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Practice Question September 11, 2014

Influenza Vaccination
You are a public health and preventive medicine specialist in a large city. The local radio
station ask for an interview with you regarding all the new choices available with the new
flu vaccines.
Hello Dr. X, thank you for joining us today. Every year we are told by public health and
our doctors to get THE FLU SHOT but this year it seems like there are many different
kinds of flu shots. I dont remember this being the case last year. Hopefully during our
brief time today you will be able tell our viewers which shot is right for them.

1. So, firstly doctor, can you tell us a bit about the flu .
2. Who should get the vaccine and when?
3. What is in the vaccine?
4. How effective is it?
5. There are so many different kinds this year, can you explain this to us?
6. What vaccine should my kids get, which should I get, which should my great aunt get?
7. Which of these vaccines is covered and which do I have to pay for?
8. When does the vaccines protection start and how long does it protect me for?
9. Is there anyone who shouldnt get the vaccine? What about people with egg allergies?
10. Thank you so much doctorWhile I have you hereI just wanted to ask you
something about the Ebola outbreak in West Africa. I though Ebola is fatal 90% of the
time, but in this outbreak it seems that the fatality rate is closer to 50% why is that?

Who should get vaccine?

NACI (CDC)- Everyone above age 6mo.
Who is at higher risk?
Children <5 <2, over 65, pregnant women, aboriginal
Medical comorbidities
How long does it take to develop immunity?
2 weeks
What kind of flu vaccines are available?
Trivalent split or subunit intramuscular (Vaxigrip, Fluviral), intradermal (intanza, >18, 9ug
and 15ug for >60)
Quadrivalent Fluzone (H1N1, H3N2, B brisbane
Adjuvanted Fluad (MF59 for >65)
Intranasal live trivalent (LAIV FluMist, 2-50) cold adapted so multiply in nasal cavity.
How effective are they?
Lancet metaanalysis "Efficacy and Effectiveness of Influenza Vaccines," analyzed 31 studies 1967 and 2011.
Overall efficacy 67%; HIV-positive adults ages 18 to 55 (76 percent), healthy adults ages 18 to 46 (70%) and healthy
children ages 6 to 24 months (66%). Least benefit among elderly.
How dangerous is influenza?
54-65 10x likelihood of death, 65+ 100x, infants.
Herd immunity inpact on elderly.

Protection without revaccination?

Abx peaks at 2-4wks, decreases 50% by 6mo, can persist 3yrs.
What strains are included this year?
Cost effective?
In elderly, may be cost-saving.
Who should not get influenza vaccine?
What is influenza?
Influenza is a respiratory infection caused by influenza A or B viruses. In Canada it
generally occurs each year in the late fall and winter months. Symptoms typically include
the sudden onset of headache, chills, cough, fever, loss of appetite, myalgia, fatigue,
coryza, sneezing, watery eyes and throat irritation. Nausea, vomiting and diarrhoea may
also occur, especially in children.
Most people will recover from influenza within a week to ten days, but some - including
those 65 years of age and older, and adults and children with chronic conditions - are at
greater risk of more severe complications, such as pneumonia. Additional information
about groups that are at increased risk of influenza complications is available below in
Table 5 and in Section V of this document.
Can Egg allergic patients get it?

NACI has concluded that egg allergic individuals may be vaccinated against influenza using TIV
and QIV without a prior influenza vaccine skin test and with the full dose.