Wednesday, September 27, 2023

How Are Flu Vaccines Administered

Factors That Determine Effectiveness

Health officials administering flu vaccine

The vaccines effectiveness depends on the following:

  • The age of the person vaccinated
  • The state of the persons immune system, meaning the system that allows their body to defend itself against infections
  • The degree of kinship between the virus strains circulating and those contained in the vaccine

The vaccine therefore does not offer 100% protection against the flu. The vaccine prevents the flu in about 40 to 60% of healthy people when the strains of viruses it contains correspond to strains circulating.

A strain of the virus included in the vaccine may not match the circulating strains. Indeed, the virus can evolve differently from what was predicted. As a result, the vaccine will be less effective against this strain. Nonetheless, the annual flu vaccine is still recommended, since it protects against the other strains included the vaccine that might be circulating.

For people aged 75 and over and those with chronic illnesses, the vaccine especially help reduce the risks of complications from the flu, hospitalisation and death.

Are There Any Flu Vaccines Without Needles

Yes, there are two flu vaccines available without needles: the Afluria Quadrivalent given via the PharmaJet Stratis Needle-Free Injector and the intranasal FluMist vaccine.

Afluria Quadrivalent can be given via a needle-free jet injector or with a needle.

  • If you are 18 through 64 years of age and are eligible for a flu vaccine, you can request needle-free Afluria. First check with your doctor, clinic, or pharmacy to be sure they have the jet injector. Call your insurance to be sure it is covered, too.
  • It’s not 100% pain-free, but the jet injector creates a narrow stream of fluid that goes through the skin, without a needle, given in one-tenth of one second.
  • Children 6 months through 17 years and adults 65 and older can receive Afluria Quadrivalent only by a needle and syringe.

FluMist is an intranasal flu vaccine spray.

  • FluMist Quadrivalent is a needle-free option that is used in certain populations between the ages of 2 to 49 years to help prevent influenza. It is a liquid vaccine that is sprayed into the nose.
  • Not everyone can use FluMist. Children under 2 years of age cannot use it due to an increased risk of wheezing. Tell your healthcare provider if you are currently wheezing, or have a history of wheezing.
  • In addition, anyone with a severe allergy to eggs, anyone who has had a life-threatening allergic reaction to any flu vaccine, and children 2 through 17 years old who take aspirin or medicines containing aspirin cannot use FluMist.

Who Should Receive The Flu Vaccine

The CDC recommends that every individual over 6 months of age receive the seasonal flu vaccine. While everyone should get a vaccination, it is particularly important for some groups. Vaccination is especially important for people who are at high risk of developing serious complications if they get the flu, such as those with asthma, diabetes, and chronic lung disease as well as pregnant women and those over 65 years of age. It is also important for caregivers to get vaccinations, in addition to those who live with people in these risk groups.

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Can You Get Influenza From The Influenza Vaccine

No. FLUAD QUAD, AFLURIA QUAD, INFLUVAC TETRA and AFLURIA QUAD JUNIOR have been made from influenza viruses that have been concentrated, inactivated, and then broken apart. Inactivated influenza vaccines cannot cause influenza as the vaccines do not contain any live viruses.

Sometimes influenza vaccination is accused of causing the disease. There are two possible reasons for this. First, when vaccinated, the body responds to vaccination by producing an immune response. This can include systemic symptoms such as fever, headache or fatigue, which may mistakenly be assumed to be early signs of influenza but are the body responding to the vaccination. Second, other respiratory viruses and bacteria circulate during the winter months and influenza vaccination does not protect against these.

Most of these other viruses cause milder infections. However, some viruses and bacteria may produce influenza-like symptoms and/or quite severe illness which can lead to the suggestion that influenza vaccination is ineffective. These illnesses should not be confused with influenza.

The Flu Shot Is Effective

Flu shot ingredients: What they contain and why

The effectiveness of the vaccine varies from season to season. It depends on:

  • how well the vaccine matches with the circulating flu viruses
  • the health and age of the person getting the flu shot

The viruses circulating in the population can sometimes change during the time it takes to produce a vaccine. When this happens during the flu season, the flu shot may not work as well as expected.

