Influenza Vaccine News

INFLUENZA VACCINE FOR 2007/2008 AND HOW TO GET IT

Public Health provides trivalent inactivated split-virus vaccine for protection against:

• A/Solomon Islands/3/2006 (H1N1)-like;
• A/Wisconsin/67/2005 (H3N2)-like; and
• B/Malaysia/2506/2004-like virus strains.

Influenza vaccine from two manufacturers is provided in the publicly funded program: Fluviral S/F® 07/08 and thimerosal-reduced Vaxigrip® 07/08 (for children 6-23 months old and pregnant women).

Please label each multi-dose vial of vaccine with the date when first opened:

• Fluviral® may be used up to 28 days from first use, after which the vial should be discarded.
• Vaxigrip®, for immunizing children 6-23 months old and pregnant and lactating women, is lower in thimerosal, so the vial is good for only 7 days from first use, after which the vial should be discarded. If you don’t vaccinate enough children aged 6-23 months old and pregnant women to use up a vial of Vaxigrip® within 7 days of starting it, please use it for other patients of any age for whom publicly funded vaccine is indicated so it won’t go to waste.
• Please note: influenza vaccine needs to be given IM using a 7/8-1 ½” needle

HOW TO GET VACCINE: Available from your local Health Unit from October 29, 2007

• If your office is expecting to deliver about the same amount of influenza vaccine as last year, you do NOT need to put in an order – you will receive the same amount as last year.
• If your office expects a major change in the amount of influenza vaccine you will use this year compared to last year, please call your local Health Unit and let us know.
• When picking up vaccine, please bring an ice pack and a cooler (see attached sheet on maintaining cold chain).

Only those eligible for publicly-funded vaccine (See 3 below) should be immunized with this supply.

BC-SPECIFIC NOTES RE: 2007/08 SEASON (Background information available on request):

• In BC, we will continue to vaccinate children <9 years of age, with 2 doses of vaccine 4 weeks apart only if they are previously unvaccinated or if influenza vaccination history is uncertain. If 1 dose has been received in any preceding season, a single dose is adequate in future seasons.
• In BC, we will offer publicly-funded influenza vaccine to any woman who will be in her 3rd trimester during the influenza season.
• The elderly (including those in residential care facilities) should be vaccinated as soon as vaccine for the season is available. A previous recommendation that seniors not be vaccinated early has been withdrawn; it is not that their immunity wanes quickly, but that they have a weaker response to influenza immunization. This reinforces the need for health care worker vaccination.

GROUPS ELIGIBLE FOR PUBLICLY-FUNDED INFLUENZA VACCINE

In British Columbia, influenza vaccine is provided free of charge to people in the following groups:

1. People older than 6 months of age who are at high risk of complications from influenza:
• Adults and children with chronic cardiac or pulmonary disorders (including bronchopulmonary dysplasia, cystic fibrosis and asthma) severe enough to require regular medical follow-up or hospital care
• People of any age who are residents of nursing homes or other chronic care facilities
• People 65 years of age and over
• Adults and children with chronic conditions such as diabetes and other metabolic diseases, cancer, immunodeficiency (including HIV infection), immunosuppression (due to underlying disease or therapy), chronic kidney disease, anemia and hemoglobinopathy
• Adults and children with any condition that can compromise respiratory function or handling of respiratory secretions, or increase risk of aspiration (e.g., cognitive dysfunction, spinal cord injury, seizure disorder, neuromuscular disorder)
• Children and adolescents (age 6 months to 18 years) treated for long periods with acetylsalicylic acid
• Children aged 6 to 23 months – offer Vaxigrip® (Note: influenza vaccine is not effective under 6 months of age)
• Pregnant women who will be in their 3rd trimester during influenza season (Nov – April) - offer Vaxigrip®. (Note that influenza vaccine is recommended for women in high risk groups at any stage of pregnancy or breastfeeding.)
• People working with live poultry and /or swine
• Inmates of correctional facilities.
2. People capable of transmitting influenza to those at high risk of complications from influenza:
• Healthcare workers and other workers (including students, trainees, volunteers, etc.) who through their activities are potentially capable of transmitting influenza to people in the high-risk groups above. This includes you as doctors and your staff; midwives, etc.
• Household contacts (including children) of people in the high risk groups above, whether vaccinated or not
• Household contacts of children aged 0 to 23 months
• Those providing regular child care to children aged 0 to 23 months, whether in or out of the home
3. People providing essential community services requiring frequent close contact with people at risk:
• First responders (police, firefighters and ambulance) and corrections officers.

