Which Flu Vaccine is Right for Your Patient?

It’s that time of year again. Patients will be flocking to your office looking to get vaccinated from the flu. Generally, it is important for healthcare providers to begin offering the flu vaccine as soon as it becomes available, preferably by October. 

Several new flu vaccines have been recently approved by the FDA giving providers greater access to the vaccine and patients a better opportunity to be immunized. 

In addition to the trivalent influenza vaccine (which contains an A/California/7/2009 (H1N1)-like virus, an H3N2 virus antigenically like the cell-propogated prototype virus A/Victoria/361/2011, and a B/Massachusets/2/2012-like virus), a quadrivalent vaccine, containing a B/Brisbane/60/2008-like virus has also been made available by several manufacturers.

Four quadrivalent vaccines have been approved by the FDA: Flumist Quadrivalent (MedImmune), Fluarix Quadrivalent (GlaxoSmithKline), Fluzone Quadrivalent (Sanofi Pasteur), and Flulaval Quadrivalent (GlaxoSmithKline).

While these vaccines may differ by indication and route of administration, the CDC has no preferential recommendation for any one specific influenza vaccine product over another with regards to efficacy.

Considerations for Children 6 Months Through 8 Years of Age

The algorithm below illustrates the approach to dosing children who are between the ages of 6 months and 8 years. Children for whom one of these conditions is not met require 2 doses in 2013-2014. All children between 6 months through 8 years who are recommended 2 doses should receive their first dose as soon as possible after vaccine becomes available; these children should receive the second dose ≥4 weeks later.

INFLUENZA VACCINE DOSING ALGORITHM: 6 MONTHS TO 8 YEARS OF AGE

NOTES

* Doses should be administered at least 4 weeks apart. † This algorithm takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. Alternative approach: Settings where vaccination history from before July 1, 2010, is available, if a child aged 6 months–8 years is known to have received at least 2 seasonal influenza vaccines during any previous season, and at least 1 dose of a 2009 (H1N1)-containing vaccine (i.e., 2010–11, 2011–12, or 2012-13 seasonal vaccine or the monovalent 2009[H1N1] vaccine), then the child needs only 1 dose for 2013–14. Using this approach, children aged 6 months–8 years need only 1 dose of vaccine in 2013–14 if they have received any of the following: 1) 2 or more doses of seasonal influenza vaccine since July 1, 2010; 2) 2 or more doses of seasonal influenza vaccine before July 1, 2010, and 1 or more doses of monovalent 2009(H1N1) vaccine; or 3) 1 or more doses of seasonal influenza vaccine before July 1, 2010, and 1 or more doses of seasonal influenza vaccine since July 1, 2010. Children in this age group for whom one of these conditions is not met require 2 doses in 2013–2014.

REFERENCES

From: Summary* Recommendations: Prevention and Control of Influenza with Vaccines Recommendations of ACIP, United States 2013; www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm  (Created 10/2013)

Considerations for Pregnant Women

Live attenuated virus vaccine is not recommended for pregnant women therefore women who are or will be pregnant should be immunized with inactivated influenza virus vaccine. Postpartum women, however, may be vaccinated with either vaccine. Avoiding contact with persons vaccinated with live attenuated virus vaccine is not necessary for either pregnant or postpartum women.

Considerations for the Elderly

All persons age 50 and older are considered at risk for medical complication due to influenza. However, not all vaccines are indicated for older patients (see Chart below). One specific influenza vaccine, Fluzone High-Dose, is FDA-approved for patients 65 years of age and older.