for Prevention

Preventing Influenza in Los Angeles County: Time to Start Immunizing

September 2019

Kim Moore, RN, PHN, MSN, FNP-C
Melanie Barr, RN, MSN, CNS
Franklin D. Pratt, MD, MPHTM, FACEP

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  Keep your patients strong. Vaccinate. Fight Flu.
 

The Centers for Disease Control and Prevention (CDC) has released this season's influenza vaccine recommendations and health care providers are asked to begin immunizing now. This brief summarizes the key points from the CDC’s influenza season recommendations and provides additional information from the Los Angeles County Department of Public Health (DPH), including an update regarding the recently expanded Health Officer Order for Annual Influenza Vaccination or Masking of Health Care Personnel. Helpful resources, including links to immunization recommendations and educational materials, are also provided.

 

Time to Start Immunizing to Prevent Influenza

It is time for you, your staff, and your patients to get immunized to prevent influenza. Last season, influenza activity in LA County began to increase in early November with peak illness occurring between February and March. The recently published 2019-2020 Influenza Season Recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP) are summarized below.

 

Key Points from 2019-2020 ACIP Influenza Season Recommendations

  • Routine annual influenza immunization is recommended for all persons aged ≥6 months who do not have contraindications. See “Groups Recommended for Influenza Vaccination.” Emphasize vaccination of high-risk groups and their household contacts and caregivers.
  • Health care providers should ideally vaccinate patients before the end of October. Immunization efforts should continue throughout the season, however, vaccine administered in November or later can be beneficial. Children ≤8 years of age who require 2 doses should receive their first dose as soon as possible after the vaccine becomes available to allow the second dose (which must be administered ≥4 weeks later) to be received by the end of October.
  • Both trivalent and quadrivalent vaccines are available during the 2019–2020 season. All vaccines available to pediatric patients are quadrivalent. The vaccine composition for 2019–2020 represents updates in the influenza A(H1N1) pdm09 and influenza A(H3N2) components of the vaccine. See "Abbreviation Conventions for Vaccines.”
  • This season’s trivalent influenza vaccines contain hemagglutinin (HA) derived from:
    • A/Brisbane/02/2018 (H1N1)pdm09–like virus
    • A/Kansas/14/2017 (H3N2)–like virus
    • B/Colorado/06/2017–like virus (Victoria lineage)
  • Quadrivalent vaccines provide broader protection against influenza B viruses that are likely to circulate. Quadrivalent influenza vaccines this season will contain HA derived from the three viruses above plus from B/Phuket/3073/2013–like virus (Yamagata lineage), which is an additional influenza B vaccine virus.
  • 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.
  • One live attenuated influenza vaccine, FluMist® Quadrivalent (LAIV4), is expected to be available during the 2019–2020 influenza season. LAIV4 is licensed for persons aged 2 through 49 years but is contraindicated for several groups, including pregnant women. See "Contraindications and Precautions to Influenza Vaccine, 2019-2020 Season” for additional contraindications and precautions. Of note, the American Academy of Pediatrics states that both inactivated and live attenuated vaccine are options for children this year, with no preference.
  • Persons with a history of egg allergy may receive any licensed, recommended, and age-appropriate influenza vaccine. Additional information concerning vaccination of persons with egg allergies can be found in the ACIP recommendations under “Persons with a History of Egg Allergy.”

Key Vaccine Changes

ACIP notes that there were two recent product labeling changes to quadrivalent inactivated influenza vaccines.

  • Afluria® Quadrivalent may now be given to persons 6 months of age, instead of persons >5 years. The dose volume is 0.25 mL for children aged 6 through 35 months and 0.5 mL for all persons aged ≥36 months (≥3 years).
  • Fluzone® Quadrivalent: The dose volume for children aged 6 through 35 months, which was previously 0.25 mL, is now either 0.25 mL or 0.5 mL. The dose volume for Fluzone Quadrivalent is 0.5 mL for all persons aged ≥36 months (≥3 years).

 

Abbreviation Conventions for Vaccines

Primary influenza vaccine types include the following:

  • IIV = inactivated influenza vaccine
  • RIV = recombinant influenza vaccine
  • LAIV = live attenuated influenza vaccine

Numerals following letter abbreviations indicate the number of influenza virus hemagglutinin antigens represented in the vaccine:

  • 3 for trivalent vaccines: one A(H1N1), one A(H3N2), and one B virus
  • 4 for quadrivalent vaccines: one A(H1N1), one A(H3N2), and two B viruses

 

Additional Information from the LA County Department of Public Health

  • Patients are more likely to get vaccinated if the vaccine is strongly recommended by their health care provider. Health care providers should ensure that all persons at higher risk of severe illness are immunized and should use evidence-based practices, such as patient reminders and recall, to encourage vaccination. 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 Immunization Programs for Healthcare Personnel or Masking of Healthcare Personnel during the Influenza Season has been updated for the 2019-2020 influenza season and future influenza seasons to include emergency medical services (EMS) provider agencies. This expanded Order mandates that all acute care hospitals, skilled nursing facilities, EMS provider agencies, and intermediate care facilities in the LA County public health jurisdiction implement a program that requires health care personnel and other staff, including volunteers, be immunized against influenza or wear a protective mask while in contact with patients or working in patient-care areas. The order is in effect from November 1 through April 30 and can be extended if the influenza season has not yet ended. The order and supporting resources are posted on the LA County DPH Influenza Information for Providers website.
  • California law prohibits administering influenza vaccines that contain more than trace amounts of mercury (> 1 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 2019-2020 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
    • Adults and children 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 but not limited to immunosuppression caused by 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 (body mass index ≥40 for adults)
    • Caregivers and contacts of those at risk:
      • Health care personnel (all paid and unpaid persons) working in health-care settings who have the potential for exposure to patients and/or to infectious materials. These include, but are not limited to, physicians, nurses, nursing assistants, nurse practitioners, physician assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff, clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing, and volunteers.
      • Household contacts (including children) 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 (including children) 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, 2019-2020 Influenza Season

 

Contraindications and Precautions to Influenza Vaccine 2019-2020 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 to 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 to 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 [excluding 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 most IIVs and LAIV4. 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. Patients with reactions to egg involving symptoms other than urticaria (e.g., angioedema or swelling, respiratory distress, lightheadedness, or recurrent emesis) or who required epinephrine or another emergency medical intervention should be vaccinated 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.

Source: Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2019-2020 Influenza Season

 

Resources

Information for Health Care Professionals

Information for Patients

 

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Author Information:

Kim Moore, RN, PHN, MSN, FNP-C
Education Coordinator

Melanie Barr, RN, MSN, CNS    Director of Nursing

Franklin D. 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, 2019
September;9(3).


Published: September 23, 2019

 

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