Influenza trivalent

Inactivated vaccines are generally acceptable (e.g, pneumococcal, meningococcal, and influenza [trivalent inactivated influenza vaccine]), and live vaccines generally are avoided in persons with immune deficiencies or immune suppressive conditions. Information on specific conditions is available at vwvw.cdc.gov/vaccines/pubs/acip-list.htm. 

The trivalent inactivated influenza vaccine can be administered to all age groups and risk populations. It is recommended that the vaccine be administered yearly to children older than 6 months of age at risk for complications from influenza, such as those with asthma, cardiac disease, sickle cell disease, human immunodeficiency virus (HIV) infection, diabetes, and other conditions that compromise respiratory function. Healthy children 6 to 23 months of age should be vaccinated because of the increased risk for influenza-related... 

Inactivated trivalent influenza virus vaccine (annual) 0.5 mL intramuscularly (Bll)... 

The two vaccines currently available for prevention of influenza are the trivalent influenza vaccine (TIV) and the live-attenuated influenza vaccine (LAIV). The specific strains included in the vaccine each year change based on antigenic drift. 

LAIV, live-attenuated influenza vaccine TIV, trivalent influenza vaccine. 

Comparison of Trivalent (TIV) and Live-Attenuated Influenza Vaccine (LAIV)... 

Influenza vaccine. (Minimum age 6 months for trivalent inactivated influenza vaccine [HVJ 5 years for live, attenuated influenza vaccine [IAIZ])... 

February (for the Northern Hemisphere winter) and September (for the Southern Hemisphere winter), the WHO provides advanced recommendations for the composition of the influenza vaccine to be manufactured. Similarly, the FDA CBER recommends trivalent influenza vaccine to be prepared for United States. 

In a randomized, double-blind study, trivalent, live, attenuated, cold-adapted intranasal influenza vaccine (FluMist) has been compared with intranasal placebo plus a trivalent injected inactivated influenza vaccine (5). The 200 patients were aged 65 years and over and had chronic cardiovascular or pulmonary conditions or diabetes mellitus. During the 7 days after immunization, sore throat was reported on at least one day by significantly more of the FluMist recipients (15 versus 2%). The increased frequency of sore throat may have been attributable to direct or indirect effects of vaccine virus replication. No other symptom was associated with FluMist. These findings were consistent with evaluations of other live, attenuated, cold-adapted influenza vaccine formulations in older adults. However, further studies of the safety of FluMist are warranted. 

Of 109 children with asthma aged 6 months to 18 years immunized with trivalent subvirion influenza vaccine, 59 vaccinees had no asthma symptoms on the day of immunization, but 50 had an exacerbation requiring prednisone (31). Antibody responses were not different in the two... 

Jackson LA, Holmes SJ, Mendelman PM, Huggins L, Cho I, Rhorer J. Safety of a trivalent live attenuated intranasal influenza vaccine, FluMist, administered in addition to parenteral trivalent inactivated influenza vaccine to seniors with chronic medical conditions. Vaccine 1999 17(15-16) 1905-9. 

Gluck R, Mischler R, Durrer P, Furer E, Lang AB, Herzog C, Cryz SJ Jr. Safety and immunogenicity of intranasally administered inactivated trivalent virosome-formulated influenza vaccine containing Escherichia coli heat-labile toxin as a mucosal adjuvant J Infect Dis 2000 181(3) 1129-32. 

Influenza vaccines are available as inactivated trivalent split or subunit vaccine or as a live attenuated vaccine administered in-tranasally. Though both types of influenza vaccine probably are equally effective in protection from infection, they are indicated for distinct populations and should not be considered interchangeable. 

The inactivated influenza vaccine preparations generally contain 45 meg antigen in 15-mcg trivalent units per 0.5 mL and are administered by IM injection. Split-virus vaccine must be used for children from 6 months to 12 years of age. Children 6 to 35 months old receive 0.25 mL of split-virus vaccine. Two doses of vaccine administered at least 1 month apart are necessary for all children younger than 9 years of age who are receiving the vaccine for the first time. Split-virus vaccine is less reactogenic than whole-virus vaccine, particnlarly in children. Whole- or split-virus vaccine can be administered to individuals older than 12 years of age. However, whole-vims vaccines are not available in the United States. ... 

