Prevention and Control of Seasonal Influenza With Vaccines
The AAFP recommends that physicians offer influenza vaccination as soon as it becomes available each year and continue to provide the vaccine throughout the flu season (i.e., as long as influenza viruses are circulating in the community).
AAFP Recommendations for the 2019-2020 Influenza Season
The AAFP recommends routine annual influenza vaccination for all persons six months and older without contraindications for this influenza season.
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Influenza Vaccines Update / Utilizing Evidence-Based Strategies to Reduce Barriers to Immunizations
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The influenza vaccine is the first step to prevent the flu, and your recommendation can make a difference. Consider the following points in discussions with patients:
- Pregnant women should receive the seasonal influenza vaccine. The risk of severe illnesses related to the flu is higher in pregnant women than in women who are not pregnant.
- The influenza vaccine protects the mother and her infant from influenza-related illnesses, hospitalization, and premature labor and delivery.
- The influenza vaccine is safe for pregnant women in any trimester. The vaccine has been given to millions of pregnant women in the last decade and has not been shown to cause harm to women or their infants.
- LAIV4 should not be given during pregnancy.
- It is safe for postpartum women to get the influenza vaccine, even if they are breastfeeding. Antivirus drugs are recommended for pregnant women who get the flu. Antivirus drugs can shorten the length of illness by one or two days, and can prevent flu complications, such as pneumonia.
The AAFP supports annual mandatory influenza immunization for health care personnel (HCP), except for refusal due to a documented allergy or medical contraindication. If HCP are not vaccinated, policies to adjust practice activities during flu season are appropriate (e.g., wearing masks, refraining from direct patient care). (AAFP Board of Directors, May 2016)
As is the case for all vaccines, influenza vaccines contain various different components that might cause allergic and anaphylactic reactions. Not all such reactions are related to egg proteins; however, the possibility of reactions to influenza vaccines in egg-allergic persons might be of concern to these persons and vaccine providers. Currently available influenza vaccines, with the exceptions of RIV4 (Flublok Quadrivalent, licensed for ages 18 years) and ccIIV4 (Flucelvax Quadrivalent, licensed for ages ≥4 years), are prepared by propagation of virus in embryonated eggs and might contain trace amounts of egg proteins, such as ovalbumin.
Severe allergic reactions to vaccines, although rare, can occur at any time, even in the absence of a history of previous allergic reaction. Therefore, all vaccine providers should be familiar with the office emergency plan and be certified in cardiopulmonary resuscitation. For persons who report a history of egg allergy, ACIP recommends the following:
- Persons with a history of egg allergy who have experienced only urticaria (hives) after exposure to egg should receive influenza vaccine. Any licensed, recommended influenza vaccine (i.e., any IIV, RIV4, or LAIV4) that is otherwise appropriate for the recipient's age and health status may be used.
- Persons who report having had reactions to egg involving symptoms other than urticaria (e.g., angioedema or swelling, respiratory distress, lightheadedness, or recurrent vomiting) or who required epinephrine or another emergency medical intervention may similarly receive any licensed, recommended influenza vaccine (i.e., any IIV, RIV4, or LAIV4) that is otherwise appropriate for their age and health status. The selected vaccine should be administered in an inpatient or outpatient medical setting (including, but not necessarily limited to, hospitals, clinics, health departments, and physician offices). Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
- A previous severe allergic reaction to influenza vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.
No postvaccination observation period is recommended specifically for egg-allergic persons. However, ACIP recommends that vaccine providers consider observing patients (seated or supine) for 15 minutes after administration of any vaccine to decrease the risk for injury should syncope occur.
Persons who are able to eat lightly cooked egg (e.g., scrambled egg) without a reaction are unlikely to be allergic. Egg-allergic persons might tolerate egg in baked products (e.g., bread or cake). Tolerance to egg-containing foods does not exclude the possibility of egg allergy. Egg allergy can be confirmed by a consistent medical history of adverse reactions to eggs and egg-containing foods, plus skin or blood testing for immunoglobulin E directed against egg proteins.
Occasional cases of anaphylaxis after administration of influenza vaccines in egg-allergic persons have been reported to VAERS. ACIP will continue to review available data regarding anaphylaxis cases after receipt of influenza vaccines.
- There is no preferential recommendation for any one flu vaccine over another.
- Routine annual influenza vaccination of all persons aged ≥6 months without contraindications continues to be recommended.
- 2019 -20 U.S. trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/Brisbane/02/2018 (H1N1) pdm09 -like virus, an A/Kansas/14/2017 (H3N2) -like virus, and a B/Colorado/06/2017 -like virus (Victoria lineage). Quadrivalent influenza vaccines will contain HA derived from these three viruses and from an additional influenza B vaccine virus, a B/Phuket/3073/2013 -like virus (Yamagata lineage). This composition includes updates in the influenza A(H1N1) pdm09 and influenza A(H3N2) components of the vaccine.
Two recent regulatory actions are described:
- In October 2018, FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of HA per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years).
- In January 2019, FDA approved a change in dose volume for Fluzone Quadrivalent (IIV4). Previously, the dose volume for children aged 6 through 35 months was 0.25 mL (containing 7.5 µg of HA per vaccine virus). Children aged 6 through 35 months who receive Fluzone Quadrivalent may now receive either 0.25 mL (containing 7.5 µg of HA per vaccine virus) or 0.5 mL (containing 15 µg of HA per vaccine virus) per dose. Children aged ≥36 months (≥3 years) and adults should receive 0.5 mL per dose.