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Influenza Vaccine Considerations 2013-2014 Season

Influenza Vaccine Considerations 2013-2014 Season. Karen K. O’Brien, PharmD Creighton University SPAHP September, 2013. Who Should Get Influenza Vaccine?.

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Influenza Vaccine Considerations 2013-2014 Season

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  1. Influenza Vaccine Considerations2013-2014 Season Karen K. O’Brien, PharmD Creighton University SPAHP September, 2013

  2. Who Should Get Influenza Vaccine? • Beginning with the 2010–11 vaccination season, ACIP recommends annual vaccination for all people ages 6 months and older who do not have a contraindication to the vaccine. • Patient-specific factors influence vaccine selection

  3. Persons at Risk for Medical Complications of Influenza • All children aged 6 through 59 months • All persons aged ≥50 years • Adults and children with chronic pulmonary (including asthma), cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus) • Persons who have immunosuppression (including immunosuppression caused by medications or by HIV infection) • Women who are or will be pregnant during the influenza season • Children and adolescents (aged 6 months--18 years) receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s syndrome after influenza virus infection • Residents of nursing homes and other long-term care facilities • American Indians/Alaska Natives • Persons who are morbidly obese (BMI ≥40) Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  4. 2013-2014 Influenza Vaccine Content • Trivalent Vaccines • A/California/7/2009 (H1N1)-like virus, A/Victoria/361/2011 (H3N2) virus, and a B/Massachusetts/2/2012-like virus • Quadrivalent vaccines • Include an additional vaccine virus, a B/Brisbane/60/2008-like virus • Type B influenza strains more problematic in pediatric population • Cause approximately same number of deaths as Type A • Encourage quadrivalent vaccine for pediatric patients Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  5. Influenza Abbreviations 2013-2014 • IIV (Inactivated Influenza Vaccine) • Replaces TIV (Trivalent Inactivated Influenza Vaccine) • IIV3: egg-based and cell culture-based trivalent inactivated influenza vaccine • IIV4: egg-based quadrivalent inactivated influenza vaccine • ccIIV3: When necessary to specifically denote a cell culture-based vaccine, the prefix “cc” is used • RIV (Recombinant Hemagglutinin Influenza Vaccine) • Available as trivalent formulation (RIV3) in 2013-2014 • LAIV(Live Attenuated Influenza Vaccine) • Available as a quadrivalent formulation (LAIV4) in 2013-2014 *IIV, LAIV & RIV denote vaccine categories *Numeric suffix indicates number of antigens in the vaccine Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  6. Quadrivalent Live Attenuated Influenza Vaccine (LAIV4) • FluMist Quadrivalent • Indicated for healthy, nonpregnant persons aged 2 through 49 years Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  7. Quadrivalent Inactivated Influenza Vaccine (IIV4) Injection • Fluzone Quadrivalent • Indicated for persons aged 6 months and older • Fluarix Quadrivalent • Indicated for persons aged 3 years and older • FluLaval Quadrivalent • Indicated for persons aged 3 years and older Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  8. ACIP: Vaccinating Persons with a History of Egg Allergy • Persons with a history of egg allergy who have experienced only hives after exposure to egg should receive influenza vaccine. • Avoid LAIV (little data available) • Use IIV or RIV • RIV is egg-free and may be used for persons aged 18-49 years who have no other contraindications. • IIV (egg- or cell-culture based) may also be used, with the following additional safety measures • Healthcare provider familiar with the potential manifestations of egg allergyshould administer vaccine • Observe patients for at least 30 minutes for signs of a reaction after everyvaccine dose Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  9. Trivalent Cell Culture-Based Inactivated Influenza Vaccine (ccIIV3) • Flucelvax • Indicated for persons aged 18 years and older • Influenza viruses grown in mammalian cultured cells, rather than hens’ eggs • Vaccine seed strain is passaged in eggs & could contain tiny amounts of albumin Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  10. Trivalent Recombinant Hemagglutinin Influenza Vaccine (RIV3) • FluBlok • Indicated for persons aged 18 through 49 years • Produced with insect virus and recombinant DNA technology • Hemagglutinin is sole virus component; created by infecting insect cell cultures with a baculovirus Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  11. Adults ≥ 65 Years of Age • Fluzone HD (High Dose) • Trivalent inactivated influenza vaccine (IIV3) for IM injection • Contains 4x amount of antigen in standard dose • Rationale • Age-related weakened immune response puts older individuals at risk for severe illness • Ageing decreases immune response to vaccine • Patient Outcomes • Clinical trial data shows higher antibody levels post Fluzone HD vs. Fluzone • Study to compare ability of Fluzone HD vs. Fluzone to prevent influenza due to be completed in 2014-2015 • Neither CDC nor ACIP express a preference for Fluzone HD over another vaccine at this time Source: http://www.cdc.gov/flu/protect/vaccine/qa_fluzone.htm

  12. Vaccinating Pregnant Women • Women who are or will be pregnant during influenza season should receive IIV • Live attenuated influenza vaccine (LAIV) is not recommended for use during pregnancy • Postpartum women can receive either LAIV or IIV • Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIV Source: http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#table1

  13. Preservative Free/Latex Free Vaccines Table of Approved Influenza Vaccines for the U.S. 201314 Season. Centers for Disease Control and Prevention Website. http://www.cdc.gov/flu/protect/vaccine/vaccines.htm. And product package inserts.

  14. Influenza Suspension vs. Solution • FluBlok (RIV) available as solution (0.5 mL single dose vial) • Shake vial gently prior to use (per manufacturer) • All other influenza vaccine is suspension • IIV3, ccIIV3, IIV4 or LAIV • Multi-dose vials • Single dose prefilled syringes • IM, ID • Check manufacturer package insert for specific instructions (shake vigorously, well or gently) prior to use (each use in the case of multi-dose vials) • IN LAIV • Suspension, but manufacturer does not indicate to shake prior to use

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