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2013-2014 Influenza
Immunization Orientation
1
September 2013
What is influenza?
Influenza, commonly known as “the flu”, is a highly contagious
infection of the airways caused by influenza viruses. It is often referred
to as “seasonal” influenza because these viruses circulate annually in
the winter season in the northern hemisphere.
The timing and duration of influenza season varies - outbreaks can
happen as early as October but most often activity peaks in January or
later. Late season outbreaks occurring in April and even May have
also been reported.
2
A, B and C influenza viruses
• Influenza A and B viruses cause seasonal epidemics, while type C
viruses cause mild respiratory illness
• Influenza A viruses are classified into different strains or subtypes
based on two proteins or antigens on the virus surface:
hemagglutinin (H) and neuraminidase (N)
– e.g., H1N1 and H3N2
• Influenza B viruses can be classified into two antigenically distinct
lineages, Yamagata and Victoria like viruses
• Influenza A and B strains are included in
each year's influenza vaccine
• The vaccine does not protect against
influenza C viruses
3
Influenza Types – A and B
Type A
(Seasonal, Avian, Swine influenza)
Can cause significant disease
Type B
(Seasonal influenza)
Generally causes milder disease
but may also cause severe disease
Infects humans and other species (e.g.
Limited to humans
birds; H5N1)
Can cause epidemics and pandemics
(worldwide epidemics)
Generally causes milder epidemics
4
How strains change each year
• Small changes in influenza viruses occur continually
– New virus strains may not be recognized by the body's immune
system
• A person infected with a specific influenza virus strain develops
antibodies against that specific strain
• In most years, some or all of the three virus strains in the influenza
vaccine are updated to align with the changes in the circulating
influenza viruses
• Annual influenza immunization is recommended to protect against
infection from these changing influenza viruses
5
Signs and symptoms of influenza
• Sudden onset
• Typically starts with a headache, chills and cough, followed rapidly
by fever, loss of appetite, muscle aches and fatigue, runny nose,
sneezing, watery eyes and throat irritation
• Nausea, vomiting and diarrhea may also occur,
especially in children
6
Influenza , the Common Cold and Gastrointestinal Infection
Symptoms
Influenza
Common Cold
Gastrointestinal
Infection
(Stomach Upset)
Fever
Usually high
Sometimes
Rarely
Chills, aches, pain
Usually and often severe
Rarely
Common
Headache
Usually, can be severe
Rarely
Sometimes
Loss of appetite
Sometimes
Sometimes
Frequently
Cough
Usually
Sometimes
Rarely
Sore throat
Sometimes
Sometimes
Rarely
Sniffles or sneezes
Sometimes
Usually
Rarely
Involves whole body
Usually
Never
Stomach/ bowel only
Symptoms appear quickly
Yes
More gradual
Yes
Extreme tiredness
Usually
Rarely
Sometimes
Complications
Pneumonia; can be life
threatening
Sinus infection/Ear infection
Dehydration
Alberta Health http://www.health.alberta.ca/health-info/influenza-compare-symptoms.html
7
The myth of the “stomach flu”
• Many people use the term "stomach flu" to describe illnesses with
nausea, vomiting, or diarrhea. These symptoms can be caused by
many different viruses, bacteria, or even parasites
• While vomiting, diarrhea, and nausea can sometimes occur when
people have influenza (particularly children), these problems are
not the main symptoms of influenza
• Influenza is a respiratory disease - not a stomach or intestinal
disease
8
How serious is influenza?
• While the majority of those who become ill will recover, it is
estimated that influenza causes about 20,000 hospitalizations and
4,000 deaths in Canada each year
• Some individuals are at higher risk of developing complications from
influenza, including:
– Seniors
– Infants and young children
– Adults and children with existing chronic health conditions
– Healthy pregnant women
– Aboriginal peoples
– Obese persons
Complications can include pneumonia (bacterial and viral), ear and sinus
infections, dehydration, and worsening of chronic medical conditions, such as
congestive heart failure, asthma, or diabetes.
9
How is influenza spread?
• The virus is spread mainly from person to person when those with
influenza cough or sneeze (droplet spread)
– The droplets are propelled about 3 feet through the air
• People may also become infected by touching an object or a
surface that has the influenza virus on it and then touching their
mouth, eyes or nose
10
Influenza incubation
• Individuals with influenza are infectious 1 day before symptoms
develop and up to 5 days after becoming ill
– The period when an infected person is contagious depends on
the age and health of the person
– Young children and people with weakened immune systems
may be contagious for longer than a week
• The time period from exposure to development of symptoms is
about 1 to 4 days, with an average of about 2 days
11
Influenza infectivity
• People infected with influenza can spread the disease to others
before they know they are ill, and while they are ill
• Some people can be infected but have no symptoms
– These individuals can still spread the virus to others
• This is important information for those caring for others, such as
parents and health care workers
• In one published study, 59% of health care workers tested had
evidence of recent influenza infection but could not recall having
symptoms
12
Health Care Workers
• Health care workers (HCWs) who have direct patient contact
should consider it their responsibility to provide the highest
standard of care, which includes annual influenza immunization
• In the absence of contraindications, refusal of HCWs who have
direct patient contact to be immunized against influenza implies
failure in their duty of care to patients
13
Treatment of influenza
Treatment recommendations for
non-complicated cases include:
• rest
• analgesics
• fluids
• time
14
Influenza vaccine development
• Each February, the World Health Organization (WHO) provides a
recommendation on the strains to be included in the influenza
vaccine for the northern hemisphere
• Two influenza "A" viruses and one influenza "B" virus are selected
based on the characteristics of the current circulating influenza
virus strains
• A new vaccine is reformulated each year to protect against new
influenza infections
• Each vaccine lot is tested on healthy individuals to ensure the
vaccine is safe and effective
15
Influenza vaccine development
(cont’d)
• There are currently eight trivalent influenza vaccines licensed for
use in Canada
– Seven are trivalent inactivated influenza vaccine (TIV)
– One is a live attenuated influenza vaccine (LAIV)
• For the 2013–2014 influenza immunization program, Alberta will be
using two TIV products and one LAIV product
16
How does inactivated influenza vaccine work?
• Both humoral and cell-mediated responses play a role in immunity
• Administration of inactivated influenza vaccine results in the
production of circulating IgG antibodies to the viral haemagglutinin
as well as a cytotoxic T lymphocyte response
• Humoral antibody levels, which correlate with vaccine protection,
are generally achieved 2 weeks after immunization and immunity
usually lasts less than 1 year
– Initial antibody response may be lower in the elderly and
immune-compromised
17
How does live attenuated influenza vaccine work?
