clinical topic updates

Issues for Health Care Practitioners Who Administer Influenza Vaccines

by Tina Q. Tan, MD, FAAP, FIDSA, FPIDS

Overview

Patients, parents, and even allied health care personnel may have distinct anxieties about various aspects of immunization. Our featured expert reports on the relevant issues for practices that administer the influenza vaccine.

Expert Commentary

Tina Q. Tan, MD, FAAP, FIDSA, FPIDS

Professor, Department of Pediatrics
Feinberg School of Medicine
Northwestern University
Attending Physician, Division of Infectious Diseases
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, IL

“I agree with guidance from the Centers for Disease Control and Prevention on the importance of ‘the right patient, right time, right dosage, right route, right site, and right documentation’ for personnel who administer the influenza vaccine.”

Tina Q. Tan, MD, FAAP, FIDSA, FPIDS

Influenza vaccines are generally administered either by intramuscular injection (eg, inactivated influenza vaccine ) or by intranasal spray (eg, live attenuated influenza vaccine [LAIV]). The LAIV is approved by the US Food and Drug Administration for healthy, nonpregnant persons aged 2 to 49 years. Different formulations of inactivated influenza vaccine are approved for children aged 6 to 35 months, as well as for children older than 3 years, with varying dosages and volumes in different age groups.

As relates to anxieties related to vaccine delivery, I agree with guidance from the Centers for Disease Control and Prevention on the importance of “the right patient, right time, right dosage, right route, right site, and right documentation” for personnel who administer the influenza vaccine. This is particularly relevant to those who work in practice settings where both pediatric and adult patients are treated, where there is the potential for a patient to receive the wrong vaccine, the wrong volume, or the wrong dose (eg, giving a pediatric dose to an older child or to an adult patient). Practices can take a number of steps to reduce the risk of errors in vaccine delivery. If 2 different influenza vaccines are being used, they can be separated in the refrigerator and can be clearly labeled to assist the staff in trying to avoid a mix-up.

It is also important to remember that children between 6 months and 8 years of age who have not been vaccinated in a previous season require 2 doses of the influenza vaccine, given at least 4 weeks apart. General guidance to personnel who deliver vaccines includes specific information about appropriate needle length, which depends on the patient’s age and body mass, and other practices to ensure efficient vaccine delivery, noting that deviation from the recommended route of administration might reduce vaccine efficacy or increase the risk for local adverse reactions. The LAIV may be easier to administer in some patients, but not in every patient, as the volume delivered is not insignificant; the patient may experience some coughing or sputtering; and, just as a child may resist all needles/shots after receiving their first vaccination, a child may resist delivery of the LAIV to the second nostril. Pregnant and postpartum women do not need to avoid contact with persons recently vaccinated with the nasal spray influenza vaccine. However, the nasal spray influenza vaccine should not be given to women who are pregnant. Postpartum women can receive a flu shot or the nasal spray influenza vaccine.

References

Centers for Disease Control and Prevention. General best practice guidelines for immunization: vaccine administration. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.pdf. Accessed October 23, 2019.

Centers for Disease Control and Prevention. Live attenuated influenza vaccine [LAIV] (the nasal spray flu vaccine). https://www.cdc.gov/flu/prevent/nasalspray.htm. Accessed October 23, 2019.

Centers for Disease Control and Prevention. Vaccine recommendations and guidelines of the ACIP. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html. Accessed October 23, 2019.

Coleman BL, McNeil SA, Langley JM, Halperin SA, McGeer AJ. Differences in efficiency, satisfaction and adverse events between self-administered intradermal and nurse-administered intramuscular influenza vaccines in hospital workers. Vaccine. 2015;33(48):6635-6640.

Fogel B, Hicks S. Influenza vaccination rates in children decline when the live attenuated influenza vaccine is not recommended. Vaccine. 2017;35(39):5278-5282.

Robison SG, Dunn AG, Richards DL, Leman RF. Changes in influenza vaccination rates after withdrawal of live vaccine. Pediatrics. 2017;140(5): e20170516.

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