Adult Immunization 2010 Influenza Segment This material is in the public domain This information is valid as of May 25, 2010

Impact of Influenza Approximately 36,000 influenza- associated deaths during each influenza season Persons 65 years of age and older accounted for more than 90% of deaths The number of deaths and cost to society from influenza is likely to increase as the nation’s population ages MMWR 2009;58 (RR-8)

Influenza Virus Strains Type A –moderate to severe illness –affects all age groups –affects humans and other animals (particularly migratory waterfowl) Type B –milder disease –primarily affects children –humans only

Influenza Virus A/Fujian/411/2002 (H3N2) Neuraminidase Hemagglutinin Type of nuclear material Virus type Geographic origin Strain number Year of isolation Virus subtype

Influenza A (H1N1) A previously unknown strain of H1N1 influenza virus appeared in April 2009 Many outbreaks in April and May Pandemic declaration in June Second wave of illness occurred in the fall and winter of 2009

Impact of Pandemic H1N1 Virus – United States, April 2009-March million infections 270,000 hospitalizations 13,000 deaths

Influenza Vaccines Live attenuated vaccine (LAIV) –intranasal –Approved only for persons 2 through 49 years of age who are healthy and not pregnant Inactivated subunit (TIV) –intramuscular –split virus or purified surface antigen MMWR 2009;58(RR-8)

Fluzone HD Vaccine (sanofi pasteur) Contains 4 times the amount of hemagglutinin than in regular Fluzone TIV Approved by the FDA only for persons 65 years and older ACIP has not stated a preference for Fluzone HD or other TIV brand among persons 65 years and older MMWR 2010;59 (in press)

Influenza Vaccines Trivalent (H3N2, H1N1, B) Efficacy varies Duration of immunity 1 year or less for TIV Duration of immunity at least 1 year for LAIV MMWR 2009;58(RR-8)

Inactivated Influenza Vaccine (TIV) Efficacy 70%-90% effective among healthy persons <65 years of age 30%-40% effective among persons 65 years and older with underlying medical conditions Prevents complications and death from influenza among those who get the disease MMWR 2009;58(RR-8)

Influenza Vaccination Recommendation Annual influenza vaccination is recommended for every person in the United States 6 months of age and older Make a special effort to vaccinate persons at increased risk of complications of influenza and their close contacts –persons with underlying medical illnesses –persons 65 years of age and older –pregnant women –children younger than 2 years of age MMWR 2010;59 (in press)

Inactivated Influenza Vaccine Recommendations Medical conditions that increase the risk of complications of influenza –Pulmonary –Cardiovascular –Metabolic –Renal dysfunction –Hemoglobinopathy –Immunosuppression –any condition that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration MMWR 2009;58(RR-8)

Pregnancy and Influenza Vaccine Excess deaths from influenza among pregnant women were documented during the pandemics of and Pregnant women were at increased risk of complications of influenza during the 2009 H1N1 influenza pandemic ACIP recommends vaccination with inactivated influenza vaccine for ALL women who will be pregnant during influenza season –inactivated vaccine only –LAIV contraindicated for pregnant women MMWR 2009;58(RR-8)

Inactivated Influenza Vaccine Contraindications and Precautions Severe allergic reaction to a vaccine component or following a prior dose Moderate or severe acute illness History of Guillain-Barre´ syndrome within 6 weeks following a previous dose of influenza vaccine MMWR 2006;55(RR-3)

Live Attenuated Influenza Vaccine Contraindications and Precautions Severe allergic reaction to a vaccine component or following a prior dose Underlying medical conditions Immunosuppression Pregnancy History of Guillain-Barre´ syndrome within 6 weeks following a previous dose of influenza vaccine Moderate or severe acute illness MMWR 2006;55(RR-3)

TIV Adverse Reactions Local reactions 15%-20% (pain, redness) Systemic reactions uncommon (fever, malaise) Severe allergic Rare reactions Neurological reactions Very rare MMWR 2006;55(RR-3)

LAIV Adverse Reactions Increased rate of cough, coryza, nasal congestion, sore throat, chills No increase in fever No serious adverse reactions have been identified MMWR 2006;55(RR-3)

Administration of LAIV Severely immunosuppressed persons should not administer LAIV Persons who have a contraindication to receipt of LAIV may administer LAIV Gloves and masks are not required MMWR 2006;55(RR-3)

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