Emphasize Influenza Immunization for 2018-19

Last year's severe flu season will ramp up interest in influenza vaccines for 2018-2019.

Timing. Vaccinate now...and continue as long as flu is circulating.

Point out that flu season can start as early as October...and it takes about two weeks for antibodies to develop after vaccination.

Vaccine options. Emphasize that it's more important to be vaccinated...rather than worry about which flu vaccine to get.

Quadrivalent vaccines might increase protection with one more B flu strain than trivalent...depending on which strains circulate this season.

Recommend a quadrivalent (Flulaval Tetra, Fluzone Quadrivalent) injectable for kids 6 months through 17 years...particularly those who are immunocompromised, have asthma, or with other chronic health conditions.

Help patients ages 65 and older compare Fluzone High-Dose and Fluad. Both are intended to boost immunity...Fluzone High-Dose has 4 times more antigen than the standard dose and Fluad has an adjuvant.

But both are TRIvalent vaccines.

Fluzone High-Dose seems to prevent more flu in elderly patients versus standard-dose TRIvalent. But the jury's still out on how Fluzone High-Dose or Fluad stack up against each other...or QUADrivalent vaccines.

Explain that both Fluzone High-Dose and Fluad may cause injection site reactions more frequently than standard vaccines.

Continue to consider intranasal FluMist Quadrivalent for healthy, NONpregnant patients ages 2 through 59 who want to avoid an injection.

Co-administration. Feel comfortable giving flu vaccine at the same time as other vaccines...pneumococcal, Tdap, Shingrix, etc.

There are theoretical concerns about more side effects if Shingrix and Fluad are given at the same time...since they both have adjuvants.

Don't delay vaccination. But consider a flu vaccine other than Fluad if one is available and you're giving Shingrix at the same visit.

Listen to PL Voices for insights from flu experts. And use our chart, Flu Vaccines for 2018-2019, to find approved ages and details on handling an egg allergy.

Key References

  • www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2018-2019.html#5
  • Pediatrics Published online Sep 3, 2018; doi:10.1542/peds.2018-2367
  • N Engl J Med 2014;371(7):635-45
Pharmacist's Letter Canada. Oct 2018, No. 341024



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