Presentation on theme: "Influenza Vaccine Considerations Season"— Presentation transcript:
1 Influenza Vaccine Considerations 2013-2014 Season Karen K. O’Brien, PharmDCreighton University SPAHPSeptember, 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 monthsAll persons aged ≥50 yearsAdults 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 seasonChildren 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 infectionResidents of nursing homes and other long-term care facilitiesAmerican Indians/Alaska NativesPersons who are morbidly obese (BMI ≥40)Source:
4 2013-2014 Influenza Vaccine Content Trivalent VaccinesA/California/7/2009 (H1N1)-like virus, A/Victoria/361/2011 (H3N2) virus, and a B/Massachusetts/2/2012-like virusQuadrivalent vaccinesInclude an additional vaccine virus, a B/Brisbane/60/2008-like virusType B influenza strains more problematic in pediatric populationCause approximately same number of deaths as Type AEncourage quadrivalent vaccine for pediatric patientsSource:
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 vaccineIIV4: egg-based quadrivalent inactivated influenza vaccineccIIV3: When necessary to specifically denote a cell culture-based vaccine, the prefix “cc” is usedRIV (Recombinant Hemagglutinin Influenza Vaccine)Available as trivalent formulation (RIV3) inLAIV (Live Attenuated Influenza Vaccine)Available as a quadrivalent formulation (LAIV4) in*IIV, LAIV & RIV denote vaccine categories*Numeric suffix indicates number of antigens in the vaccineSource:
6 Quadrivalent Live Attenuated Influenza Vaccine (LAIV4) FluMist QuadrivalentIndicated for healthy, nonpregnant persons aged 2 through 49 yearsSource:
7 Quadrivalent Inactivated Influenza Vaccine (IIV4) Injection Fluzone QuadrivalentIndicated for persons aged 6 months and olderFluarix QuadrivalentIndicated for persons aged 3 years and olderFluLaval QuadrivalentSource:
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 RIVRIV is egg-free and may be used for persons aged years who have no other contraindications.IIV (egg- or cell-culture based) may also be used, with the following additional safety measuresHealthcare provider familiar with the potential manifestations of egg allergy should administer vaccineObserve patients for at least 30 minutes for signs of a reaction after every vaccine doseSource:
9 Trivalent Cell Culture-Based Inactivated Influenza Vaccine (ccIIV3) FlucelvaxIndicated for persons aged 18 years and olderInfluenza viruses grown in mammalian cultured cells, rather than hens’ eggsVaccine seed strain is passaged in eggs & could contain tiny amounts of albuminSource:
10 Trivalent Recombinant Hemagglutinin Influenza Vaccine (RIV3) FluBlokIndicated for persons aged 18 through 49 yearsProduced with insect virus and recombinant DNA technologyHemagglutinin is sole virus component; created by infecting insect cell cultures with a baculovirusSource:
11 Adults ≥ 65 Years of Age Fluzone HD (High Dose) Rationale Trivalent inactivated influenza vaccine (IIV3) for IM injectionContains 4x amount of antigen in standard doseRationaleAge-related weakened immune response puts older individuals at risk for severe illnessAgeing decreases immune response to vaccinePatient OutcomesClinical trial data shows higher antibody levels post Fluzone HD vs. FluzoneStudy to compare ability of Fluzone HD vs. Fluzone to prevent influenza due to be completed inNeither CDC nor ACIP express a preference for Fluzone HD over another vaccine at this timeSource:
12 Vaccinating Pregnant Women Women who are or will be pregnant during influenza season should receive IIVLive attenuated influenza vaccine (LAIV) is not recommended for use during pregnancyPostpartum women can receive either LAIV or IIVPregnant and postpartum women do not need to avoid contact with persons recently vaccinated with LAIVSource:
13 Preservative Free/Latex Free Vaccines RouteAfluria (IIV3) 0.5 mL single-dose prefilled syringeYesIMFluarix (IIV3) 0.5 mL single-dose prefilled syringeNoFlucelvax (IIV3) 0.5 mL single-dose prefilled syringeFluzone (IIV3) 0.25 & 0.5 mL single-dose prefilled syringeFluzone ID (IIV3) 0.1 mL prefilled microinjection systemIDFluzone HD (IIV3) 0.5 mL single-dose prefilled syringeFluarix Quadrivalent (IIV4) 0.5 mL single-dose prefilled syringeFluzone Quadrivalent (IIV4) 0.25 & 0.5 mL single-dose prefilled syringeFluMist Quadrivalent (LAIV4) 0.2 mL prefilled intranasal sprayerINTable of Approved Influenza Vaccines for the U.S Season. Centers for Disease Control and Prevention Website. 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 suspensionIIV3, ccIIV3, IIV4 or LAIVMulti-dose vialsSingle dose prefilled syringesIM, IDCheck manufacturer package insert for specific instructions (shake vigorously, well or gently) prior to use (each use in the case of multi-dose vials)IN LAIVSuspension, but manufacturer does not indicate to shake prior to use
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