Friday, September 29, 2023

High Dose Flu Vaccine Guidelines

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Meet The Different Types Of Flu Vaccine

Flu Vaccine Guidelines for Children

IIV are made with either inactivated flu viruses or with only a single protein from the flu virus . They do not contain any live flu viruses, so they cannot cause the flu, even in people with severely weakened immune systems . IIV are injected .

LAIV contain flu viruses that have been weakened so that they create a protective immune response but do not cause the flu in healthy people . LAIV is given as a nasal spray .

Traditionally, both IIV and LAIV influenza vaccines have been produced to protect against three different seasonal influenza viruses . However, recently vaccines that protect against four different viruses have become available in more and more European countries. While quadrivalent IIV are expected to replace the trivalent vaccines over time , all currently available LAIV are quadrivalent vaccines .

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A Staff Member Inadvertently Administered The Wrong Dosage Of Influenza Vaccine How Do We Correct This

If a smaller than recommended dose of any inactivated influenza product is inadvertently administered, additional vaccine should be given so that the patient receives a full dose. The amount of vaccine that should be administered is based on when the patient is available to be revaccinated. For example:

  • If a partial dose of an inactivated influenza vaccine product is administered and revaccination can occur on the same clinic day, the patient should receive a remaining volume to total the correct dosage. For example, if the correct dosage for the patient is 0.5 mL and they received only 0.25 mL, an additional 0.25 mL should be given if revaccination can occur on the same day.
  • If the patient cannot be revaccinated until the next day or later, a full dose of inactivated influenza vaccine should be administered as soon as the patient can return.
  • If a larger dose of influenza vaccine is inadvertently administered, count the dose as valid. Revaccination with additional vaccine is not needed.

Giving an incorrect dose is considered a vaccine administration error. Healthcare personnel should take steps to determine how the error occurred and put strategies in place to prevent it from happening in the future.

What Are The Influenza Vaccine Options This Season

CDC recommends use of any licensed, age-appropriate influenza vaccine during the 2021-2022 influenza season. Available influenza vaccines include quadrivalent inactivated influenza vaccine , recombinant influenza vaccine , or live attenuated influenza vaccine . No preference is expressed for any influenza vaccine over another.

Quadrivalent flu vaccines include:

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Iv1 Older Adults With Risk Factors

The majority of studies reviewed for this report were conducted with ambulatory, community-dwelling older adults without immune suppressing diseases and who were not using immune suppressing medication. Also, the mean age of the participants is in the early 70s, when the immune response is expected to be better than for older adults. Studies need to be completed in older adults with immune suppressing conditions or using immune suppressing medications, people who are institutionalized, and adults who are 75 years of age and older to determine whether these vaccines are as effective in these cohorts as they are in the younger, healthier cohorts of seniors.

Canadian Immunization Guide Chapter On Influenza And Statement On Seasonal Influenza Vaccine For 2016

Prevention and Control of Seasonal Influenza with Vaccines ...


The National Advisory Committee on Immunization has updated its recommendations on the use of live attenuated influenza vaccine for the 2016-2017 influenza season. These updated recommendations supersede those found in the Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2016-2017 and can be found in the following Addendums:

  • ADDENDUM – LAIV Use in Children and Adolescents: This addendum addresses updated recommendations regarding the use of live attenuated influenza vaccine in children 2-17 years of age.
  • For readers interested in the PDF version, the document is available for downloading or viewing:

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    Can Inactivated Influenza Vaccine Be Given At The Same Time As Other Vaccines Such As Pneumococcal Polysaccharide Or Zoster Vaccines

    Yes if other vaccines are indicated, they can be administered during the same clinical encounter as inactivated influenza vaccine. When giving several injections at a single visit, administer each vaccine at a separate injection site. The injection sites should be separated by 1 inch or more, if possible, so that any local reactions can be differentiated.