It’s also important to remember that the flu shot protects against several different flu viruses each season. The seasonal flu shot can still provide protection against the remaining 2 or 3 viruses, even when theres:

  • a less-than-ideal match
  • lower effectiveness against one virus

If you do get the flu, the flu shot may reduce the severity of flu-related complications.

Getting your flu shot is still the most effective way to protect yourself against the flu and flu-related complications.

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The Flu Vaccine Is Safe

To ensure that the flu vaccine is safe, effective, and of high quality, the FDA prepares and provides reagents to manufacturers that they need to make their vaccine and to verify its identity and potency. The FDA also inspects manufacturing facilities regularly and evaluates each manufacturers vaccine annually before it can be approved.

The FDAs oversight doesnt end there. After manufacturers have distributed their vaccines for use by the public, the FDA and CDC work together to routinely evaluate reports of adverse events following vaccination submitted by vaccine manufacturers, health care providers and vaccine recipients to the Vaccine Adverse Event Reporting System .

Additional efforts are in place to monitor vaccine safety. The FDA partners with private organizations that collect health care data and other federal agencies to further evaluate the safety and effectiveness of the influenza vaccines and other vaccines that the FDA has approved or authorized for emergency use.

The Biologics Effectiveness and Safety Initiative is one of the programs the FDA utilizes to assess vaccine safety and effectiveness in real-world conditions, reflecting patient care and the real-world use of the influenza vaccine and other vaccines in the U.S. In addition, the CDC maintains the Vaccine Safety Datalink program, which evaluates the vaccines safety similar to the BEST Initiative. VSD receives its data from nine integrated health care organizations in the U.S.

Antigenic Shift And Pandemic Influenza

Antigenic shift is a dramatic change in the H antigen of influenza A. This occurs unpredictably and infrequently.98Antigenic shift gives rise to pandemic influenza subtypes by 1 of 2 ways:

  • an avian or other animal virus directly adapts so that it can infect humans
  • an avian or other animal virus mixes with a human virus, called genetic reassortment

There have been 4 influenza pandemics in the 20th and 21st centuries:

  • 1918
  • 1968
  • 2009

Each of these pandemic strains replaced the previously circulating influenza A subtype and went on to circulate as seasonal influenza.

More recently, various avian influenza A virus subtypes have caused human infections. Examples are H5N1, H7N9 and H9N2. Sustained human-to-human transmission of these subtypes has not been reported.101,102

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Consider Timing For Coadministration

Flu vaccinations should be offered by the end of October. And for children who need two doses, they should receive their first dose as soon as possible after the vaccine is available because they cant have the second dose until at least four weeks later. The timing of the onset and peak of influenza activity varies from season to season. Within a particular season, this can also vary geographically with localized pockets of activity in some portions of the country are seen before others in any given season.

Over 36 seasons between 1982 and 2018, peak flu activity varied widely. It happened in December and March in 19% of seasons, while it occurred in February in 42% of the seasons. Vaccination should continue throughout the season, as long as influenza viruses are circulating and unexpired vaccine is available.

The AMA has developed frequently-asked-questions documents on COVID-19 vaccination covering safety, allocation and distribution, administration and more. There are two FAQs, one designed to answer patients questions , and another to address physicians COVID-19 vaccine questions .

Why Should My Child Get A Flu Vaccine

Live, Attenuated Influenza Vaccine (LAIV)
  • Reduces the risk of flu illness and hospitalization among children.
  • Shown to be life-saving for children.
  • Can make illness less severe among people who get vaccinated but still get sick with flu.
  • Reduces the risk of illness, which can keep your child from missing school or childcare and you from having to miss work.
  • Reduces the high risk of developing serious flu complication especially if your child is younger than 5 years, or of any age with certain chronic conditions.
  • Helps prevent spreading flu to family and friends, including babies younger than 6 months who are too young to get a flu vaccine.

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What Is In The Influenza Vaccine

Information on specific ingredients included within individual influenza vaccines can be found on the label of the medicine, the Product Information and Consumer Medicine Information leaflets for each individual vaccine. You can ask your pharmacist for a copy or find it through our CMI database by searching the products name. The CMI provides the full list of ingredients for each product.

