INTRODUCTION
Influenza virus infections occur
every year in the United States but vary greatly in incidence and geographic
distribution. Efforts to prevent or control influenza in the U.S. have been
aimed at protecting persons at risk of serious illness or death.
The 2003-2004 trivalent vaccine virus strains are A/New Caledonia/20/99-like
(H1N1), A/Moscow/10/99-like (H3N2), and B/Hong Kong/330/2001-like antigens. Influenza vaccines distributed in the United States may contain thimerosal.
The influenza vaccine is strongly
recommended for:
1. Any person >
six months of age, who by virtue of age or underlying conditions is at increased
risk for complications of influenza.
2. Health
care workers and others (including household members) who may have close contact
with high risk persons to decrease risk of transmitting disease.
3. Any other person who
wishes to reduce his/her chance of becoming infected with influenza, even if
that person is not at increased risk for complications.
The vaccine is also recommended for persons at high risk for influenza
related complications, including persons > 50 years, nursing
home/chronic care facility residents with chronic medical conditions,
adults/children with chronic pulmonary or cardiovascular disease, persons
requiring hospitalization within the last year for a chronic metabolic disease,
renal failure, hemoglobinopathies or immunosuprression, and children/teenagers
taking long term aspirin therapy.
For persons infected with HIV, vaccination is advised because influenza
may result in serious illness and complications in these individuals. The
effectiveness of vaccination may be reduced due to the inability of HIV patients
to mount an antibody response.
Women beyond the 1st trimester of pregnancy (> 14 wks) during the influenza season should be vaccinated. Pregnant women
who have medical conditions that increase their risk of complications from
influenza should be vaccinated before the influenza season – regardless of
pregnancy stage. To minimize the theoretical possibility of teratogenecity, it
is reasonable to administer the vaccine after the first trimester if
immunization will be accomplished
when the influenza season begins. Breastfeeding is not a contraindication for
vaccination.
Persons with acute febrile illnesses
usually should NOT be vaccinated until symptoms have abated. Inactivated
influenza vaccine should NOT be given to persons with known hypersensitivity to
eggs.
TIMING OF ADMINISTRATION/DOSAGE
High levels of influenza activity
generally do not occur before December in the United States. Influenza vaccine
may be offered to high risk patients presenting for routine care or
hospitalization starting in September. Organized vaccination campaigns for high
risk persons are optimal from October to mid November and continued into
December or influenza season as vaccine is available.
Only the split virus preparation
will be stocked at KUMC, as this preparation is associated with fewer febrile
reactions in children and is the only preparation recommended for use in
children < 13 years. Influenza vaccine should only be administered intramuscularly
at the following dosages.
|
Age Group |
Dosage
Schedule |
|
>
9 years old |
0.50 mL x 1 dose |
|
3
to 8 years old |
0.50 mL, [1 or 2 doses]* |
|
6 to 35 months
|
0.25 mL, [1 or 2 doses]* |
* For children < 9 yrs who are receiving the vaccine
for the first time, two doses at least four weeks apart are recommended. Both
doses are recommended for maximum protection.
The recommended site of
vaccination is the deltoid muscle for adults and older children. The
anterolateral aspect of the thigh is recommended for infants and small children.
NEVER administer the vaccine intravenously.
SIDE EFFECTS AND ADVERSE REACTIONS
Because influenza vaccine contains
only non-infectious viruses, it cannot cause influenza. The most frequent
side effect is soreness around the injection site. Any significant
adverse reactions should be reported to the Drug Information Center at ext 2328
and the appropriate VAERS (Vaccine Adverse Event Reporting System) forms will be
completed and forwarded to the CDC and FDA.
The following reactions have also occurred:
1.
Fever, malaise and myalgia infrequently affect persons who have had no
exposure to the influenza virus antigens.
Symptoms usually occur six to
12 hours after the vaccination and can persist for one to two days.
2.
Immediate, presumably allergic reactions are extremely rare post
influenza
vaccine administration. Persons who have anaphylactic hypersensitivity
to eggs should not be vaccinated. This includes people who develop hives,
swelling of the lips, or respiratory distress after eating eggs.
KUMC AVAILABILITY AND CHARGING
The 2003-2004 trivalent influenza
vaccine will soon be available to KUMC clinics. We anticipate receiving multiple allocations through the
next few months, with the final allocation occurring by mid-November. Any of the 2002-2003 vaccine
should be returned to the pharmacy. DO
NOT use the 2002-2003 preparation.
The charge to the clinic is $10.64
per dose. An individual prescription for each dose administered will be
needed, and stock will be replaced accordingly.