Submitted by Allison Baroco, MD – Augusta Health Infectious Disease
As Augusta Health prepares for the upcoming flu season, we are starting to see a couple cases trickle in the first week of September. Though the exact timing and duration of flu seasons can vary, we frequently see the first cases as school gets back into session, and influenza activity tends to increase in October. Most of the time flu activity peaks between December and February, although activity can last as late as May.
Please remember to check in with Employee Health to get your flu vaccine September through October. Additionally please remember to check your patients’ records for pneumonia vaccine (Prevnar and/or Pneumovax based on age and Risk Factors). With many people getting onto new Electronic Health Records, now is the perfect time to make sure your patients are up to date!
Each year questions come up in regards to best practice for flu vaccination and utilizing the annual CDC recommendations I would like to highlight a couple of these for you today.
When is the best time to get the flu vaccine? If I get it too early will not I lose the protective effect if we have a late flu season?
“Optimally, vaccination should occur before onset of influenza activity in the community. The CDC recommends that health care providers offer vaccination by the end of October, if possible. Although delaying vaccination might result in greater immunity later in the season, deferral also might result in missed opportunities to vaccinate, as well as difficulties in vaccinating a population within a more constrained time period. Revaccination later in the season of persons who have already been fully vaccinated is not recommended.
Vaccination efforts should be structured to ensure the vaccination of as many persons as possible before influenza activity in the community begins.”
Should older adults receive high-dose flu vaccine?
Based on CDC recommendations, for adults greater than or equal to 65 years of age the recommendation remains that any approved/age-appropriate flu vaccination is considered an acceptable option and there is no preferential recommendation for use of any specific product. Vaccination should not be delayed if a specific product is not available.
If older patients do have access to high dose flu vaccine, there has been a randomized trial suggesting improved efficacy and it would be reasonable to offer this preparation. However we do have to remember that some vaccine is better than no vaccine, and delays in vaccination can effect a community or healthcare facility due to the importance of herd immunity.
“Fluzone High-Dose (HD-IIV3; Sanofi Pasteur, Swiftwater, Pennsylvania) met prespecified criteria for superior efficacy to that of SD-IIV3 in a randomized trial conducted over two seasons among 31,989 persons aged ≥65 years, and might provide better protection than SD-IIV3 for this age group”. DiazGranados CA, Dunning AJ, Kimmel M, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med 2014;371:635–45
Above Flu Vaccine recommendations are based on “Recommendations of the Advisory Committee on Immunization Practices — United States, 2017–18 Influenza Season” : MMWR article