WHATCOM COUNTY Health Department Regina A. Delahunt Director Greg Stern, M.D. Health Officer Leading the community in promoting health and preventing disease. Immunization Program Update Please distribute to each physician, NP, PA and Vaccine Coordinator in your office Subject: ACIP Seasonal Influenza Vaccination Recommendations 2014-15 To: Family Practice, Internists, OB/GYN, Pediatrics, ER/Urgent Care, Infectious Disease, Occupational Health, Allergists, Parish Nurses, Pharmacists, Nursing Home/Assisted Living Facilities and other interested healthcare providers. From: German, Gonzalez MD, MPH Communicable Disease and Epidemiology Manager Contact Person: Alice Simmons, RN Nursing Supervisor Phone: 360.676.4593 Ext. 32029 Date: September 15, 2014 Pages 3 Updates for 2014-15 Influenza Season  The influenza vaccines contain the same virus strains as those in 2013-14 vaccine. The U.S. trivalent influenza vaccines contain an A/California/7/2009 (H1N1)-like virus, an A/Texas/50/2012 (H3N2)-like virus and a B/Massachusetts/2/2012-like virus. Quadrivalent vaccines also include a B/Brisbane/60/2008-like virus. Recommendations for Vaccination:  Routine annual influenza vaccination is recommended for all persons ≥ 6 months who do not have contraindications. Vaccination should be offered as soon as vaccine is available, optimally before the onset of influenza activity in the community, and continue as long as the influenza viruses are circulating. It should not be postponed out of concern for waning immunity by the end of the season.  When available live attenuated influenza vaccine (LAIV) should be used for healthy children aged 2-8 years who have no contraindications or precautions. If LAIV is not available, inactivated influenza vaccine (IIV) should be used. Vaccine Administration Guidelines:  Live attenuated influenza vaccine (LAIV) is licensed for use in healthy, non-pregnant persons aged 2–49 years.  The inactivated influenza vaccine (IIV) may be administered to persons 6 months and older except for those who have contraindications.  Washington State requires children 6-35 months and pregnant women receive preservative-free IIV.  Recombinant hemagglutinin vaccine (RIV3) may be used for persons aged 18-49 years.  Children aged 6 months up to the 9th birthday require 2 doses of influenza vaccine separated by 4 weeks during their first season of vaccination to optimize immune response.  Children aged 6 months up to the 9th birthday need only 1 dose of vaccine in the 2014-15 if they have received any of the following:  1 dose of seasonal influenza vaccine during the 2013-14 season  2 or more doses of seasonal influenza vaccine since July 1, 2010 or  2 or more doses of seasonal influenza vaccine before July 1, 2010 and 1 or more doses of monovalent 2009 (H1N1) vaccine or  1 or more doses of seasonal influenza vaccine before July1, 2010 and 1 or more doses of seasonal influenza vaccine since July 1, 2010.  Children who do not meet one of these conditions require 2 doses in 2014-15. ADMINISTRATION DISEASE RESPONSE ENVIRONMENTAL HEALTH HUMAN SERVICES 509 Girard Street Bellingham, WA 98225-4005 (360) 676-6724 FAX (360) 676-6771 COMMUNITY HEALTH www.whatcomcounty.us/health 1500 North State Street Bellingham, WA 98225-4551 (360) 676-4593 FAX (360) 676-6762    Women who 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. See Ref. (3) for vaccine dosing algorithm for children age 6 months through 8 years 2014-15. LAIV should not be used with the following:  Persons <2 years or >49 years  Those with contraindications listed in the package insert: o Children aged 2-17 years who are receiving aspirin or aspirin-containing products o Persons who have experienced severe allergic reactions to the vaccine of any of its components or a previous dose of influenza  Pregnant women  Immunosuppressed persons  Persons with a history of egg allergy  Children 2-4 years who have asthma or who have had a wheezing episode within the past 12 months  Persons who care for severely immunocompromised persons who require a protective environment should not receive LAIV or should avoid contact for 7 days following administration. LAIV