Flu Vaccines for the Upcoming Influenza Season

Those big, white coolers filled with flu vaccines are about to come rolling into the pharmacy. E-mails will also start coming in from corporate advising us to make sure we maintain the cold chain and start speaking with patients about getting their flu vaccines as soon as possible.

Last year, the influenza vaccine turned out to be only 19% effective in preventing medical visits across all age groups, according to data collected between November 10, 2014, and January 30, 2015. This was due to the predominant circulation of an antigenically and genetically drifted influenza A (H3N2) strain differing from the H3N2 component of the vaccine. The flu season peaked in late December 2014 for influenza A and late February 2015 for influenza B, according to the US Centers for Disease Control and Prevention.

Because antibody levels induced by the flu vaccine have been shown to decline over time, flu vaccination programs should maximize the probability of continuation of protection throughout the season (typically October through April) while avoiding missed opportunities to vaccinate after influenza circulation has already begun.

For the 2015-2016 flu season, trivalent vaccines will contain hemagglutinin derived from A/California/7/2009 (H1N1)-like virus, an A/Switzerland/9715293/2013 (H3N2)-like virus, and a B/Phuket/3073/2013-like (Yamagata lineage) virus. Quadrivalent vaccines will also contain a B/Brisbane/60/2008-like virus.

The available agents are:

Trade Name

Thimerosal

(µg/0.5 mL)

Ovalbumin

(egg albumin)

Age Indications

Latex

Route

Inactivated influenza vaccine, quadrivalent, standard dose

Fluarix

Prefilled syringe: 0 Mulit-dose vial: <25

Prefilled syringe: ≤0.05

Multi-dose vial: ≤0.3

>3 years

No

IM

FluLaval

0

Unavailable

6-35 months

No

IM

Fluzone

Prefilled syringe: 0

Single dose vial: 0

Multi-dose vial: 25

Unavailable

Prefilled syringe: ≥36 months

Single-dose vial: ≥36 months

Multi-dose vial: ≥6 months

No

IM

Fluzone Intradermal

0

Unavailable

18-64 years

No

ID

Inactivated influenza vaccine, trivalent, standard dose

Afluria

Prefilled syringe: 0

Multi-dose vial: 24.5

<1

≥9 years

No

IM

Fluvirin

Prefilled syringe: ≤1

Multi-dose vial: 25

≤1

≥4 years

Yes

IM

Fluzone

25

Unavailable

≥6 months

No

IM

Inactivated influenza vaccine, cell-culture-based, standard dose

Flucelvax

0

See package insert

≥18 years

Yes

IM

Inactivated influenza vaccine, trivalent, high dose

Fluzone

0

Unavailable

≥65 years

No

IM

Live attenuated influenza vaccine, quadrivalent

FluMist

0

<0.24/0.2 mL

2-49 years

No

IN

Recombinant influenza vaccine, trivalent, standard dose

Flublok

0

0

≥18 years

No

IM

In addition to checking your supply of needles, syringes, alcohol wipes, cotton balls, band aids, sharps containers, and gloves, make sure your emergency kit is fully stocked and nothing is out of date. You should have aqueous epinephrine 1:1000 dilution, diphenhydramine, alcohol wipes, adult pocket mask, stethoscope, and sphygmomanometer.

Signs of anaphylactic reactions include sudden or gradual onset of generalized itching, erythema, or uricaria; angioedema of the lips, face, or throat; severe bronchospasm; shortness of breath; shock; abdominal cramping; and cardiovascular collapse. If any of these symptoms occur, call 911 and administer aqueous epinephrine 1:1000 dilution intramuscularly. Adult doses range from 0.3 mL to 0.5 mL.

If EMS has not arrived and symptoms are still present, administer doses of epinephrine every 5 to 15 minutes for up to 3 doses, and continue monitoring the patient. Perform CPR if necessary to maintain airway. For hives or itching, you may also administer up to 50 mg of diphenhydramine or up to 100 mg of hydroxyzine.

If the patient is having difficulty breathing, elevate the head. If the patient’s blood pressure is low, elevate the legs. Monitor blood pressure and pulse every 5 minutes.

Patients who report an egg allergy but have only experienced hives after exposure should still receive the flu vaccine. Those who required medical intervention or reported symptoms involving angioedema, respiratory distress, lightheadedness, or recurrent emesis may receive recombinant influenza vaccine if they are 18 years or older and don’t have any other contraindications.

If recombinant vaccine is unavailable, or if the patient is not within this age range, then they should receive their flu vaccine from a physician with experience in the management of severe allergic conditions.

Otherwise, happy immunizing!