Questions & Answers
Influenza - Seasonal - The Vaccines
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Questions

General Questions

  1. How effective is influenza immunization in protecting me from illness caused by the different strains of influenza?
  2. What if I'm pregnant or breastfeeding? Can I still receive the seasonal influenza vaccine?
  3. Are influenza vaccines harmful during my pregnancy?
  4. If a child is receiving an influenza vaccination for the first time, what is the appropriate administration schedule?
  5. If a child 6 months - 8 years of age is receiving an influenza vaccination for the first time, must the same type of vaccine be administered for both doses?
  6. How are injectable and intranasal influenza vaccines shipped and stored?
  7. If I need to administer a tuberculin skin test (TST), should I be concerned about administering the influenza vaccine at the same time?
  8. Can live vaccines and the influenza vaccine be administered on the same day?
  9. Can I get seasonal flu illness from the flu vaccine?
  10. Why does my child need to get the flu vaccine?

Trivalent Inactivated Influenza Vaccine (IIV3), Injectable: Fluzone®, Afluria®, Flurivin® and Flucelvax®

  1. What is Fluzone®?
  2. What is Afluria®?
  3. Who should receive the injectable vaccines?
  4. Who should not receive the injectable influenza vaccines?
  5. What side effects can I expect when I receive the injectable influenza vaccine?
  6. What is Fluvirin®?
  7. What is Flucelvax®?

Live Attenuated Intranasal Vaccine (LAIV), Intranasal FluMist®

  1. Who should receive the live, attenuated intranasal vaccine?
  2. What side effects can I expect when I receive FluMist®?
  3. Who should not receive the live, attenuated intranasal vaccine?
  4. What is FluMist®?
Answers

General Questions

  1. How effective is influenza immunization in protecting me from illness caused by the different strains of influenza?
    Vaccines are developed each year in an attempt to match the predicted virus strains. When they are well-matched, immunization of healthy adults is 70-90% effective in preventing influenza illness. When the majority of circulating influenza strains is not well matched by the vaccine, effectiveness has been as low as 47-77%. Vaccines may be somewhat less effective in elderly persons and very young children, but immunization can still help prevent serious complications from influenza illness.

  2. What if I'm pregnant or breastfeeding? Can I still receive the seasonal influenza vaccine?
    Yes. The ACIP, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians have all recommended the routine vaccination of women who are pregnant, or who become pregnant during the influenza season. Pregnant women, as well as lactating/postpartum women and their newborn babies, are at high risk for influenza complications. Pregnant women may receive the inactivated injectable influenza vaccine, during any point of gestation and postpartum; breastfeeding women may receive the inactivated or live vaccine.

  3. Are influenza vaccines harmful during my pregnancy?

    Pregnant women are at high risk for influenza related complications and are a priority group for vaccination. The FDA has classified Fluzone and Afluria as "Pregnancy Category B", indicating that animal reproduction studies have not demonstrated a fetal risk, but there are no controlled studies in pregnant women.

    The ACIP, the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians recommends the use of injectable influenza vaccine for immunization of pregnant women because the benefit of protection outweighs the potential risk of any adverse event.



  4. If a child is receiving an influenza vaccination for the first time, what is the appropriate administration schedule?

    According to the ACIP and the American Academy of Pediatrics (AAP):

    Children aged 6 months to 8 years who are receiving the influenza vaccine for the first time or whose previous vaccination status is unknown should receive two (2) doses of vaccine separated by at least four weeks.

    Children aged 6 months through 8 years who have NOT received two (2) or more total doses of seasonal influenza vaccine since July 2010 should receive two (2) doses of vaccine separated by at least four weeks.

    Children aged 6 months through 8 years who received two (2) or more total doses of seasonal influenza vaccine since July 2010 and all children 9 and older should receive one dose of seasonal influenza vaccine.



