Arkansas Pharmacists Association



FAQ for Healthcare Providers about FluWhen is it appropriate to start administering seasonal influenza vaccine?The Centers for Disease Control recommends that healthcare providers start administering seasonal influenza vaccine as soon as it is available.It takes 2 to 4 weeks for a person’s body to mount a full immune response to the vaccineHow long does immunity from the influenza vaccine last?It is thought to persist for one year or less because of waning antibody titers and because of changes in the circulating influenza virus from year to yearThere is no evidence for late-season outbreaks among vaccinated persons that can be attributed to waning immunityCan you get the flu from the flu shot?No, the flu shot and mist do NOT cause the flu Less than 1% of patients who are vaccinated will develop flu-like symptomsThe influenza vaccine is not 100% effective, especially in older patientsThe seasonal influenza vaccine only protects against the 3 types of flu that are predicted to circulate for that year. This year’s vaccine contains:H1N1H3N2Type B (from the B / Yamagata lineage)Can multiple vaccines be given at the same time as the flu shot?Yes, there are no restriction on how many immunizations can be given on the same dayZoster, flu, pneumonia, and Tdap can all be given on the same day just separate the injection sites by one inchThe only vaccines providers need to space out by 4 weeks are live vaccines (i.e. zoster, MMR, yellow fever, etc)Can be given the same day (within 24 hours) or spaced out by 4 weeksThe package insert (PI) for Zostavax? advises providers to not give the pneumonia vaccine and shingles vaccine at the same time and to space them out by 4 weeks?The PI for Zostavax? does in fact state the above, but the Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control recommend that they be given on the same dayReasoning behind this is that the study quoted in the PI found a decrease in antibody titers to shingles, however this does not necessarily correlate with a decrease in efficacy Efficacy for the shingles vaccine was established by showing a decrease incidence in shingles, not measured antibody titersAlso, how many patients are going to remember in 4 weeks to come back to the pharmacy and get another vaccination?Are healthcare providers required to give the patient a Vaccine Information Statement (VIS)?Since January 1, 2006 the VIS is required to be given to the patient or guardian per the National Vaccine Injury Compensation Program. Current copies of all VIS’s in multiple languages can be found online at visAlso, the date of the VIS version must be printed on the consent formWhat is the recommended interval for receiving influenza vaccine after an allergy injection?Vaccines can be administered at any time before or after administration of an “allergy injection”Can a patient who received blood products or IVIG get the flu vaccine?Yes, but only receive inactivated influenza vaccineCan pregnant women receive a flu shot at the pharmacy?Yes as long as they are not excluded in your protocol (ie must explicitly state in your protocol that you cannot administer vaccinations to a pregnant patient)Pregnant women are at increased risk for influenza-related complications as well as postpartum women Vaccination can be given in any trimesterIs the influenza vaccine safe to administer to patients with multiple sclerosis (MS)?MS is NOT a contraindication for any vaccine including influenza and pneumococcalThese patients should only receive inactivated influenza vaccineContraindications to the influenza vaccinePatients who have experienced a severe allergic reaction to a previous dose of influenza vaccine or vaccine componentHistory of Guillain-Barre syndrome occurring within 6 weeks of previous influenza vaccinationShould be differed in patients who have moderate or severe acute illness until it improvesThis does not include patients will a cold or low-grade feverDo not differ immunization if patient is on antibioticsWhat is the best way to screen patients for potential egg allergy in a busy pharmacy?People who can eat eggs without reaction are unlikely to have an egg allergyAbility to eat eggs in baked products may be misinterpreted as egg toleranceWhat length needle should be used to administer the influenza vaccine?Generally, intramuscular injections should be administered with a 1” needle in adultsSome experts feel that a shorter needle can be used in adults less than 132 lbs only if given over the deltoid and only if the skin is stretched tight and given at a 90 degree angleWhat immunizations must be reported to the state immunization registry?At this time, only immunizations given to patients 21 years of age and younger are required to be reported to the registryIt is recommended to report all immunizations to all ages to the registrySend requests for access to the registry to nina.miller@What influenza vaccine is safe for children?Has ACIP recommended the use of high-dose and intradermal influenza vaccines?High dose only approved for patients 65 years of age and olderThis vaccine is as least as good as the regular flu shotElicits a higher antibody response, but there are no studies to show this means more protectionIntradermalOnly approved for patients 18 to 64 years oldUses a micro-injector given over the deltoid muscleOnce a dose has been drawn out of a vial of vaccine, does the remaining vaccine need to be discarded before the expiration date?No, as long as the remaining vaccine in the vial is stored at the appropriate temperature, it is good until the expiration dateIs it okay to draw up vaccine into syringes at the beginning of the day or before a large clinic?CDC discourages this practiceIncreased possibility of administration and dosing errorsRisk of inappropriate storageProbability of bacterial contaminationReduction of vaccine potency overtime because of its interaction with the plastic syringe componentsAlthough this practice is discouraged, a limited amount may be pre-drawn prior to a mass-immunization clinic if:Only a single type of vaccine is administeredIt is drawn up upon arrival to the clinic settingPre-drawn syringes are stored at temperature appropriate for vaccineNo more than 1 vial or 10 doses drawn into syringesAt the end of the clinic, all unused, pre-drawn doses are discarded ................
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