• Immune mechanisms conferring immunity following administration
of live attenuated vaccine are not fully understood
• Administered by the intranasal route, LAIV is thought to result in an
immune response that mimics that induced by natural infection with
wild-type virus, developing both mucosal and systemic immunity
• Serum antibodies, mucosal antibodies and influenza-specific T
cells may play a role
• The viral strains in LAIV are engineered to be cold adapted (can
only replicate in the nasopharynx), temperature sensitive (cannot
replicate in the warm temperatures of the lower airways and lungs)
and attenuated (unable to cause clinical disease)
18
Effectiveness of influenza vaccine
•
Vaccine effectiveness depends on the similarity between vaccine strains and
the strains in circulation during influenza season
– With a good "match," influenza immunization prevents disease in 70 to
90% of healthy individuals
– This drops to 30 to 40% in the frail and elderly
• It does, however, prevent death in 85% of the frail and elderly
– It prevents hospitalization in 50 to 60% of individuals immunized
•
Even with an imperfect match, Canadian studies show the vaccine still
reduces the overall risk of infection by about 40-60%
•
A vaccine that is not perfectly matched can still offer protection against
related viruses making illness milder and preventing complications
•
LAIV has generally shown to be equally or more immunogenic than TIV in
children and adolescents 2 to 17 years of age.
19
Vaccine strains for 2013-2014
The three strains that will be included in the 2013-2014 influenza
vaccine for the Northern hemisphere are:
• A/California/7/2009 (H1N1)pdm09-like virus
• A(H3N2) virus antigenically like the cell-propagated prototype virus
A/Victoria/361/2011 (A/Texas/50/2012 viruses, which are
antigenically like the A/Victoria/361/2011, will be used in
manufacturing the vaccine)
• B/Massachusetts/2/2012-like virus (Yamagata lineage)
20
Facts about trivalent inactivated influenza vaccine (TIV)
• Is an inactivated (killed) vaccine – cannot cause influenza disease in
the vaccine recipient
• The virus is grown in hens’ eggs, inactivated, broken apart and
highly purified
• In addition to the antigen, the vaccine may contain:
- Thimerosal (preservative in multidose vials)
- Trace residual amounts of egg proteins, formaldehyde,
kanamycin, neomycin, cetyltrimethylammonium bromide (CTAB),
polysorbate 80, sodium deoxycholate and sucrose
• Check the product monograph as ingredients vary with specific
inactivated influenza vaccines
21
Facts about live attenuated influenza vaccine (LAIV)
• Is a live vaccine – cannot cause influenza disease in the vaccine
recipient because the virus is attenuated or weakened (however is
contraindicated in immunocompromised individuals)
• The virus is grown in specific pathogen-free eggs from specific
pathogen-free chicken flocks
• In addition to the antigen, the vaccine may contain:
- Trace residual amount of arginine, gelatin hydrolysate (porcine
type A), gentamicin, monosodium glutamate, ovalbumin and
sucrose
• Check the product monograph for other product excipients
22
Facts about LAIV (cont’d)
• Individuals receiving LAIV can shed vaccine virus in small
amounts, generally below the levels needed to transmit vaccine
virus to others
• In rare instances, vaccine virus can be transmitted from vaccine
recipients to unimmunized persons
• Individuals who wish to receive LAIV should be advised there is
potential for transmission of vaccine virus to immunocompromised
contacts, and they should avoid contact with anyone who is
severely immunocompromised (e.g., bone marrow transplant
recipients requiring isolation) for at least 2 weeks following
immunization
23
Universal Influenza Immunization Program
Alberta Health (AH) funds a Universal
Influenza Immunization Program.
• All people 6 months of age and older
who live, work or go to school in Alberta
are eligible for vaccine at no charge
24
Influenza Immunization Program in Alberta
Alberta Health Services (AHS) will coordinate the delivery and
administration of a Universal Influenza Immunization Program with
mass public immunization clinics beginning mid October 2013.
• Vaccine may be offered earlier for certain high risk populations (e.g.,
continuing care residents, lodge residents, homebound clients,
homeless individuals, HCWs, children 6-59 months in routine
immunization clinic) once vaccine becomes available
• As in previous years, immunization partners (e.g., physicians,
pharmacists, private health agencies, occupational health services) will
play an essential role in achieving the AH immunization targets:
-
75% of those 65 years of age and older
95% of all residents of continuing care facilities
75% of those 6-23 months of age
95% of all long term care staff
80% of health care workers
25
Provincially funded influenza vaccines
Fluviral® (TIV)
(GlaxoSmithKline)
Agriflu® (TIV)
(Novartis)
FluMist® (LAIV)
(AstraZeneca)
Dosage/Route
0.5 mL IM
0.5 mL IM
0.2 mL Intranasal
Packaging
5 mL vial
Pre-filled, single dose syringe
(luer lock needles not included)
Pre-filled, single use glass sprayer
Eligibility
Individuals who live, work or go to
school in Alberta
Individuals who live, work or go to
school in Alberta
Individuals who live, work or go to
school in Alberta
Indication
6 months1 of age and older
6 months1 of age and older
2 years up to and including 17 years
of age
Ingredients2
Thimerosal 50mcg/0.5mL, trace
amounts of egg proteins,
formaldehyde, sodium deoxycholate,
sucrose
Thimerosal-free, trace amounts of
egg proteins, formaldehyde,
kanamycin, neomycin, polysorbate
80, cetyltrimethylammonium bromide
(CTAB)
Thimerosal-free, arginine, gelatin
hydrolysate, (porcine type A),
gentamicin, monosodium glutamate,
ovalbumin, sucrose
1 or 2 doses3
1 or 2 doses3
1 or 2 doses3
Schedule
1Children
2Refer
must be 6 calendar months of age; do not compress this age by using 28 day months
to vaccine product monograph for a complete listing of the ingredients
3Children
less than 9 years of age require 2 doses given at a minimum of 4 weeks apart if they have never received seasonal
influenza vaccine. This recommendation applies whether or not the child received monovalent pH1N1 vaccine in 2009-2010.
26
Provincially funded influenza vaccine use
• TIV is safe and immunogenic in individuals 6 months of age and
older
• LAIV is safe and immunogenic in individuals 2 years of age up to
and including 59 years of age
• There is no preference indicated for the use of Fluviral® or Agriflu®
in specific age or risk groups for the 2013-2014 influenza season
• FluMist® will be the vaccine of choice for children 2 years up to and
including 17 years of age for the 2013-2014 influenza season
– It may be used in adults 18 years up to and including 59 years
of age who would not otherwise receive an influenza vaccine
27
Provincially funded influenza vaccine use (cont’d)
• Persons with medical contraindications and/or refusals to one
product should be offered the alternate product if supply is
available
• When determining which product to use, immunizers should
minimize vaccine wastage
28
Influenza vaccine dosing for specific ages
6 months up to & including 8 years of age
• 2 doses* if never been previously immunized with seasonal
influenza vaccine (spaced 4 weeks apart – minimum interval)
• 1 dose only if previously immunized with seasonal influenza
vaccine
9 years of age and older
• 1 dose
* This recommendation applies whether or not the child received
monovalent pH1N1 vaccine in 2009-2010.
