Emphasize Influenza Immunization for 2018-19

Last year's severe flu season will ramp up interest in influenza vaccines for 2018-2019.

Timing. Vaccinate now...and continue as long as flu is circulating.

Point out that flu season can start as early as October...and it takes about two weeks for antibodies to develop after vaccination.

Vaccine options. Emphasize that it's more important to be vaccinated...rather than worry about which flu vaccine to get.

Over 80% of this year's vaccine supply will be quadrivalent...with one more B flu strain than trivalent. Quadrivalent vaccines might increase protection...depending on which strains circulate this year.

CDC didn't recommend FluMist Quadrivalent intranasal vaccine the last two flu seasons...but this year it does. Early data suggest FluMist may work better now than in recent years. Consider FluMist an option when healthy, NONpregnant patients ages 2 through 49 refuse an injection.

But keep in mind, the Am Acad of Pediatrics still prefers injectable flu vaccine due to a more consistent track record of effectiveness.

Help patients ages 65 and older compare Fluzone High-Dose and Fluad. Both are trivalent vaccines intended to boost immunity...Fluzone High-Dose has 4 times more antigen than the standard dose and Fluad has an adjuvant.

Fluzone High-Dose seems to prevent more flu in elderly patients versus standard-dose trivalent. But the jury's still out on how Fluzone High-Dose or Fluad stack up against each other...or quadrivalent vaccines.

Explain both Fluzone High-Dose and Fluad may cause more injection site reactions than standard vaccines. All are covered by Medicare B.

Co-administration. Feel comfortable giving flu vaccine at the same time as other vaccines...pneumococcal, Tdap, Shingrix, etc.

There are theoretical concerns about more side effects if Shingrix and Fluad are given at the same time...since they both have adjuvants.

Don't delay vaccination. But consider a flu vaccine other than Fluad if one is available and you're giving Shingrix at the same visit.

Listen to PL Voices for insights from guideline authors. And use our chart, Flu Vaccines for 2018-19, to find approved ages, details on handling an egg allergy, and the role of Flublok.

Key References

  • MMWR Recomm Rep 2018;67(3):1-20
  • Pediatrics Published online Sep 3, 2018; doi:10.1542/peds.2018-2367
  • MMWR Morb Mortal Wkly Rep 2018;67(22):643-5
  • N Engl J Med 2014;371(7):635-45
Pharmacist's Letter. Oct 2018, No. 341001

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