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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. Influenza Antigenic Changes. Antigenic Shift major change, new subtype

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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


Influenza antigenic changes
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


Influenza antigenic changes1
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


Influenza clinical features
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


Influenza complications
Influenza Complications

  • Pneumonia

    • secondary bacterial

    • primary influenza viral

  • Reye syndrome

  • Myocarditis

  • Death 0.5-1 per 1,000 cases


Impact of influenza united states 1990 1999
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


Impact of influenza united states 1990 19991
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


Influenza among school aged children
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


Month of peak influenza activity united states 1976 2008
Month of Peak Influenza Activity United States, 1976-2008

47%

19%

13%

13%

3%

3%

MMWR 2006;55:22


Influenza vaccines
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


Inactivated influenza vaccine efficacy
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


Vaccinated*

Unvaccinated

Influenza and Complications Among Nursing Home Residents

RR=1.9

RR=2.0

RR=2.5

RR=4.2

*Inactivated influenza vaccine. Genesee County, MI, 1982-1983


Laiv efficacy in healthy children
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


Laiv efficacy in healthy adults
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


Timing of influenza vaccine programs
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


Timing of influenza vaccine programs1
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


Dose

0.25 mL

0.50 mL

0.50 mL

Age

Group

6-35 mos

3-8 yrs

>9 yrs

No.

Doses

1* or 2

1* or 2

1

Inactivated Influenza Vaccine Schedule

*Only one dose is needed if the child received 2 doses of influenza vaccine during the previous influenza season


Influenza vaccination of children
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


Influenza vaccination schedule
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 2010;59 (early release) From the Immunization Update 2010 webcast (originally broadcast August 5, 2010


Influenza vaccination schedule1
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 2010;59 (early release) From the Immunization Update 2010 webcast (originally broadcast August 5, 2010


Live attenuated influenza vaccine indications
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


Fluzone high dose tiv
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 2010;59 (early release) From the Immunization Update 2010 webcast (originally broadcast August 5, 2010


Inactivated influenza vaccine adverse reactions
Inactivated Influenza Vaccine Adverse Reactions

Local reactions 15%-20%

Fever, malaise not common

Allergic reactions rare

Neurological very rare reactions


Live attenuated influenza vaccine adverse reactions
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


Inactivated influenza vaccine contraindications and precautions
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)


Live attenuated influenza vaccine contraindications and precautions
Live Attenuated Influenza VaccineContraindications 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


Live attenuated influenza vaccine contraindications and precautions1
Live Attenuated Influenza VaccineContraindications 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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