|September 2015 | Archive|
It’s a New Influenza Season
While many things have changed in influenza care, some things won’t go away—the excuses remain the same, don’t they? Here are some strategies to break through these barriers.
The following provides a review of the types of flu vaccines available for patients aged 65 and over.
(Note: The nasal spray shot and jet injector device are not approved for those aged 65 and over.)
Keep in mind that there is limited evidence of markedly increased benefit of alternative vaccines over the regular flu vaccine. The type of vaccine a patient receives is less important than receiving the vaccine.
We are learning more about the different types of vaccines. There is evidence that the “high dose” shot leads to a stronger antibody response.
According to the Centers for Disease Control and Prevention (CDC), the high-dose vaccine contains four times the amount of antigen in the regular flu shot and is associated with a stronger immune response following vaccination (ie, higher antibody production).1 Preliminary studies suggest this may translate into greater protection against the flu. For example, one recent study published in The New England Journal of Medicine indicated that the high-dose vaccine was 24.2% more effective in preventing flu in adults aged 65 and older relative to a standard dose flu vaccine. (The confidence interval for this result was 9.7% to 36.5%).1,2
What remains to be learned, however, is whether that leads to fewer people infected with flu. For patients who are at standard risk (ie, those without chronic illnesses such as diabetes, chronic kidney disease, and COPD), the regular flu shot is likely adequate. You may want to consider the high-dose vaccine for patients with increased risk factors. I know I will advise it for most of my elderly patients and especially anyone with chronic illness or chronic stress. Keep in mind any patients who are family caregivers. The chronic stress of that role can increase flu risk.
Another new formulation of vaccine is the quadrivalent vaccine. Each regular flu vaccine is trivalent, or covers three strains of circulating flu viruses. Two A and one B strains are covered in each trivalent vaccine. In a quadrivalent vaccine, four strains, two A and two B strains, are covered. In the elderly, type A strains tend to cause more severe flu, so it is unclear whether this additional coverage will make a difference in their morbidity and/or mortality.
Educate your patients about the existence of antiviral medications and the need to initiate them within 48 hours of flu symptom onset. There is evidence these medications can lessen the severity of the illness and prevent serious complications such as pneumonia.
The following are some key points to keep in mind about treatment. Find full details on the CDC website.3
— Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, executive medical director of senior services for Florida Hospital at Winter Park, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.
1. What you should know and do this flu season if you are 65 years and older. Centers for Disease Control and Prevention website. http://www.cdc.gov/flu/about/disease/65over.htm. Updated August 17, 2015.
2. DiazGranados CA, Dunning AJ, Kimmel M, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014;371(7):635-645.
3. Use of antivirals: background and guidance on the use of influenza antiviral agents. Centers for Disease Control and Prevention website. http://www.cdc.gov/flu/professionals/antivirals/antiviral-use-influenza.htm. Updated February 25, 2015.
4. Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA. 2010;303(15):1517-1525.
5. Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009–10 season. Centers for Disease Control and Prevention website. http://www.cdc.gov/H1N1flu/recommendations.htm. Updated December 7, 2009.
6. Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza, Bautista E, Chotpitayasunondh T, et al. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med. 2010;362(18):1708-1719.
7. Harper SA, Bradley JS, Englund JA, et al. Seasonal influenza in adults and children—diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(8):1003-1032.
8. Hageman JC, Uyeki TM, Francis JS, et al. Severe community-acquired pneumonia due to Staphylococcus aureus, 2003–04 influenza season. Emerg Infect Dis. 2006;12(6):894-899.9. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-S72.