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Influenza Vaccine Considerations 2014-2015 Season

Influenza Vaccine Considerations 2014-2015 Season. Alicia Vanden Bosch, PharmD Creighton University SPAHP September, 2014. Who Should Get Influenza Vaccine?.

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Influenza Vaccine Considerations 2014-2015 Season

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  1. Influenza Vaccine Considerations2014-2015 Season Alicia Vanden Bosch, PharmD Creighton University SPAHP September, 2014

  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 • Children aged <5 years, especially <2 years old • Adults aged ≥65 years • Pregnant women or will be pregnant during the influenza season • American Indians/Alaska Natives • Chronic Diseases - Adults and children with chronic pulmonary (including asthma), cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus) • Immunosuppressed - Persons with immunosuppression (including caused by medications or by HIV infection) • Aspirin Therapy - Children and adolescents (6 months--18 years) receiving long-term aspirin therapy who might be at risk for experiencing Reye’s syndrome after influenza virus infection • Residents of nursing homes and other long-term care facilities • Morbidly obese (BMI ≥40) Source: http://www.cdc.gov/flu/about/disease/high_risk.htm

  4. 2014-2015 Influenza Vaccine Content • Trivalent Vaccines • A/California/7/2009 (H1N1)-like virus, A/Texas/50/2012 (H3N2)-like 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 • Recommend quadrivalent vaccine for pediatric patients Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm

  5. Influenza Abbreviations • 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) • LAIV (Live Attenuated Influenza Vaccine) • Available as a quadrivalent formulation (LAIV4) *IIV, LAIV & RIV denote vaccine categories *Numeric suffix indicates number of antigens in the vaccine Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm

  6. Quadrivalent Live Attenuated Influenza Vaccine (LAIV4) • FluMist Quadrivalent • Indicated for healthy, nonpregnant persons aged 2 through 49 yrs • Recommeded for healthy 2-8 yr olds instead of the shot (when immediately available) Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm

  7. Quadrivalent Inactivated Influenza Vaccine (IIV4) Injection • Fluzone Quadrivalent • Indicated for persons 6 months and older • Fluarix Quadrivalent • Indicated for persons 3 years and older • FluLaval Quadrivalent • Indicated for persons 3 years and older Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm

  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/mmwr/preview/mmwrhtml/mm6332a3.htm

  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/mmwr/preview/mmwrhtml/mm6332a3.htm

  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/mmwr/preview/mmwrhtml/mm6332a3.htm

  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 significantly higher antibody response post Fluzone HD vs. Fluzone • Study indicated Fluzone HD was 24.2% more effective vs. Fluzone to prevent influenza • Neither CDC nor ACIP express a preference for Fluzone HD over another vaccine at this time Source: http://www.cdc.gov/flu/about/disease/65over.htm

  12. Vaccinating Pregnant Women • Pregnant women or women who 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/protect/vaccine/pregnant.htm

  13. Preservative Free/Latex Free Vaccines Table of Approved Influenza Vaccines for the U.S. 2014-15 Season. Centers for Disease Control and Prevention Website. http://www.cdc.gov/flu/protect/vaccine/vaccines.htm. And product package inserts.

  14. Influenza Vaccines – U.S. 2014 -15

  15. Influenza Vaccines – U.S. 2014 -15 Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm

  16. 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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