Thursday, September 29, 2016

Baby Boomers - Get Your Flu Shot

We Are Getting Older Folks
Currently information on this blog is aimed at people living with or treating hepatitis C, for the most part that is the baby boomer generation born between 1946 to1964. This year the oldest baby boomers will reach the age of 70. That certainly is disturbing news, I am 60 - where did the time go? With that said, the focus today is on this years influenza season, and yes that annual flu shot.

We begin with a link to the CDC's 2016-2017 influenza vaccination recommendations, which will take forever to read, if you just want the facts why not start by watching a few videos explaining this years vaccine options offered further down the page.

Information From The CDC

CDC - Weekly U.S. Influenza Surveillance Report
During week 42 (October 16-22, 2016),  flu activity was low in the United States.

Viral Surveillance: The most frequently identified influenza virus type reported by public health laboratories during week 42 was influenza A. The percentage of respiratory specimens testing positive for influenza in clinical laboratories was low.

Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.

Influenza-associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.

Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.3%, which is below the national baseline of 2.2%. All 10 regions reported ILI below region-specific baseline levels. New York City, Puerto Rico, and all 50 states experienced minimal ILI activity and the District of Columbia had insufficient data.

Geographic Spread of Influenza: The geographic spread of influenza in Guam was reported as widespread; Puerto Rico reported regional activity; one state reported local activity; the District of Columbia, the U.S. Virgin Islands and 41 states reported sporadic activity; and eight states reported no activity.

Stay updated; CDC
Weekly U.S. Influenza Surveillance Report
Influenza vaccine distribution information for the 2016-2017 season is posted here as CDC receives it, typically on Fridays.

Who Should Get A Flu Shot?
The bottom line is the CDC recommends a yearly flu vaccine for everyone 6 months and older.  The upcoming season's flu vaccine will protect against the influenza viruses that research indicates will be most common during the season. This includes an influenza A (H1N1) virus, an influenza A (H3N2) virus, and one or two influenza B viruses, depending on the flu vaccine. After vaccination, it takes a person about two weeks to build up immunity against the flu.

Changes and Updates

In June the CDC released a statement stating the “nasal spray” flu vaccine; live attenuated influenza vaccine (LAIV) should not be used during the 2016-2017 flu season.

Show Me A Video

Adults Ages 18 And Older - The flu shot for patients, 2016 - 2017
David Z Hirsch, MD

No more needle-free flu vaccine for now.
FOX 5 Atlanta            

Medscape Videos
Medscape published three videos with Lisa Grohskopf from CDC's Influenza Division discussing changes and updates in the recommendations for this influenza season.

Free registration is required to view the following videos

1 - CDC Provides Vaccine Recommendations for the 2016-2017 Influenza Season
Recommended 2016-2017 influenza vaccines include a number of inactivated injectable vaccines as well as recombinant influenza vaccine. Both trivalent and quadrivalent injectable vaccines will be available this season. Trivalent vaccines are designed to protect against three different influenza viruses. Quadrivalent influenza vaccines protect against the same three viruses plus an additional B virus from a different lineage of influenza B viruses.

2 - No LAIV (Nasal Spray) Flu Vaccine This Season
In this commentary, I will discuss an important change in the US 2016-2017 influenza vaccine recommendations. Specifically, I will explain why we are recommending that only injectable influenza vaccines (inactivated influenza vaccine [IIV] or recombinant influenza vaccine [RIV]) should be used during the upcoming influenza season.

3 - Flu Vaccine for People With Egg Allergies
People with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine; and people with a history of severe allergic reaction to egg (ie, any symptom other than hives) can now be vaccinated in a medical setting, under the supervision of a healthcare provider who is able to recognize and manage severe allergic conditions.

News Article
The nose is out. The arm is in
A federal agency and a national pediatric association are pushing pediatricians and other doctors not to provide the nasal spray influenza vaccination, FluMist, and instead to rely only on shots.

Of Interest
Commentary - Healio
Citing a lack of evidence of efficacy, the AAP’s Committee on Infectious Diseases recommends that clinicians not administer the FluMist quadrivalent live-attenuated vaccine during the upcoming influenza season.