29
Return visit for children who need a second dose
• Indicate date to return for second dose of vaccine on the NCR form
and provide a copy of the form to the client
• See local protocol for indicating location for second dose of vaccine
30
Thimerosal
• Multidose vials of vaccine contain a preservative called thimerosal
(ethylmercury)
• Ethylmercury is not the same compound as methylmercury
– Methylmercury is a known neurotoxin in high concentrations or
with prolonged exposure (e.g., ingesting some types of fish)
• Ethylmercury is eliminated much more quickly and is less likely to
reach toxic levels in the blood than methylmercury
• Studies have demonstrated that there is no association between
immunization with thimerosal-containing vaccines and
neurodevelopmental outcomes, including autistic-spectrum disorders
• Additional information regarding thimerosal is available at
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/07vol33/acs-06/indexeng.php
31
Pregnancy and breastfeeding
“NACI recommends the inclusion of all pregnant women,
at any stage of pregnancy, among high priority recipients
of influenza vaccine due to:
• the risk of influenza associated morbidity in
pregnant women
• evidence of adverse neonatal outcomes associated
with maternal respiratory hospitalization or influenza
during pregnancy
• evidence that vaccination of pregnant women
protects their newborns from influenza and influenzarelated hospitalization, and
• evidence that infants born during influenza season to
vaccinated women are less likely to be premature, small
for gestational age, and low birth weight.”
NACI Statement 2013
32
Pregnancy and breastfeeding (cont’d)
• TIV is safe for pregnant women at all stages
of pregnancy
• TIV and LAIV are safe for breastfeeding
mothers
• LAIV is contraindicated in pregnant women
33
Reactions to inactivated influenza vaccine
The majority of people do not have a reaction to TIV; however some
reactions that may occur are outlined below. These reactions generally
start 6 to 12 hours after immunization and can last for 1 to 2 days.
Common Reactions
•
•
•
Injection site redness, swelling, pain
Fatigue, headache, myalgia
Arthralgia, fever, chills, malaise
34
Reactions to live attenuated influenza vaccine
Most people have no reaction to LAIV. If reactions occur they tend to be
mild and last for 1-3 days, peaking 2 days following immunization.
Common Reactions
• Runny, stuffy nose in children and adults
• Children – decreased appetite, headache, weakness and fever
• Adults – sore throat, headache, cough and weakness
For children requiring two doses of vaccine, the symptoms tend to
be less frequent following the second dose.
35
Reactions to TIV and LAIV
Rare Reactions
•
Immediate, allergic-type responses such as hives,
angioedema, allergic asthma, systemic anaphylaxis
•
Guillain-Barré Syndrome (GBS)
•
Oculorespiratory Syndrome (ORS)
36
Guillain-Barré Syndrome (GBS)
• GBS is an illness that affects the nervous system
– It is rare; general risk is about 2 cases per 100,000 person years
– It is characterized by loss of reflexes and symmetric paralysis
usually beginning in the legs
– It results in complete or near complete recovery in most cases
• It is thought that GBS may be triggered by an infection
– The infection that most commonly precedes GBS is the
Campylobacter jejuni bacteria
– Other respiratory or intestinal illnesses and other triggers may
also precede an episode of GBS, including Cytomegalovirus,
Epstein-Barr virus and Mycoplasma pneumoniae
37
Guillain-Barré Syndrome (GBS) (cont’d)
• In 1976, the “swine flu” vaccine was associated with an increased
risk of GBS – this has not been found with influenza vaccines
administered after the swine influenza vaccine program according
to the US Institute of Medicine
• Absolute risk of GBS after vaccination is about 1 excess case per 1
million vaccinees above background rate (10 - 20 cases/million)
It is recommended that you do not provide influenza
immunization to people who have been diagnosed with GBS
within 6 weeks of previous influenza immunization.
38
Oculorespiratory Syndrome (ORS)
In 2000-2001, Health Canada received increased reports of
unusual symptoms following influenza immunization. These
symptoms were subsequently described as Oculorespiratory
Syndrome (ORS).
Case definition of ORS (onset within 24 hours of immunization)
•
bilateral red eyes
and/or
•
respiratory symptoms (cough, wheeze, chest tightness,
difficulty breathing, difficulty swallowing, hoarseness, and/or
sore throat)
and/or
•
facial swelling
39
Oculorespiratory Syndrome (ORS) (cont’d)
Immunization recommendations following client report of ORS
are based on:
• risk/benefit assessment,
and
• severity of symptoms as perceived by the individual who
experienced the symptoms
For immunization recommendations following client report of
ORS:
Refer to Decision Making Algorithm: Influenza Vaccine for
Persons with Previous ORS Symptoms
40
ORS Decision Flowchart
How severe were the ORS symptoms?
Mild
(easily tolerated, present
but not problematic)
May receive the
influenza vaccine
Moderate
(bothersome, interferes with activities
of daily living, requires activity change
& possible medication)
Severe
(prevents activities of
daily living, unable to
work or sleep)
May receive the
influenza vaccine
Non-lower respiratory symptoms
(bilateral red eyes, cough,
hoarseness, sore throat, facial
swelling)
May receive the
influenza vaccine
Lower respiratory symptoms
(wheeze, chest tightness,
difficulty breathing) and/or
difficulty swallowing (within 24
hrs of immunization)
Case should be reviewed by
MOH before receiving
subsequent influenza vaccine
41
Reporting of adverse events following immunization (AEFI)
An adverse event following immunization is defined as a serious or unexpected
event temporally associated with immunization.
Local reactions are reportable if they have:
• onset within 48 hrs following immunization
and one or more of the following:
• redness or swelling at the injection site which is at least 5 cm in diameter
lasting 4 or more days
or
• severe pain that interferes with the normal use of the limb lasting 4 or
more days
or
• swelling that extends past the nearest joint or reactions that require
hospitalization
42
AEFI reporting (cont’d)
Any of the following are also reportable adverse events:
• GBS
• ORS
• Anaphylaxis
• Other allergic reactions
• Any reaction outside of what is expected
Report AEFIs or unusual incidents that may occur as per local
protocols. Severe reactions should be reported within 24 hours and all
other reactions within one week to your zone contact. “Reportable
AEFIs” are reported to Alberta Health, and in turn to the National
Surveillance Program.
43
Contraindications to TIV
TIV should not be administered to individuals who:
• Are less than 6 calendar months of age
• Have had an anaphylactic reaction to a previous dose of influenza
vaccine
• Have a known hypersensitivity to any component of the vaccine
• Have been diagnosed with Guillain-Barré Syndrome within 6 weeks
of a previous dose of influenza vaccine
• Have experienced severe Oculorespiratory Syndrome (ORS) within
24 hrs of receiving influenza immunization – these individuals
should be assessed further prior to immunizing
44
Contraindications to LAIV
LAIV should not be administered to individuals who:
• Are less than 2 years of age or older than 59 years of age
• Have had an anaphylactic reaction to a previous dose of influenza
vaccine
• Have a known hypersensitivity to any component of the vaccine
• Have been diagnosed with Guillain-Barré Syndrome within 6 weeks
of a previous dose of influenza vaccine
• Have experienced severe Oculorespiratory Syndrome (ORS) within
24 hrs of receiving influenza immunization – these individuals
should be assessed further prior to immunizing
• Have an egg allergy
45
Contraindications to LAIV (cont’d)
LAIV should not be administered to individuals who:
• Have severe asthma (defined as currently on oral or high dose
inhaled glucocorticosteroids or active wheezing) or those with
medically attended wheezing in the 7 days prior to immunization
– High dose inhaled steroid will be defined as an individual taking
greater than 500 mcg per day of inhaled steroid, regardless of
age and drug (MOH recommendation)
• Are immunocompromised due to underlying disease and/or therapy
• Are pregnant
• Are 2 years up to and including 17 years of age on aspirin or
aspirin-containing therapy
46
Contraindications to LAIV (cont’d)
• Have received a live parenteral vaccine in the past 4 weeks
– There are varying expert opinions regarding the spacing of
LAIV and other live parenteral vaccines; however, Alberta
Health recommends that LAIV may be administered
concurrently with other live parenteral vaccines or separated by
a minimum of 4 weeks.