Additionally, information on medicines supplied in Australia, including ingredients, can be located by searching the Australian Register of Therapeutic Goods either by product name or ARTG number.

Influenza vaccines available for the 2021 influenza season within Australia do not contain any thiomersal/mercury.

Formaldehyde is used in the early stages of manufacture of some influenza vaccines as an inactivation agent. The formaldehyde is removed in the latter stages of manufacture and the product is tested to ensure formaldehyde levels are below detectable limits before the final product can be released.

All influenza vaccines available this year are latex free. However, the possibility that the product may have come into contact with instruments which contain latex cannot be excluded. Patients who are extremely sensitive to latex should consult their doctor for advice.

Fluad Quad is the only product that contains an adjuvant to boost effectiveness of the vaccine in people aged over 65 years.

Do We Have To Use The Needles Sourced By Seqirus To Administer Afluria Quad Or Fluad Quad

No. At the time of vaccination, the choice of needle gauge and length will be based on the vaccinators clinical judgment to ensure needle length is appropriate to reach muscle. Table 2.8 in the online Immunisation Handbook 2020 provides guidance on the needle gauge and length by site and age:



2325 G x 16 mm

A 16 mm needle should be sufficient to effect deep IM deposition in the deltoid in most children.

764 years

2325 G x 16 mm2325 G x 25 mm2122 G x 38 mm

Most adolescents and adults will require a 25 mm needle to effect deep IM deposition.
Very large or obese person Deltoid 2122 G x 38 mm Use clinical judgment to ensure needle length is appropriate to reach muscle.

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All People Aged 6 Months

Registered for use in people aged 6 months.

Quadrivalent inactivated influenza vaccine

Each 0.5 mL monodose pre-filled syringe contains:

  • 15 µg haemagglutinin of each of the 4 recommended influenza virus strains
  • 0.05 µg ovalbumin

Registered for use in people aged 6 months.

Quadrivalent inactivated influenza vaccine

Each 0.5 mL monodose pre-filled syringe contains:

  • 15 µg haemagglutinin of each of the 4 recommended influenza virus strains
  • 100 µg formaldehyde

Registered for use in people aged 6 months.

Quadrivalent inactivated influenza vaccine

Each 0.5 mL monodose pre-filled syringe contains:

  • 15 µg haemagglutinin of each of the 4 recommended influenza virus strains

Also contains traces of:

Registered for use in people aged 3 years.

Quadrivalent inactivated influenza vaccine

Each 0.5 mL monodose pre-filled syringe contains:

  • 15 µg haemagglutinin of each of the 4 recommended influenza virus strains
  • 100 ng ovalbumin

Registered for use in people aged 5 years.

Quadrivalent inactivated influenza vaccine

Each 0.5 mL monodose pre-filled syringe contains:

  • 15 µg haemagglutinin of each of the 4 recommended influenza virus strains
  • < 1 µg ovalbumin

Registered for use in people aged 9 years.

Quadrivalent inactivated influenza vaccine

Each 0.5 mL monodose pre-filled syringe contains:

  • 15 µg haemagglutinin of each of the 4 recommended influenza virus strains

May contain traces of:

Registered for use in people aged 65 years.

Adjuvanted quadrivalent inactivated influenza vaccine

Safety And Side Effects

Flu shot administration 1

The inactivated flu vaccine does not contain the live virus and cannot cause flu. Flu vaccines have a very good safety record. The most commonly reported side effects of flu vaccines are:

  • pain, swelling, bruising, hardness or redness at the injection site
  • slightly raised temperature
  • tiredness
  • feeling generally unwell

A higher rate of these common side effects has been reported with Fluad, an adjuvanted trivalent vaccine which was recommended for people aged 65 and over in previous years. This year, Fluad Tetra is being offered to people aged over 65, which also uses an adjuvant. Side effects usually last 1-2 days.

There are several different makes of flu vaccine available each year. For more information on side effects, ask for the Patient Information Leaflet for the vaccine you are offered. Additional information about vaccine side effects, anaphylaxis and adverse reactions can be found here.