  5. If a child 6 months - 8 years of age is receiving an influenza vaccination for the first time, must the same type of vaccine be administered for both doses?
    No. The first and second doses can be from different manufactures or age-appropriate formulations. IIV can be used when vaccinating children aged 6 months to 8 years and LAIV (FluMist®) for children aged 2 years and older, who have not been previously vaccinated.

  6. How are injectable and intranasal influenza vaccines shipped and stored?
    All injectable and intranasal vaccines are shipped and should be stored at 2 to 8 degrees Celsius. When the vaccine arrives at your facility, it must immediately be placed in a refrigerator. In addition, protect Afluria, Flucelvax and Fluvirin from light until use. Do not use vaccines past the expiration date printed on the vaccine vial or syringe. Once the Afluria multi-dose vial has been punctured the vaccine must be used within 28 days. Fluzone multi-dose vials may be used after puncture until the expiration date on the vial. Any prefilled syringes, sprayers or single dose vials must be discarded at the end of the day if the tip cap is removed, a needle is placed on the syringe or the cap of the vial has been removed.

  7. If I need to administer a tuberculin skin test (TST), should I be concerned about administering the influenza vaccine at the same time?

    Yes. The live vaccine (FluMist®) may suppress a positive response to a tuberculin skin testing (TST or PPD) in a person who is infected with tuberculosis (TB), resulting in a false negative skin test. If a person needs TB skin testing and LAIV, you can correctly administer both in one of three ways

    • Give the TST (PPD) and the vaccine simultaneously.
    • Give the TST (PPD) first and when the person returns to have the skin test results interpreted, administer the live vaccine.
    • Give the live vaccine and then delay administration of the TST (PPD) for 28 days. Injectable influenza vaccines and tuberculin skin test can be administered concurrently or at any interval.


    • Can live vaccines and the influenza vaccine be administered on the same day?
      The inactivated injectable influenza vaccine may be administered on the same day as live vaccines or at any interval thereafter, but the live intranasal influenza vaccine must be administered on the same day as the other live vaccines or separated by an interval of at least 28 days.

    • Can I get seasonal flu illness from the flu vaccine?
      Influenza vaccine does not cause the flu virus. Some vaccinated people may have mild flu-like symptoms, which are caused by the immune system's response to the vaccine. Other people may feel soreness or have mild, uncomfortable side effects. The most common side effects associated with the injected flu vaccine are redness, swelling, and soreness at the injection site. The nasal spray type of flu vaccine may cause runny nose, nasal congestion, sore throat, and chills in some patients. For more information please visit the CDC flu website or contact the MILVAX-VHCN.

    • Why does my child need to get the flu vaccine?
      Infants and children, as well as the elderly, are more likely to have serious complications from the flu virus. In addition, children may be exposed to flu virus at school and daycare. Please contact the MILVAX-VHCN if you want to discuss the influenza vaccine with a MILVAX-VHCN healthcare provider.

    Trivalent Inactivated Influenza Vaccine (IIV3), Injectable: Fluzone®, Afluria®, Flurivin® and Flucelvax®

    1. What is Fluzone®?

      Fluzone®, Fluzone® Pediatric, Fluzone® High-Dose (HD), and Fluzone® Intradermal are inactivated injectable influenza virus vaccines manufactured by Sanofi-Pasteur. Presentations available this year include a multi-dose vial and a thimerosal-free single-dose syringe.

      Fluzone and Fluzone Pediatric are licensed for persons aged 6 months and older, Fluzone HD is licensed for persons aged 65 years and older and Fluzone Intradermal is licensed for persons aged 18 through 64 years. DoD only contracted for Fluzone and Fluzone Pediatric this season.



    2. What is Afluria®?
      Afluria® is an inactivated injectable influenza virus vaccine manufactured by CSL Biotherapies. The presentation available this year include a multi-dose vial. Afluria is licensed for persons aged 5 years and older; however, ACIP recommends Afluria be administered to children aged 9 years and older due to increased reports of febrile reactions in children 5 to 8 years of age. Afluria may be given, if no other age-appropriate, licensed seasonal influenza vaccine is available for children aged 5 through 8 years who are at high risk for influenza complications.

