FAQ for Healthcare Providers about Flu
New for 2014 – 2015 flu season
 Live attenuated influenza vaccine (LAIV) or Flumist© is preferred in healthy
children 2 through 8 years of age
o Do not differ vaccination in this group if the LAIV is not available
When is it appropriate to start administering seasonal influenza vaccine?
 The Centers for Disease Control recommends that healthcare providers start
administering seasonal influenza vaccine as soon as it is available
 It takes 2 to 4 weeks for a person’s body to mount a full immune response to the
vaccine
How long does immunity from the influenza vaccine last?
 It is thought to persist for one year or less because of waning antibody titers and
because of changes in the circulating influenza virus from year to year
 There is no evidence for late-season outbreaks among vaccinated persons that
can be attributed to waning immunity
Can you get the flu from the flu shot?
 No, the flu shot and mist do NOT cause the flu
 Less than 1% of patients who are vaccinated will develop flu-like symptoms
 The influenza vaccine is not 100% effective, especially in older patients
 The seasonal influenza vaccine only protects against the 3 types of flu that are
predicted to circulate for that year
 This year’s vaccine contains:
o H1N1
o H3N2
o Type B (from the B / Massachusetts)
o Only in quadrivalent formulations: type B (from the B / Bisbane)
Can multiple vaccines be given at the same time as the flu shot?
 Yes, there are no restriction on how many immunizations can be given on the
same day
 Zoster, flu, pneumonia, and Tdap can all be given on the same day
o Injection sites need to be separated by one inch
 The only vaccines providers need to space out by 4 weeks are live vaccines (i.e.
zoster, MMR, yellow fever, etc)
o Can be given the same day (within 24 hours) or spaced out by 4 weeks
Adapted from http://www.immunize.org/askexperts/experts_inf.asp on August 29, 2012. We thank the
Immunization Action Coalition
The package insert (PI) for Zostavax© advises providers to not give the
pneumonia vaccine and shingles vaccine at the same time and to space them out
by 4 weeks?
 The PI for Zostavax© does in fact state the above, but the Advisory Committee
on Immunization Practices (ACIP) to the Centers for Disease Control recommend
that they be given on the same day
 Reasoning behind this is that the study quoted in the PI found a decrease in
antibody titers to shingles, however this does not necessarily correlate with a
decrease in efficacy
o Efficacy for the shingles vaccine was established by showing a decrease
incidence in shingles, not measured antibody titers
 Also, how many patients are going to remember in 4 weeks to come back to the
pharmacy and get another vaccination?
Are healthcare providers required to give the patient a Vaccine Information
Statement (VIS)?
 Since January 1, 2006 the VIS is required to be given to the patient or guardian
per the National Vaccine Injury Compensation Program
 Current copies of all VIS’s in multiple languages can be found online at
www.immunize.org/vis
 The date of the VIS version must be printed on the consent form
What is the recommended interval for receiving influenza vaccine after an allergy
injection?
 Vaccines can be administered at any time before or after administration of an
“allergy injection”
Can a patient who received blood products or IVIG get the flu vaccine?
 Yes, but only receive an inactivated influenza vaccine
Can pregnant women receive a flu shot at the pharmacy?
 Yes, as long as they are not excluded in your protocol (i.e. must explicitly state in
your protocol that you cannot administer vaccinations to a pregnant patient)
 Pregnant women are at increased risk for influenza-related complications as well
as postpartum women
 Vaccination can be given in any trimester
Adapted from http://www.immunize.org/askexperts/experts_inf.asp on August 29, 2012. We thank the
Immunization Action Coalition
Is the influenza vaccine safe to administer to patients with multiple sclerosis
(MS)?
 MS is NOT a contraindication for any vaccine including influenza and
pneumococcal
 These patients should only receive inactivated influenza vaccine
Contraindications to the influenza vaccine
 Patients who have experienced a severe allergic reaction to a previous dose of
influenza vaccine or vaccine component
 History of Guillain-Barre syndrome occurring within 6 weeks of previous influenza
vaccination
 In patients who have moderate or severe acute illness should be deferred until it
improves
o This does not include patients will a cold or low-grade fever
o Do NOT defer vaccinating patients on antibiotics
What is the best way to screen patients for potential egg allergy in a busy
pharmacy?
 People who can eat eggs without reaction are unlikely to have an egg allergy
 Ability to eat eggs in baked products may be misinterpreted as egg tolerance
What length needle should be used to administer the influenza vaccine?
 Generally, intramuscular injections should be administered with a 1” needle in
adults
 Some experts feel that a shorter needle can be used in adults less than 132 lbs
only if given over the deltoid and only if the skin is stretched tight and given at a
90 degree angle
What immunizations must be reported to the state immunization registry?
 At this time, only immunizations given to patients 21 years of age and younger
are required to be reported to the registry
 It is recommended to report all immunizations of all ages to the registry
 For more information about the Arkansas Immunization Information System or
WebIZ, go to http://www.arrx.org/arkansas-immunization-registry--webiz
What influenza vaccine is safe for children?
Go to http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm (Table 1) to see
approved vaccines and age indications for 2014 – 2015 flu vaccine
Adapted from http://www.immunize.org/askexperts/experts_inf.asp on August 29, 2012. We thank the
Immunization Action Coalition
Has ACIP recommended the use of high-dose and intradermal influenza
vaccines?
 High dose
o Only approved for patients 65 years of age and older
o This vaccine is as efficacious as the regular flu shot
o Elicits a higher antibody response, but there are no studies to show that this
means more protection
o ACIP has no preference for any formulation of the flu vaccine
 Intradermal
o Only approved for patients 18 to 64 years old
o Uses a micro-injector given over the deltoid muscle
Once a dose has been drawn out of a vial of vaccine, does the remaining vaccine
need to be discarded before the expiration date?
 No, as long as the remaining vaccine in the vial is stored at the appropriate
temperature, it is good until the expiration date
Is it okay to draw up vaccine into syringes at the beginning of the day or before a
large clinic?
 CDC discourages this practice due to:
o Increased possibility of administration and dosing errors
o Risk of inappropriate storage
o Probability of bacterial contamination
o Reduction of vaccine potency overtime because of its interaction with the
plastic syringe components
 Although this practice is discouraged, a limited amount may be pre-drawn prior to
a mass-immunization clinic if:
o Only a single type of vaccine is administered
o It is drawn up upon arrival to the clinic setting
o Pre-drawn syringes are stored at temperature appropriate for vaccine
o No more than 1 vial or 10 doses drawn into syringes
o At the end of the clinic, all unused, pre-drawn doses are discarded
Adapted from http://www.immunize.org/askexperts/experts_inf.asp on August 29, 2012. We thank the
Immunization Action Coalition