You’ll get more questions about flu vaccines for the 2018-2019 season...due to record-breaking hospitalizations from flu last year.
When should we start screening patients for the flu vaccine? Now. Tell your patients flu season can start as early as October...and it takes two weeks for the vaccine to kick in.
If your patient can’t remember getting a flu vaccine this season, suggest getting it. An extra dose is fine...and much better than no dose.
What if patients ask for a flu vaccine our hospital doesn’t carry? Emphasize that it’s more important to get vaccinated now than to worry about which vaccine to get. Explain that guidelines don’t prefer one injectable flu vaccine over another.
Your hospital will likely carry a QUADrivalent vaccine. These protect against four flu strains...one more than a TRIvalent vaccine.
Some seniors may hear they should get Fluzone High-Dose or Fluad. The immune system weakens with age...and these vaccines are designed to produce a better immune response. But Fluzone High-Dose and Fluad are trivalent, not quadrivalent. And it’s too soon to know if these “boosted” trivalent vaccines work better than the unboosted quadrivalent vaccine.
Be aware, the INTRANASAL influenza vaccine (FluMist Quadrivalent) is an option this year...after two years of not being recommended. Early data suggest it may work better now than in previous years.
But don’t expect FluMist to be on your formulary. It should not be used in some patients, such as those who are pregnant or immunosuppressed.
When is flu vaccine contraindicated? Rarely ever. Feel comfortable vaccinating most hospitalized patients...even if they’re admitted with the flu. The vaccine can protect against other circulating flu strains.
Consider your hospital’s process for ICU patients. Some experts suggest delaying the flu vaccine until transfer to the floor...primarily so side effects (fever, etc) don’t confuse the clinical picture.
Re-evaluate ICU patients upon transfer out of the unit and before discharge...to prevent a missed vaccination opportunity.
And keep in mind, an egg allergy is no longer a contraindication for a flu vaccine...any age-appropriate vaccine can be administered.
- MMWR Recomm Rep 2018;67(3):1-20
- Pediatrics Published online Sep 3, 2018; doi:10.1542/peds.2018-2367
- MMWR Morb Mortal Wkly Rep 2018;67(22):643-5
- N Engl J Med 2014;371(7):635-45