Treanor JJ, Kotloff K, Betts RF, et al. Evaluation of trivalent, hve, cold-adapted (CAIV-T) and inactivated (TIV) influenza vaccines in prevention of virus infection and illness following challenge of adults with wild-type influenza A (HlNl), A (H3N2), and B viruses. Vaccine 1999 18 899-906. 

Belshe RB, Mendelman PM, Treanor J, et al. The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenza virus vaccine in children. N Engl J Med 1998 338 1405-1412. 

Similarly, the FDA CBER recommended similar trivalent influenza vaccine to be prepared for the 2002-2003 US winter season ... 

G.A. (1994) Systemic cytokine profiles in BALB/c mice immunized with trivalent influenza vaccine containing MF59 oil emulsion and other advanced adjuvants. J. Immunol. 153, 4029-4039. 

INFLUENZA VIRUS VACCINE, TRIVALENT TYPES A B (SPLIT VIRUS)... 

In a randomised study in 26 patients stabilised on warfarin, there was no difference in injection site adverse events between intramuscular or subcutaneous injection of a standard trivalent influenza vaccine, and no patient had bruising or swelling. In addition, both routes of administration produced similar levels of antibody titres. In another study that specifically assessed the local reactions to intramuscular influenza vaccination, there were no detectable local complications after intramuscular injection, including no change in arm circumference. ... 

In yet another study, within 4 days of receiving 0.5 mL of a subvirion, trivalent influenza vaccine, the serum phenytoin levels of 7 patients were reduced by 11 to 14%, which is unlikely to have much clinical significance. A further study measured both free and total phenytoin levels in 8 patients receiving phenytoin alone. Two days after receiving 0.5 mL of a trivalent influenza vaccine, the total phenytoin level had increased by 10%, and this then returned to baseline levels by day 7. However, the free phenytoin level gradually decreased after vaccination to a maximum of 25% less at day 14. 

In contrast, another study in 16 patients given 0.5 mL of an inactivated whole-virion trivalent influenza vaccine found that 7 and 14 days later their mean serum phenytoin levels were not significantly altered, although... 

The pharmacokinetics of single doses of oral alprazolam 1 mg, or intravenous lorazepam 2 mg remained unaffected in healthy subjects when the benzodiazepines were given 7 and 21 days after 0.5 mL of an intramuscular trivalent influenza vaccine. Similarly, in another study, neither lorazepam nor chlordiazepoxide metabolism was altered when they were given 1 and 7 days after a trivalent influenza vaccine. There would seem to be no reason for avoiding the concurrent use of these drugs. 

The clearance of theophylline (given as choline theophyllinate) was reduced by 25% one day after influenza vaccination (trivalent influenza vaccine, F/wogen, Parke Davis) in 8 healthy subjects, but this was of borderline significance. Theophylline metabolism had returned to pre-vaccination levels after 7 days."... 

A patient with COPD treated with sustained-release theophylline 300 mg twice daily (theophylline levels between 7 and 12 mg/L) developed nausea and palpitations the day after he received a trivalent influenza vaccination Fluogen). His theophylline level was increased to 26 [mg/L]. His dose was reduced to 200 mg twice daily and the adverse effects resolved. However, a few days later his COPD had become symptomatic and the theophylline level was found to be subtherapeutic, so the dose was raised to 300 mg twice daily, as before. ... 

Inactivated trivalent influenza vaccine Tetanus toxoid... 

Observational studies In October 2003 the Advisory Committee on Immunization Practices (ACIP) recommended influenza immunization for all children aged 6-23 months [30 ]. The safety of this recommendation has been evaluated using the Vaccine Adverse Event Reporting System (VAERS) to study serious adverse events reported between 1 July 2003 and 30 June 2006 in children aged 6-23 months who had been given trivalent inactivated influenza vaccine. There were 104 serious adverse events at a median time after immunization of 1 day. The two most common serious adverse events were fever (52 reports) and seizures (35 reports). Causality assessment suggested that none was definitely related to influenza vaccine. No new or unexpected concerns were identified. 

Children are another at risk population and a number of studies have looked at various influenza vaccines in this age group. One of these studies - a randomised observer blind study of 2116 children in the United States - compared thimerosal-free, trivalent, inactivated influenza vaccine (TIIV) against an active comparator. The study vaccine had a similar safety profile to the comparator [20 ]. 

---