 |
| photo/ad credit: CDC |
Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications. The best way to prevent the flu is by getting vaccinated each year.
Each year, influenza results in an average of 114,000 hospitalization and 25,000 deaths in the United States. For this reason, the Centers for Disease Control and Prevention (CDC) recommends that all persons over the age of 6 months (unless there is a medical contra-indication) should receive immunization, preferably by October. Early immunization is important because seasonal flu activity can begin as early as October and continue to occur as late as May.
Multiple influenza vaccines are now available. These include standard intramuscular vaccine, intradermal vaccine, and live attenuated vaccine. The live attenuated vaccine should be provided only to healthy non-pregnant persons (i.e., do NOT provide to pregnant women, immunocompromised persons, persons with asthma). It can be provided to healthcare personnel (HCP) but should HCP who receive this vaccine should not work in a protected environment that houses stem cell transplant patients (i.e., BMTU unit) for 5 days after immunization. They may work with all other groups of patients including neonates and immunocompromised patients. All HCP should receive influenza vaccine annually unless there is a medical contra-indication. Occupational health services may wish to stock in addition to a standard intramuscular (IM) vaccine both the intradermal (ID) and inhaled (LAIV) vaccines as some healthcare providers may prefer these vaccines. High dose vaccine is also available for persons >65 years of age; it is more immunogenic (i.e., higher antibody titers) and reactogenic (i.e., increased frequency of local reactions to the vaccine) but studies have not been published assessing whether it is more effective in preventing influenza that standard dose influenza vaccines.
Several
new vaccines are available for use this year.
Quadivalent vaccines improve coverage of circulating strains by 10-15%. RIV3 (see below) is egg-free and may be used
for persons 18-49 with egg allergies.
The use of the new vaccines has been summarized by the CDC (http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm).
- 2013-14 U.S. trivalent influenza vaccines will contain an A/California/7/2009 (H1N1)-like virus, an H3N2 virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011, and a B/Massachusetts/2/2012-like virus. Quadrivalent vaccines will include an additional vaccine virus, a B/Brisbane/60/2008-like virus.
- Several new, recently-licensed vaccines will be available for the 2013-14 season, and are acceptable alternatives to other licensed vaccines indicated for their respective age groups when otherwise appropriate:
- A quadrivalent live attenuated influenza vaccine (LAIV4; Flumist® Quadrivalent [MedImmune]) is expected to replace the trivalent (LAIV3) formulation. FluMist® Quadrivalent is indicated for healthy, nonpregnant persons aged 2 through 49 years;
- A quadrivalent inactivated influenza vaccine (IIV4; Fluarix® Quadrivalent [GlaxoSmithKline]) will be available, in addition to the previous trivalent formulation. Fluarix® Quadrivalent is indicated for persons aged 3 years and older;
- A quadrivalent inactivated influenza vaccine (IIV4; Fluzone® Quadrivalent [Sanofi Pasteur]) will be available in addition to the previous trivalent formulation. Fluzone® Quadrivalent is indicated for persons aged 6 months and older;
- A trivalent cell culture-based inactivated influenza vaccine (ccIIV3; Flucelvax® [Novartis]), which is indicated for persons aged 18 years and older; and
- A recombinant hemagglutinin (HA) vaccine (RIV3; FluBlok® [Protein Sciences]), which is indicated for persons aged 18 through 49 years.
- Within approved indications and recommendations, no preferential recommendation is made for any type or brand of licensed influenza vaccine over another.
