Influenza Vaccine

Aka: Influenza Vaccine, Trivalent Influenza Vaccine, Fluzone, Inactivated Influenza Vaccine, TIV Vaccine

1. See Also
   1. Influenza
2. Background: Vaccine Production
   1. Preparation (Inactivated Influenza Vaccine)
      1. Trivalent Influenza Vaccine (TIV, Fluzone)
   2. Virus strains chosen based on:
      1. Virulence
      2. Lack of immunity in community
      3. Technical limitations on virus culture
   3. Virus grown in 90 million hens eggs over 1 year
   4. Vaccine developed and potency tested over 6-7 months
      1. Inject sheep and testing antigenicity
      2. Measure effective hemagglutinin concentration
      3. Develop reference strains
3. Efficacy
   1. Prevents illness in 70% healthy people age <65 years
   2. Prevents 30-70% Pneumonia hospitalizations in elderly
4. Indications: High risk groups (but recommended for all patients 6 months and over)
   1. Age 65 years and older
   2. All children ages 6 months to 18 years
   3. Nursing Home and Chronic care residents
   4. Chronic pulmonary disease
      1. Asthma
      2. COPD
   5. Chronic disease (especially those requiring frequent hospitalization)
      1. Chronic Kidney Disease
      2. Chronic Liver Disease
      3. Heart disease
      4. Diabetes Mellitus
      5. Sickle Cell Anemia
   6. Long term Aspirin use under age 18 years
      1. Prevents Reye's Syndrome
   7. Vectors
      1. Health care workers
      2. Nursing Home personnel
      3. Family members of high risk patients
      4. Families and child care workers caring for children under age 5 years
   8. Essential service providers
   9. Students in Institutional settings
   10. Human Immunodeficiency Virus or other immunosuppresion
   11. Travel to tropics any time of year
   12. Travel to Southern Hemisphere April to September
   13. Pregnancy (second and third trimester)
       1. Administer injectable Influenza Vaccine in any trimester (do not use Flumist)
   14. Breast Feeding
5. Contraindications
   1. Age under 6 months
   2. Anaphylaxis to eggs or other vaccine components
   3. Acute febrile illness
   4. History of Guillain Barre Syndrome
6. Protocol
   1. Site
      1. Adults and older children: Deltoid
      2. Infants and young children: Anterolateral thigh
   2. Timing
      1. Clinic Visits starting in September
      2. Nursing Homes in October-November (not too early!)
   3. Dosing Frequency
      1. Children (Age 6 months to 8 years)
         1. First Immunization year: 2 doses, 1 month apart before December
         2. Subsequent Immunization years: 1 dose before December
      2. Adults and children over age 9 years
         1. Dosing: 1 dose per year before December
         2. Consider a second dose if first dose given early
   4. Dose
      1. Age 6 to 35 months: 0.25 ml
      2. Age 3 years or older: 0.50 ml (contains 45 mcg hemagglutinin antigen per dose)
      3. Age 65 years of older
         1. Standard dose as above (45 mcg hemagglutinin) or
         2. High dose Fluzone (180 mcg hemagglutinin)
            1. May offer better immunity but as of 2011, either vaccine may be given
7. Safety
   1. No longer contains thimerosal
   2. Influenza Vaccine is safe in infants and children
      1. France (2004) Arch Pediatr Adolesc Med 158:1031-6
8. References
   1. (1999) Preparing for the Next Pandemic telecast, CDC
   2. (1997) Am Fam Physician 56(1):279-282