47
Precautions to LAIV
• Health care workers (HCW) or caregivers working with severely
immunocompromised individuals should receive TIV.
– If the HCW or caregiver will only accept LAIV, they should wait
2 weeks following immunization before continuing to provide
care to immunocompromised individuals
• Individuals on influenza antiviral medication should not be
immunized with LAIV until 48 hrs after antiviral medication has
been stopped
– Antiviral medication should not be administered until 2 weeks
after administration of LAIV unless medically indicated
– If antiviral agents are administered from 48 hrs before to 2
weeks after LAIV is given, re-immunization should take place at
least 48 hrs after the antivirals are stopped
48
Precautions to LAIV
• If nasal congestion is present that might impede the delivery of the
vaccine to the nasopharyngeal mucosa, defer the immunization
until the illness is resolved or consider immunization with trivalent
inactivated vaccine.
49
Egg-allergic individuals
•
Egg allergy is no longer considered a contraindication for inactivated
influenza vaccine (TIV)
•
Egg-allergic individuals may be immunized using TIV without a prior
influenza vaccine skin test and with the full dose of vaccine with the
following conditions:
– Egg-allergic individuals who have experienced anaphylaxis with
respiratory or cardiovascular symptoms should be immunized in a
medical clinic, allergist’s office or hospital where appropriate expertise
and equipment to manage respiratory or cardiovascular compromise is
present. These individuals should be kept under observation for 30
minutes.
– Egg-allergic individuals with mild reactions such as hives, or those who
tolerate eggs in baked goods may be immunized in regular
immunization clinics and should be kept under observation for 30
minutes following immunization.
50
Vaccine deferral
Vaccine may be deferred until later in the following situations:
• Those with serious acute febrile illness usually should not be
immunized until symptoms have abated
Vaccine does not require deferral and can safely be given to the
following individuals:
• Those with mild acute illness, with or without fever
• Individuals who are recovering from illness or are taking antibiotics
51
Pneumococcal Immunization
52
What is pneumococcal polysaccharide vaccine?
• Pneumococcal vaccines are used to prevent serious illnesses
caused by the Streptococcus pneumoniae bacteria
– the vaccine protects against 23 serotypes of this bacteria
• The vaccine is sometimes referred to as the “pneumonia shot”
• The immunization program was implemented nationally in 1998
• The vaccine is provided throughout the year by Public Health or
community physician partners, but also in conjunction with the
Influenza Immunization Program due to ease of access to target
population
• Pneumococcal polysaccharide vaccine is available for eligible
people age 24 months and older
• Onset of immunity is about 10 to 15 days after immunization
53
Why is pneumococcal polysaccharide vaccine important?
• This vaccine can prevent the most common types of bacterial
pneumonia and other serious infections, such as bacteremia and
meningitis
• Certain populations are more at risk of serious illness caused by
this bacteria, so the vaccine is offered to them to provide protection
• This bacteria is becoming resistant to some of the antibiotics used
to treat it
• Vaccine effectiveness is dependent on the age and immune
competency of the vaccine recipient
– The immunity conferred is serotype specific
– The vaccine is 56% - 81% effective in preventing invasive
pneumococcal disease
54
Pneumococcal polysaccharide vaccine eligibility
I. Routine Recommended Immunization
• Individuals 65 years of age and older
II. Medically at Risk
• Individuals 24 months up to and including 64 years of age with the
following:
– Chronic lung disease (except asthma, unless on high dose steroids)
– Chronic heart disease; includes congestive heart failure, myocardial infarction
and individuals taking heart medications or being followed by a cardiac
specialist
– Diabetes mellitus; includes both insulin and non insulin dependent (controlled
by oral medication or diet)
– Chronic kidney disease; includes nephrotic syndrome and renal dialysis
– Immunosuppression related to disease or therapy; includes individuals with:
o congenital immunodeficiency
o HIV infection
55
Pneumococcal polysaccharide vaccine eligibility (cont’d)
–
–
–
–
–
–
–
o malignancies; includes leukemia, lymphoma, multiple myeloma, Hodgkin’s
disease
o solid organ transplants (candidates/recipients)
o therapy with alkylating agents, antimetabolites or systemic corticosteroids
o lupus
o multiple sclerosis,
o muscular dystrophy
Anatomic or functional asplenia, splenic dysfunction
Sickle cell disease
Chronic cerebrospinal fluid (CSF) leak
Chronic liver disease; includes chronic hepatitis B, hepatitis C and cirrhosis
Alcoholism; includes individuals with any history of alcohol abuse
Cochlear implant (candidates and recipients)
Individuals who have recovered from any type of cancer
• Hematopoietic stem cell (HSCT) recipients 24 months of age and older
56
Pneumococcal polysaccharide vaccine eligibility (cont’d)
III. High Risk Setting
• Individuals 24 months up to and including 64 years of age who are
homeless or living in chronic disadvantaged situations
– Includes those with no fixed address or living in shelters
• Individuals 24 months up to and including 64 years of age who are
residents of Long Term Care or Continuing Care facilities
57
Pneumococcal polysaccharide vaccine eligibility (cont’d)
Yes
NO
Lupus
Repeated pneumonia
Multiple sclerosis
Fibromyalgia
Muscular dystrophy
Chronic Fatigue Syndrome
Myocardial infarction
Hypertension
Chronic liver disease –
includes cirrhosis, Hepatitis
B and Hepatitis C
Asthma
58
Pneumococcal polysaccharide vaccine
•
Provincially funded product - Pneumovax®23 (Merck)
•
Dosage is 0.5 mL (comes in a single dose vial)
•
Intramuscular injection given in the deltoid
– use 3 cc syringe
– needle size dependent on muscle mass
•
Eligible person can receive pneumococcal vaccine with influenza vaccine
on the same visit but it must be given in a separate injection, in a different
immunization site (e.g., one vaccine in left deltoid, one in the right)
•
The vaccine should be given at least 14 days prior to initiation of
immunosuppressive therapies (e.g., chemotherapy)
•
Check your local protocol for clients who are unsure of past pneumococcal
polysaccharide immunization history
59
Schedule and reinforcing dose
•
One primary dose is sufficient for most individuals
– Two doses are required for HSCT recipients
•
Select high risk individuals qualify for a single reinforcing dose
•
A one-time single reinforcing dose is recommended ONLY for individuals
with:
– Functional or anatomic asplenia, splenic dysfunction or sickle cell disease
– Hepatic cirrhosis
– Chronic renal failure or nephrotic syndrome
– HIV infection
– Immunosuppression related to disease or therapy (e.g., lymphoma,
Hodgkin’s disease, multiple myeloma, high-dose systemic steroids)
– Solid organ transplant
60
Reinforcing dose
• A one-time single reinforcing dose should be given:
– 3 years after the initial dose of pneumococcal polysaccharide
vaccine if the client was 2 to 10 years of age at the time of the
initial dose
– 5 years after the initial dose of pneumococcal polysaccharide
vaccine if the client was 11 years of age or older at the time of
the initial dose
61
Pneumococcal polysaccharide vaccine side effects
• About half of those immunized will have a
small amount of swelling and soreness at the
injection site
• Fewer may have mild fever, headache and/or
muscle pain
• Some individuals have more serious side
effects such as a large amount of swelling and
pain
– People who have a reaction that concerns
them or unusual reactions should contact
Health Link Alberta for direction
62
Contraindications
Pneumococcal polysaccharide vaccine is contraindicated for the
following people:
• People who have experienced anaphylaxis to a previous dose of
pneumococcal polysaccharide vaccine
• People who have a severe allergy to any component of the vaccine
• Children under 24 months of age
Special consideration needs to be given to clients undergoing
splenectomies, transplants or immunosuppressive therapy. Refer
these individuals to Public Health (in some zones to the
Communicable Disease Unit) for assessment.
