News from the CDC

Thursday September 19, 2013

Aah, tis favorite time of year....and a young man's fancy turns to...influenza?!?

This year's vaccine is again a trivalent, inactivated vaccine. It contains two A viruses: California (H1N1) and Texas (H3N2). There is also a B virus present: Massachusetts. The Texas A and Massachusetts B viruses are new to this year's vaccine, compared to last year.

There is also a quadrivalent vaccine that contains a second influenza B virus. However, I could NOT see any recommendation from the Centers for Disease Control (CDC) that seemed to suggest there was any particular need to give any one this quadrivalent vaccine.

There is also a live attenuated vaccine (FluMist)available as a nasal inhalation, for persons < age 50. Persons > 50 years old must receive the intramuscular injection.

Last year, in older persons and diabetics, in particular, there was a diminished immunogenic response to the other words, it didn't protect them. Why exactly is unclear, but this year we are recommending the high - dose trivalent vaccine for such persons, though the immunogenic advantage appears to be slight. For everyone else, we recommend the regular trivalent vaccine (Flulaval).

If persons have concerns about egg allergy, there are vaccines made without eggs. Ordering those is impractical for us, but if that is your concern, I would check with Walgreens or other large pharmacies, as they likely have or can get it.

I continue to believe optimal timing of vaccination is the 1st or 2nd week of November, unless you are going to be headed to CA, FL or TX (the usual portals of entry of influenza to the U. S.) at Thanksgiving or sooner, in which case any time now would be fine.

So, in review:
  1. trivalent Flulaval intramuscularly for nearly everyone
  2. we have no current plans to use the tetravalent vaccine, as we have none in stock and are unlikely to get any
  3. we are going to use the higher dose trivalent vaccine in persons > 70, diabetics, those with emphysema or other high - risk cases
  4. we do NOT have any FluMist in stock and are unlikely to get any

On a related topic, earlier this week, the CDC released its 2012 resistant - bacteria data, which showed 23,000 such deaths in the U. S. last year. Two important reasons exist for this in my opinion: wildly inappropriate antibiotic use in livestock feed and wildly inappropriate antibiotic use by physicians in persons with viral illnesses.

This is one of the reasons I am such a hard a-- when it comes to calling in a script for antibiotics over the phone, where I am taking a wild, wild guess. At least if I see you, I feel as if I've got a chance to differentiate between a viral and a bacterial illness.

I hope some of this is helpful

Enjoy the brilliant colors of Indiana autumn!