Mandated, Highly Recommended, and Other Vaccines for Oral Healthcare Personnel
Course Number: 479
Course Contents
Influenza
Human influenza is caused by two influenza viruses, types A and B. They are spread by airborne droplets generated when an infected person coughs and sneezes, by direct contact with nasal or throat secretions of infected persons, and less frequently by freshly contaminated articles. Uncomplicated influenza is characterized by the abrupt onset of fever, myalgia, headache, nonproductive cough, sore throat, and rhinitis. Complications include secondary bacterial sinusitis and otitis, and primary viral and secondary bacterial pneumonia.22
Active Immunization: Influenza Vaccines 4,6,23
It is strongly recommended that all OHCP, including those in training, be vaccinated annually against influenza. Vaccination not only protects the provider, but very likely reduces the risk of healthcare-associated transmission. Each year one or more virus strains in the vaccine might change on the basis of global surveillance and the emergence and spread of new strains. For example, the seasonal influenza vaccines for the 2023–24 season were quadrivalent, containing hemagglutinin (HA) derived from influenza A(H1N1)pdm09 virus, influenza A(H3N2) virus, influenza B/Victoria lineage virus, and influenza B/Yamagata lineage virus.23
Three types of influenza vaccines are available in the U.S.: multiple inactivated influenza vaccines (IIVs) one recombinant influenza vaccine (RIV), and one live attenuated influenza vaccine (Table 2).23 The live attenuated intranasal vaccine (Flumist™) is approved for use by healthy persons between the ages of 19-49 years. OHCP who choose to use Flumist™ in lieu of an inactivated influenza vaccine should refrain from contact with immunosuppressed persons for 7 days. Two IIVs are specifically formulated for patients ≥65 years of age. It is recommended that all individuals over 6 months, who do not have a contraindication, receive an influenza vaccine, including those with an egg allergy.23
Table 2. Influenza Vaccines.24
| Vaccine Type | Vaccines | Schedules | Adverse Effects |
|---|---|---|---|
IIV4 | Afluria Quadrivalent Fluarix Quadrivalent FluLaval Quadrivalent Fluzone Quadrivalent Flucelvax Quadrivalent * Fluzone High-Dose Quadrivalent Fluad Quadrivalent Fluad | 1 IM dose annually | Pain at injection site (most common); fever; anaphylaxis in persons with history of allergic reaction to baker’s yeast. |
| RIV4 | Flublok Quadrivalent † | 1 IM dose annually | Pain at injection site (most common); fever; anaphylaxis in persons with history of allergic reaction to baker’s yeast. |
| LAIV4 | Flumist Quadrivalent | 1 intranasal dose annually | Mild rhinorrhea, nasal congestion, and sore throat; may exacerbate asthma; anaphylaxis in persons with history of allergic reaction to egg. |
| * cell culture-based † recombinant, egg-free | |||
Antiviral Chemoprophylaxis: Antiviral Agents
Four antiviral agents are available to reduce influenza duration and the risk of complications such as pneumonia, respiratory failure and death. These include the neuraminidase inhibitors (oral oseltamivir [Tamiflu], inhaled zanamivir [Relenza], IV peramivir [Rapivab]) and the oral polymerase acidic endonuclease inhibitor baloxavir [Xofluza]. All of these agents are active against influenza A and B viruses and are most effective if initiated within 48 hours of the onset of symptoms.25 The use of oseltamivir or zanamivir within 48 hours before, peramivir within 5 days before, or baloxavir within 17 days before administration of the live-attenuated intranasal influenza vaccine (FluMist Quadrivalent) could inhibit replication of the vaccine virus, reducing the vaccine's effectiveness, and is not recommended.25