Let’s start with a quick review of the essentials. Influenza or the flu is a contagious respiratory illness caused by influenza viruses type A or B. In most people it causes mild to moderate symptoms lasting about 2 weeks and doesn’t require treatment or antiviral meds. But for some groups of people it can cause severe illness and even death.
You get the flu via droplet transmission. Droplets from the nose or mouth of an infected person are inhaled into the lungs of other people. You can get the flu by touching contaminated surfaces and then touching your mouth or nose. But the most common method is droplet transmission. Droplet transmission can occur as far as 6 feet away.
You can be infectious beginning 1 day before the onset of symptoms and be contagious continuously for 5-7 days after the onset o symptoms. Kids can be infectious longer than 7 days. Signs and symptoms usually begin in 1-4 days after exposure.
A great way to prevent the flu is washing your hands with soap and water. Use hand sanitizer only if soap and water are not available .
The best way to prevent the flu is vaccination. Everyone 6 months of age and older should get a flu vaccine every season. With rare exceptions.
2018-2019 strains included in the
Trivalent : A/Michigan/45/2015 (H1N1)pdm09–like virus, A/Singapore/INFIMH-16-0019/2016 (H3N2)–like virus and B/Colorado/06/2017–like virus (Victoria lineage).
Quadrivalent: All of the above and B/Phuket/3073/2013–like virus (Yamagata lineage).
Because of viral shifts, the flu strains mutate making it necessary to make changes in the vaccine every year.
Here’s the rare exception piece -life threatening egg allergies. The recommendations for vaccination of people with egg allergies were changed for 2018-2019 flu season.
People with a history of severe egg allergy who have experienced only hives after exposure to egg should receive flu vaccine. Any licensed and recommended flu vaccine (i.e., any form of IIV or RIV) that is otherwise appropriate for the recipient’s age and health status may be used. It doesn’t have to be egg free.
Persons who report having had severe reactions other than hives, such as angioedema, respiratory distress, or who required epinephrine or any other emergency medical intervention, may receive any licensed and recommended flu vaccines but it should be administered in an inpatient or outpatient medical setting where they can manage severe allergic reactions.
Egg allergy is very rare with only 1.3 % of all kids and 0.2% of all adults being affected. 25.1 million doses of vaccines had been given over a 3 year period with only 33 incidences of anaphylaxis.
GBS, Guilain Barre Syndrome, used to be a contraindication for flu vaccination. About 2/3 of people who develop GBS symptoms do so after they have been sick with diarrhea or a respiratory illness. Camphylobacter is one of the most common risk factors for GBS. People also can develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks after getting a vaccination. Now precautions to vaccination includes a recent history of GBS. They need to wait after 6 weeks of having recovered from GBS to get the flu vaccine.
- Standard dose
- High dose trivalent - > 65 yo
- Trivalent with adjuvant - > 65 (new this year)
• Standard dose
• Quadrivalent grown in cell culture 4 and older
• LAIV4 - live attenuated intranasal spray
• Egg free ccIIV4
• Recombinant formula RIV4
Back this year is Fluad (Seqirus), a trivalent, MF59-adjuvanted inactivated influenza vaccine, for people age 65 years and older. Fluad is an adjuvanted influenza vaccine. The adjuvant is a substance added to a vaccine to increase its immunogenicity.
Flucel vaccine (ccIIV4) quad is the only flu vaccine formula grown in cell cultures so it is egg free.
There is no intradermal vaccine available for 2018-2019.
FLU VACCINE BY AGE
Immunize everyone over 6 months every year with few exceptions.
LAIV, nasal spray is back this year nut no intradermal formulas are available.
Pediatric patients -6 mo to less than 9 yr old who have never received the seasonal influenza vaccine require 2 doses of influenza vaccine at least 4 wks apart.
Immunize pregnant women.
Get your own flu vaccine every year!
Use standing orders http://www.immunize.org/catg.d/p3074.pdf
Give VIS to everyone www.immunize.org/vis/vis_flu_inactive.asp
Use the VAERs to report reactions https://vaers.hhs.gov/
Egg allergy guidelines https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm
Best single quick reference. http://www.immunize.org/askexperts/experts_inf.asp
Best single comprehensive reverence.