August 2015, Vol 3, No 8 - Inside Influenza Readiness
Chelsey D’Ambrosio, PharmDc

It is never too early to start preparing for the flu season. With last season’s drifted influenza A (H3N2) viruses,1,2 and >200,000 reported influenza-associated hospitalizations every year,3 it is imperative that we start planning for the upcoming flu season.

The accessibility of pharmacies and retail clinics provides patients with opportunities to prepare for the flu season, and can ultimately impact the occurrence and severity of the infection within the community. Pharmacists and other healthcare providers must properly manage inventory, staff, and patient communication to avoid and contain infection.

More than 147 million doses of seasonal influenza vaccine were distributed from 7 manufacturers during the 2014-2015 flu season.4 The vaccine is recommended for all patients ≥6 months of age5; all pharmacists who provide vaccinations should check their respective state laws regularly for updates on patient age restrictions.6

To prepare inventory for the upcoming flu season, healthcare providers should consider all available vaccine options to best serve their patients. Vaccine products can be chosen based on past utilization and inventory statistics. Not all products can be used in every patient population, and it is our responsibility to ensure that patients receive the correct type of vaccination.

Trivalent and Quadrivalent Influenza Vaccines

The trivalent flu shot includes 2 strains of the influenza A virus (H1N1 and H3N2), and 1 strain of the influenza B virus.7 It can be used in all patients except those aged <6 months, or patients with severe allergies to any component of the vaccine.5 Most vaccines contain some amount of egg, and patients with serious allergies to eggs should be given the recombinant flu vaccine if they are aged ≥18 years. However, patients with mild or severe egg allergies may still be able to receive the regular flu vaccine if it is administered by an experienced healthcare provider capable of managing allergic conditions.

The flu shot is also available as a quadrivalent vaccine, which includes an additional strain of the influenza B virus.7 Most quadrivalent vaccines are approved for use in patients aged ≥3 years, with the exception of 1 vaccine, Fluzone Quadrivalent, which can be administered to infants as young as 6 months old.7,8 Approximately half of last year’s total vaccine supply consisted of trivalent products and the other half included quadrivalent products.2

Patients aged >65 years may receive a different flu shot, the Fluzone High-Dose.9 This vaccine has a higher dose of antigen and provides a better immune response in this patient population.

Another option, the quadrivalent intranasal spray, is a live, attenuated vaccine approved for use in patients aged 2 through 49 years.10 In addition to this age restriction, patients with allergies to any component of the vaccine, including eggs, cannot receive the intranasal vaccine. The product is also contraindicated in pregnant women, immunocompromised patients and their caretakers, children with asthma aged 2 through 4 years, and patients who have taken an antiviral drug within the past 48 hours.

Prepare Staff and Inventory

While evaluating their inventory of vaccines, healthcare professionals must also consider the inventory of antiviral medications. Although manufacturers stated that their antiviral medication production would meet the projected demand for the 2014-2015 flu season, there were still various reports of shortages.11 Healthcare professionals should prepare inventory by evaluating information from previous seasons, and must also acknowledge the possibility of spot shortages based on local supply and demand. In the event of a shortage, we must act in a timely manner, and in the best interest of the patient to try to find the product elsewhere. Patients should also be advised to call in advance to check for availability.7

To ensure that staff members are appropriately prepared for this flu season, healthcare professionals can conduct a meeting to discuss the importance of infection control within the workplace, and current or new protocols to prevent contagion. Staff should be trained for the new season, and evaluate how to improve on practices from past seasons. All staff members should be vaccinated; this requirement can be enforced through a mandatory immunization policy.12 It is the responsibility of all healthcare professionals to get vaccinated, as this will ensure the best standard of care for their patients.

Communicate with Patients

Patient communication is essential when preparing for the flu season. There is often confusion among patients regarding who needs the vaccine, whether it is safe, and when to get vaccinated. In addition, because a drift in the H3N2 viruses last season resulted in mismatched coverage, patient doubts regarding the efficacy of the vaccine may be elevated.1 The US Food and Drug Administration has recommended that the drifted strains be included in the vaccine for the 2015-2016 flu season, thus providing increased coverage and efficacy. Healthcare providers must provide their patients with complete and accurate information to guarantee adequate knowledge and immunization use. Healthcare professionals can find updates and more information about influenza and flu vaccines at the websites listed in the Resources section below.

