NAPNAP President Jean Martin got her Flu Shot…. Did you? 
Nurse Mary Jo Miedema and NAPNAP President Jean Martin In preparation for the upcoming flu season, NAPNAP Immunization experts provide answers to common questions asked by healthcare providers, parents and caregivers. Frequently Asked Questions for the Seasonal Influenza Vaccine
1. Why should I get a flu shot? During the week ending October 24, 2009, the weekly percentage of visits for influenza like illness reported reached 7.7%, the highest level to date in the 2009 season. This level was higher than the three times higher than previous seasons (1). Health professionals get seasonal influenza each year which is often transmitted to their patients. You are at risk if you do not receive an influenza vaccine each year as the antigens change from year to year and immunity is not expected to last more than one season. 2. Do I need to get the H1N1 and seasonal influenza vaccine this year?
No, only one vaccination is needed for the 2010-2011 season. H1N1 is included in the trivalent influenza vaccine for this season. 3. Are there ethical reasons that I should receive influenza vaccine?
Nurses and nurse practitioners are expected to act responsibly according to the biomedical ethical principles of Beneficence (seeking to do good) and Non-maleficence (duty to avoid causing harm) (2). These same principles are elaborated in the Code of Ethics for Nurses (3). If you do not get the seasonal influenza vaccine you are not protecting yourself or protecting the children and their families you encounter in your professional practice. 4. Who is recommended to receive influenza vaccine? Annual influenza immunization is recommended for every person in the United States 6 months of age or older (4). Health care providers should make special efforts to vaccinate all high risk individuals and their contacts. Some at-risk groups should be specifically targeted, including families and caregivers of children under 5 years of age, pregnant women, health care workers, and those with certain chronic illnesses. 5. Who is exempt from receiving influenza vaccine?
Influenza vaccine is contraindicated in those who have had an anaphylactic reaction to egg protein or have had an anaphylactic reaction to a previous dose of influenza vaccine. History of Guillian Barre’ syndrome within 6 weeks following a previous dose of vaccine, and moderate to severe illness are precautions. Children who are less than 2 years of age or who have a history of asthma with an episode of wheezing within the last year should not receive LAIV (4).
6. What age group experiences more influenza disease than any other age group?
Infants and children experience more attack rates of influenza than any other age group. Infants younger than 2 years of age experience more hospitalizations than any other age group (4). 7. What age group experiences more deaths due to influenza annually? 90% of deaths occur in those 65 years and older. Influenza causes the greatest number of deaths from any vaccine preventable disease in the U.S. On average 226,000 individuals are hospitalized due to influenza disease annually (4). 8. What are the conditions that put individuals at higher risk for complications due to influenza? Conditions include age such as those 65 years and older; individuals 50-64 years of age; children 6 months through 18 years of age; pulmonary diseases such as asthma and obstructive pulmonary disease, cardiovascular disease; metabolic disorders such as diabetes; renal disease, hemoglobinopathies; immune suppression such as HIV infection; pregnancy; and any condition that compromises respiratory function or the increased risk of aspiration (4). 9. What types of influenza vaccine are available?
Two types of influenza vaccine are available. The inactivated subunit vaccine (TIV) is a trivalent vaccine containing egg protein. TIV is administered by the intramuscular route. The live attenuated vaccine (LAIV) is also a trivalent vaccine which contains egg protein. LAIV is administered via the intranasal route. LAIV is indicated only for healthy persons 2 to 49 years of age who are not pregnant. It is also approved for health care personnel who have no medical or age contraindications and for those who come in contact with high risk groups (4). 10. When should individuals begin to receive influenza during a season?
Influenza activity can begin as early as October and health care providers are encouraged to begin administering the vaccine as soon as it becomes available. Peak activity has not occurred until January or later in more than 80% of previous influenza seasons. In more than 60% of previous seasons, peak activity did not occur until February or later. Health care providers should offer the vaccine during routine health care visits or during hospitalizations whenever the vaccine is available. The vaccine should continue to be offered in December and beyond, especially to health care personnel and those at high risk. Vaccination should continue throughout influenza season for as long as vaccine is available (4).
11. Who should get 2 doses of influenza vaccine?
All children younger than 9 years of age receiving seasonal influenza vaccine for the first time should receive TWO doses separated by 4 weeks. Children younger than 9 years who received a seasonal vaccine for the first time last year, but received only 1 dose, should receive 2 doses this season. Children who did not receive at least 1 dose of a monovalent vaccine in 2009, should receive TWO doses of seasonal vaccine this season. Children younger than 9 years whose 2009 pandemic vaccine history is not know should receive 2 doses this season. Children with febrile respiratory illness in 2009 should not be assumed to have had H1N1 unless laboratory tests were performed to confirm the presence of the virus. If these children did not receive monovalent vaccine in 2009, they should receive 2 doses of seasonal vaccine during the 2010-2011 season (4).
12. What else needs to be known about giving children more than one dose of influenza vaccine during a season? ACIP does not recommend the administration of more than 1 dose of seasonal influenza vaccine for any age group except children 6 months through 8 years of age receiving influenza vaccine for the first time, or who did not receive any doses of H1N1 vaccine in 2009. Children 6 months through 8 years of age who did not receive the recommended second dose of influenza vaccine in the initial year that they received influenza vaccine for the first time should receive 2 doses during the next influenza season. Children 6 months through 8 years of age who are being vaccinated 2 or more seasons after receiving an influenza vaccine for the first time should receive a single annual dose, regardless of the number of doses previously administered (4). The CDC has developed a flow chart to assist providers in determining the appropriate number of doses to administer to children based on previous history. This flow chart can be found in the broadcast graphics from the CDC 2010-2010 Annual Immunization Update at http://www.cdc.gov/vaccines/ed/imzupdate/default.htm#anc2. 13. Do most health care workers including nurses get an influenza immunization every year?
As of 2009-10 61.9% of U.S. health care workers were vaccinated against influenza. The previous highest level of immunizations was 40% in any given year. Last year many states instituted a mandatory requirement which has had an impact on health care worker immunization. Health care workers should not need mandates to be vaccinated. They should be role models for the community and be vaccinated against influenza (5). Helpful Websites:
Every Child By Two www.ecbt.org
Children's Hospital of Philadelphia Vaccine Information Center www.vaccine.chop.edu
Immunization Action Coalition www.immunize.org
Centers for Disease Control and Prevention National Center for Immunizations and Respiratory Diseases www.cdc.gov/vaccines
National Network for Immunization Information www.immunizationinfo.org
The ANA Immunization Web site www.anaimmunize.org
Immunization for Health care workers:
http://www.flu.gov/professional/hospital/hcworkers_vaccine.html References
1. Centers for Disease Control and Prevention. Update: Influenza activity, United States, August 30,2009-January 9, 2010. MMWR. January 22, 2010/59(02);38-43.
2. Beauchamp T.L., Childress, J.F. (2001). Principles of biomedical ethics, 5th edition. New York: Oxford University Press.
3. American Nurses Association. Code of ethics for nurses. Accessed 31 August 2010 at: http://nursingworld.org/ethics/code/protected_nwcoe629.htm
4. Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: Recommendations of the Advisory Committee on Immunizations (ACIP). MMWR Early Release 2010;59 July 29:1-61.
5. Centers for Disease Control and Prevention. MMWR. Interim results: Influenza A (H1N1) 2009 monovalent and seasonal influenza vaccination among health-care personnel-United States August 2009 – January 2010;59(12);357-362.
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