    Are Any Of The Available Influenza Vaccines Recommended Over Others

    Yes, for some people. For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-DoseQuadrivalent vaccine, Flublok Quadrivalent recombinantflu vaccine or Fluad Quadrivalent adjuvanted flu vaccine. On June 22, 2022, CDCs Advisory Committee on Immunization Practices voted unanimously to preferentially recommend these vaccines overstandard-dose unadjuvanted flu vaccines. This recommendation was based on a review of available studies which suggests that, in this age group, these vaccines are potentially more effective than standard dose unadjuvanted flu vaccines. There is no preferential recommendation for people younger than 65 years.

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    Iii1 People At High Risk Of Influenza

    All pregnant women

    NACI recommends the inclusion of all pregnant women, at any stage of pregnancy, among the particularly recommended recipients of IIV, due to the risk of influenza-associated morbidity in pregnant womenFootnote 25,Footnote 26,Footnote 27,Footnote 28,Footnote 29, evidence of adverse neonatal outcomes associated with maternal respiratory hospitalization or influenza during pregnancyFootnote 30,Footnote 31,Footnote 32,Footnote 33, evidence that vaccination of pregnant women protects their newborns from influenza and influenza-related hospitalizationFootnote 34,Footnote 35,Footnote 36,Footnote 37, and evidence that infants born during influenza season to vaccinated women are less likely to be premature, small for gestational age, and of low birth weight than if born to women that had not received an influenza vaccineFootnote 38,Footnote 39,Footnote 40,Footnote 41. The risk of influenza-related hospitalization increases with length of gestation .

    Refer to the Statement on Seasonal Influenza Vaccine for 2011-2012 and the Statement on Seasonal Influenza Vaccine for 2012-2013 for further details on influenza vaccination during pregnancy.

    Adults and children with chronic health conditions

    Neurologic or neurodevelopment conditions

    People of any age who are residents of nursing homes and other chronic care facilities

    Adults 65 years of age and older

    All children 6-59 months of age

    Indigenous peoples

    Flu & People 65 Years And Older

    NVAC l September 2021 l CDC Flu Vaccine Recommendations, Member Updates, and Public Comment

    On June 30, 2022, CDC announced that Director Rochelle P. Walensky adopted the Decision memo approving the ACIP vote for a preferential recommendation for the use of higher dose or adjuvanted flu vaccines over standard-dose unadjuvanted flu vaccines for adults 65 years and older. CDCs full recommendations for the use of flu vaccines during 2022-2023 will appear in a forthcoming Morbidity and Mortality Weekly Report. Edits to this page are also forthcoming. More information can be found online: CDC Director Adopts Preference for Specific Flu Vaccines for Seniors

    People 65 years and older are at higher risk of developing serious flu complications compared with young, healthy adults. This increased risk is due in part to changes in immune defenses with increasing age. While flu seasons vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. In recent years, for example, its estimated that between 70 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older, and between 50 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in this age group.

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    Quantity Of Research Available

    A total of 461 citations were identified in the literature search. Following screening of titles and abstracts, 420 citations were excluded and 41 potentially relevant reports from the electronic search were retrieved for full-text review. Two potentially relevant publications were retrieved from the grey literature search for full text review. Of these potentially relevant articles, 31 publications were excluded for various reasons, and 12 publications met the inclusion criteria and were included in this report. These comprised three systematic reviews , four RCTs, four economic evaluations, and one evidence-based guideline, with an accompanying systematic review and update., presents the PRISMA flowchart of the study selection. One additional systematic review was identified that also fit the inclusion criteria . However, this review was excluded as the relevant primary study was already included in another, more comprehensive systematic review, resulting in 100% overlap of primary studies.

    Iv2 Live Attenuated Influenza Vaccine

    LAIV contains standardized quantities of FFU of live attenuated influenza virus reassortants. The virus strains in LAIV are cold-adapted and temperature sensitive, so they replicate in the nasal mucosa rather than the lower respiratory tract, and they are attenuated, so they do not produce ILI. There have been no reported or documented cases, and no theoretical or scientific basis to suggest transmission of vaccine virus would occur to the individual administering LAIV. As a live replicating whole virus formulation administered intranasally, it elicits mucosal immunity, which may more closely mimic natural infection.

