Ask a #WiseChoice: Flu Vaccinations

With flu season creeping up, The Shot Nurse, your #WiseChoice for immunizations and wellness services, helps answer the most frequently asked questions about flu vaccinations.

October marks the start of flu season, according to the Centers for Disease Control and Prevention (CDC). If you’re wary about getting a flu shot, Deborah Overall, RN, vice president of The Shot Nurse, can put you at ease with answers to the most common questions about the flu vaccine, as provided by the CDC and by the Immunization Action Coalition (IAC).

According to the IAC, there are two kinds of flu vaccines. One has an additional strain. But the Advisory Committee on Immunization Practices (ACIP) does not have a preference. The ACIP advised not to delay vaccination for the purpose of waiting on a specific vaccine.

Overall said these are the most common flu vaccine questions and answers, per the CDC and IAC:

Q: We have noticed that ACIP recommends that we begin vaccinating with seasonal influenza vaccine in September or even earlier. Does protection from seasonal influenza vaccine decline or wane within three or four months of vaccination? Should I wait until later in the year to vaccinate my elderly or medically frail patients?

“No one can predict when influenza disease will peak in a given season,” said the IAC. “Several studies have reported decreases in vaccine effectiveness within a single influenza season with increasing time since vaccination. However, waning effects have not been observed consistently across age groups, virus sub-types or seasons. While delaying vaccination might permit greater immunity later in the season, deferral could result in missed opportunities to vaccinate, as well as difficulties in vaccinating a large number of people within a more limited time period. Vaccination programs should balance maximizing the likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after influenza virus circulation begins.”

Q: Which influenza vaccines can we give to children?

“Among the injectable inactivated influenza vaccines, only Fluzone, FluLaval and Fluarix are approved by the FDA for use in children ages 3 through 6. There are several inactivated influenza vaccines that can be given to children age 3 years or older. The nasal spray live attenuated influenza vaccine (LAIV, FluMist, AstraZeneca) is approved for healthy children ages 2 years and older.”

Q: Please tell me about Fluad, one of the influenza vaccines for people age 65 years and older.

“Fluad is the first adjuvanted influenza vaccine marketed in the U.S. An adjuvant is a substance added to a vaccine to increase its immunogenicity. The MF59 adjuvant is based on squalene, an oil that occurs naturally in many plants and animals. Fluad has been used in Europe since 1997 and is approved in 38 other countries. In contrast to Fluzone High-Dose, Fluad is a standard-dose vaccine, containing 15 mcg of hemagglutinin per virus per dose. In a small observational study among adults 65 years and older, Fluad was about 63 percent more effective than (a vaccine without an adjuvant).”

Q: What is the latest ACIP guidance on influenza and egg allergy?

“ACIP recommends that people with a history of egg allergy who have experienced only hives after exposure to egg should receive influenza vaccine without specific precautions, except for a 15-minute observation period to make sure the patient doesn’t pass out from a sudden loss in blood pressure. Any age-appropriate vaccine may be used. People who report having had a more severe reaction to egg may also receive any age-appropriate influenza vaccine (but) the vaccine for those individuals should be administered in a medical setting (instead of a pharmacy or an on-site vaccination visit). Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic conditions. Although not specifically recommended by ACIP, providers may prefer an egg-free recombinant vaccine for people age 18 years and older with severe egg allergy.”

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