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Influenza and Influenza Vaccine

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Epidemiology and Prevention of Vaccine-Preventable Diseases National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention – PowerPoint PPT presentation

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Title: Influenza and Influenza Vaccine


1
  • Influenza and Influenza Vaccine

Epidemiology and Prevention of Vaccine-Preventable
Diseases National Center for Immunization and
Respiratory Diseases Centers for Disease Control
and Prevention
Revised May 2009
2
Influenza Antigenic Changes
  • Antigenic Shift
  • major change, new subtype
  • caused by exchange of gene segments
  • may result in pandemic
  • Example of antigenic shift
  • H2N2 virus circulated in 1957-1967
  • H3N2 virus appeared in 1968 and completely
    replaced H2N2 virus

3
Influenza Antigenic Changes
  • Antigenic Drift
  • minor change, same subtype
  • caused by point mutations in gene
  • may result in epidemic
  • Example of antigenic drift
  • in 2002-2003, A/Panama/2007/99 (H3N2) virus was
    dominant
  • A/Fujian/411/2002 (H3N2) appeared in late 2003
    and caused widespread illness in 2003-2004

4
Influenza Clinical Features
  • Incubation period 2 days (range 1-4 days)
  • Abrupt onset of fever, myalgia, sore throat,
    nonproductive cough, headache
  • Severity of illness depends on prior experience
    with related variants

5
Influenza Complications
  • Pneumonia
  • secondary bacterial
  • primary influenza viral
  • Reye syndrome
  • Myocarditis
  • Death 0.5-1 per 1,000 cases

6
Impact of Influenza-United States, 1990-1999
  • Approximately 36,000 influenza-associated deaths
    during each influenza season
  • Persons 65 years of age and older account for
    more than 90 of deaths
  • Higher mortality during seasons when influenza
    type A (H3N2) viruses predominate

7
Impact of Influenza-United States, 1990-1999
  • Highest rates of complications and
    hospitalization among young children and person
    65 years and older
  • Average of more than 200,000 influenza-related
    excess hospitalizations
  • 57 of hospitalizations among persons younger
    than 65 years of age
  • Greater number of hospitalizations during type A
    (H3N2) epidemics

8
Influenza Among School-Aged Children
  • School-aged children
  • typically have the highest attack rates during
    community outbreaks of influenza
  • serve as a major source of transmission of
    influenza within communities

9
Month of Peak Influenza Activity United States,
1976-2008
47
19
13
13
3
3
MMWR 20065522
10
Influenza Vaccines
  • Inactivated subunit (TIV)
  • intramuscular
  • trivalent
  • split virus and subunit types
  • duration of immunity 1 year or less
  • Live attenuated vaccine (LAIV)
  • intranasal
  • trivalent
  • duration of immunity at least 1 year

11
Inactivated Influenza Vaccine Efficacy
  • 70-90 effective among healthy persons younger
    than 65 years of age
  • 30-40 effective among frail elderly persons
  • 50-60 effective in preventing hospitalization
  • 80 effective in preventing death

12
  • Influenza and Complications Among Nursing Home
    Residents

RR1.9
RR2.0
RR2.5
RR4.2
Inactivated influenza vaccine. Genesee County,
MI, 1982-1983
13
LAIV Efficacy in Healthy Children
  • 87 effective against culture-confirmed influenza
    in children 5-7 years old
  • 27 reduction in febrile otitis media (OM)
  • 28 reduction in OM with accompanying antibiotic
    use
  • Decreased fever and OM in vaccine recipients who
    developed influenza

14
LAIV Efficacy in Healthy Adults
  • 20 fewer severe febrile illness episodes
  • 24 fewer febrile upper respiratory illness
    episodes
  • 27 fewer lost work days due to febrile upper
    respiratory illness
  • 18-37 fewer days of healthcare provider visits
    due to febrile illness
  • 41-45 fewer days of antibiotic use

15
Timing of Influenza Vaccine Programs
  • Influenza activity can occur as early as October
  • In more than 80 of seasons since 1976, peak
    influenza activity has not occurred until January
    or later
  • In more than 60 of seasons the peak was in
    February or later