63
Vaccine Administration
• Client Interview (Fit to Immunize Assessment)
• Informed Consent
• Vaccine Administration Process
64
Fit to immunize assessment
The immunizer will:
• Assess the need for immunization
• Confirm the client has not received a dose of influenza vaccine in the
2013-2014 influenza season
• Complete a “fit to immunize” assessment
– health status today
– history of allergies
– previous reactions
– chronic illness/medications
– pregnancy
– HCW working with or contact of immunocompromised individuals
– history of live parenteral vaccine in past 4 weeks
65
Informed consent
• Clients must give informed consent before immunization
• Prior to immunizing the immunizer must:
– Determine that the client is eligible (lives, works or goes to
school in Alberta)
– Review the disease(s)* being prevented
– Review antigen(s)*
– Risks and benefits of getting the vaccine(s)* and not getting the
vaccine(s)*
– Side effects and after care
– How the vaccine(s) is given
– Provide the opportunity to ask questions
– Affirm verbal consent
* You will review two vaccines if you are administering pneumococcal polysaccharide
vaccine.
66
Vaccine management
• All multi-dose vials must be dated upon opening*
– Fluviral® discarded 28 days after first puncture
• Check expiry date of all products being administered
• Communicate use of near expiry vials to other staff members, so
the vaccine can be used before it expires
• Vaccine should be withdrawn from the vial by the immunizer
administering the vaccine
• Do not mix vaccine from vials with different lot numbers
• No pre-drawing vaccine
* Refer to local protocol for dating vials
67
Preparing the vaccine
• Determine the appropriate vaccine and route of administration
• Provide appropriate information to client
• Detach self from conversation
• For TIV and LAIV, visually inspect the vaccine. Do not use if:
– it is discolored
– you notice extraneous particulate matter present
– the multidose vial/prefilled syringe/nasal sprayer is defective
68
Preparing the vaccine (cont’d)
For LAIV
• Select and read the label on the nasal sprayer
• Check the expiry date
• Ensure the lot number on the sprayer matches the lot number on
the box (sprayer is discarded after administering vaccine and lot
number is recorded from the box)
• Remove rubber tip protector
• DO NOT remove dose divider clip at other end of the sprayer
69
Preparing the vaccine (cont’d)
For TIV
•
•
Determine the site of injection
For multidose vials – select appropriate syringe and needle
– it is not necessary to change needles after drawing up vaccine, unless
the needle is damaged or contaminated
•
For prefilled syringes – select appropriate needle to attach to syringe
•
Select and read the label on the multidose vial or prefilled syringe
•
Check the vaccine expiry date
– if applicable, check the date the multidose vial was opened
•
For prefilled syringes, ensure the lot number on the syringe matches the lot
number on the box (syringe is discarded after administering vaccine and
lot number is recorded from the box)
70
Preparing the vaccine (cont’d)
• For multidose vials
– agitate the vial before drawing up each dose
– swab the top of the vial and allow it to dry
– withdraw the appropriate dose of the vaccine
• For prefilled syringes
– agitate the prefilled syringe before administration
• Recheck the vaccine label
• Check the record to verify you have the correct vaccine for each
client (e.g., Fluviral®, Agriflu®, FluMist® or pneumococcal
polysaccharide vaccine)
71
Administering LAIV
• Have the client sit upright with head tilted slightly backwards
• Place the tip of the nasal sprayer just inside the nostril and angle
syringe parallel to the nose
• With a single motion, depress the plunger as rapidly as possible,
the dose divider clip will stop at the half dose point
• Pinch and remove the dose divider clip from the plunger
• Place the tip of the nasal sprayer into the other nostril
• With a single motion, depress the plunger as quickly as possible to
administer remaining vaccine
• Discard the empty nasal sprayer into an appropriate sharps
container
• Reinforce the 15 min wait period with the client or parent/guardian
72
Administering TIV
•
•
•
•
•
•
•
•
•
•
Expose and position the client’s limb for injection
Swab the site of injection
Allow the site to dry for 10 - 15 seconds
Secure the injection site using the appropriate stabilization
technique
Insert the needle at a 90º angle
Administer the vaccine with controlled pressure
Activate the safety engineered device
Discard the needle and syringe, and empty vaccine vials into an
appropriate sharps container
Use a cotton ball and apply pressure to the injection site
Reinforce the 15 min wait period with the client or parent/guardian
73
Intramuscular injections
Children less than 12 months old
– 3 mL syringe
– 25G 1” needle
– insert at 90 degree angle
– vastus lateralis - middle third
of anterior thigh and slightly
lateral to the midline
Note: This site can be used for
children older than 12 months
of age with inadequate deltoid
muscle mass. Check with a
Public Health Nurse if you are
unsure
74
Intramuscular injections
Children 12 months and older
– 3 mL syringe
– 25G - 5/8” to 1” needle depending
on muscle mass
– insert at 90 degree angle
– mid portion of deltoid
Adults
– 3 mL syringe
– 25G - 1” to 1½” needle depending on muscle mass and adipose
tissue
– insert at 90 degree angle
– mid portion of deltoid
75
Immunizing mastectomy clients
Single Mastectomy
• Influenza Vaccine Only:
– Give IM in arm opposite to mastectomy
• Influenza and Pneumococcal Vaccine:
– Give both vaccines IM in arm opposite to mastectomy (space
injections minimum of 1” apart)
Double Mastectomy
• Influenza Vaccine Only:
– Give IM in Vastus Lateralis
• Influenza and Pneumococcal Vaccine:
– Give both vaccines IM in Vastus Lateralis (space injections
minimum of 1” apart)
76
Position & stabilization for young children receiving LAIV
• Child sits on parent’s lap.