In The News
The importance of vaccination in persons with chronic liver disease, cirrhosis, transplant receipts and people 65 years and older is provided on this page as well. Just yesterday the CDC reported a decrease in people 50 to 64 getting out to get vaccinated and a drop in people 65 and older, read the story here.

The Flu In People 50 And Over
Persons that are 50 and over may be more likely to have chronic medical conditions that put them at higher risk of severe influenza illness, especially in people 65 and over. According to the CDC; "In recent years, it’s estimated that between 71 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older and between 54 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in that age group. So influenza is often quite serious for people 65 and older."

High-dose Flu Shot For People 65 And Older

There are two vaccines designed specifically for people 65 and older:
Fluzone and FLUAD

Fluzone - The high dose vaccine has been approved for use in the United States since 2009.
The “high dose vaccine fluzone” is designed specifically for people 65 and older and contains 4 times the amount of antigen as the regular flu shot. It is associated with a stronger immune response following vaccination (higher antibody production).

A 2014 study published in the New England Journal of Medicine of more than 30,000 participants showed that adults 65 years and older who received Fluzone High-Dose vaccine had 24% fewer influenza infections as compared to those who received the standard dose Fluzone vaccine.

FLUAD - vaccine will be available for the first time in the United States during the 2016-2017 season.
The adjuvanted flu vaccine, Fluad, is made with MF59 adjuvant which is designed to help create a stronger immune response to vaccination. In a Canadian observational study of 282 persons aged 65 years and older conducted during the 2011-12 season, Fluad was 63% more effective than regular-dose unadjuvanted flu shots.

*There are no randomized studies comparing Fluad with Fluzone High-Dose.

The high dose and adjuvanted flu vaccines may result in more of the mild side effects that can occur with standard-dose seasonal shots. Mild side effects can include pain, redness or swelling at the injection site, headache, muscle ache and malaise.

Over 65? Is Timing Important?
The CDC recommends that you should try to get your flu vaccine anytime between now and the end of October. Flu activity typically peaks between December and March . However, immunologist Laura Haynes suggests people over 65 wait until Halloween to get their flu shots to make sure the immunity lasts through the flu season, read the article over at NPR. Along with this piece by Kaiser Health News; Yes, It Is Possible To Get Your Flu Shot Too Soon. Or check out this new article; CDC Urges Americans To Get A Flu Shot As Soon As Possible

Liver Disease

Evidence suggests people living with chronic liver disease, cirrhosis and liver transplant recipients are particularly at risk from the flu and its complications.

Cirrhotic Patients
Multiple studies indicate that vaccination might be beneficial for persons with chronic liver disease. In a prospective 2007 study influenza vaccination decreased influenza-related complication rates in patients with liver cirrhosis. The study included 311 persons with cirrhosis, 198 of whom were vaccinated with a trivalent influenza vaccine and the rest were not vaccinated. Most of the cirrhotic patients with influenza had fever (91.6%) and complained of myalgia (83.3%) without respiratory symptoms, which were not typical clinical presentations of influenza. Influenza vaccination decreased influenza-related complication rates in patients with liver cirrhosis (14% versus 23%).

Transplant Recipients
Influenza is one of the common endemic viral diseases that is associated with higher morbidity and mortality in solid organ transplant (SOT) recipients than in immunocompetent patients.

This review summarizes current information and the evidences regarding the efficacy and safety of immunization in adult solid organ transplant candidates and recipients.
Read the 2016 article, here.

Viral Hepatitis
In a more recent 2015 study, data from Taiwan’s National Health Insurance program was reviewed from 2000 through 2009  to evaluate hospitalization and mortality in patients with chronic hepatitis B who received an annual influenza vaccination vs those who did not. The study concluded that not only was there a lower hospitalization rate among persons with chronic hepatitis B infection who had been vaccinated against the flu compared with those who had not, but annual influenza vaccination can lower the risk of mortality in patients with chronic HBV infection.

Remember getting your flu shot not only protects you, it also helps protect the people you love.

Stay well, until next time.


No comments:

Post a Comment