemagglutinin
per virus per dose (total of 45 mcg). In a
small observational study among adults age 65
years and older Fluad was about 63% more
effective than unadjuvanted trivalent IIV.
ACIP has not stated a preference for Fluad (or
Fluzone HD or Flublok, Sanofi Pasteur) over
standard dose IIV for people age 65 years and
older. |
|
| A study
published in 2014 found that the injectable
vaccine Fluzone High-Dose protects 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.
However, despite published evidence of better
protection from Fluzone High-Dose when
compared to standard-dose Fluzone (N Engl J
Med 2014; 371:635–45), ACIP has not stated
a preference for this vaccine for people age
65 years and older. |
|
| May Fluzone
High-Dose or Fluad be administered to patients
younger than age 65 years? |
|
| No. Fluzone
High-Dose and Fluad 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)
or adjuvanted vaccine (Fluad) 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 LAIV) 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 should be
administered beginning at least 6 months after
bone marrow transplant and annually thereafter
for the life of the patient. A dose of
inactivated influenza 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 an 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 78% of HCP report
influenza vaccination during the 2017–18
season. |
|
| Influenza
vaccination of HCP are summarized in the
following points: |
|
| • |
|
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," which 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 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 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,
including volunteers, housekeeping staff). To
read about the policies of the various
facilities included in the Honor Roll, go to
www.immunize.org/honor-roll/influenza-mandates/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 also 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 forms for
healthcare workers: |
|
|
|
| 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/. |
|
|
|
|
|
| For whom is
inactivated 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 (except egg) should not be
vaccinated. |
|
| Precautions to
vaccination include moderate or severe acute
illness, and history of Guillain-Barré
syndrome within 6 weeks of a dose of influenza
vaccine. |
|
| What are
contraindications and precautions for
recombinant influenza vaccine (RIV)? |
|
|
Contraindications to RIV: |
|
| • |
|
History of severe allergic reaction to any
component of the vaccine. |
|
|
| Precautions for
RIV: |
|
| • |
|
Moderate or severe acute illness with or
without fever |
|
|
|
| • |
|
History of
Guillain-Barré syndrome within 6 weeks
after receipt of influenza vaccine |
|
|
|
| What are the
contraindications for live attenuated
influenza vaccine (LAIV)? |
|
|
Contraindications to LAIV are: |
|
| • |
|
a history of a 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 health care
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 |
|
|
|
| • |
|
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 |
|
|
| Precautions to
LAIV are: |
|
| • |
|
moderate or severe acute illness with or
without fever |
|
|
|
| • |
|
history of
Guillain-Barré syndrome within 6 weeks of
receipt 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 |
|
|
| Beginning in
2019 LAIV is not recommended for persons with
anatomic or functional asplenia, persistent
complement component deficiency, a cochlear
implant or cerebrospinal fluid (CSF) leak.
Persons with these conditions should receive
IIV or RIV. |
|
|
| 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 (IIV, RIV or LAIV) may
be used. People who report having had an
anaphylactic reaction to egg (more severe than
hives) may also receive any age-appropriate
influenza vaccine (IIV, RIV or LAIV). The
vaccine for those individuals should be
administered in a medical setting (such as a
physician office or health department clinic).
Vaccine administration should be supervised by
a healthcare provider who is able to recognize
and manage severe allergic conditions.
Although not specifically recommended by ACIP,
providers may prefer an egg-free inactivated
vaccine (Flucelvax Quadrivalent, Seqirus,
licensed for people age 4 years and older) or
recombinant vaccine (Flublok, Sanofi Pasteur,
licensed for people age 18 years and older)
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/68/rr/pdfs/rr6803-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), 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 2019–2020
influenza season? |
|
| Yes. Both the
inactivated and the live influenza vaccine
VISs (dated August 15, 2019) were updated for
the 2019–2020 influenza season. |
|
| Which
formulations of influenza vaccines (e.g., live
attenuated influenza vaccine (LAIV),
inactivated injectable high-dose, inactivated
injectable standard-dose, adjuvanted
inactivated injectable, and recombinant
injectable) are licensed for various age
groups? |
|
| There are
multiple manufacturers of influenza vaccine
and each may have differences in their product
line (for example, licensed age group). ACIP
does not state a preference for one influenza
vaccine over another for persons for whom more
than one vaccine is recommended and age- and
health condition-appropriate. IAC has
developed a handout that summarizes each of
the products available for the current
influenza vaccination season that is available
online at
www.immunize.org/catg.d/p4072.pdf. |
|
| Does the 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. CDC stresses that vaccination is
the first and most important step in
protecting against influenza. |
|
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 (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, |
|
|
|
| • |
|
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, 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 this is 10 doses. After the maximum
number of doses has been withdrawn, 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 (Sanofi Pasteur), FluLaval
Quadrivalent 0.5 mL (GSK), Fluarix
Quadrivalent 0.5 mL (GSK), Afluria (trivalent)
0.25 mL and Afluria Quadrivalent 0.25 mL are
the only inactivated influenza vaccines
approved for use in children age 6 months
through 35 months. LAIV 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 2018–2019 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 (RIV, FluBlok)
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 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
(or Fluarix) 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 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 (IIV, RIV and LAIV) should be stored
at refrigerator temperature of 2° to 8°C (36°
to 46°F). No influenza vaccine should be
frozen. Influenza
vaccine exposed to freezing temperature should
not be used. |
| |
ACIP Recommendations
Vaccine Information Statements 
