Influenza Vaccine

Indications

• One dose should be administered annually. A second dose is not recommended.
• All persons >6 months of age, including those age >65 years and/or with high-risk conditions such as chronic pulmonary (including asthma) or cardiovascular (except hypertension); chronic hepatic, renal disease or hemoglobinopathies; immunosuppression; metabolic disorder (eg, diabetes); neurologic or neuromuscular disorder (eg, cognitive dysfunction, seizures, spinal cord injury).
• All residents of nursing homes or chronic care facilities.
• All household contacts of high-risk adults or those 65+ years.

Contraindications and Precautions

• Any prior anaphylactic reaction to vaccine or components (eg, eggs).
• Do not give live vaccine (LAIV) to persons 50+ years.
• Guillain-Barré syndrome within 6 weeks of a previous dose.

Vaccine Dosing and Administration

Dosing

ACIP recommends that adults aged 65+ preferentially receive any one of the following higher dose or adjuvanted influenza vaccines:

• trivalent high-dose inactivated influenza vaccine (HD-IIV3)-Fluzone, High Dose
• trivalent adjuvanted inactivated influenza vaccine (all IIV3)-Fluad Trivalent
• trivalent recombinant influenza vaccine (RIV3)-Flublok Trivalent

If none of these three vaccines is available at an opportunity for vaccine administration, than any other age-appropriate influenza vaccine should be used, below.

• Inactivated influenza vaccine, quadrivalent (IIV3), standard dose
  • Fluarix Trivalent
  • FluLaval Trivalent
  • Fluzone Trivalent
  • Afluria Trivalent
  • Flucelvax Trivalent

Administration

• Store at 35–46^oF (2–8^oC). Do not freeze.
• Vaccinate in deltoid muscle using needle length ≥1 inch (≥25 mm).
• Administer just prior to annual flu season.

Side Effects

• Soreness, redness at injection site lasting 1–2 days
• Joint pain
• Fatigue
• Fever/ chills
• Muscle aches
• Hoarseness, sore or red eyes
• Headache

Talking Points with Patients

• Influenza is a serious respiratory disease and is not the same as the common cold.
• Flu causes 40,000 deaths and 200,000 hospitalizations in the US/year.
• Flu spreads easily to other people, especially those most vulnerable (this includes those who are 65 years and older, immunocompromised, diagnosed with multiple chronic conditions, etc.).
• Vaccination is effective in preventing death and hospitalization…
  • in community-dwelling older persons; and
  • among patients residing in long-term care institutions.
• Can be given concurrently with the COVID-19 vaccine.