2012-2013 Influenza Vaccine Composition

1. 2012-2013 Influenza Vaccine Composition • A/California/7/2009 (H1N1)-like • A/Victoria/361/2011(H3N2)-like • B/Wisconsin/1/2010

2. Trivalent Inactivated Influenza Vaccine (TIV)

3. Proposed 2012-2013 Algorithm for Children 6 Mos. Through 8 yrs. Has the child ever received influenza vaccine? No/Don’t know 2 doses* Yes Did the child receive a total of 2 or more doses of seasonal influenza vaccine since July 1, 2010? No/Don’t know 2 doses*† Yes 1 dose *Doses should be administered at least 4 weeks apart. † For simplicity, this algorithm takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. However, if a child 6 months through 8 years of age is known to have received at least 2 seasonal influenza vaccines during any prior season, and at least 1 dose of a 2009(H1N1)-containing vaccine--i.e., either 2010-2011 or 2011-2012 seasonal vaccine or the monovalent 2009(H1N1) vaccine--then the child needs only 1 dose for 2012-2013.

4. Proposed 2012-2013 Algorithm for Children 6 Mos. Through 8 yrs. Has the child ever received influenza vaccine? Has the child ever received influenza vaccine? No/Don’t know No/Don’t know 2 doses* 2 doses* Yes Did the child receive a total of 2 or more doses of seasonal influenza vaccine since July 1, 2010? No/Don’t know 2 doses*† Yes 1 dose *Doses should be administered at least 4 weeks apart. † For simplicity, this algorithm takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. However, if a child 6 months through 8 years of age is known to have received at least 2 seasonal influenza vaccines during any prior season, and at least 1 dose of a 2009(H1N1)-containing vaccine--i.e., either 2010-2011 or 2011-2012 seasonal vaccine or the monovalent 2009(H1N1) vaccine--then the child needs only 1 dose for 2012-2013.

5. Proposed 2012-2013 Algorithm for Children 6 Mos. Through 8 yrs. Has the child ever received influenza vaccine? No/Don’t know 2 doses* Yes Did the child receive a total of 2 or more doses of seasonal influenza vaccine since July 1, 2010? Did the child receive a total of 2 or more doses of seasonal influenza vaccine since July 1, 2010? No/Don’t know No/Don’t know 2 doses*† 2 doses*† Yes 1 dose *Doses should be administered at least 4 weeks apart. † For simplicity, this algorithm takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. However, if a child 6 months through 8 years of age is known to have received at least 2 seasonal influenza vaccines during any prior season, and at least 1 dose of a 2009(H1N1)-containing vaccine--i.e., either 2010-2011 or 2011-2012 seasonal vaccine or the monovalent 2009(H1N1) vaccine--then the child needs only 1 dose for 2012-2013.

6. Proposed 2012-2013 Algorithm for Children 6 Mos. Through 8 yrs. Has the child ever received influenza vaccine? No/Don’t know 2 doses* Yes Did the child receive a total of 2 or more doses of seasonal influenza vaccine since July 1, 2010? Did the child receive a total of 2 or more doses of seasonal influenza vaccine since July 1, 2010? No/Don’t know 2 doses*† Yes Yes 1 dose 1 dose *Doses should be administered at least 4 weeks apart. † For simplicity, this algorithm takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. However, if a child 6 months through 8 years of age is known to have received at least 2 seasonal influenza vaccines during any prior season, and at least 1 dose of a 2009(H1N1)-containing vaccine--i.e., either 2010-2011 or 2011-2012 seasonal vaccine or the monovalent 2009(H1N1) vaccine--then the child needs only 1 dose for 2012-2013.

