Kathleen Amos, MLIS, Assistant Director, Academic/Practice Linkages, Public Health Foundation
In December 2018, the Public Health Foundation (PHF), in collaboration with the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), hosted #HowIRecommend Flu Vaccine: How to Make Recommendations that Matter to Patients, a webinar offering tips on how to make stronger and more effective flu vaccine recommendations and answer important questions from patients.
With nearly 1,200 participants joining the webinar, numerous questions and comments were shared. Read on to learn more about these questions and their answers.
Webinar Participants’ Questions & Answers
Q: How to answer to patients who say that the vaccine effectiveness is only 15-30% max so why even bother to inject something into the body that does not work?
A: Flu vaccines always minimize the chance that you’ll get the flu, but also make the flu dramatically less serious if you do get it, converting what could be a weeklong illness into a few hours of nausea. The flu vaccine always works, if “works” means minimizing the overall effects of the flu. Additionally, even if only that percentage is protected, it is better than zero. Even at this level of effectiveness, the impact of resource utilization is decreased so that those that do become sick can access those resources such as hospital beds.
Q: What if the patient asks for documented scientific evidence of the efficacy of the flu vaccine?
A: There are some CDC resources. Every season, there's an update in the Advisory Committee on Immunization Practices (ACIP) guidance around flu vaccination, and a lot of that guidance points to the randomized trials and the observational studies that have looked at the efficacy as well as the effectiveness of influenza vaccination. Also on the CDC website, every year, the flu division measures vaccine effectiveness in the outpatient as well as the inpatient setting, and every time those estimates are published, whether they are interim estimates in the middle of a flu season or final published estimates of the flu vaccine effectiveness, those also go up on the CDC website.
Q: You mentioned nobody likes shots. I understand the LAIV4 spray is available again this season. What are your recommendations for the spray and how do you handle questions from patients or caregivers if they state they had heard the spray hasn't worked in the past?
A: Influenza vaccine effectiveness (VE) can vary from year to year, among different age and risk groups, by vaccine type, and even by virus type and subtype. While data from 2010-2011 through 2016-2017 indicated that LAIV lacked effectiveness among 2 through 17-year-olds against H1N1pdm09 influenza viruses (2009 H1N1) in the US, LAIV was effective against influenza B viruses, and was similarly effective against H3N2 viruses as inactivated influenza vaccines. For the 2018-2019 season, the manufacturer of LAIV4 has included a new H1N1 vaccine component. Some data suggest this will result in improved effectiveness of LAIV4 against H1N1. However, no published effectiveness estimates for this vaccine component against H1N1 viruses are yet available. The Advisory Committee on Immunization Practices (ACIP) and CDC voted to resume the recommendation for the use of LAIV4 based on evidence suggesting that the new H1N1 component will result in improved effectiveness of LAIV against these viruses. There is no expressed preference for any flu shot or the nasal spray vaccine.
Q: How do we approach healthcare workers who voice concerns about "all the additives" in the vaccine? Healthcare workers have expressed concerns about all the chemicals in the vaccine. And also for those healthcare workers who state, "every time I get the flu vaccine, I get sick, but I haven't gotten sick when I don't." Please advise.
A: It is recommended that healthcare workers receive influenza vaccination to protect themselves and others from getting sick. Healthcare workers can get influenza from patients or coworkers who are infected. Infected workers can potentially transmit influenza to patients or coworkers even if they don’t feel sick. These are all great reasons to take concrete preventive actions against influenza, including getting vaccinated.
Influenza vaccines contain small quantities of inactive ingredients. Vaccines in multi-dose vials contain thimerosal, a preservative that helps prevent microbial growth. Currently available US-licensed single-dose vial and pre-filled syringe presentations of influenza vaccines do not contain preservatives, according to the package inserts.
Some, but not all, influenza vaccines contain small quantities of other ingredients such as antibiotics and gelatin. Some individuals have allergies to these substances. The prescribing information for each vaccine lists the ingredients, and can be helpful in choosing an acceptable vaccine in these situations.
Influenza vaccines do not cause influenza, as they contain either inactivated virus, recombinant hemagglutinin, or virus that is live but has been changed (attenuated) so that it cannot establish infection. Most people experience only local side effects of vaccination, such as soreness at the injection site. Less commonly, one might have more general systemic symptoms such as headache, fever, nausea, and muscle aches. These side effects may be confused by some as being influenza, but they are generally short-lived and more mild than symptoms of actual influenza virus infection.
Q: What suggestions would you have for those of us who work with pregnant women? About getting them on board for the flu shot. Please discuss any concerns regarding pregnant women receiving the vaccine in the first trimester.
A: Influenza vaccination during pregnancy is beneficial to both the pregnant mother as well as her developing baby. CDC recommends that all people aged ≥6 months get an annual influenza vaccination, including pregnant women. Pregnant women are at higher risk for serious flu-related complications, particularly in the second and third trimesters. Influenza illness can also be associated with fever, and maternal fever may be associated with some types of birth defects. Vaccination of pregnant women is recommended, and may occur during any trimester.
Inactivated influenza vaccines have been available for several decades and have a reassuring history of use in pregnancy, though in general there is less information available regarding vaccination during the first trimester. A recent CDC-funded Vaccine Safety Datalink study found an association between vaccination and increased risk of spontaneous abortion (miscarriage) when an H1N1pdm09-containing vaccine had also been received during the previous season. Most of the miscarriages included in the study occurred during first trimester, a time when miscarriages are relatively common. Earlier studies have not found such an association. Results of a follow-up study are anticipated soon.
Women who may be concerned about influenza vaccination during the first trimester of a pregnancy should talk with their obstetricians about the best timing to receive influenza vaccination given their pregnancy as well as their possible exposure to influenza.
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to access additional immunization webinars featuring CDC experts, as well as the schedule of upcoming immunization events.