Community elderly influenza vaccination, expert consensus advice at a glance!

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Infectious disease (infectious disease) is a general term for diseases caused by pathogenic microorganisms, which have a high incidence and high case fatality rate in the elderly population, which seriously affect the quality of life of the elderly and cause a heavy economic burden, and have become one of the major public health problems in the world. Vaccination is a measure that specifically protects susceptible populations, improves the level of specific immunity in vaccinated populations, and reduces the risk of infectious diseases and related complications. Vaccination can also slow the progression of chronic diseases in older adults by preventing infections, reducing the risk of adverse outcomes from complications of chronic diseases. Regarding the vaccination of influenza vaccines for the elderly in the community, let's look at the latest expert consensus recommendations.

Inoculation targets

The Technical Guidelines for Influenza Vaccination in China issued by the mainland over the years and the Chinese Expert Recommendations on Influenza and Streptococcus Vaccination for the Elderly in 2018 recommend that ≥ 60-year-olds be vaccinated against influenza every year.

In particular, influenza vaccination can reduce the risk of severe influenza in the following subjects: the elderly at home; the elderly and employees in nursing homes, welfare homes, long-term care institutions and other crowd gathering places, influenza vaccination can reduce the risk of cluster epidemics; the elderly with chronic diseases: cardiovascular disease (except simple hypertension), chronic respiratory diseases, metabolic diseases (including diabetes), liver and kidney insufficiency, hematologic diseases, nervous system diseases, Chronic diseases such as neuromuscular dysfunction and the elderly suffering from immunosuppressive diseases or immunocompromised diseases.

Timing of vaccination

Because influenza viruses are susceptible to mutation and the titers of antibodies produced after influenza vaccination begin to decay after 6 to 8 months, influenza vaccines should be given annually. In order to obtain protection before the high incidence season of influenza, it is recommended to be vaccinated as soon as possible after the vaccine is available in that year, preferably before the end of October; those who have not been vaccinated before the end of October can be vaccinated throughout the epidemic season. During the same influenza epidemic season, people who have completed influenza vaccination do not need to repeat the vaccination.

Inoculation method

Inactivated influenza vaccines are given using intramuscular injection (except for intradermal formulations). Adults choose to vaccinate against deltoid muscles in the upper arm. 1 dose per dose, 0.5 ml per dose.

Contraindications to vaccination

Vaccination is prohibited for those who are allergic to any of the ingredients contained in the vaccine ( including excipients , formaldehyde , cleavers and antimicrobials ) . For mild or moderate acute disease with or without fever symptoms, it is recommended to re-administer after the symptoms have subsided. Contraindications to specific vaccine products should refer to the product manual and the doctor's recommendation.

Adverse reactions

Common adverse effects of inactivated influenza vaccines include systemic reactions and local reactions at the site of vaccination, which generally disappear naturally 1 to 2 days after injection without treatment.

The main local reactions are redness, pain, swelling, induration, burning sensation and so on.

Systemic reactions mainly include fever, dizziness, headache, drowsiness, fatigue, myalgia, general malaise, abdominal pain, diarrhea, nausea, vomiting and so on.

Serious adverse effects are extremely rare, such as allergic rash, allergic purpura, anaphylactic shock, angioedema, convulsions, transient thrombocytopenia, meningoccal meningitis, neuralgia, neuritis, paresthesias, and Guillain-Barré syndrome.

Precautions

1. Because the incubation period of influenza is several days, it is still possible to get the flu if you are exposed to the presence of influenza virus before or immediately after vaccination.

2. Vaccine bottles with cracks, unclear labels or invalidity, vaccines are cloudy or foreign-appearanceed are prohibited.

3. It is forbidden to mix the influenza vaccine with other vaccines in the same container, and 2 or more vaccines should be selected at different sites at the same time.

4. At the vaccination site, drugs such as epinephrine and rescue facilities are always prepared to prevent severe allergic reactions after vaccination.

5. Fever, acute infection and acute exacerbation of chronic diseases should be vaccinated after the symptoms have subsided.

6. The vaccinated subject should stay at the vaccination site for 30 minutes after vaccination.

7. Inactivated influenza vaccine and other inactivated vaccines and live attenuated vaccines such as pneumococcal vaccine, live attenuated herpes zoster vaccine, chickenpox vaccine, measles vaccine, DTP vaccine can be given at different sites at the same time; however, after receiving the live attenuated influenza vaccine, it must be > 28 days apart before other live attenuated vaccines can be vaccinated. In addition, ≥ 65-year-olds can be vaccinated against both influenza and pneumococcal vaccines.

According to the recommendations of the Mainland's Technical Guidelines for COVID-19 Vaccination (First Edition), the flu vaccine should be > 14 days apart, that is, the new coronavirus vaccine can be given after 14 days of influenza vaccination; or the influenza vaccine is given after completing the full vaccination procedure of the new crown virus vaccine for 14 days; or the influenza vaccine is given between two doses of the new crown virus vaccine, that is, the influenza vaccine is given after the first dose of the new crown virus vaccine is given 14 days, and the second dose of the new crown virus vaccine is given after 14 days. Choosing to get the flu vaccine between two doses of COVID-19 vaccine is subject to the requirements for the number and spacing of COVID-19 vaccinations. The interval between influenza vaccine and COVID-19 vaccine must be updated in accordance with the vaccination guidelines for both vaccines.

To avoid possible drug-to-drug interactions, the vaccinator should be informed of any vaccines, medications, or treatments that have been or have been used recently prior to vaccination. The use of immunosuppressants may affect the immune effect after vaccination. During the period of prevention and treatment with influenza antiviral drugs, inactivated influenza vaccines can be given.

The above content is excerpted from: Chinese Medical Association General Medicine Branch, Chinese Medical Association Journal, Chinese Medical Association Chinese Journal of General Practitioners Editorial Board, etc. Expert consensus on the application of vaccines for common infectious diseases in the elderly in the community[J]. Chinese Journal of General Practitioners, 2022, 21(1): 6-23.