1. Influenza Vaccine Considerations 2013-2014 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:

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:

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
LAIV (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 vaccine
Source:

6. Quadrivalent Live Attenuated Influenza Vaccine (LAIV4)
FluMist Quadrivalent
Indicated for healthy, nonpregnant persons aged 2 through 49 years
Source:

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
Source:

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 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 allergy should administer vaccine
Observe patients for at least 30 minutes for signs of a reaction after every vaccine dose
Source:

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:

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:

11. Adults ≥ 65 Years of Age Fluzone HD (High Dose) Rationale
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
Neither CDC nor ACIP express a preference for Fluzone HD over another vaccine at this time
Source:

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:

13. Preservative Free/Latex Free Vaccines
Route
Afluria (IIV3) 0.5 mL single-dose prefilled syringe
Yes IM
Fluarix (IIV3) 0.5 mL single-dose prefilled syringe No
Flucelvax (IIV3) 0.5 mL single-dose prefilled syringe
Fluzone (IIV3) 0.25 & 0.5 mL single-dose prefilled syringe
Fluzone ID (IIV3) 0.1 mL prefilled microinjection system ID
Fluzone HD (IIV3) 0.5 mL single-dose prefilled syringe
Fluarix Quadrivalent (IIV4) 0.5 mL single-dose prefilled syringe
Fluzone Quadrivalent (IIV4) 0.25 & 0.5 mL single-dose prefilled syringe
FluMist Quadrivalent (LAIV4) 0.2 mL prefilled intranasal sprayer IN
Table 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 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