    Vaccine currently authorized for use:

    • FluMist® Quadrivalent
    Efficacy and effectiveness

    After careful review of the available Canadian and international LAIV VE data over many influenza seasons, NACI concluded that the current evidence is consistent with LAIV providing comparable protection against influenza to that afforded by IIV and does not support a recommendation for the preferential use of LAIV in children 2-17 years of age.

    Refer to the Statement on Seasonal Influenza Vaccine for 2018-2019 for detailed information supporting this recommendation.


    LAIV4 has shown non-inferiority based on immunogenicity compared to LAIV3 in both children and adults. The immune response to the B strain found only in the quadrivalent formulation was better in children who received the quadrivalent vaccine Footnote 158, Footnote 159, Footnote 160.


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    Who Can Receive Fluzone High

    In the United States, Fluzone High-Dose Quadrivalent is licensed only for people 65 years and older. Fluzone High-Dose Quadrivalent is not recommended for people with a history of severe allergic reaction to the vaccine or to ingredients other than eggs. Information about vaccine ingredients is located in package inserts from each manufacturer.

    What Is The Correct Dosage Of Vaccine

    Safety of High Doses of Influenza Vaccine and Effect on Antibody ...

    The amount of inactivated vaccine that should be administered intramuscularly is based on the patients age and the vaccine product you are using.

    • For children 635 months of age, the correct dosage is:
    • 0.25 mL for Afluria Quadrivalent
    • 0.5 mL for Fluarix Quadrivalent
    • 0.25 mL or 0.5 mL for Fluzone Quadrivalent
    • 0.5 mL for FluLaval Quadrivalent
  • For persons 3 years of age and older, the correct dosage is 0.5 mL for most inactivated influenza vaccine products. Fluzone High-Dose Quadrivalent is for use in persons 65 years of age and older, and the correct dosage is 0.7 mL.
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    There Are Two Senior Vaccines This Year

    Keep in mind that there are two different flu vaccines that are designed for people aged 65 and up. One vaccine has the exact same amount of antigen as the injection for younger adults. It also contains an adjuvant, which is an ingredient added that’s designed to help you get a stronger immune response from the vaccine. The other shot is a high-dose version of the vaccineit has four times the amount of antigen.

    “The adjuvanted flu vaccine is another vaccine specially formulated for older adults and would also be preferable to the ordinary flu vaccine in older age groups,” says Dr. Adalja. The adjuvanted flu vaccine is made with MF59 adjuvant, an additive that triggers a stronger immune response to vaccination.

    If you want to get the high-dose flu vaccine, it’s important to specify that vs. just assuming you’ll be given it based on your age alone. Still, “either one is fine for people over 65,” Dr. Murphy says. “Both are considered equally effective.”

    Iii2 Efficacy And Effectiveness

    Four studies comparing the relative efficacy of high dose vaccines were identified and described below.

    The relative efficacy of Fluzone®High Dose compared with Fluzone® has been evaluated in two studies to date. The first study of 9158 ambulatory, medically-stable adults 65 years and older was conducted in 2009-2010 during the H1N1 pandemicFootnote 21. The relative efficacy was 12.5% in favour of Fluzone®High Dose against laboratory-confirmed influenza, but with exceedingly wide confidence bounds in this study 21 of the 22 symptomatic cases of influenza were caused by the Apdm09 strain, which was not in the seasonal vaccine.

    The second study was conducted in 2011-2012 and 2012-2013 Footnote 22. In this study of almost 32,000 older adults, 18-24% fewer illnesses caused by influenza occurred in people who received Fluzone®High Dose compared with those who received Fluzone®. The relative efficacy against laboratory-confirmed influenza of the high dose vaccine compared to the standard dose vaccine was 18% in participants who provided swabs when they had an acute respiratory illness, with 2.0% and 2.4%, respectively, diagnosed with influenza. The relative efficacy against laboratory-confirmed influenza was 24% , with 1.4% and 1.9%, respectively, diagnosed with influenza, in those who provided swabs when they had an influenza-like illness ).

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    I1 New Or Updated Information For 20212022

    Guidance on the use of seasonal influenza vaccine in the presence of the novel coronavirus 2019 disease

    In light of the COVID-19 pandemic, PHAC has developed additional guidance on seasonal influenza vaccination to support provincial and territorial vaccine programs and primary care providers offering influenza vaccine during the COVID-19 pandemic. Please refer to the Guidance on the use of influenza vaccine in the presence of COVID-19 webpage for the most recent PHAC guidance.