Precautions:  Persons aged ≥5 years with asthma may be at increased risk for wheezing after administration of LAIV  Persons with underlying medical conditions. See Reference (1) below. See Ref. (2) for contraindications and precautions to the use of Influenza vaccines 2014-15. Vaccination of Persons with a History of Egg Allergy:  Persons who have experienced only hives following exposure to egg should receive influenza vaccine with the following additional measures: o Because studies published to date involved the use of IIV, IIV (egg or cell culture based) or RIV should be used rather than LAIV. o Vaccine should be administered by a health-care provider who is familiar with the potential manifestations of egg allergy. o Vaccine recipients should be observed for at least 30 minutes for signs of a reaction following administration of each vaccine dose.  Persons who report having had reactions to egg involving angioedema, respiratory distress, lightheadedness, or recurrent emesis, or persons who required epinephrine or other emergency medical intervention may receive RIV3 if aged 18-49 years and there are no other contraindications. If RIV3 is not available or the recipient is not within the indicated age range, such persons should be referred to a physician with expertise in the management of allergic conditions for further risk assessment.  All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available.  Persons who are able to eat lightly cooked egg (e.g. scrambled eggs) without reaction are unlikely to be allergic. However tolerance to egg-containing goods does not exclude the possibility of egg allergy.  A previous severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to receipt of influenza vaccine. See Ref. (4) for algorithm showing recommendations for persons who report an allergy to eggs. Influenza Vaccine and Use of Influenza Antiviral Medications  Administration of IIV to persons receiving influenza antiviral drugs for treatment or chemoprophylaxis is acceptable.  LAIV should not be administered until 48 hour after cessation of influenza antiviral therapy.  If influenza antiviral medications are administered within 2 weeks after receipt of LAIV, the vaccine dose should be repeated 48 or more hours after the last dose of antiviral medication.  Persons receiving antiviral drugs within the period 2 days before to 14 days after vaccination with LAIV should be revaccinated at a later date with any approved vaccine formulation. References: (1) http://www.cdc.gov/mmwr/pdf/rr/rr6207.pdf (page 26, Persons at Risk for Medical Complications Attributable to Severe Influenza) (2) http://www.cdc.gov/mmwr/pdf/rr/rr6207.pdf (page 25, table 2. Contraindications and precautions to the use of influenza vaccines) a. Immunization Action Coalition (IAC) screening checklists i. IIV and LAIV (3) http://www.cdc.gov/mmwr/pdf/wk/mm6332.pdf (page 695, figure 1. Influenza vaccine dosing algorithm for children aged 6 months through 8 years) a. IAC algorithm for children aged 6 months through 8 years (4) http://www.cdc.gov/mmwr/pdf/wk/mm6332.pdf (page 696, figure 2. Recommendations regarding influenza vaccination of persons who report allergy to eggs) a. IAC algorithm for persons with a history of egg allergy Resources: Prevention and Control of Seasonal Influenza with Vaccines (ACIP Report) http://www.cdc.gov/flu/professionals/acip/index.htm Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices United States, 2013-14. http://www.cdc.gov/mmwr/pdf/rr/rr6207.pdf Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices United States, 2014-15. http://www.cdc.gov/mmwr/pdf/wk/mm6332.pdf Preventing Seasonal Flu with Vaccination and Flu Vaccine Finder (for patients) http://www.cdc.gov/flu/protect/vaccine/index.htm Vaccine Information Statements http://www.cdc.gov/vaccines/hcp/vis/index.html Centers for Disease Control & Prevention: Seasonal Influenza (for health care professionals) http://www.cdc.gov/flu/professionals/ WA DOH: Influenza Information for Health Professionals http://www.doh.wa.gov/PublicHealthandHealthcareProviders/PublicHealthSystemResourcesandServices/I mmunization/InfluenzaFluInformation.aspx