Influenza Prevention: Make Sure Patients Understand the Vaccine

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The Advisory Committee on Immunization Practices (ACIP) recommends that all Americans 6 months and older who do not have contraindications receive the flu vaccine.Health care providers should recommend the high-dose or adjuvanted flu vaccine for patients 65 and older. These 2 types of the vaccine are designed to spur a stronger immune response. The difference between adjuvanted and high-dose vaccines is that the adjuvanted vaccine is made with MF59 adjuvant, which is designed to enhance the immune response. The high-dose vaccine is designed for patients 65 and older and contains 4 times the amount of antigen as the regular flu vaccine. As such, it is associated with a stronger immune response, and patients who received the high-dose vaccine had 24% fewer influenza infections compared with those who received the standard-dose flu vaccine.

Children aged 6 months to 8 years who have never received the vaccine should receive 2 doses, the first as soon as it is available and the second about a month later.

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A CDC study published in

Pediatrics

showed that the vaccine significantly reduces a child’s risk of dying from the influenza virus. The study looked at data from 2010 to 2014 and found that the vaccine reduced the risk of flu-associated death by 51% among children with underlying high-risk medical conditions. Just 1 in 4 children who reportedly died from influenza had received the vaccine. As of March, 61 pediatric flu-related deaths had been reported in 2017.

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From 1982-2016, peak influenza activity did not occur until January or later, but it can start as early as October.Considering inconclusive evidence that delaying immunization may increase immunity in the latter half of the flu season, the ACIP recommends that patients get vaccinated early. The deferral of vaccination could result in a missed opportunity to vaccinate a patient or the patient becoming infected with the influenza virus prior to obtaining the vaccine.

A potential safety signal associated with the flu vaccination of pregnant women has been raised. A case control study has reported that women early in pregnancy who have been vaccinated with vaccine containing the H1N1 component had a higher rate of spontaneous abortion within 28 days of vaccination. However, the ACIP has not changed its re

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commendation on not vaccinating pregnant women in any trimester. There is an ongoing study involving pregnant patients and the flu vaccine that should produce results by 2018 or 2019.

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According to the CDC, the flu vaccine is associated with decreased hospitalizations among patients with diabetes (79%) and chronic lung disease (52%).Additionally, a meta-analysis suggests that the influenza vaccine is associated with a lower risk of major cardiovascular events in patients with active coronary disease.With these statistics in mind, health care providers should be the most prominent advocates of the flu vaccine, especially concerning these special patient populations.

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Another concern when considering the flu vaccine in certain patient populations is an egg allergy. The ACIP recommends that patients who have experienced urticaria after exposure to eggs should be vaccinated. Patients who have experienced severe reactions to eggs, such as angioedema or respiratory distress, or who require epinephrine, may receive any licensed and recommended flu vaccine. However, vaccine administration should be supervised by a health care provider who is trained to manage severe allergic reactions. As always, patients who have suffered an allergic reaction to the flu vaccine previously should not receive the vaccine.One option for patients with severe egg allergies is Flublok, a vaccine that is not produced using chicken eggs. If a patient asks for the Flublok vaccine, it should be noted that the vaccine has a slightly shorter shelf life of 9 months from the production date.

Always remember the CDC’s SHARE method: Share the reasons that the influenza vaccine is right for patients, highlight positive experiences with the vaccine, address all patient questions, remind patients that influenza vaccines protect them and their loved ones, and explain the potential costs of getting the flu. It is important that patients understand the vaccine and the reasoning behind its recommendation so that they can make informed decisions about the flu and other vaccines.

Pharmacists, nurse practitioners, physician assistants, and physicians are vital to increasing influenza immunization rates. Patients trust health care providers to provide the latest evidence involving the vaccine and data surrounding special patient populations.

Abby Case, PharmD,

is a community pharmacy resident at the University of Georgia and Kroger Pharmacy.

References

1. CDC. Prevention and control of influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices—United States, 2013-2014.MMWR Recomm Rep.2013;6259 (RR-07);1-43.

2. What you should know and do this flu season if you are 65 years and older. CDC website.cdc.gov/flu/about/disease/65over.htm. Updated October 13, 2017. Accessed November 2, 2017.

3. Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 influenza season.MMWR Morb Mortal Wkly Rep.2015;64(30):818-825.

4. CDC study finds flu vaccine saves children’s lives [news release]. CDC. April 3, 2017.cdc.gov/media/releases/2017/p0403-flu-vaccine.html. Accessed November 2, 2017.

5. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices - United States, 2017-18 influenza season.MMWR Recomm Rep.2017;66(2):1-20. doi: 10.15585/mmwr.rr6602a1.

6. Flu vaccination & possible safety signal. CDC website.cdc.gov/flu/professionals/vaccination/vaccination-possible-safety-signal.html. Updated September 13, 2017. Accessed November 2, 2017.

7.Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis.JAMA.2013;310(16):1711-1120.doi: 10.1001/jama.2013.279206.

8. Flu vaccine and people with egg allergies. CDC website.cdc.gov/flu/protect/vaccine/egg-allergies.htm. Updated September 2, 2016. Accessed November 2, 2017.

9. Flublok seasonal influenza (flu) vaccine. CDC website.cdc.gov/flu/protect/vaccine/qa_flublok-vaccine.htm. Updated October 3, 2017. Accessed November 2, 2017.

10. When & how to wash your hands. CDC website.cdc.gov/handwashing/when-how-handwashing.html. Updated March 7, 2017. Accessed November 2, 2017.