    3. Who should receive the injectable vaccines?

      ACIP recommends the use of injectable vaccines for immunization of persons described as eligible in manufacturer package inserts and for whom the live virus vaccine (FluMist®) is contraindicated.

      • Anyone who is at risk of complications from influenza, or more likely to require medical care.
      • Women who are or will be pregnant during influenza season.
      • Anyone with long-term health problems.
      • Anyone with a weakened immune system.
      • Anyone 6 months through 18 years of age on long-term aspirin treatment.
      • Residents of nursing homes and other chronic-care facilities.
      • Anyone who lives with or cares for people at high risk for influenza-related complications.
      • Household contacts and caregivers of children from birth up to 5 years of age and people 50 years and older.


    4. Who should not receive the injectable influenza vaccines?
      • People who have a severe allergy to chicken proteins, eggs, egg products, or any components of the influenza vaccine.
      • People who have had a severe reaction to an influenza vaccination in the past.
      • People who have a history of Guillain-Barré Syndrome.
      • People who are sick with a fever. These individuals may be immunized once their symptoms resolve.
      • Children younger than 6 months of age.


    5. What side effects can I expect when I receive the injectable influenza vaccine?
      The viruses in inactivated influenza vaccine have been killed so you cannot become infected with influenza. Side effects which may occur are: soreness, redness, or swelling at the vaccination site., l fever, weakness, headache, and muscle aches. If these problems occur, they usually begin soon after immunization and typically last for one or two days. Most people who receive influenza vaccine experience no serious problems. In rare instances, serious problems such as a severe allergic reaction can occur.

    6. What is Fluvirin®?
      Fluvirin® is an inactivated injectable influenza virus vaccine manufactured by Novartis. The presentation available this year include a thimerosal-free single-dose syringe. It is licensed for persons 4 years of age and older.

    7. What is Flucelvax®?
      Flucelvax® is a new cell-culture-derived, inactivated injectable influenza virus vaccine manufactured by Novartis. It is presented in a thimerosal-free single-dose syringe. It is licensed for persons 18 years of age and older.

    Live Attenuated Intranasal Vaccine (LAIV), Intranasal FluMist®

    1. Who should receive the live, attenuated intranasal vaccine?
      FluMist® is approved for all healthy people aged 2-49 years who are not pregnant. For more information, see http://www.vaccines.mil/flu.

    2. What side effects can I expect when I receive FluMist®?
      The viruses in the intranasal vaccine are weakened and do not cause severe symptoms associated with influenza. Common side effects may include runny nose, headache, fever, cough, and sore throat. Other possible side effects are chills, cough, decreased activity, decreased appetite, headache, irritability, muscle aches, and tiredness/weakness. For more information, see http://www.flumist.com.

    3. Who should not receive the live, attenuated intranasal vaccine?

      The following populations should not be immunized with the Live Attenuated Intranasal Vaccine:

      • People less than 2 years old or those 50 years old or older
      • People with asthma, reactive airways disease, or other chronic disorders of the pulmonary or cardiovascular systems
      • People with other underlying medical conditions, including such metabolic diseases as diabetes, cardiac/kidney/liver diseases, and blood disorders
      • People with known or suspected immunodeficiency diseases or who are receiving immunosuppressive therapies
      • Children or adolescents receiving aspirin therapy or other
      • People with a history of Guillain-Barré Syndrome
      • Pregnant women
      • People with a history of hypersensitivity, including anaphylaxis, to any of the components of LAIV or to eggs


    4. What is FluMist®?
      FluMist® is a quadrivalent, live, attenuated influenza virus vaccine manufactured by MedImmune. The only presentation is a thimerosal free single dose sprayer.