By Lindsey Ghiringhelli, Pharm.D., BCGP, LTC consultant pharmacist, Pharmerica, Midland
Flu season is upon us again! To better protect against circulating flu viruses, the B/Victoria component and the influenza A (H3N2) were changed. This year’s recommended influenza vaccines include the inactivated quadrivalent influenza vaccine (IIV4) the inactivated trivalent (IIV3), the recombinant quadrivalent (RIV4) and the live-attenuated quadrivalent (LAIV4) nasal spray. The Centers for Disease Control and Prevention (CDC) recommends that everyone receive an influenza vaccine by the end of October.
Among the available trivalent vaccines are a high-dose product (Fluzone) with four times the amount of antigen and a vaccine with an adjuvant (Fluad), both available for patients over 65. The CDC estimates that 80 to 90 percent of flu-related deaths occur in patients aged 65 and over. The goal of these vaccines is to elicit a stronger immune response in the elderly population. The high dose vaccine has been associated with stronger immune response than the regular dose vaccine in the elderly, but the CDC indicates that studies are ongoing and is not recommending one vaccine over the over for elderly patients.
Though the CDC did not feel that the live-attenuated influenza vaccine (FluMist nasal spray) would be effective enough for use last year, it has made the cut for this flu season. It is approved for patients aged two to 49, but the American Academy of Pediatrics and American Academy of Family Physicians recommend reserving it for age-appropriate patients who refuse the injection. This vaccine is contraindicated in pregnancy, immunocompromised patients or those in close contact with immunocompromised patients, children aged two to four years with asthma, recent antiviral use (within 48 hours) or history of severe allergic reaction to any vaccine component. Please see the product labeling for additional precautions.
Patients with egg allergies are still recommended to receive the influenza flu vaccine. Patients who have developed only hives with egg exposure may receive any recommended vaccine. Those who report any other symptoms related to egg exposure, such as angioedema, respiratory distress, recurrent emesis, etc, should receive any appropriate vaccine under the supervision of a healthcare provider, in an inpatient or outpatient setting, who can recognize and manage severe allergic reaction. A prior severe allergic reaction to the influenza vaccine is a contraindication to future influenza vaccinations. There are two vaccines available which do not use any egg in their manufacturing processes, Flucelvax and Flublok, which can be offered to accommodate patient preference. Since the recombinant vaccine (Flublok) does not use any animal products, it may also be preferred for strict vegans.
Remind your patients, family and friends to vaccinate as soon as possible because it can take up to two weeks for antibodies to fully develop. Wash your hands frequently and stay home or wear a mask if you are sick. Though there are many different types of flu vaccines, the most important thing is that everyone over six months of age receives a flu vaccine every year. The vaccine protects you and everyone around you.
- Centers for Disease Control and Prevention. Influenza vaccines – United States, 2018-2019 influenza season. CDC website. https://www.cdc.gov/flu/protect/vaccine/vaccines.htm. Updated Sept. 5, 2018. Accessed Oct. 7, 2018.
- Centers for Disease Control and Prevention. Frequently Asked Flu Questions 2018-2019 Influenza Season. CDC website. https://www.cdc.gov/flu/about/season/flu-season-2018-2019.htm. Updated Aug. 30, 2018. Accessed Oct. 7, 2018.
- Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory committee on immunization practices – United States, 2018-19 influenza season. CDC website. https://www.cdc.gov/mmwr/volumes/67/rr/rr6703a1.htm?s_cid=rr6703a1_w. Updated Aug. 24, 2018. Accessed Oct. 7, 2018.
- Pharmacist’s Letter. Flu Vaccines for 2018-2019. Therapeutics Research website. http://pharmacistsletter.therapeuticresearch.com/pl/ArticlePDF.aspx?cs=&s=PL&DocumentFileID=0&DetailID=341001&SegmentID=0 . October 2018.