The Nurse Practitioner's Guide to the 2016 Flu Shot

It's that time of year again, folks! The weather is crisp and leaves are beginning to fall from the trees. Yes, it's flu shot season. In the emergency department where I work, we've already seen a handful of patients test positive for influenza. So, it looks like the flu could come early this year. As a result, nurse practitioners should encourage patients to get vaccinated sooner rather than later. What do NPs need to know about the 2016-2017 flu shot?

There have been a few changes to the recommendations for the influenza vaccine this year, here's what nurse practitioners need to know. 

The Biggest Change for 2016-2017

The most notable change to the CDC's flu shot guidelines for the 2016-2017 influenza season, is that the nasal spray vaccine is no longer recommended for use. The vaccine, provided under the name FluMist, did not protect against a number of influenza strains over the past few years, with an efficacy rate between 2 and 17 percent. The injectable vaccine, in contrast, had an efficacy rate of 63 percent. So, this season, all patients must receive the injectable vaccine. 

Changes for Patients with Egg Allergies

The influenza vaccine is manufactured using an egg-based technology. As a result, the vaccine contains a small amount of egg protein. Previous recommendations called for patients with a history of egg allergy to be monitored for 30 minutes after administration of the vaccine.

Based on new research showing that allergic reaction to the vaccine is extremely rare, even in individuals with egg allergy, recommendations have changed. Patients with egg allergy no longer need to be monitored after vaccine administration. 

Individuals with an egg allergy who have experienced only hives after exposure to egg may receive any flu vaccine recommended for the patient's age and health status. Individuals with reactions to egg other than hives, including angioedema, respiratory distress, lightheadedness, recurrent emesis, or who have required epinephrine or emergency care with egg exposure, should receive the vaccine in a setting supervised by a health care provider able to recognize severe allergic conditions. 

Categories of Influenza Vaccines

Once again, this year there are two main types of influenza vaccine on the market. Quadrivalent vaccines protect against four strains of influenza and trivalent vaccines protect against three strains of influenza. Branded influenza vaccines fall under these two categories as follows: 

  • Quadrivalent - Fluarix, Flulaval, Fluzone Intradermal, Fluzone Quadrivalent, FluceIvax
  • Trivalent - Afluria, Fluvirin, Fluad, Fluzone High Dose, FluBlok

Recommendations for Children

Children ages six months and older may be vaccinated for influenza. Some children may need two doses of the influenza vaccine, with the second dose administered at least 4 weeks after the first dose. Children who require two doses of the vaccine include: 

  • Those who have previously received only one dose of the influenza vaccine
  • Those who have never received the influenza vaccine

Kids requiring two doses of the vaccine do not need to receive the same type of injection each time. Children who have previously received two doses of the flu vaccine require only one dose. 

Recommendations for Older Adults 

While a high-dose influenza vaccine, Fluzone High Dose, is available for individuals over the age of 65, the CDC does not recommend one vaccine over the other for these patients.

The high dose flu vaccine is designed to illicit an enhanced immune response in aging individuals. While research shows that individuals over the age of 65 do produce more antibodies after vaccination with high dose vaccine, it is still unclear whether this enhanced immune response leads to greater protection against influenza. So, adults over the age of 65 may opt for the standard or high dose influenza vaccine. 

What questions do you have about the 2016-2017 influenza vaccine guidelines?