Others not listed above are encouraged to be vaccinated, but must buy vaccine. Vaccine for purchase for 2007/08 is available from pharmacies. Vaccine for purchase is not available from Public Health.

CONTRAINDICATIONS:

1. The only absolute contraindication to influenza vaccination is known anaphylactic hypersensitivity to egg, previous influenza immunization or any of the components of influenza vaccine, as manifested by hives, swelling of the mouth and throat, difficulty breathing, hypotension, or shock.
2. It is not known whether influenza vaccination is causally associated with increased risk of recurrent Guillain-Barre syndrome (GBS) in individuals with a previous history of GBS. However, avoiding subsequent influenza vaccination of individuals known to have developed GBS within 8 weeks of a previous influenza vaccination appears to be prudent at this time.
3. Influenza vaccine is not effective under six months of age.

Not Contraindications:

• Although influenza vaccination can inhibit clearance of warfarin and theophylline, clinical studies have not shown any adverse effects attributable to this interaction.
• Beta-blockers
• Allergy to anything that is not a component of influenza vaccine

The NACI Statement on Influenza for 2007/2008 is available online. (Paper copy available at local health unit)

FRASER HEALTH COMMUNITY INFLUENZA IMMUNIZATION CLINICS

Fraser Health will continue to provide mass immunization clinics for those eligible for publicly-funded vaccine, both in the community and in health units. Clinic times and locations will be published in local newspapers, and be available at www.fraserhealth.ca (click on "Health Info" (middle of top of screen), then "Public Health" (left side of screen), then "Flu Shots" (left side of screen), then click on the link under "Flu Clinics.") PUBLIC HEALTH CLINICS WILL START THE WEEK OF OCTOBER 29TH.

OCULO-RESPIRATORY SYNDROME and REPORTING VACCINE-ASSOCIATED ADVERSE EVENTS

Physicians should feel free to call a medical health officer if consultation about vaccination following ORS is desired. Information can be found in this year’s Influenza NACI statement on page 18 at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/acs-07/index_e.html or if you require more detailed information see the 2002 ORS NACI statement at (www.phac-aspc.gc.ca/publicat/ccdr-rmtc/02vol28/28sup/acs6.html).

Please report post-immunization ORS or other suspected vaccine adverse events to your local health unit.

IMPORTANT: SENTINEL PHYSICIANS NEEDED

There is a continued shortage of Sentinel Physicians and a lack of good geographic representation in the Lower Mainland and Fraser Valley. In this vital program, Sentinel Physicians report and swab patients who present with influenza-like illness and alert public health of higher levels or unusual presentations of such disease. The Sentinel Physician contribution is extremely helpful in monitoring influenza-like illness and determining the effectiveness of interventions, including the influenza immunization program. Sentinel Physicians receive some financial compensation for their efforts.

For more information please contact Ms. Louise Hoogewerf at 604-255-0711 or 1-888-255-5561.

PNEUMOCOCCAL VACCINE

Pneumococcal vaccine (23-valent polysaccharide) is provided free to those age 65 years and over and individuals age 2 through 64 with specific health conditions.
Influenza season is a good time to offer patients pneumococcal vaccine, though of course pneumococcal vaccine is available throughout the year. Pneumococcal vaccine can be given at the same time as the influenza vaccine, using separate syringes/needles at separate sites. It is given only once, except in defined, special circumstances. Refer to the Canadian Immunization Guide at http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-pneu_e.html

Please call your local public health unit if you have questions about influenza or pneumococcal vaccines.