16
Timing of Influenza Vaccine Programs
  • Providers should begin offering vaccine soon
    after it becomes available, if possible by
    October
  • To avoid missed opportunities for vaccination,
    providers should offer vaccine during routine
    healthcare visits or during hospitalizations
    whenever vaccine is available

17
  • Inactivated Influenza Vaccine Schedule

Dose 0.25 mL 0.50 mL 0.50 mL
Age Group 6-35 mos 3-8 yrs gt9 yrs
No. Doses 1 or 2 1 or 2 1
Only one dose is needed if the child received 2
doses of influenza vaccine during the previous
influenza season
18
Influenza Vaccination of Children
  • 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 should receive 2 doses
    during the next influenza season
  • Children 6 months through 8 years of age who are
    being vaccinated two or more seasons after
    receiving an influenza vaccine for the first time
    should receive a single annual dose, regardless
    of the number of doses administered previously

applies only to the influenza season that
follows the first season that a child younger
than 9 years receives influenza vaccine
19
Influenza Vaccination Schedule
  • All children younger than 9 years receiving
    seasonal influenza vaccine for the first time
    this season should receive 2 doses, separated by
    4 weeks
  • Children younger than 9 years who received a
    seasonal vaccine for the first time last season
    but who received only 1 dose should receive 2
    doses this season

MMWR 201059 (early release) From the
Immunization Update 2010 webcast (originally
broadcast August 5, 2010
20
Influenza Vaccination Schedule
  • Children younger than 9 years who did not
    receive at least 1 dose of a 2009 monovalent
    vaccine should receive 2 doses of seasonal
    vaccine this season
  • Children younger than 9 years whose 2009
    pandemic vaccine history is not known should
    receive 2 doses this season

MMWR 201059 (early release) From the
Immunization Update 2010 webcast (originally
broadcast August 5, 2010
21
Live Attenuated Influenza VaccineIndications
  • Healthy, nonpregnant persons 2 through 49 years
    of age, including
  • healthy children
  • healthcare personnel
  • persons in close contact with high-risk groups
  • persons who want to reduce their risk of influenza

Persons who do not have medical conditions that
increase their risk for complications of influenza
22
Fluzone High-Dose TIV
  • Approved only for persons 65 years of age or
    older
  • Each dose contains 4 times as much
    hemagglutinin as the regular formulation of
    Fluzone for adults
  • ACIP has not expressed a preference for the
    high dose Fluzone formulation or any other
    inactivated vaccine for use in persons 65 years
    and older

MMWR 201059 (early release) From the
Immunization Update 2010 webcast (originally
broadcast August 5, 2010
23
Inactivated Influenza Vaccine Adverse Reactions
  • Local reactions 15-20
  • Fever, malaise not common
  • Allergic reactions rare
  • Neurological very rare reactions

24
Live Attenuated Influenza VaccineAdverse
Reactions
  • Children
  • no significant increase in URI symptoms, fever,
    or other systemic symptoms
  • significantly increased risk of asthma or
    reactive airways disease in children 12-59 months
    of age
  • Adults
  • significantly increased rate of cough, runny
    nose, nasal congestion, sore throat, and chills
    reported among vaccine recipients
  • no increase in the occurrence of fever
  • No serious adverse reactions identified

25
Inactivated Influenza VaccineContraindications
and Precautions
  • Severe allergic reaction to a vaccine component
    (e.g., egg) or following a prior dose of vaccine
  • Moderate or severe acute illness
  • History of Guillian Barré syndrome within 6 weeks
    following a previous dose of TIV (precaution)

26
Live Attenuated Influenza VaccineContraindication
s and Precautions
  • Children younger than 2 years of age
  • Persons 50 years of age or older
  • Persons with chronic medical conditions
  • Children and adolescents receiving long-term
    aspirin therapy

These persons should receive inactivated
influenza vaccine
27
Live Attenuated Influenza VaccineContraindication
s and Precautions
  • Immunosuppression from any cause
  • Pregnant women
  • Severe (anaphylactic) allergy to egg or other
    vaccine components
  • History of Guillian-Barré syndrome
  • Children younger than 5 years with recurrent
    wheezing
  • Moderate or severe acute illness

These persons should receive inactivated
influenza vaccine
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