In addition to education, patient communication also involves letting patients know where to get vaccinated. Whether a healthcare provider is looking to begin a new advertising campaign, or expand on a preexisting one, there are many strategies that can be implemented for the upcoming flu season, including offer on-site administration of the vaccinations to local businesses and their employees; provide coupons for purchases at the retail store with each flu vaccine; place flyers in each prescription bag; post advertisements on social media; and send customized letters to high-risk patients.13

Figure

Conclusion

Preparedness can determine the impact of the upcoming flu season on our communities. By providing adequate inventory, managing a trained staff, and communicating important and accurate information to patients, pharmacists will be equipped to prevent and control influenza infections. Through their work, pharmacists can encourage healthcare cost-savings by decreasing hospitalizations, and more importantly, preserve positive patient outcomes.




Resources

Online Resources for Information About Influenza

  • Centers for Disease Control and Prevention
    The influenza page provides a breadth of information, including basic information for patients, health professionals, as well as free resources, and news and highlights about the flu.
    www.cdc.gov/flu
  • US Department of Health & Human Services
    Flu.gov provides information on flu symptoms and management, prevention, and vaccination, as well as information about who is at risk, planning and preparedness, and pandemic awareness.
    www.flu.gov
  • World Health Organization (WHO)
    The influenza page includes general information, WHO programs and activities, influenza in different WHO regions, technical information, publications, and statistics.
    www.who.int/topics/influenza
  • National Vaccine Information Center
    The flu page has information about influenza, influenza vaccine, contraindications, as well as recommendations in different patient populations, and questions to ask about the vaccine.
    www.nvic.org/Vaccines-and-Diseases/Influenza.aspx




References

  1. American Academy of Allergy, Asthma & Immunology. 2015-16 Influenza vaccine expected to be a better “match.” www.aaaai.org/conditions-and-treatments/library/allergy-library/2015-16-influenza-vaccine.aspx. Accessed June 18, 2015.
  2. Centers for Disease Control and Prevention. CDC influenza division key points. www.izsummitpartners.org/wp-content/uploads/2014/11/CDC-Influenza-Key-Points-11-21-14.pdf. Published November 21, 2014. Accessed June 18, 2015.
  3. Centers for Disease Control and Prevention. Seasonal influenza Q&A. www.cdc.gov/flu/about/qa/disease.htm. Updated August 14, 2014. Accessed June 23, 2015.
  4. Centers for Disease Control and Prevention. Examining the U.S. public health response to seasonal influenza. www.cdc.gov/washington/testimony/2015/t20150203.htm. Updated April 9, 2015. Accessed June 23, 2015.
  5. Centers for Disease Control and Prevention. Vaccination: who should do it, who should not and who should take precautions. www.cdc.gov/flu/protect/whoshouldvax.htm#flu-shot. Updated November 24, 2014. Accessed June 23, 2015.
  6. Centers for Disease Control and Prevention. Influenza (flu). www.cdc.gov/flu/. Updated June 5, 2015. Accessed June 18, 2015.
  7. Centers for Disease Control and Prevention. Quadrivalent influenza vaccine www.cdc.gov/flu/protect/vaccine/quadrivalent.htm. Updated October 16, 2014. Accessed June 23, 2015.
  8. Fluzone Quadrivalent [package insert]. Swiftwater, PA: Sanofi Pasteur Inc; 2014.
  9. Centers for Disease Control and Prevention. Fluzone High-Dose seasonal influenza vaccine. www.cdc.gov/flu/protect/vaccine/qa_fluzone.htm. Updated September 3, 2014. Accessed June 23, 2015.
  10. Centers for Disease Control and Prevention. Live attenuated influenza vaccine [LAIV] (the nasal spray flu vaccine). www.cdc.gov/flu/about/qa/nasalspray.htm. Updated September 9, 2014. Accessed June 23, 2015.
  11. Ross M. Pharmacies nationwide seeing Tamiflu shortages. Pharmacy Times. www.pharmacytimes.com/news/pharmacies-nationwide-seeing-tamiflu-shortages. Published January 4, 2015. Accessed June 18, 2015.
  12. American Academy of Pediatrics. What’s the latest with the flu? American Academy of Pediatrics website. www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/What’s-the-Latest-with-the-Flu.aspx. Published May 2015. Accessed June 18, 2015.
  13. Timmermann S. 24 awesome flu shot marketing strategies for independent pharmacies. Pharmacy Development Services, Inc website. www.pharmacyowners.com/blog/flushot2014. Published September 10, 2010. Accessed June 18, 2015.
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