• Place child’s feet between parent’s
legs and have parent apply sufficient
pressure to hold.
• Child’s arms are crossed against his
chest and parent firmly holds the
forearms against the child’s chest.
• Child’s head rests against parent’s
shoulder.
• Immunizer supports child’s forehead
77
Support for older children and adults receiving LAIV
• Support chin with fingers of
immunizing hand
• Support chin and jaw or chin
and back of neck with free
hand.
• Support chin only with free
hand.
78
Position & stabilization techniques for vastus lateralis
site (infants less than 12 months)
For injection in the vastus lateralis
79
Position & stabilization techniques for deltoid site
Infants 12 months and older
Infants 18 months old and older
(“The pretzel hold”)
80
Anaphylaxis
and
Syncope
81
Anaphylaxis
• Anaphylaxis is a potentially life-threatening allergic reaction
• Very rare (about 1 per 1,000,000 doses) but even so, it should be
anticipated with every client
• Pre-immunization screening can prevent episodes - questions about
possible allergy to the vaccine or any vaccine component
• Every immunizer should be familiar with the symptoms of anaphylaxis
and be ready to initiate appropriate interventions
• Most instances begin within 15 minutes after immunization
All clients are encouraged to wait for 15 minutes after immunization.
– For clients with any known anaphylactic allergies, extend this
recommended wait period to 30 minutes
• Have clients remain within a short distance and return immediately for
assessment if they feel unwell
82
Anaphylaxis recognition & treatment
The immunizer must:
• be able to identify allergic reactions
and anaphylaxis, and know how to
respond appropriately
• be able to distinguish between fainting,
breath-holding spells, anxiety, and
anaphylaxis
• always have an up-to-date anaphylaxis
kit when immunizing
83
Histamine/mediators – do what??
They cause:
•
Capillary permeability and therefore the escape of plasma into the
tissues
•
Widespread dilatation of arterioles and capillaries (vasodilation)
•
Smooth muscle contraction
•
Over secretion by mucous glands
84
… which is why we see these symptoms…
Respiratory:
 dyspnea - wheezing - sneezing
 choking - drooling
 cyanosis – angioedema - tightness
in throat/chest
Dermatologic (skin):
 urticaria - erythema - pruritus
 flushing - pale/grey - facial swelling
 tingling of mouth or face followed by a feeling of warmth
85
... and these symptoms...
Vascular Collapse (cardiovascular)
 rapidly falling blood pressure
 sweating
 rapid, thready pulse
 a feeling of uneasiness, restlessness or anxiety
 weakness or dizziness
 throbbing in the ears or a headache
Gastrointestinal:
 nausea, vomiting
 diarrhea
 abdominal cramps
86
Anaphylactic shock intervention
The Initial Response …
– Call for help
– Lie the client on his/her back with feet elevated, if possible
– Loosen restrictive clothing around the neck
– Establish an adequate airway
– Note the time
87
What would you do?
Would you give this child
epinephrine? Why or why not?
88
Prompt administration of epinephrine is essential
Refer to your local Anaphylaxis Guideline and information in your
anaphylaxis kit for direction on how to proceed with administration of
epinephrine and diphenhydramine hydrochloride (e.g., Benadryl®)
Remember:
Failure to administer epinephrine promptly
is more dangerous than administering it in
a situation where anaphylaxis is not truly
present!
89
Syncope post immunization
• Fainting is also known as syncope or vasovagal syncope
• Vasovagal syncope is triggered by a stimulus (anxiety) that causes
an exaggerated response in the part of the nervous system that
regulates involuntary body functions (like heart rate and blood flow)
• When a stimulus triggers an exaggerated response, both heart rate
and blood pressure drop, quickly reducing blood flow to the brain
and leading to loss of consciousness
90
Syncope post immunization
• In about 25% of cases, reduced blood flow can result in jerking
movements that resemble seizures
• These movements are more common when fainting occurs soon
after immunization, and disappear when consciousness is regained
• Clients fainting due to vasovagal syncope recover quickly, usually
within seconds or a few minutes
91
Signs and symptoms of syncope
Musculoskeletal
• muscles relaxed
• weakness
• incontinence (rare)
• clonic jerks of limbs and face
Respiratory
• normal or yawning
Dermatologic
• pallor/grey color - sweating
92
Signs and symptoms of syncope
(cont’d)
Gastrointestinal
• vomiting - nausea
Cardiovascular
• hypotension, slow weak pulse
• ringing in ears
Neurological
• light headedness, dizziness
• spots before the eyes
• dazed
• unconsciousness
93
Facts about syncope
• There is a clear incidence peak in age 10 to 19 years, with a
smaller peak at age 4-6 years
– After the age of 20 years, the incidence decreases with age
• 57.5% occur in females
• The incidence of fainting is under-reported
• Most cases occur within 5 minutes of
immunization
• Fainting can result in head trauma if a client falls
– The goal is to prevent falls!
94
Tips to prevent syncope
• Administer vaccine while client is seated
• Maintain a calm and confident demeanor
• Observe anxious client while seated until anxiety has resolved after
immunization
• Have clients with a history of fainting lie down prior to administering
vaccine
• Client with pre-syncopal symptoms (such as dizziness, anxiety,
pallor, perspiration, trembling, or cool, clammy skin) should sit or lie
down until symptoms resolve
95
Assisting clients after syncope
• Assist the client to lay down with feet elevated
• Ensure the client’s airway is open (ABCs)
• Monitor for signs of allergic reaction
• Call for assistance if needed
• Cover the client with a blanket for warmth if available
• Wipe the client’s forehead with a damp cool cloth
• May offer fluids
• Have the client resume a standing position in stages (sit, stand,
walk)
• Observe the client until the symptoms have resolved
96
Anxiety spells
• Signs and Symptoms
– Fearful
– Pale
– Diaphoretic
– Complains of light headedness, dizziness, numbness, and
tingling of face and extremities
– Hyperventilation
• Treatment
– Reassurance
– Instruct to relax and breath slowly
97
Breath holding
• Occurs in young children when upset
• Signs and symptoms:
– Suddenly become quiet but still very agitated
– Facial flushing & perioral cyanosis
– Often ends with resumption of crying, or a brief period of
unconsciousness during which time breathing resumes
• Treatment
– Reassurance
98
Infection Prevention
&
Control (IPC)
99
Hand hygiene
• Hand hygiene is the single most important action that decreases
the spread of infection
• Hand hygiene is done with:
– Alcohol-based hand rub (ABHR)
– Regular liquid soap, water and disposable hand towels
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0
Hand hygiene
• Alcohol-based hand rub (ABHR)
– 70-90% concentration is recommended
– Use sufficient ABHR to rub all surfaces of hands including
between fingers and the base of the thumbs for a
minimum of 15 seconds
• Regular liquid soap, water and disposable hand towels
– Soap and running warm water must be used for a minimum of
15-20 seconds
– Recommended if hands are visibly soiled
• Apply hand creams to maintain skin integrity
• Glove use is not a substitute for hand hygiene
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1
Preparing for immunization in mass clinic settings
• Hand hygiene must be performed before handling immunization
supplies, including the set up of immunizing stations
• Clean and disinfect clinic table/ work surface with appropriate lowlevel disinfectant (e.g., accelerated hydrogen peroxide, quaternary
ammonium compounds) at the end of each shift and as needed
• Cover table/work station with a large clean drape
• Use a small drape in front of immunizing staff as a clean work area
– avoid placing papers/pens on this area.
