It’s the flu season and it’s time to get my flu shot. I have been meaning to write a post about the flu vaccines – what’s new, what’s changed and what’s important to know. Unfortunately,  the information has been a little confusing to follow, to understand and to digest, especially with few of our recommendations significantly different from the CDC recommendations in the United States. Nonetheless, here are few key facts I have managed to gather and hope to share:

Who else is highly recommended to receive the influenza vaccine this year?

This year, adults and children with neurologic or neurodevelopment conditions have been added as a group of individuals who are highly recommended to receive the influenza vaccine.

who-is-recommended

These individuals include:

  • Children with  seizure disorders, febrile seizures and isolated developmental delay
  • Adults with neuromuscular, neurovascular, neurodegenerative, neurodevelopmental conditions and seizures
  • But it excludes migraines and neuropsychiatric conditions without neurological conditions.

The reasoning behind this recommendation is based on preliminary studies and expert opinions.   The odds ratios for influenza complications in individuals with neurologic conditions were much higher:

  • Pneumonia OR = 1.57 95% CI, 1.05 to 2.36
  • ICU admission OR = 19.11, 95% CI, 3.92-93.22
  • Hospitalization OR = 22.2, 95% CI, 2.6=186.0

Findings from the  Canadian Immunization Monitoring Program Active (IMPACT) are also consistent in that it documents the significant burden of the influenza infection in children with neurological and neurodevelopment conditions.

What’s the new vaccine Fluzone-HD good for?

New superior vaccine available and appears to be more effective for the elderly but unfortunately it is not publicly funded yet

  • Fluzone HD is a high dose trivalent influenza vaccine that has been shown to be superior in the elderly population.  However, there has also been reports of higher incidence of injection related adverse reactions.
  • While the elderly population may benefit from the high dose TIV, it is currently not publicly funded.  This will restrict and limit its access for this vulnerable population.

What’s new and different with Live Attenuated Influenza Vaccine (FluMist) this year?

The confusing part of this year’s recommendation is that while we continue to recommend the Live Attentuated influenza Vaccine (FluMist – intranasal), the United States has to decided to do otherwise.

  • FluMist is an intranasal vaccine that is a live attenuated influenza vaccine.
  • This year, we continue to recommend the Live Attentuated influenza Vaccine (FluMist – intranasal), but we have removed the preferential recommendation of LAIV for children 2- 17. (e.g. all vaccines are considered equivalent to use for this age group)
    • The US has decided to remove its recommendation for LAIV use this year because LAIV provided no protective benefit during the influenza A(H1N1) dominant 2015–2016 influenza season and no evidence of effectiveness against the dominant circulating strains in the two prior influenza seasons (2013–2014 and 2014–2015).  We continue to have efficacy data supporting the use of LAIV in Canada.
  • FluMist  continues to have the same contraindications as last year such as not recommended in severe asthma, pregnant women or persons with immune compromising conditions. But the recommendation related to egg allergies has changed:
    •  Previously, individuals with egg allergies were recommended to avoid the LAIV due to the lack of safety data. However, the Canadian Immunization Guide Chapter has just released an addendum this year concluding egg allergic individuals can be safely vaccinated with LAIV in Canada.

Given many children may have needle aversion, there is a definite advantage with LAIV – FluMist, as it is given intranasally. An added bonus is that individuals with egg allergies are also given the green light to use LAIV.

For more information, Please visit the Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza vaccine for 2016-2017 here.  

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