Vaccine recommendations 2019/2020 influenza season

Question 1

Who should be vaccinated?

Answer 1

• All children 6 months of age or older
• Particular focus on high risk for influenza related complications and people at high risk of transmitting to those who are high risk (e.g. HCP)

Question 2

High risk of influenza-related complications or hospitalization?

Answer 2

• All children 6-59 months of age
• All children >/= 6 months of age, adolescents and adults with chronic health conditions, specifically:
• -Cardiac or pulmonary disorders (BPD, CF, asthma)
• -DM and othe rmetabolic
• -Cancer, other immune compromising conditions (including therapy)
• -Renal disease
• -Anemia or hemoglobinopathy
• -Neurological or neurodevelopmental conditonis *(includes febrile seizures and isolated developmental delay, excludes mgirainies and neuropsych without neuroabnormalities)
• -Morbid obesity (BMI >/=40kg/m2)
• -6 months to 18 years undergoinig prolonged treatment with ASA, because of potential for Reye’s syndrome
• Indigenous peoples
• All residents of chronic care facilities
• All pregnant women/adolescents, in all trimesters
• All adults >/=65 years of age

Question 3

People capable of transmitting influenza t individuals at high risk?

Answer 3

• Household contacts of individuals at high risk, regardless of whether at risk person immunized
• Household contacts of infants <6 months of age (too young to receive vaccine)
• Members of household expecting to birth, adopt or foster a newborn during influenza season
• Individuals providing regular child care to children <59 months of age, regardless of whether in or out of the home
• Health care and other care providers in facilities and community settings who, through their activities are capable of transmitting influenza to those at high risk
• Others who provide services to individuals at high risk in closed or relatively confined settings (e.g. camps, cruise ships)

Question 4

Who else is influenza vaccination particularly recommended for?

Answer 4

• People who provide essential community services

- People in direct contact during culling operations with poultry infected with avian influenza

Question 5

Why vaccinate annually?

Answer 5

-Although some vaccinated individuals retain immunity from one season to the next, it is less likely when the predominant circulating strain changes; therefore annual revaccination is recommended

Question 6

NACI recommends preferential use of ______ vaccines for children and adolescents because influenza __ causes more morbidity and mortality in children than in adults.

Answer 6

Quadrivalent, B

Question 7

An adjuvanted IIV3 (trivalent) is available for children 6-23 months of age and may be used when ______.

Answer 7

II4 is not available

Question 8

While adjuvants are designed to __________, there is insufficient evidence at the present time to make a preferential recommendation for adjuvanted or unadjuvanted IIV.

Answer 8

enhance vaccine immunogenicity

Question 9

Most common side effects of live attenuated influenza vaccine (LAIV)?

Answer 9

Nasal congestion and rhinorrhea

Question 10

In NACI statements up to 2015/2016, ____ was preferred over ___ for children because early studies had shown ____ to have greater efficacy than ___. However, more recent studies have not consistently shown ____ to provide better protection than ___.

Answer 10

LAIV, IIV, LAIV, IIIV

LAIV, IIV

Question 11

For 2019/2020, with evidence of effectiveness of ____ against influenza A H1N1 for the 2018/2019 season in the UK, AAP also recommends that _____ be used.

Answer 11

LAIV

LAIV or IIV

Question 12

NACI has conducted ongoing review of all available data on LAIV effectiveness since concern about effectiveness int he US arose. It concluded ________________.

Answer 12

The evidence suggests LAIV provides comparable protection against influenza to that of IIV in sever jurisdictions, including Canada, and has continued to recommend LAIV as an option, if available.

Question 13

For maximum benefit, when should influenza vaccine be given?

Answer 13

As soon as it is available, before the onset of influenza season

Question 14

Contraindications to influenza vaccine?

Answer 14

• Anaphylactic reaction to a previous dose of influenza vaccine or to any of the components of the vaccine EXCEPT EGG
• Onset of Guillain-Barre syndrome within 6 weeks of influenza vaccination WITHOUT other known cause

Question 15

Like all other vaccines, influenza vaccine should be given _____________.

Answer 15

In a setting where anaphylaxis can be managed

Question 16

Contraindications to LAIV?

Answer 16

• Individuals with immunocompromising conditions
• Severe asthma - defined as current active wheezing or currently on oral OR high-dose inhaled glucocorticosteroids, or medically attended wheeze within the previous 7 days)
• Pregnancy (not studied, theoretical risk to fetus)
• 2-17 years on chronic ASA-containing therapy (Reye’s syndrome)
• (<2 years not authorized because of small, but significant, increased rate of wheezing 2-4 weeks following vaccination)

Question 17

LAIV should not be administered until ___ after antiviral agents active against influenza have been discontinued.

Answer 17

48h

Question 18

As a precaution, it is recommended that contact witth _______ (e.g._______) be avoided for _____ following receipt of LAIV.

Answer 18

Severely immunocompromised patients (e.g. recent HSCT still in hospital)
2 weeks

Question 19

Dose?

Answer 19

• IIV 0.5ml IM, regardless of age
• IIV3-Adj 0.25ml IM
• LAIV4 0.2ml (0.1ml each nostril)

Question 20

The first year that a child ____ years of age receives influenza vaccine (either IIV or LAIV) __ doses at least ____ apart are required.

Answer 20

<9
2
4 weeks