7. Proposed 2012-2013 Algorithm for Children 6 Mos. Through 8 yrs. ”For simplicity, this algorithm takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. However, if a child 6 months through 8 years of age is known to have received at least 2 seasonal influenza vaccines during any prior season, and at least 1 dose of a 2009(H1N1)-containing vaccine-i.e., either 2010-2011 or 2011-2012 seasonal vaccine or the monovalent 2009(H1N1) vaccine--then the child needs only 1 dose for 2012-2013.” Has the child ever received influenza vaccine? No/Don’t know 2 doses* Yes Did the child receive a total of 2 or more doses of seasonal influenza vaccine since July 1, 2010? No/Don’t know 2 doses*† Yes 1 dose *Doses should be administered at least 4 weeks apart. † For simplicity, this algorithm takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. However, if a child 6 months through 8 years of age is known to have received at least 2 seasonal influenza vaccines during any prior season, and at least 1 dose of a 2009(H1N1)-containing vaccine--i.e., either 2010-2011 or 2011-2012 seasonal vaccine or the monovalent 2009(H1N1) vaccine--then the child needs only 1 dose for 2012-2013. *Doses should be administered at least 4 weeks apart. † For simplicity, this algorithm takes into consideration only doses of seasonal influenza vaccine received since July 1, 2010. However, if a child 6 months through 8 years of age is known to have received at least 2 seasonal influenza vaccines during any prior season, and at least 1 dose of a 2009(H1N1)-containing vaccine--i.e., either 2010-2011 or 2011-2012 seasonal vaccine or the monovalent 2009(H1N1) vaccine--then the child needs only 1 dose for 2012-2013.

8. TIV Products 2012-2013

9. TIV Products 2012-2013 *Afluria may be administered to children 5 through 8 years of age with a high-risk condition if no other age appropriate inactivated seasonal influenza vaccine is available.

10. Fluzone High-Dose TIV • Approved only for persons 65 years of age and older • Each dose contains 4 times as much hemagglutinin as the standard formulation of Fluzone for adults

11. FluzoneIntradermalMicroinjection Syringe

13. FluzoneIntradermalInjection Technique

14. Live Attenuated InfluenzaVaccine (LAIV) • Approved for healthy persons 2 through 49 years of age who are not pregnant • healthcare personnel • persons in close contact with high-risk groups such as household contacts

15. LAIV Schedule

16. Timing of Influenza Vaccination • In more than 80% of influenza seasons, peak activity has not occurred until January or later • In more than 60% of seasons, the peak was in February or later

17. Timing of Influenza Vaccination • Immunization providers should begin offering vaccine as soon as it becomes available • Providers should offer vaccine during routine healthcare visits or during hospitalizations whenever vaccine is available

18. Timing of Influenza Vaccination • Continue to offer influenza vaccine throughout the influenza season, especially to healthcare personnel and those at high risk of complications • Continue to vaccinate even after influenza activity has been documented in the community

19. Inactivated Influenza Vaccination Contraindication • A prior severe allergic reaction to influenza vaccine is a contraindication to future receipt of the vaccine

20. Inactivated Influenza Vaccines and Egg Sensitivity • All influenza vaccine viruses for the 2012-2013 season are grown in hen’s eggs • Allergy to eggs must be distinguished from allergy to influenza vaccine • Severe egg allergy is neither a precaution nor a contraindication for influenza vaccine

28. Influenza Vaccine and Egg Sensitivity • All vaccines should be administered in settings where personnel and equipment are available for rapid recognition and treatment of anaphylaxis • All vaccination providers should be familiar with office emergency plan • Staff should be prepared with: • CPR certification • epinephrine, and • equipment for maintaining an airway

29. Influenza Vaccine Precautions • Moderate or severe acute illness • History of Guillain-Barré syndrome within 6 weeks following a prior dose of influenza vaccine

30. Live Attenuated Influenza Vaccination Contraindications and Precautions • Children younger than 2 years of age • Adults 50 years of age and older • Underlying medical condition including immunosuppression • Children 18 years and younger receiving chronic aspirin therapy • Pregnant women

31. Live Attenuated Influenza Vaccination Contraindications and Precautions • Severe allergic reaction to a vaccine component or following a prior dose • Children 2 through 4 years of age with asthma or recurrent wheezing that might indicate asthma • History of Guillain-Barré syndrome within 6 weeks following a prior dose of influenza vaccine • Moderate or severe acute illness

32. Live Attenuated Influenza Vaccination Among Children 2-4 Years of Age • Consult the medical record, when available, to identify children 2 through 4 years of age with asthma or recurrent wheezing that might indicate asthma

33. Live Attenuated Influenza Vaccination Among Children 2-4 Years of Age • Parents or caregivers of children 2 through 4 years should be asked: • “In the past 12 months, has a healthcare provider ever told you that your child had wheezing or asthma?”

34. Live Attenuated Influenza Vaccination Among Children 2-4 Years of Age • Children whose parents or caregivers answer “yes” or whose medical record notes asthma or a wheezing episode within the past 12 months should not receive LAIV • Inactivated influenza vaccine should be administered to children with asthma or possible reactive airway disease