Ask the Experts - Immunization Action Coalition

1 Ask the When should influenza vaccine be given? You can begin administering vaccine as soon as it of at least two doses of trivalent or quadrivalent influenza vaccine before July 1, 2017, or 3) if their Experts becomes available. Optimally, vaccination should occur before onset of influenza activity in the com- munity. Healthcare providers should offer vaccina- vaccination history is unknown. The two doses need not have been received during the same season or consecutive seasons. IAC's handout titled Guide The Immunization Action Coalition extends thanks tion by the end of October, if possible, and vaccina- for Determining the Number of Doses of Influenza to our Experts , medical officers Andrew T.

2 Kroger, tion activity should continue through the fall and Vaccine to Give to Children Ages 6 Months MD, MPH; Candice L. Robinson, MD, MPH; winter months, as long as influenza virus is circu- Through 8 Years provides guidance on this issue; it Raymond A. Strikas, MD, MPH, FACP, FIDSA; lating in the community. Early vaccination of is available at and nurse educators Donna L. Weaver, RN, MN, children younger than age 9 years who need 2 doses and JoEllen Wolicki, BSN, RN, all with the National of vaccine can be helpful in assuring routine second Can a child 6 through 35 months of age who Center for Immunization and Respiratory Diseases doses are given before the influenza season begins.

3 Needs 2 doses of influenza vaccine this season receive one each of Fluzone and FluLaval at the Centers for Disease Control and Prevention When administering influenza vaccine, vaccine? (CDC). is giving patients a VIS mandatory or Yes. Both Fluzone ( mL dose) and FluLaval is it only recommended ? ( mL dose) are approved by the FDA for use in Influenza vaccines Giving patients an influenza Vaccine Information children 6 through 35 months of age. Statement (VIS) is mandatory under the National What's new in the 2017 18 influenza vaccine Childhood Vaccine Injury Act of 1986.

4 The VIS If a child receives Fluzone vaccine ( mL). recommendations? must be given to all adults as well as to parents or at age 34 or 35 months for the first time and The 2017 18 ACIP influenza vaccine recommen- guardians of children prior to vaccination. Two then returns for the second dose at age 37. dations were published on August 25, 2017, and are VISs are available, one for LAIV (although LAIV months, should we give another mL dose available online at is not recommended to be used during the 2017 18 of Fluzone or should we give the mL dose 66/rr/ The new guidance season) and one for inactivated influenza vaccine that is indicated for age 3 and older?

5 Describes the vaccine composition for this season (IIV). Each can be found at The child should always receive the dose appropri- (a change in the A/H1N1 component); vis along with many translations. The influenza ate for his or her age at the time of the clinic visit;. Discusses recent FDA licensure and labelling VIS has been modified so that it does not need to at age 37 months that would be mL. changes including be replaced each year. The 2015 16 influenza VIS. approval of Afluria Quadrivalent (Seqirus) and A 1-year-old was inadvertently given a (used for the past two years) should be used during Flublok Quadrivalent (Protein Sciences); mL dose of FluLaval rather than the recom- the 2017 18 season.

6 Expansion of the age indication for FluLaval mended mL dose. What should we do? Quadrivalent (GSK) to age 6 months and older Which influenza vaccines can we give to If the error is discovered while the child is still in (previously licensed for people 3 years and children? the office, you can administer the other half of older); Among the injectable inactivated influenza vac- the FluLaval dose. If the error is discovered later, expansion of the age indication for Afluria cines, both Fluzone (Sanofi Pasteur) and FluLaval the dose should not be counted, and then the child (Seqirus) to include persons 5 years and older are approved by the FDA for use in children ages should be recalled to the office and given a full (previously recommended for persons 9 years 6 through 35 months.)

7 There are several inactivated age-appropriate repeat dose, either a mL dose and older); and influenza vaccines that can be given to children age of FluLaval or a mL dose of Fluzone. Recommends that live attenuated influenza vac- 3 years or older. Is influenza vaccine recommended cine (LAIV, FluMist; AstraZeneca) not be used Please provide details about the use for pregnant women? during the 2017 18 season. of FluLaval influenza vaccine in children Yes. It is especially important to vaccinate pregnant Which influenza vaccines will be available younger than 3 years.

8 Women because of their increased risk for influ- during the 2017 18 influenza season? On November 18, 2016, the FDA approved an enza-related complications. An increased risk of Multiple manufacturers are producing influenza extension of the age range of quadrivalent FluLaval severe influenza infection was also observed in vaccine for the market for the 2017 18 season. IIV to include children 6 through 35 months of age. postpartum women (those who delivered within Inactivated vaccines will be produced using egg- FluLaval was previously approved for people 3 the previous 2 weeks) during the 2009 10 H1N1.

9 Based, cell culture based, and recombinant tech- years of age and older. The approval of the extended pandemic. Vaccination can occur in any trimester, nologies. Some of the inactivated influenza vac- age range for FluLaval was based on a study show- including the first. Only inactivated vaccine should cines will be quadrivalent (containing four strains ing an equivalent ( non-inferior ) response com- be given to pregnant women. of influenza virus) rather than trivalent (three pared to children who received the Fluzone pediatric I heard that a recent study suggested strains).

10 LAIV may be available but is not recom- dosage. The vaccine is supplied for this indication an increase in miscarriage among women mended for use during the 2017 18 season. A in manufacturer-filled syringes and multi-dose who received inactivated influenza vaccine. complete listing of influenza vaccine products is vials. The dosage approved for children 6 through Please provide details. available from the Immunization Action Coalition 35 months of age is mL the same dosage as A CDC-funded study found that women who had (IAC) at for people 3 years of age and older.