The 2013 flu season is upon us. While there is direct positive impact of influenza vaccination on infection rate, there may also be indirect mortality benefits such as improving cardiovascular mortality based on a meta-analysis published in the most recent issue of the Journal of the American Medical Association.
Nevertheless, vaccination rates remain low with less than 50 percent of those younger than 65 years old receiving the vaccine during the 2012-2013 flu season. While individuals older than 65 years old have higher rates of adoption at around 66 percent. Dr. Kathleen Neuzil of University of Washington's Department of Global Health points out in a recent editorial that vaccination recommendations from physicians is a strong predictor of vaccine adoption by patients. Dr. Neuzil also highlighted the relative vaccine effectiveness rate of 56 percent in preventing medically attended influenza infections, which does not reflect milder infections that do not come under medical attention. Hence, increasing vaccine adoption may do more to reduce influenza associated morbidity than increasing vaccine efficacy.
So as you gird up your loins to become a flu vaccine evangelist, here is quick refresher on the updated recommendations.
- Inactive trivalent standard dose
- Inactive trivalent standard dose, egg free
- Inactive trivalent high dose
- Inactive quadrivalent standard dose
- Recombinant trivalent (for 18 to 49 year-olds only)
- Live attenuated quadrivalent (for healthy, non-pregnant, 2 to 49 year-olds only)
Who should be vaccinated:
- Everyone >6 months old
- High risk individuals*
- Healthcare providers and household contacts of high risk individuals
*High risk individuals:
- Children 6 to 59 months-old
- Age ≥ 59 years-old
- Individuals with chronic pulmonary (include asthma), cardiovascular, renal, hepatic, neurologic, hematologic, metabolic (include diabetes) diseases
- Individual who are or will be pregnant during the flu season
- Residents of skilled nursing or long-term care facilities
- Children on long-term aspirin therapy
- American Indians and Alaskan natives
- Morbidly obese, BMI ≥ 40
Who should not get the flu vaccine:
- Those with egg allergy: though can use recombinant or inactive trivalent egg-free vaccine. Or if the allergy is only hives after eating eggs, can also consider inactive vaccines
- Live vaccines need to be administered at least 4 weeks apart from other live vaccines
Finally, Dr. Lanny Hsieh, associate clinical professor of Infectious disease at the University of California Irvine reminds us that even with all the different types of vaccines, “the CDC generally do not have specific recommendations for one over the other, contraindications aside.” For example, even though the high dose flu vaccine has been shown to improved immunogenic response, the CDC does not make a specific recommendation between the two doses for patients older than 65 years. She surmises that current vaccine choice decisions are driven by cost considerations, as the high dose and also the egg free vaccines are substantially more expensive.
http://www.cdc.gov/flu/professionals/acip/2013-summary-recommendations.htm#primary-changes accessed on October 22nd 2013.