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Safe Use Of Needles And Syringes

Needles and syringes used for vaccine injections must be sterile and disposable. A separate needle and syringe should be used for each injection. Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated .

To prevent inadvertent needlestick injury or reuse, safety mechanisms should be deployed after use and needles and syringes should be discarded immediately in labeled, puncture-proof containers located in the same room where the vaccine is administered . Used needles should never be recapped.

What Is The Appropriate Schedule For Children

Annual influenza vaccination is recommended for persons 6 months of age and older. Some children will need 2 doses of influenza vaccine in the same season. The following children will require 2 doses of influenza vaccine, administered at least 4 weeks apart, for the 20202021 season:

  • Children 6 months through 8 years of age who have never received seasonal influenza vaccine or for whom vaccination history is unknown
  • Children 6 months through 8 years of age who have not received at least 2 doses* of seasonal influenza vaccine before July 1, 2020

The following children will require 1 dose of influenza vaccine for the 20202021 season:

  • Children 6 months through 8 years of age who have received at least 2 doses* of seasonal influenza vaccine before July 1, 2020
  • Children 9 years of age and older

*Doses do not need to have been received during the same or consecutive influenza seasons.

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Flu Vaccine And Covid

Flu vaccination is important because:

  • more people are likely to get flu this winter as fewer people will have built up natural immunity to it during the COVID-19 pandemic
  • if you get flu and COVID-19 at the same time, research shows you’re more likely to be seriously ill
  • getting vaccinated against flu and COVID-19 will provide protection for you and those around you for both these serious illnesses

Why The Flu Vaccine Is Reformulated Every Year

How is the flu shot given?

Welcome to National Influenza Vaccination Week, established in 2005 by the Centers for Disease Control and Prevention to promote vaccination awareness to the general public. In that spirit, Dr. Sebeen Razzaq-Ahmed and the team here at East Meadow Medical P.C. remind you to get your annual flu vaccine. You may be one of the many people we hear ask why they need to get vaccinated each year. Well, were here to answer that for you!

Its no secret that influenza, commonly called the flu, is inconvenient, nasty, and downright deadly. The 2017-2018 flu season was among the worst on record, afflicting and killing more Americans about 80,000 than in any season dating back more than three decades. Because the flu is so common, not to mention so deadly, we always recommend that anyone whos able to gets an updated vaccine each year.

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Syringe And Needle Selection For Parenteral Vaccines

A separate sterile needle and syringe should be used for each injection. Different vaccines must never be mixed in the same syringe, unless specified by the manufacturer. The use of safety-engineered needles and syringes is preferred and, in many jurisdictions, mandated by law to reduce risk of injury. However, vaccines packaged by the manufacturer in pre-filled syringes should not be transferred to safety-engineered injection devices unless jurisdictional or organizational regulations make this mandatory.

Syringe selection

Use a 1 mL or 3 mL syringe, depending on the volume of the vaccine dose.

Needle selection

Table 3: Needle selection guidelines

Route of administration

Filter needles are not recommended for vaccine administration as they may filter out active ingredients such as adjuvants.

How Does The Flu Vaccine Work To Prevent The Flu

The flu vaccines stimulate the immune system to produce of antibodies in the body that fight the particular flu virus in the vaccination. When the virus enters a vaccinated person, the antibodies attack and kill the virus and prevent infection. Antibodies are produced against the specific strains of the virus contained in the yearly vaccine.

Flu vaccination does not protect against infection caused by microbes other than the influenza virus.

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If An Inactivated Influenza Vaccine Approved For Adult Use Is Inadvertently Administered To A Child Is This Considered A Valid Dose

If an inactivated influenza formulation approved for adults is inadvertently administered to a child, this should be counted as a single valid dose for the child. However, this is considered a vaccine administration error. Healthcare personnel should take steps to determine how the error occurred and put strategies in place to prevent it from happening in the future. In addition, we encourage providers to report all vaccine administration errorseven those not associated with an adverse eventto the Vaccine Adverse Event Reporting System external icon. A discussion of strategies to prevent errors can be found in the Vaccine Administration chapter of Epidemiology and Prevention of Vaccine-Preventable Diseases . Additional resources can be found on CDCs vaccine administration web page.

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