Vaccine, Influenza

Influenza. The ACIP recommends annual influenza vaccination for all persons who are at risk from infections of the lower respiratory tract and for all older persons. Influen2a vimses types A and B are responsible for periodic outbreaks of febrile respiratory disease. 

Influenza. Although current influenza vaccine (subunit spHt vaccine) has been in use yearly for the elderly, it is not recommended for the general population or infants. Improvements to increase or prolong the immunogenicity, reduce the side-effects (due to egg production procedure), and provide mass protection are stiU being pursued. One approach is to use a five, attenuated vims though cold adaptation. A vaccine has been used in Russia and demonstrated to be safe and efficacious for infants (82). Clinical trials for a similar vaccine are being carried out in the United States (83). 

The use of antibiotics is not recommended, except for the treatment of infectious exacerbations of COPD and other bacterial infections. Influenza vaccines decrease illness and death in COPD patients. Pneumococcal vaccination is also recommended. 

Adults at high risk for certain diseases (eg, pneumocoacal and influenza vaccines for individuals with serious respiratory disorders)... 

Influenza vaccine. Influenza vaccine is recommended annually for children age > 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes see MMWR. 2001 50(RR-4) 1-44), and can be administered to all others wishing to obtain immunity. Children aged <12 years should receive vaccine in a dosage appropriate for their age (0.25 mL if age 6-35 months or 0.5 mL if age >3 years). Children aged <8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks. 

Normal spirometry ° Avoidance of risk factors ° Influenza vaccine... 

In general, it is suggested that patients remain up to date on standard immunizations. Patients with HF should be counseled to receive yearly influenza vaccinations. Additionally, a pneumococcal vaccine is recommended. Usually only one pneumonia vaccination is necessary unless a patient is vaccinated before age 65. In that case, a booster vaccination is suggested 5 years after the initial vaccination. 

Educate the patient on lifestyle modifications such as salt restriction (maximum 2 to 4 grams per day), fluid restriction if appropriate, limitation of alcohol, tobacco cessation, participation in a cardiac rehabilitation and exercise program, and proper immunizations such as the pneumococcal vaccine and yearly influenza vaccine. 

Chloral hydrate Chloramphenicol Cimetidine Ciprofloxacin Clofibrate Danazol Disulfiram Doxycycline Erythromycin Fenofibrate Fluconazole Fluorouracil Fluoxetine Fluvoxamine Gemfibrozil Influenza vaccine Isoniazid Itraconazole Fovastatin Metronidazole Miconazole Moxalactam Neomycin Norfloxacin Ofloxacin Omeprazole Phenylbutazone Piroxicam Propafenone Propoyxphene Quinidine Sertraline Sulfamethoxazole Sulfinpyrazone Tamoxifen Testosterone Vitamin E Zafirlukast... 

Asthma patients should receive the influenza vaccine every year.1 Although the pneumococcal vaccine may decrease the risk of invasive pneumococcal disease in asthmatics, current guidelines do not include the routine administration of this vaccine to asthma patients.1,14... 

Serious illness and death in COPD patients can be reduced by about 50% with annual influenza vaccination. The optimal time for vaccination is usually from early October through mid-November. All patients with COPD should also receive a one-time vaccination with the pneumococcal polysaccharide vaccine, even though sufficient data supporting its use in COPD patients are lacking.1,2 Patients over 65 years of age should be revacdnated if it has been more than 5 years since initial vaccination and they were less than 65 years of age at the time. 

Vaccination against hepatitis A and B is recommended in patients with underlying cirrhosis to prevent additional liver damage from an acute viral infection.35 Pneumococcal and influenza vaccination may also be appropriate and can reduce hospitalizations due to influenza or pneumonia. 

Influenza and pneumonia are common preventable infectious diseases that increase mortality and morbidity in persons with chronic diseases including DM.5 Yearly influenza vaccinations, commonly called flu shots, are recommended for patients with DM. Pneumococcal vaccination also is recommended for patients with DM as a one-time vaccination for most patients. 

Children with SCD should receive the required immunizations as recommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices.15 Additionally, influenza vaccine should be administered yearly to SCD patients 6 months of age and older, including adult patients. Any SCD patient who is scheduled for splenectomy should receive the vaccine for meningococcal disease if over 2 years of age.16... 

The influenza vaccine is available in two forms, injectable and nasal inhalation. The injectable is an inactivated vaccine... 

H. influenzae type b and influenza vaccines have the potential for confusion and medication errors because of the similarity of the names. Care should be taken when ordering, dispensing, and administering these vaccines. 

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... 

Influenza vaccine should be given yearly to all adults 50 years of age or older. Younger adults with chronic disorders of the cardiovascular or pulmonary systems, chronic metabolic diseases, renal dysfunction, immunosuppression, or disorders that compromise respiratory function should also be vaccinated. Women who will be pregnant during the winter months should be vaccinated against influenza. 

Healthy individuals 5 to 49 years of age can receive the live attenuated influenza vaccine instead of the inactivated vaccine. There are limited data on transmission of the vaccine strain following intranasal vaccination however, secondary transmission does not appear to be a concern. 

Adults with HIV infection should be vaccinated with the 23-valent pneumococcal polysaccharide and hepatitis B vaccines as early in the course of the disease as possible. Inactivated influenza vaccine should be given yearly. Children should continue to receive vaccinations on the standard childhood immunization schedule. The individual may experience a transient elevation in HIV viral load following vaccination.17... 

Following hematopoietic stem cell transplantation the patient will need virtually all routine vaccines to be administered again however, the patient will not be able to mount an adequate response for 6 to 12 months post-transplant. Diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, hepatitis B, pneumococcal, and inactivated poliovirus should be given at 12,14, and 24 months post-hematopoietic stem cell transplantation. Inactivated influenza vaccine should be given yearly, starting 6 months after transplant. Measles, mumps and rubella can be given 2 years after transplant and varicella vaccine is contraindicated.16... 

Household contacts of immunocompromised persons should have all routine vaccines as scheduled, including yearly influenza vaccination. Children in the household may receive live virus vaccines without special precautions however, if a rash develops following varicella vaccination, contact should be avoided with the immunocompromised host until the rash resolves. 

All health care personnel should be strongly encouraged to receive the influenza vaccine yearly in order to prevent transmission of influenza within the health care facility and to decrease employee absenteeism for influenza-related reasons. The vaccine should be made available to employees at the workplace, free of charge. Employees should be asked to sign a declination if refusing to receive the influenza vaccine. Additionally, health care facilities should report the number of health care personnel receiving influenza vaccine as a patient safety measure.19... 

The vaccination rate in adults is much lower than that in children. Only 50% to 60% of adults who meet criteria have received pneumococcal or influenza vaccination. Comprehensive initiatives need to be implemented to increase the adult vaccination rate. Some proven concepts are providing reminders to patients that vaccines are due and implementation of standing orders for vaccines. This latter concept allows nurses and pharmacists to screen patients to see if pneumococcal, influenza, or other vaccines are needed and to vaccinate without a physician s order. 

The Centers for Medicare and Medicaid Services has incorporated pneumococcal and influenza immunization rates into some of their quality standards. Patients admitted to a hospital for community-acquired pneumonia should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines prior to discharge if not previously administered. In physicians office practice, all persons over 65 years of age who have been hospitalized in the past year should be screened for, offered, and vaccinated with pneumococcal and influenza vaccines if not previously administered. Both of these standards will affect payment if the standard is not met. The Joint Commission on Accreditation of Healthcare Organizations has also incorporated these standards into their accreditation reviews of health care facilities. 

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