for Prevention

Influenza: Time to Start Vaccinating

Melanie Barr, RN, MSN, CNS

Franklin D Pratt, MD, MPHTM, FACEP

September-October 2017

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  Keep your patients strong. Vaccinate. Fight Flu.

Seasonal influenza activity in Los Angeles County began in mid-September this year when 3% of respiratory specimens from sentinel surveillance sites tested positive for influenza. Peak illness generally occurs between December and February, and disease may continue through March or later. The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) recently published the 2017–18 Influenza Season Recommendations.

This brief serves as a reminder to health care providers that it is time to start vaccinating patients and for you and your staff to get vaccinated to prevent influenza.



Key points from the ACIP 2017–18 Influenza Season Recommendations:

  • Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Particular emphasis should be placed on vaccination of high-risk groups and their contacts and caregivers (see box Groups Recommended for Vaccination).
  • Both trivalent and quadrivalent vaccines will be available during the 2017–18 season. The quadrivalent vaccine provides broader protection against influenza B viruses that are likely to circulate; however, the ACIP states no preference of one vaccine over the other. 


  • The ACIP notes that the high-dose trivalent vaccine might provide better protection for patients aged 65 years and older. However, any age appropriate formulation is an acceptable option and opportunities for vaccination should not be missed if only the standard dose formulation is available. 
  • The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2017-2018 given its low effectiveness against (H1N1)pdm09 viruses in 2013–14 and 2015–16.


  • Health care providers should ideally vaccinate patients before the end of October. However, vaccination efforts should continue throughout the season as vaccine administered in November or later is likely to be beneficial in the majority of influenza seasons, even if influenza activity has already begun.


Additional points from LA County Department of Public Health (DPH) Immunization Program:

  • Health care providers should be particularly diligent in ensuring that all persons at higher risk of severe illness receive vaccine and are encouraged to use evidence-based practices such as reminder-recall systems to do so.


  • The LA County “Health Officer Order for Annual Influenza Vaccination Programs for Healthcare Personnel or Masking of Health Care Workers during the Influenza season” (Order) remains in effect for the 2017-2018 Influenza Season. This Order mandates that all health care personnel and other staff, including volunteers, in acute care hospitals, long term care facilities, and intermediate care facilities in LA County be vaccinated against influenza or wear a protective mask from November 1 through March 31 or longer if the influenza season has not yet ended. The 2017 continuation of the Order and related resources can be accessed on the DPH Influenza Information for Providers website.
  • The State of California requires that children <3 years of age and pregnant women, be immunized with vaccines containing restricted amounts of thimerosal, a preservative in some vaccines. Therefore, vaccines contained in multi-dose vials should not be used to vaccinate pregnant women & children less than 3 years of age.


  • Providers are encouraged to contact the DPH Immunization Program (213-351-7800) with any questions.



Centers for Disease Control and Prevention

LA County Department of Public Health

California Vaccines for Children Program

Groups Recommended for Influenza Vaccination 2017-18, ACIP

  • Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. 
  • Emphasis should be placed on vaccination of high-risk groups and their contacts and caregivers (no hierarchy is implied by order of listing):
    • Children aged 6-59 months;
    • Adults aged ≥50 years;
    • Persons with chronic pulmonary (including asthma), cardiovascular (except isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus);
    • Persons who are immunocompromised due to any cause, (including medications or HIV infection);
    • Women who are or will be pregnant during the influenza season;
    • Children and adolescents (aged 6 months through 18 years) receiving aspirin- or salicylate-containing medications and who might be at risk for Reye syndrome;
    • Residents of nursing homes and other long-term care facilities;
    • American Indians/Alaska Natives;
    • Persons who are extremely obese (BMI ≥40); and
    • Caregivers and contacts of those at risk:
      • Health care personnel in inpatient and outpatient care settings, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients;
      • Household contacts and caregivers of children aged ≤59 months (i.e., <5 years), particularly contacts of children aged <6 months, and adults aged ≥50 years; and
      • Household contacts and caregivers of persons who are in one of the high-risk categories listed.




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Author Information:

Melanie Barr, RN, MSN, CNS    Director of Nursing

Franklin Pratt, MD, MPHTM, FACEP
Medical Director

Immunization Program

County of Los Angeles
Department of Public Health

Rx for Prevention, 2017

Published: September 22, 2017


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