Infection Control Today

NOV 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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20 ICT November 2018 www.infectioncontroltoday.com Recommendations for the compo - sition of Northern Hemisphere infl uenza vaccines are made by the World Health Organization (WHO), which organizes a consultation, generally in February of each year. Surveillance data are reviewed, and candidate vaccine viruses are discussed. The WHO's Vaccines and Related Biological Products Advisory Committee (VRBPAC) considers the recommendations of WHO, reviews and discusses similar data, and makes a fi nal decision regarding vaccine virus composition for infl uenza vaccines licensed and marketed in the U.S. As for the current fl u season, Grohskopf, et al. (2018) summarize the 2018 -19 recommendations of the ACIP regarding the use of seasonal infl uenza vaccines in the U.S.: "Routine annual infl uenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. A licensed, recommended, and age-appropriate vaccine should be used. Inactivated infl uenza vaccines (IIVs), recombinant infl uenza vaccine (RIV), and live attenuated infl uenza vaccine (LAIV) are expected to be available for the 2018–19 season. Standard-dose, unadju- vanted, inactivated infl uenza vaccines will be available in quadrivalent (IIV4) and trivalent (IIV3) formulations. Recombinant infl uenza vaccine (RIV4) and live attenuated infl uenza vaccine (LAIV4) will be available in quadri- valent formulations. High-dose inactivated infl uenza vaccine (HD-IIV3) and adjuvanted inactivated infl uenza vaccine (aIIV3) will be available in trivalent formulations." Grohskopf, et al. (2018) explain the primary changes for this fl u season: ✦ Routine annual infl uenza vaccination of all persons aged ≥6 months without contraindications continues to be recommended. No preferential recom- mendation is made for one infl uenza vaccine product over another for persons for whom more than one licensed, recommended, and appro- priate product is available. Updated information and guidance in this report includes the following: ✦ Vaccine viruses included in the 2018-19 U.S. trivalent infl uenza vaccines will be an A /Michigan/45/2015 (H1N1) pdm09–like virus, an A /Singapore/ INFIMH-16-0019/2016 (H3N2)-like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent infl uenza vaccines will contain these three viruses and an additional infl uenza B vaccine virus, a B/Phuket/3073/2013– like virus (Yamagata lineage). ✦ Following t wo seasons (2016 -17 and 2017-18) during which ACIP recommended that L AIV4 not be used, ACIP voted in February 2018 to recommend that for the 2018-19 season, vaccination providers may choose to administer any licensed, age-appropriate infl uenza vaccine (IIV, RIV4, or LAIV4). LAIV4 is an option for those for whom it is appropriate. ✦ Persons with a history of egg allergy of any severity may receive any licensed, recommended, and age-appropriate infl uenza vaccine (IIV, RIV4, or LAIV4). IIV and RIV4 have been previously recommended. Use of LAIV4 for persons with egg allergy was approved by ACIP in February 2016. Additional recom- mendations concerning vaccination of egg-allergic persons are discussed. References: Association of Occupational Health Professionals in Healthcare (AOHP). Position Statement on Best Practices for Healthcare Worker Immunizations. May 2018. Centers for Disease Control and Prevention (CDC). Health Care Personnel and Flu Vaccination, Internet Panel Survey, United States, November 2017. Grohskopf LA, Sokolow LZ, Broder KR, Emmanuel B. Walter EB, Fry AM and Jernigan DB. Prevention and Control of Seasonal Infl uenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Infl uenza Season Recommendations and Reports. Aug. 24, 2018; 67(3);1-20. The CDC provides the following Q&A addressing vaccine supply for 2018-2019 season: Q: How much influenza vaccine is projected to be available for the 2018-2019 infl uenza season? A: Flu vaccine is produced by private manufacturers, so supply depends on manufacturers. Vaccine manufacturers have projected that they will supply as many as 163 million to 168 million doses of fl u vaccine for the 2018-2019 season. Q: How much thimerosal-free influenza vaccine is expected to be available for the 2018-2019 season? A: For the 2018-2019 season, manufacturers will produce infl uenza vaccines containing thimerosal and some vaccines that do not contain thimerosal. For the 2018-2019 season, only multidose vial presentations of infl uenza vaccines contain thimerosal. More than 80 percent of projected vaccine supply produced for the 2018-2019 fl u season will be thimerosal-free (i.e., preservative-free). Q: How much quadrivalent vaccine is expected to be available for the 2018-2019 season? A: For the 2018-2019 season, manufacturers will produce both trivalent (three-component) and quadrivalent (four-component) infl uenza vaccines. More than 80 percent of the projected vaccine supply produced for the 2018-2019 fl u season will be quadrivalent (4-component) vaccines. The remaining vaccine will be trivalent, including the high-dose and adjuvanted fl u vaccines, as well as one brand of standard-dose inactivated vaccine. Q: How much of the U.S. fl u vaccine supply for 2018-2019 will be produced using egg-based manufacturing? A: Approximately 85 percent of the projected vaccine supply produced for the 2018-2019 fl u season will be produced using egg-based manufacturing technology. The remaining vaccine will be produced using cell-based and recombinant technology. Q : Can I still buy infl uenza vaccine for the 2018-2019 season? A: Influenza vaccine pre-booking typically occurs between January and March, though most preparations of vaccine should still be available for purchase. Providers should contact distributors and local vendors about remaining supply. In addition, beginning in early October each year, information about manufacturers and distributors who still have influenza vaccine available for sale can be found at ht tp: // w w w. preventinfluenza.org/ivats/. Updates on the distribution of influenza vaccine doses for the 2018-2019 season will be provided as the season progresses. Q: What can be anticipated in terms of the timing of vaccine availability for the 2018-2019 season? A: The timing of vaccine availability depends on when production is completed. Infl uenza vaccine shipments will continue through October and November until all of the vaccine is distributed. Q: Are all infl uenza vaccines the same? A: All infl uenza vaccines contain antigen derived from the same influenza viruses, with the one difference being that trivalent vaccines have three different antigens and quadrivalent vaccines have four different antigens (the same three that are in the trivalent vaccines, plus one more). However, aside from the antigen composition, the different infl uenza vaccine preparations have different indications as licensed by the FDA. Each is licensed for a specifi c age range. All recipients should receive a vaccine that is appropriate for their age. In addition, LAIV is not recommended for use in some populations. Vaccine Supply for the 2018-2019 Season

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