Fluzone Intradermal (ID) vaccine was licensed in the United States in May 2011 and uses a microinjection device with a 1.5-mm, 30-gauge needle that delivers a smaller volume and antigen load than the Fluzone Intramuscular (IM) vaccine. The same ID microinjection system has been used in Argentina and Australia since 2010 with documented acceptance by both patients and vaccine administrators.
To evaluate the acceptability of Fluzone ID influenza vaccine in clinical practice in the United States among patients and vaccine administrators and to compare the ID and IM influenza vaccines in terms of patient preference, preinjection anxiety, postinjection pain, and vaccine selection in future years.
The authors developed 3 surveys-an initial and a follow-up survey for recipients of the ID vaccine and another survey for administrators-to assess opinions of ID administration. Vaccine recipients were surveyed at the time of injection concerning vaccine acceptability, vaccine preference, preinjection anxiety, and postinjection pain. Recipients who had received the IM influenza vaccine within the past 3 years were asked to compare the ID vaccine with their prior IM vaccine experience. Vaccine administrators were also surveyed after administering the ID vaccine at their assigned clinic. Recipients were then surveyed 7 days later.
Vaccine clinic participants were offered 3 vaccines: the ID and the IM Fluzone vaccines and Flumist (Medimmune) intranasal vaccine. Of the 367 participants vaccinated, 249 (67.8%) chose the ID vaccine and 117 (31.9%) chose the IM vaccine. Immediately after ID vaccination, 234 of 235 recipients (99.6%) reported being satisfied with the method of administration. One hundred seventy-five of 178 ID vaccine recipients (99.4%) who had also received the IM vaccine in the past 3 years reported being satisfied. Previous IM recipients reported a preference for the ID vaccine over the IM vaccine. They also reported less preinjection anxiety and postinjection pain compared with the IM vaccine administration, both immediately and 7 days after vaccination. All vaccine administrators reported satisfaction with the ID vaccine.
The current study demonstrates the overall acceptability of the Fluzone ID vaccine in clinical practice in the United States by both patients and vaccine administrators. Additionally, the study is the first to our knowledge to document a patient preference for ID influenza vaccine over IM influenza vaccine.
"In recent years, intranasally delivered, live attenuated influenza vaccine, FluMist ® , and a prefilled, hollow microneedle delivery system, Fluzone Intradermal ® , have become available . Each has significant advantages over intramuscular delivery of influenza vaccine, including increased acceptability   , and in the case of FluMist ® , superior efficacy and cost-effectiveness   . However , neither vaccine is licensed for all age groups, and both are priced higher than other influenza vaccines, factors which have likely decreased their adoption rate. "
[Show abstract][Hide abstract] ABSTRACT: Healthcare personnel (HCP) are at risk for exposure to and transmission of potentially life-threatening vaccine preventable diseases to patients and colleagues. The Centers for Disease Control and Advisory Committee on Immunization Practices (ACIP) recommend routine influenza immunization and maintenance of immunity to hepatitis B and pertussis, among others. In this article, we aim to review recently approved influenza vaccines, as well as address some of the issues regarding hepatitis B and pertussis vaccinations in HCP.
Several new formulations of influenza vaccines are now available, including quadrivalent vaccines and non-egg-based vaccines; their use in HCP requires further study. An alarming rise in pertussis rates has led to a revision of ACIP guidelines recommending vaccination for women during each pregnancy. Persistent lack of immunity to hepatitis B after vaccine series remains a problem for many HCP.
Inactivated trivalent influenza vaccines remain the safest and most widely studied influenza vaccinations for healthcare workers. A pertussis booster in the form of Tdap is now recommended for most HCP. More studies are needed regarding the issue of nonresponders in HCP who receive the three-dose hepatitis B vaccine series, as there are some promising strategies available that may boost immune responses.
Current Opinion in Infectious Diseases 08/2013; 26(4):366-377. DOI:10.1097/QCO.0b013e3283630ee5 · 5.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Immunosenescence makes the elderly more susceptible to influenza complications and less responsive to vaccination. An intradermal formulation (IDflu) is one of several strategies being investigated to increase the immunogenicity of influenza vaccines.
The overall goal of the study was to assess the safety and immunogenicity of IDflu compared with the intramuscular route (IMflu) in the elderly.
A meta-analysis of randomized controlled trials (RCTs) was performed. Included articles met the following criteria: RCTs; primary studies, not re-analyses or reviews; enrolment of elderly people; comparing the immunogenicity and/or safety of IDflu with IMflu; measuring seroprotection and/or seroconversion rate to assess immunogenicity; measuring local reactions and/or general symptoms and/or other mild local reactions that could affect acceptability of vaccine as safety indicators, according to the European Medicines Agency (EMA) criteria; published through January 2015.
The results of our meta-analysis on seroprotection showed that IDflu is comparable to IMflu for each strain (A/H1N1: risk ratio [RR] 1.02, 95 % confidence interval [CI] 0.98-1.07; A/H3N2: RR 1.01, 95 % CI 0.99-1.04; B 1.02, 95 % CI 0.98-1.08). The seroconversion rate achieved with IDflu was comparable to that of the control group (A/H1N1: RR 1.08, 95 % CI 0.97-1.2; A/H3N2: RR 1.08, 95 % CI 0.96-1.21; B: RR 1.21, 95 % CI 1-1.45). Systemic reactogenicity appeared similar in the two groups, while local reactions were significantly more frequent in the IDflu group.
The novel IDflu appears to have the adequate balance between immunogenicity and safety in the elderly compared with IMflu, and its utilization may be considered among the possible strategies to enhance the control of seasonal influenza outbreaks according to the existing policy recommendations in the elderly.
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