August 21, 2013
Unprecedented Choice of Influenza Vaccines for
2013-14 Season

Atlanta—Influenza vaccine seekers and the pharmacies offering the service will face an unprecedented number of options this year, but they shouldn’t look to the CDC for advice on which one to choose.

Public health officials still recommend annual influenza vaccination for everyone 6 months and older and strongly urge that immunization occurs by October, but said otherwise, “No preferential recommendation is made for any type or brand of licensed influenza vaccine over another.”

In its recently released summary recommendations for the 2013–14 U.S. flu season, the CDC said the trivalent influenza vaccines will contain an A/California/7/2009 (H1N1)-like virus, an H3N2 virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011, and a B/Massachusetts/2/2012-like virus. An additional vaccine virus, a B/Brisbane/60/2008-like virus, will be added to quadrivalent vaccines.

The recommendations said that the recently licensed vaccines, available for the 2013-14 season, are acceptable alternatives to other licensed vaccines, taking into consideration the age limitations and appropriateness. Those include:

• A quadrivalent live attenuated influenza vaccine (LAIV4; Flumist Quadrivalent [MedImmune]) is expected to replace the trivalent (LAIV3) formulation. FluMist Quadrivalent is indicated for healthy, nonpregnant persons aged 2 through 49 years;
• A quadrivalent inactivated influenza vaccine (IIV4; Fluarix Quadrivalent [GlaxoSmithKline]) will be available, in addition to the previous trivalent formulation. Fluarix Quadrivalent is indicated for persons aged 3 years and older;
• A quadrivalent inactivated influenza vaccine (IIV4; Fluzone Quadrivalent [Sanofi Pasteur]) will be available in addition to the previous trivalent formulation. Fluzone Quadrivalent is indicated for persons aged 6 months and older;
• A trivalent cell culture–based inactivated influenza vaccine (ccIIV3; Flucelvax [Novartis]), which is indicated for persons aged 18 years and older; and
• A recombinant hemagglutinin (HA) vaccine (RIV3; FluBlok [Protein Sciences]), which is indicated for persons aged 18 through 49 years.

If vaccine supply should become limited at any point during the season, CDC said pharmacists and other health professionals should focus on immunizing the following groups in no particular order:

• All children older than 6 months and under 5 years;
• All persons older than 50 years old;
• Both adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus);
• Patients with immunosuppression, including immunosuppression caused by medications or by HIV infection;
• Women who are or will be pregnant during the influenza season;
• Children and adolescents—6 months to 18 years old—who currently are receiving long-term aspirin therapy, which might put them at risk of Reye’s syndrome with influenza virus infection;
• Residents of nursing homes and other long-term-care facilities;
• American Indians/Alaska Natives;
• The morbidly obese, defined as having body mass index equal to or greater than 40.

Public health officials also are strongly urging vaccination of people who live with or care for those at higher risk for influenza-related complications if vaccine supply becomes limited. Those include all health care personnel.

As of earlier this month, GlaxoSmithKline, MedImmune, and Sanofi Pasteur all had received FDA approval to begin shipping influenza vaccine for the 2013-14 flu season and were initiating the process.

U.S. Pharmacist Social Connect