Preventing Influenza in Los Angeles County: Time to Start Vaccinating

September-October 2018

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  Keep your patients strong. Vaccinate. Fight Flu.
 

The Centers for Disease Control and Prevention (CDC) has released this season's flu vaccine recommendations and health care providers are asked to begin vaccinating now. This brief summarizes key recommendations for flu vaccination in Los Angeles County, including the Health Officer Order for annual influenza vaccination or masking of health care personnel. Helpful resources including links to vaccination recommendations and educational materials are also provided.

 

It’s Time to Start Vaccinating against Influenza

It is time for you, your staff, and your patients to get vaccinated to prevent influenza. Last year, seasonal influenza activity in Los Angeles County began in mid-September when almost 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 CDC’s Advisory Committee on Immunization Practices (ACIP) recently published the 2018-19 Influenza Season Recommendations, which are summarized below.

 

Key Points from 2018-2019 ACIP Influenza Season Recommendations

  • 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.

  • Both trivalent and quadrivalent vaccines will be available during the 2018–2019 season. The quadrivalent vaccine provides broader protection against influenza B viruses that are likely to circulate and all injectable vaccines contain a new H3N2 virus; however, ACIP states no preference of one vaccine over the other.

  • FluMist Quadrivalent (live attenuated influenza vaccine; LAIV4) is one of the several options this flu season. LAIV4 was not recommended the previous two seasons due to its poor effectiveness against the H1N1 pandemic virus in children. This year, LAIV4 contains a new H1N1 A/Slovenia virus. Because the effectiveness of this new LAIV is unproven, the American Academy of Pediatrics is continuing to recommend the inactivated influenza vaccine (IIV) over the live version for children and adolescents. However, ACIP has not expressed a preference for any influenza vaccine product.

    LAIV4 is licensed for persons 2 through 49 years of age but is contraindicated for several groups, including pregnant women. See “Contraindications and Precautions to Influenza Vaccine, 2018-2019 Influenza Season” for additional contraindications and precautions.

  • Persons with a history of egg allergy may receive any licensed, recommended, and age-appropriate influenza vaccine (i.e., inactivated influenza vaccine, recombinant influenza vaccine, or LAIV4). Additional information concerning vaccination of persons with egg allergies can be found in the new ACIP recommendations.

  • Alfluria Quadrivalent (inactivated influenza vaccine; IIV4) may now be given to persons 5 years of age and older, instead of persons aged 18 years and older.

  • Fluarix Quadrivalent (IIV4) may now be administered to all patients aged 6 months of age and older, instead of those aged 3 years and older.

  • ACIP notes that the high-dose trivalent vaccine (HD-IIV3) 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.

  • 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 most influenza seasons, even if influenza activity has already begun.

Abbreviations: High-Dose Trivalent Vaccine (HD-IIV3), Inactivated Influenza Vaccine (IIV), Live Attenuated Influenza Vaccine (LAIV4), and Recombinant Influenza Vaccine (RIV)

 

Additional Information from LA County Department of Public Health

  • Health care providers should be particularly diligent in ensuring that all persons at higher risk of severe illness receive vaccine and providers are encouraged to use evidence-based practices such as patient reminders and recall to do so. Patients are more likely to get vaccinated if the vaccine is strongly recommended by their health care provider. Please see the "Resources" section for information regarding evidenced-based strategies for increasing vaccination rates in children and adults.

  • The LA County “Health Officer Order for Annual Influenza Vaccination Programs for Healthcare Personnel or Masking of Health Care Workers during the Influenza Season” remains in effect for the 2018-2019 Influenza Season. This order mandates that all health care personnel and other staff, including volunteers, in acute care hospitals, skilled nursing facilities, and intermediate care facilities in LA County be vaccinated against influenza or wear a protective mask while in contact with patients or working in patient-care areas, from November 1 through April 30 or longer if the influenza season has not yet ended. The 2018 order and related resources can be accessed on the Los Angeles County Department of Public Health (DPH) Influenza Information for Providers website.

  • California law prohibits administering influenza vaccines that contain more than trace amounts of mercury (> 0.5 µg per 0.5 ml) to children less than 3 years of age and pregnant women. Because thimerosal contains mercury, influenza vaccines contained in multi-dose vials should not be used to vaccinate pregnant women and children less than 3 years of age.

  • Throughout the influenza season, DPH issues a biweekly surveillance report with influenza and related disease updates for LA County. To view the report, visit the Influenza Watch website or subscribe to the listserv.

  • Providers are encouraged to contact the DPH Vaccine Preventable Disease Control Program at 213-351-7800 with any questions.

 

Groups Recommended for Influenza Vaccination
2018-2019 Advisory Committee on Immunization Practices Recommendations

Download a printable version of recommendations and contraindications.

  • Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. 
  • Emphasis should be placed on vaccination of the following high-risk groups and their contacts and caregivers (no hierarchy is implied by order of listing):
    • Children aged 6 through 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)
    • 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 of age) and adults aged ≥50 years, particularly contacts of children aged <6 months
      • Household contacts and caregivers of persons who are in one of the high-risk categories listed.

 

Source: Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2018-2019 Influenza Season 

 

Contraindications and Precautions to Influenza Vaccine
2018-2019 Advisory Committee on Immunization Practices Recommendations

Download a printable version of recommendations and contraindications.

Vaccine Type

Contraindications

Precautions

Inactivated Influenza Vaccine (IIV)

  •  History of severe allergic reaction to any component of the vaccine† or after a previous dose of any influenza vaccine
  • Moderate or severe acute illness with or without fever

  • History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine

Recombinant Influenza Vaccine (RIV)

  • History of severe allergic reaction to any component of the vaccine
  • Moderate or severe acute illness with or without fever

  • History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine

Live Attenuated Influenza Vaccine (LAIV)

  • History of severe allergic reaction to any component of the vaccine† or after a previous dose of any influenza vaccine

  • Concomitant aspirin- or salicylate-containing therapy in children and adolescents

  • Children aged 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a health care provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode has occurred during the preceding 12 months

  • Children and adults who are immunocompromised due to any cause (including immunosuppression caused by medications or by HIV infection)

  • Close contacts and caregivers of severely immunosuppressed persons who require a protected environment

  • Pregnancy

  • Receipt of influenza antiviral medication within the previous 48 hours
  • Moderate or severe acute illness with or without fever

  • History of Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine.

  • Asthma in persons aged >5 years

  • Other underlying medical conditions that might predispose to complications after wild-type influenza infection (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])
 

History of severe allergic reaction (e.g., anaphylaxis) to egg is a labeled contraindication to the use of IIV and LAIV. However, ACIP recommends that any licensed, recommended, and age-appropriate influenza vaccine (IIV, RIV, or LAIV) may be administered to persons with egg allergy of any severity.

Source: Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2018-2019 Influenza Season

 

Resources

Information for Health Care Professionals

Information for Patients

 

 

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Author Information:

Melanie Barr, RN, MSN, CNS    Director of Nursing

Franklin Pratt, MD, MPHTM, FACEP
Medical Director

Vaccine Preventable Disease  Program

County of Los Angeles
Department of Public Health

fpratt@ph.lacounty.gov

mbarr@ph.lacounty.gov

www.publichealth.lacounty.gov/ip


Rx for Prevention, 2018
September-October;8(5).


Published: September 13, 2018