    New egg-based quadrivalent influenza vaccine

    Influvac® Tetra is a split virus quadrivalent inactivated influenza vaccine that was first authorized for use in Canada in adults on March 1, 2019 and subsequently in children 3 years of age and older on February 20, 2020. Based on a review of available pre-licensure clinical trial data and Health Canadas Clinical Review Reports, NACI has concluded that Influvac Tetra has a comparable safety and immunogenicity profile to already authorized quadrivalent inactivated influenza vaccines. Therefore, NACI recommends that Influvac Tetra may be considered among the quadrivalent inactivated influenza vaccines offered to adults and children 3 years of age and older .

    Inclusion of mammalian cell culture-based quadrivalent influenza vaccine

    New egg-based high dose quadrivalent influenza vaccine

    Two: Receipt Of A Ministry Email Confirming Application Submission

    Jan 12, 2022 ACIP Meeting – Influenza Vaccines

    The ministry will respond to ALL application forms received within two business days and confirm either that:

  • Your application form has been accepted and the information provided has been forwarded to your local public health unit for a cold chain inspection on the vaccine refrigerator that will be storing publicly funded influenza vaccines or
  • Your application form has not been accepted. Your organization must comply with the resubmission deadline stipulated by the ministry.
  • If you do not receive a response from the ministry within two business days, you must resend your application form to . Send a plain text e-mail, as images, signatures and logos may prevent the ministry from receiving your email.

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    Simultaneous Administration With Other Vaccines

    For people 12 years of age and older, seasonal influenza vaccines may be given:

    • at the same time as a COVID-19 vaccine
    • at any time before a COVID-19 vaccine
    • at any time after a COVID-19 vaccine

    For children aged 5 to 11, it is not recommended that COVID-19 vaccines be routinely given simultaneously with non-COVID-19 vaccines . NACI recommends that a 14-day interval between a COVID-19 vaccine and the influenza vaccine should be considered. This is a precaution to assist with the monitoring of possible side effects from each vaccine.

    Simultaneous administration or a shortened interval between a COVID-19 vaccine and a non-COVID-19 vaccine may be warranted on an individual basis in some circumstances at the clinical discretion of the healthcare provider.

    Provinces and territories may decide on a specific interval for this age group as part of their vaccination programs.

    If more than 1 type of vaccine is administered at a single visit, they should be administered at different injection sites using separate injection equipment.

    Informed consent should include a discussion of the benefits and risks given the limited data available on administration of COVID-19 vaccines at the same time as, or shortly before or after, other vaccines.

    NACI will continue to:

    • monitor the evidence base, including ongoing and anticipated trials investigating influenza vaccines administered at the same time as, or any time before or after, COVID-19 vaccines
    • update its recommendations as needed

    Vaccination Dose And Schedule By Age1

    VACCINATION STATUS Not previously vaccinated with influenza vaccine Vaccinated with influenza vaccine in a previous season Not Applicable

    at least 4 weeks apart

    1 or 2 dosesa

    1 dosea

    aOne dose or 2 doses , depending on vaccination history, per the annual Advisory Committee on Immunization Practices recommendations on prevention and control of influenza with vaccines. If 2 doses, administer each 0.5-mL dose at least 4 weeks apart.

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    When To Get Your Shot

    The best time to get your shot is from mid-September through October, with the goal of hitting the sweet spot between being early enough to ensure your body has time to build up immunity and late enough in the season to make sure immunity doesnt wear off by March or April, says Ronan Factora, M.D., a geriatrician at the Cleveland Clinics Center for Geriatric Medicine. Factora also recommends you consult with your physician about timing, as peak flu season may vary from one part of the country to another.

    Also try to schedule the shot in the morning when possible. A 2016 study published in the journal Vaccine found that adults over 65 who were given vaccines between 9 and 11 a.m. had higher levels of protective antibodies than those given the shot between 3 and 5 p.m.

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