10
2
IPC for vaccine administration
• Hand hygiene is done prior to the preparation of vaccines and
before entry into vaccine bags
• Once vaccine is administered, hand hygiene is performed after
client contact and before handling other equipment, such as papers
and pens
• Individual sharps must be disposed of in an appropriate puncture
resistant biohazard container at the point of use
10
3
Cleaning of blood and body fluids
• Appropriate Personal Protective Equipment (PPE) must be worn
• Gloves must be worn and if there is the possibility of splashing,
further PPE (gown, mask and eye protection) may be required
• Clean area by blotting blood/body fluids with disposable towels,
discarding in a regular plastic-lined waste container
– in addition, for non porous surfaces, clean area with soap & water
– once clean-up is completed, tie garbage bag and place in regular
garbage
• After initial cleaning, disinfect with a fresh solution of bleach 1:10 or
use a low level disinfectant
• Equipment used for cleaning (e.g., mop including handle, pail) must
be thoroughly cleaned and disinfected before re-use
10
4
Vaccine Management
And
Cold Chain
10
5
Cold chain
• Refers to all equipment and procedures used to ensure vaccines
are protected from inappropriate temperatures and light
• Vaccine that has been frozen is immediately inactivated – avoid
freezing vaccine!
• The effects of exposure to adverse environmental conditions, such
as exposure to heat and light, are cumulative
– Some vaccines may remain stable at temperatures outside of
+2ºC to +8ºC for short time periods, but it is difficult to
measure the effect of cumulative exposures
• Loss of potency of vaccines can result if cold chain is
compromised
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6
Vaccine storage & temperature
Before vaccine is stored in refrigerators, it is important to
determine that consistent cold chain protocols are in place.
• Store vaccine between +2ºC and +8ºC at all times
• Vaccine should be placed on the middle shelves of the
refrigerator (not in refrigerator doors)
• Do not keep food or drinks in the vaccine refrigerator
• Monitor and record refrigerator temperatures a
minimum of twice per day using a minimum-maximum
thermometer
• Be sure not to freeze vaccine!
10
7
Light sensitive – influenza vaccines
Light sensitive means that the vaccine effectiveness can be
decreased by exposure to light.
• Keep the vaccine in the original box except when drawing up
• Develop a system to communicate which boxes contain vaccine
vials that have been opened and dated
– For example: write the date opened clearly on the box and the
vial
10
8
Removing vaccine from refrigerator
Vaccine should only be removed from the refrigerator or insulated
bags during drawing up of vaccine for immediate administration, and
then immediately returned to the refrigerator or insulated bag.
When drawing up from a multidose vial, use the following guidelines:
• Remove only one vial from the refrigerator and carry in insulated
cooler bag
• Draw up vaccine immediately prior to administration
– Do not pre-draw multiple syringes of vaccine ahead of time
Note: Open the refrigerator door only when necessary.
10
9
Vaccine packing and transport
Refer to local protocols for specific instructions
for packing of vaccine bags and coolers.
Note: Vaccine must not be frozen. It should
never come into direct contact with ice.
Transporting Vaccine
• Use insulated containers with a temperature
monitoring device and appropriate cooling agents
• Avoid vehicle trunks, heaters, air conditioning vents, and direct
sunlight
• Keep vaccine in insulated bags – do not carry it in your pocket!
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0
Cold chain break
• A Cold Chain break has occurred if vaccine is found to be outside
the recommended +2ºC to +8ºC range. For example, if vaccine is
left out of the refrigerator, or the vaccine refrigerator temperature is
too high or too low.
• If this occurs, label the vaccine - “Cold chain break – do not use”.
• Do not use the vaccine, but ensure it is placed in a functioning,
monitored refrigerator (store between +2ºC to +8ºC). If the vaccine
refrigerator is not working properly, make arrangements to have it
moved to a “working refrigerator”.
• Before using any of the affected vaccine, consult with a Public
Health Nurse (or in some zones with the Communicable Disease
Unit) for advice on whether or not the vaccine can still be used.
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Recording & Data Collection
11
2
Influenza/pneumococcal vaccine recording
Information required to be recorded on all clients includes:
• Client demographic information
– full name, personal health number, date of birth, gender,
address including postal code
• Reason code for immunization
• Dose number
• Vaccine name & lot number
• Dosage administered
• Site of injection
• Route of administration
• Date of immunization
• Immunizer’s name, designation & signature
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3
Influenza/pneumococcal vaccine recording (cont’d)
• Public Health will utilize the Influenza/Pneumococcal Vaccine
Record for recording purposes
– Vaccine record is in a triplicate format - no carbon record (NCR)
– White/yellow copy to be kept by AHS
– Client receives pink copy as their record of immunization
– Client copy has aftercare information on the back
• Community providers may utilize the Influenza/Pneumococcal
Vaccine Record (NCR) for recording purposes or a record of their
own choosing
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4
Influenza/Pneumococcal Vaccine Record (NCR)
11
5
Choosing the reason for immunization code from the Priority List
When completing the documentation, include the immunization
“reason code”. Start at the top of the priority list, and choose the
first code that applies (e.g. If the client is a health care worker in
long term care, is pregnant, and has asthma, choose code #44
“Long term care staff” because it is higher on the list).
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6
Influenza Vaccine Priority List
When determining which code to pick, start at the top of the list and choose
the first code that applies
11
7
Pneumococcal Vaccine Priority List
11
8
Employee Data Collection
AHS Workplace Health and Safety (WHS) and Covenant Health
Occupational Health and Safety (OHS) require notification of
employee immunization for the following reasons:
• In the event of an outbreak, influenza immunization status of
employees is required to manage the outbreak
• AHS WHS/Covenant Health OHS are required to provide overall
organizational rates of influenza immunization each year – doses
provided by Public Health are included in the rates.
