This is a summary of the CDC recommendation on H1N1 vaccination this year, I have added information to add some context to some of the recomendations.
Who should receive the 2009 H1N1 vaccination?
The goals of vaccination are to protect those at most risk of complications from disease, those who cannot be safely vaccinated and those who are at greatest risk of being a transmitter to other susceptible persons.
The groups that should be vaccinated therefore are:
1. Pregnant women – they have been seen to have higher rates of hospitalization and death. This group should only receive the inactivated injectable vaccine.
2. People who live with or take care of children younger than 6 months of age, as these young children are under the recommended age for vaccination and need a protective wall of immunized people around them. Remember the virus needs to spread from an infected person to be transmitted to a non-infected person. Therefore the best way to protect the very young is to only let immunized persons be in contact with them. These persons can receive live intranasal vaccine as long as they are healthy, not pregnant, and under the age of 50 years. All others will receive inactivated injectable vaccination.
3. Healthcare and emergency workers, this is not just to protect them but more importantly to protect their patients. Hospitals and clinics obviously attract patients with H1N1. Healthcare personell will have significant contact with them and if themselves become infected will transmit infection to their colleagues and more importantly other patients that they care for. Vaccinating all healthcare personell will significantly reduce transmission. Remember transmission starts about a day before the fever starts. Therefore damage may have already been done the day before you even get ill. Healthcare workers CAN receive either live or inactivated as long as they are under 50 years of age and are not pregnant and are not involved with bone marrow transplant units.
4. Persons between ages 6 months and 24 years- this group was over represented in the recent ICU admissions and deaths. This group can receive either live or inactivated vaccine as long as they are not pregnant and are healthy.
5. People ages 25-64 with chronic health issues. They will need inactivated vaccination.
Notice that the over 65 age group that is commonly vaccinated for seasonal influenza is NOT on the list.
What if there are shortages of vaccine? The groups that should be vaccinated first are pregnant women, those who live with or care for children under the age of 6 months, healthcare personnel with direct patient contact, children 6 months to 4 yrs and children 5 through 18 years with chronic medical conditions. Once these high risk groups are vaccinated then focus will be on persons ages 25-64 years.
For those ages 10 and above should receive one dose. Whereas children 9 years and under should receive two doses separated by a month. This is due to the lower immune response with a single dose to have adequate antibodies.
List of those NOT receiving live intranasal vaccine for H1N1
• People younger than 2 years of age; insufficient testing
• Pregnant women; insufficient testing in this group
• People 50 years of age and older; insufficient testing in this group
• People with a medical condition that places them at higher risk for complications from influenza, including those with chronic heart or lung disease, such as asthma or reactive airways disease; people with medical conditions such as diabetes or kidney failure; or people with illnesses that weaken the immune system, or who take medications that can weaken the immune system;
• Children younger than 5 years old with a history of recurrent wheezing;
• Children or adolescents receiving aspirin therapy;
• People who have had Guillain-Barré syndrome (GBS), a rare disorder of the nervous system, within 6 weeks of getting a flu vaccine, though this has never been shown to be causally related any more than getting the “wild type” infection, it is recommended as a precaution.
• People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components. The vaccine including the live form is made with chicken eggs. Remember SEVERE allergy to eggs is the contraindication. Most individuals can take the vaccine if they can eat scrambled eggs or have cake made with eggs.
Regarding seasonal vaccination
It is still necessary for the usual groups– ages over 65 etc
It will not provide protection against H1N1
the list of individuals needing vaccination for seasonal influenza is as follows
Children aged 6 months up to their 19th birthday
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
Note that there is considerable overlap between the seasonal and H1N1 list, many persons will need both vaccinations.
Can seasonal vaccine and H1N1 be given together?
Inactivated seasonal (TIV) and inactivated H1N1 along with pneumovax can be given together.
Live seasonal (LAIV) and inactivated H1N1 can be given together.
TIV and live H1N1 can be given together.
Do NOT give live intranasal seasonal (typo corrected: this was previously written as TIV) and live intranasal H1N1 together
What if I already had the flu this year?
Regardless of whether the illness was H1N1 or not, if you are in a risk group that should be vaccinated do get immunized.
Breast feeding and vaccination?
It is safe, including the live intranasal vaccination.
What about Tamiflu and vaccination?
Do not take Tamiflu for 2 weeks after live intranasal vaccine, it will kill the vaccine virus.
Do not get vaccinated for at least 48 hours after Tamiflu is discontinued.
Inactivated injectable vaccine can be given with Tamiflu. Continue reading