No

Vaccine

Provide active immunity to influenza virus strains contained in the vaccine; for high-risk persons, previous year vaccines should not be used to prevent present year influenza

• Persons greater than or equal to 65 years of age
• Residents of nursing homes and other chronic-care facilities that house persons of any age with chronic medical conditions
• Adults and children with chronic disorders of the pulmonary or cardiovascular systems, including children with asthma
• Adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications)

Children and teenagers (6 months to 18 years of age) who are receiving long-term aspirin therapy and therefore, may be at risk for developing Reye's syndrome after influenza

C

Persons with allergy history to eggs or egg products, chicken, chicken feathers or chicken dander, hypersensitivity to thimerosal, influenza virus vaccine or any component, presence of acute respiratory disease or other active infections or illnesses, delay immunization in a patient with an active neurological disorder

Although there is no evidence of maternal or fetal risk when vaccine is given in pregnancy, waiting until the 2nd or 3rd trimester to vaccinate the pregnant woman with a high-risk condition may be reasonable. Antigenic response may not be as great as expected in patients requiring immunosuppressive drug; hypersensitivity reactions may occur; because of potential for febrile reactions, risks and benefits must carefully be considered in patients with history of febrile convulsions; influenza vaccines from previous seasons must not be used; patients with sulfite sensitivity may be affected by this product.

All serious adverse reactions must be reported to the U.S. Department of Health and Human Services (DHHS) Vaccine Adverse Event Reporting System (VAERS) 1-800-822-7967.

Central nervous system: Fever, malaise

Local: Tenderness, redness, or induration at the site of injection (<33%)

<1%: Guillain-Barré syndrome, fever, urticaria, angioedema, myalgia, asthma, anaphylactoid reactions (most likely to residual egg protein), allergic reactions

Decreased effect with immunosuppressive agents; some manufacturers and clinicians recommend that the flu vaccine not be administered with the DTP for the potential for increased febrile reactions (specifically whole-cell pertussis), and that one should wait at least 3 days. ACIP recommends that children at high risk for influenza may get the vaccine concomitantly with DTP.

Increased effect/toxicity of theophylline and warfarin possible

Refrigerate

Promotes immunity to influenza virus by inducing specific antibody production. Each year the formulation is standardized according to the U.S. Public Health Service. Preparations from previous seasons must not be used.

I.M.:

6-35 months: 1-2 doses of 0.25 mL with greater than or equal to 4 weeks between doses and the last dose administered before December

3-8 years: 1-2 doses of 0.5 mL (in anterolateral aspect of thigh) with greater than or equal to 4 weeks between doses and the last dose administered before December

Children greater than or equal to 9 years and Adults: 0.5 mL each year of appropriate vaccine for the year, one dose is all that is necessary; administer in late fall to allow maximum titers to develop by peak epidemic periods usually occurring in early December

Note: The split virus or purified surface antigen is recommended for children less than or equal to 12 years of age; if the child has received at least one dose of the 1978-79 or later vaccine, one dose is sufficient

Administer in anterolateral aspect of thigh for children; for adults, in deltoid muscle

None reported

None reported

No information available to require special precautions

No effects or complications reported

Be aware of possible adverse effects

Inspect for particulate matter and discoloration prior to administration; for I.M. administration only

Injection:

Split-virus (Fluogen®, Fluzone®): 0.5 mL, 5 mL

Whole-virus (Fluzone®): 5 mL

Bentley DW, "Vaccinations," Clin Geriatr Med, 1992, 8(4):745-60.

Gardner P and Schaffner W, "Immunization of Adults," N Engl J Med, 1993, 328(17):1252-8.