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9
Employee Data Collection (cont’d)
When an AHS or Covenant Health employee presents at a
Public Health Clinic for influenza immunization you will need to:
1. Determine if the employee works for AHS or Covenant
Health
2. Have the employee complete the bottom section of the
NCR form
3. Retain the white and yellow of the NCR – the yellow copy
will be sent to AHS WHS or Covenant Health OHS
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Employee Data Collection (cont’d)
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1
Employee Data Collection (cont’d)
Please remember the following:
• Identify the employee as either:
44 Long term care staff
AHS/Covenant Employee
03 Health care worker
AHS/Covenant Employee
• Have the employee complete the bottom portion of the NCR form
–
•
•
•
•
ensure all fields have been completed including their employee number and their
signature giving or declining consent to release the information to AHS WHS or
Covenant Health OHS
White copy to be kept by Public Health
Yellow copy to be sent to AHS WHS or Covenant Health OHS
Pink copy to be given to the AHS or Covenant Health employee
Employee copy has aftercare information on back
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2
Data collection (cont’d)
• All immunization providers are required to account for vaccine
doses administered, vaccine doses wasted and vaccine doses on
hand. The rationale for requiring data collection is as follows:
– To determine influenza immunization rates
– To be accountable for doses administered and meet
requirements of government auditing processes
– To monitor vaccine safety
– For planning and operational decisions for subsequent
seasonal programs
• Refer to local protocols for data collection instructions
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3
Questions
12
4
Can too many vaccines weaken the immune system?
• Vaccines do not weaken the immune system. Rather, they harness
and train it to defend, rapidly, against vaccine-preventable diseases
before illness can occur. Getting an annual influenza vaccine is a
good way to keep both yourself and your immune system healthy.
• Our immune systems are bombarded with constant challenges –
from bacteria in food to the dust we breathe. Compared to what the
immune system typically encounters and manages each day,
vaccines are literally a drop in the ocean. At present, infants
receiving recommended vaccines starting at two months of age
come into contact with only 34 antigens – just 34 antigens among
the millions handled every day by our immune systems.
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5
Should I get the influenza vaccine if I am healthy?
• You may not be in a group that is at
high risk for influenza related complications,
but your patients/residents/clients may be,
and members of your family may be as well.
• If you get influenza, you put people
around you at high risk for serious
illness. You can help ensure that
they stay healthy this winter by protecting
yourself.
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6
If residents/patients get immunized, why should I?
• Can you be sure that all those you care for were immunized? What
if they weren’t?
• Remember, even if they were immunized, the vaccine is 70-90%
effective for you, but in the frail elderly, and others with weakened
immune systems, effectiveness may be as low as 30%.
• Getting the vaccine will add an
extra level of certainty that you
will not get the flu, and will not
pass it on to others.
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7
Can the influenza vaccine give me influenza?
• Immunization with inactivated vaccine cannot
cause influenza disease because the vaccine
does not contain live viruses. Immunization
with live attenuated vaccine does not cause
influenza disease in vaccine recipients
because the virus is weakened.
• The vaccine takes about two weeks to become
completely effective, so you could still get
influenza during these two weeks. If you get
influenza after this period, you may experience
milder symptoms than if you had not had the
immunization.
• Many people confuse influenza with a cold or
other respiratory infections, which the vaccine
will not protect you against.
12
8
Should I get an influenza shot every year?
YES…
• Strains of the influenza virus change every
year, and new vaccines are produced to
counter them as soon as they are identified
• The immunization you had last year will likely
not be effective against this year’s virus
• Even if you have avoided getting influenza so
far, it does not mean that you will not get sick
this year
• By not getting the influenza immunization,
you are increasing your chances of becoming
ill
12
9
Self care during influenza season
• Get the influenza vaccine every fall.
• Cover your cough with a tissue, or cough or sneeze
into your upper sleeve, not your hands. Then, clean
your hands, and do so every time you cough or sneeze.
• Wash your hands well, and often.
• Avoid touching your eyes, nose, or mouth. Germs are
often spread when a person touches something that is
contaminated with germs and then touches their eyes,
nose, or mouth.
• Exercise. Drink plenty of water. Eat well and do not
smoke.
• Avoid crowds when influenza season hits your area.
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0
Influenza prevention hand washing
√ Use regular soap – antibacterial soap is
not necessary.
√ Rub hands vigorously for at least 15
seconds covering all surfaces (Sing
Happy Birthday !!).
√ Rinse your hands under running water.
√ Dry hands with clean or disposable
towel.
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Self care at work
• Frequently wipe down your keyboard, mouse and phone (for
example with low level disinfectants not with antibacterial wipes).
• If you are ill, stay home from work so you do not spread illness to
others. Children who are ill should stay home from school and
daycare.
• Use hand hygiene frequently, especially after using copy
machines, fax machines, someone else’s computer or phone, or
after sneezing or other contact with your own secretions.
• Wash your hands before eating or drinking during
breaks.
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References
1.
Alberta Health and Wellness: Government of Alberta. (2007). Alberta immunization manual.
2.
Alberta Health and Wellness: Government of Alberta. (2013). Alberta’s Influenza Immunization Program Policy
3.
AstraZeneca Canada. (June 27, 2013). FluMist® Influenza Vaccine (live, attenuated) Intranasal spray. Product monograph.
4.
Do Bugs Need Drugs (September 2011). Healthy Hands at Work: Being sick at work is everyone’s business, Employer Handbook.
http://cdn.dobugsneeddrugs.org/wp-content/uploads/employer-handbook.pdf
5.
Do Bugs Need Drugs (September 2011). Healthy Hands at Work: Being sick at work is everyone’s business, Worker Handbook.
http://cdn.dobugsneeddrugs.org/wp-content/uploads/worker-handbook.pdf
6.
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Hamborsky
J, Wolfe S, eds. 12th ed., second printing. Washington DC: Public Health Foundation, 2012.
7.
GlaxoSmithKline Inc. (April 29, 2013). FLUVIRAL®(2013-2014) Influenza Virus Vaccine Trivalent, Inactivated Split Virion Prepared in
Eggs. Product monograph.
8.
Immunize Canada. Influenza. Retrieved September 6, 2013 from http://www.immunize.cpha.ca/en/diseases-vaccines/influenza.aspx
9.
Merck Canada Inc. (March 5, 2012). PNEUMOVAX®23 (pneumococcal vaccine, polyvalent, MSD Std.). Product monograph.
10.
Merck Canada Inc. (February 7, 2013). ZOSTAVAX® (zoster vaccine live, attenuated [Oka/Merck]). Product monograph.
11.
National Advisory Committee on Immunization. Canadian immunization guide (Evergreen Edition). Ottawa, ON: Public Health Agency
of Canada. http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php
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References
12.
National Advisory Committee on Immunization (2013). Statement on Seasonal Influenza Vaccine for 2013 - 2014. Ottawa, ON: Public
Health Agency of Canada.
13.
Novartis Vaccines and Diagnostics, Inc. (June 3, 2013). AGRIFLU™ (Influenza Vaccine, Surface Antigen , Inactivated). Product
monograph.
14.
Public Health Agency of Canada (PHAC). National vaccine storage and handling guidelines for immunization providers 2007. Retrieved
July 11, 2011 from http://www.phac-aspc.gc.ca/publicat/2007/nvshglp-ldemv/pdf/nvshglp-ldemv-eng.pdf
15.
Public Health Agency of Canada (PHAC). Influenza. Retrieved September 6, 2013 from http://www.phac-aspc.gc.ca/influenza/indexeng.php
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