2014–2015 Influenza Vaccine Guide

 
Who Should Be Vaccinated?
Annual vaccination against influenza is recommended for all people age 6 months and older who do not have a contraindication to the vaccine.
 
Important Points for Healthcare Providers

• Vaccination should begin as soon as vaccine becomes available in late summer and should continue through the spring months.
• Vaccines for the 2014–15 season include inactivated influenza vaccine (IIV), live attenuated influenza vaccine (LAIV), and recombinant influenza vaccine (RIV). Vaccine is either trivalent, made with two A viruses and one B virus (IIV3, RIV3) or quadrivalent, containing an additional B virus (IIV4, LAIV4).
• Help your patients learn more about the vaccine by providing Vaccine Information Statements (VISs). These federally required VISs are available in English and many other languages at www.immunize.org/vis.
• It is important that you and everyone in your healthcare setting be vaccinated to protect your patients and to set the right example.

Talking Points with Patients

• Influenza is a serious respiratory disease caused by a virus. It is not the same as the common cold or an intestinal illness.
• People with influenza may be contagious for 24 hours before any symptoms develop. Though everyday preventive actions (e.g., handwashing) can help prevent transmission of influenza and many other types of germs, the best way to avoid influenza infection is to get vaccinated.
• Influenza vaccine may be more effective in some people than in others. However, vaccination is still our best method of protection.
• It is important that every person age 6 months and older be vaccinated for their own protection, as well as the protection of those they love and those who are especially vulnerable to the serious and sometimes deadly complications of influenza.
• Because influenza vaccine is recommended for almost everyone, it is covered by most health insurance plans; it is covered under Medicare Part B for those enrolled in Medicare.
• Many places offer influenza vaccination. In addition to physician practices, many health departments, pharmacies, retail stores, community sites, workplaces, and schools offer vaccination. For locations in your area, visit http://flushot.healthmap.org.

Vaccine Dosing and Administration

• Intramuscular (IM): Give 0.25 mL if age 6–35 months; give 0.5 mL if age 3 years or older. Give IM with a 22–25g, 1–1½” needle. Choose vaccine according to patient’s age (i.e., Fluzone IIV: 6 months & older/ Fluarix IIV: 3 years & older/ Fluvirin IIV: 4 years & older / Afluria IIV: 9 years & older1/ FluLaval IIV: 3 years & older/ Flucelvax IIV: 18 years & older/ Flublok RIV: 18 through 49 years/ Fluzone IIV [high dose]: 65 years & older)
• Intranasal (IN): Give 0.2 mL FluMist (0.1 mL sprayed into each nostril) to healthy non-pregnant people age 2 through 49 years; this vaccine can provide better protection and is preferred in healthy children ages 2 through 8 years. If not readily available, IIV should be administered.
• Intradermal (ID): For adults age 18 through 64 years: Give 0.1 mL FluZone (intradermal) via prefilled microinjection system.
• IGive 2 doses of influenza vaccine separated by at least 4 weeks to all children age 6 months through 8 years who are receiving influenza vaccine for the first time or who either did not get or are unsure if they got 1) at least 2 doses of influenza vaccine since July 1, 2010 or 2) at least 1 dose of influenza vaccine in the 2013—14 season. For an alternative approach, see footnote 2.

Contraindications and Precautions

• Minor illnesses with or without fever do NOT contraindicate influenza vaccine.
• Do not give influenza vaccine to a person who has had a serious systemic or anaphylactic reaction to a prior dose of the vaccine or any of its components.
• Flublok is recommended for people age 18 through 49 years with egg allergy of any severity; for more information on egg allergy, see footnote 2.
• Do not give nasal-spray LAIV to people who have a severe allergy to eggs; are younger than age 2 years or older than age 49 years; age 2 through 4 years with possible reactive airways disease (e.g., history of recurrent wheezing or a recent wheezing episode3); age 50 years or older; pregnant; immunosuppressed; or are a child or teen receiving long-term aspirin therapy; or who have taken antiviral medications within the previous 48 hours. Due to theoretical concerns over transmission of a live virus, IIV may be preferred for people who have close contact with severely immunosuppressed people during periods when the immunocompromised person requires protective isolation.
• Guillain-Barré syndrome within 6 weeks following a previous dose of influenza vaccine is a precaution for ANY influenza vaccine.
• Providers should consider asthma in persons age 5 years or older, and chronic pulmonary, cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders as precautions to LAIV.

Side Effects

• IIV and RIV’s most common side effects are soreness, redness, and (for IIV-ID only) itching at the injection site, lasting 1–2 days.
• LAIV’s most common side effects are runny nose and nasal congestion.

Footnotes:

1. If no other age-appropriate IIV is available, Afluria may be considered for a child age 5–8 years at high risk for influenza complications, after risks & benefits have been discussed with the parent/guardian.
2. CDC. Prevention and Control of Influenza with Vaccines: Recommendations of the ACIP—U.S., 2014—15 Influenza Season. (This document references information on vaccinating persons with egg allergy as well as CDC’s alternative approach of using documented histories (e.g., electronic registries) of vaccination prior to the 2010-11 season. If the 2014-15 ACIP statement also includes this, we will update this reference.)
3. Ask parents of children age 2–4 years: “In the past 12 months, has a healthcare provider ever told you that your child had wheezing or asthma?” If yes, do not give LAIV; instead give IIV