PGY 39, Day 124
FIRST OF ALL
If you don't have a Doctor whom you trust, get one! If you don't know how, contact me and I will give you guidance. She or He should be able to guide you in the right direction.
AFTER YOU HAVE YOUR DOCTOR, CHECK THIS OUT with your DOC!
There seems to be a bit of confusion regarding "the flu" and the influenza vaccine, and that is quite easy to understand. It is very confusing, because the bug confuses everyone ... it keeps changing.
BUT ... there are some fundamental rules that have not changed over the years. This CDC document
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0729a1.htm
covers the whole story, and the recommendations have not changed since last year. Their reasoning for expanding the population to be immunized is covered in this document. I recommend that you study it, if you are NOT high risk and you need to decide weather or not to get immunized. If you ARE HIGH RISK, and have NO CONTRAINDICATIONS, you should be immunized for sure. Keep in mind that my conclusion is based upon the fact that I see the casualties who end up in the Intensive Care Unit ... not a good way to spend your days, if avoidable, eh?
TWO TYPES OF VACCINE: INACTIVATED & LIVE ATTENUATED
From the CDC DOCUMENT
"TIV contains inactivated viruses and thus cannot cause influenza. LAIV contains live attenuated influenza viruses that have the potential to cause mild signs or symptoms related to vaccine virus infection (e.g., rhinorrhea, nasal congestion, fever, or sore throat). LAIV is administered intranasally by sprayer, whereas TIV is administered intramuscularly by injection. LAIV is licensed for use among nonpregnant persons aged 2--49 years; safety has not been established in persons with underlying medical conditions that confer a higher risk for influenza complications. TIV is licensed for use among persons aged ≥6 months, including those who are healthy and those with chronic medical conditions (Table 1). During the preparation of TIV, the vaccine viruses are made noninfectious (i.e., inactivated or killed) (8). Only subvirion and purified surface antigen preparations of TIV (often referred to as "split" and subunit vaccines, respectively) are available in the United States. Standard-dose TIV preparations contain 7.5 mcg HA antigen per vaccine strain (for children aged <36 months) or 15 mcg of HA antigen (for persons aged ≥36 months) per vaccine strain (i.e., 22.5 mcg or 45 mcg total HA antigen). A newly licensed higher dose TIV (60 mcg per vaccine strain or 180 mcg total HA antigen) was approved recently for persons aged ≥65 years (Fluzone High-Dose, Sanofi pasteur)."
WHO IS HIGH RISK:
FROM THE CDC DOCUMENT
"Vaccination to prevent influenza is particularly important for persons who are at increased risk for severe complications from influenza or at higher risk for influenza-related outpatient, ED, or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following persons:
all children aged 6 months--4 years (59 months);
all persons aged ≥50 years;
adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus);
persons who have immunosuppression (including immunosuppression caused by medications or by HIV);
women who are or will be pregnant during the influenza season;
children and adolescents (aged 6 months--18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;
residents of nursing homes and other long-term--care facilities;
American Indians/Alaska Natives;
persons who are morbidly obese (BMI ≥40);
HCP;
household contacts and caregivers of children aged <5 years and adults aged ≥50 years, with particular emphasis on vaccinating contacts of children aged <6 months; and
household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza."
STILL CONFUSED?
You will have to study the whole document and ask for guidance. Feel free to ask me questions and send your comments.
Buona Fortuna & Ciao for now,
Dr. Mike
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