A Publication of Northeast Physicians Hospital Organization  
       Flu Vaccine for 2015 -2016
  
Vaccine composition for 2015-16 will change from the 2014-15 formulation.  Changes are in the A H3N2 virus and the influenza B virus.  Both the A H1N1 virus and the second B virus in the quadrivalent vaccine will not change.
  
Certain children ages 6 months through 8 years will require TWO doses of vaccine, at least 4 weeks apart.  These are children who have never had the vaccine, OR who had just 1 dose in their lifetime.  See algorithm for decision-making:
  
For healthy people 2 through 49 years of age with no precautions or contraindications, either LAIV4 (FluMist) or inactivated vaccine can be used.  There is no longer a preference for LAIV4 in children ages 2 to 8 years. LAIV4 is not clearly superior based on new data.
  
FluBlok is now approved for individuals 18 years and older, and can be used in adults with hives or a severe allergic reaction to eggs (e.g. hypotension, wheezing, etc - see Choosing Wisely Snapshot). An inactivated vaccine should be administered by appropriately trained personnel if the patient falls outside the approve age range for FluBlok or if FluBlok is not available.  See algorithm with factors to consider when administering flu vaccine to egg-allergic patients:
  
FluZone Intradermal is now a quadrivalent vaccine. Fluarix, FluMist and FluLaval are now available ONLY as quadirvalent products.
  
See the attached chart for seasonal influenza vaccines for 2015-16, plus information such as FDA-approved ages for use, route of administration, dose and cost. 
  
PL Detail-Document, Flu Vaccines for 2015-2016. Pharmacist's Letter/Prescriber's Letter. September 2015   

    ACIP Simplifies Pneumococcal Vaccine   Recommendations for Immunocompetent

                        Older Adults

The CDC's Advisory Committee on Immunization Practices has changed the recommended interval between 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23) in immunocompetent adults aged 65 and older from 6-12 months to at least 1 year. Published in MMWR, the document recommends the following intervals:
  • Immunocompetent individuals aged 65 and older who have not received any pneumococcal vaccine should be given PCV13 first, followed by a dose of PPSV23 after at least 1 year.
  • Those who already received PPSV23 when they were aged 65 or older should be given PCV13 at least 1 year later.
  • Those aged 65 and older who received PPSV23 vaccine before they were 65 should be given PCV13, followed by PPSV23 at least 1 year later.
The changes are based on immunogenicity studies showing that a longer time between the two vaccines might improve the immune response. Recommendations for other age and risk groups have not changed.
Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
 
Open Enrollment for Medicare Part D
 
Medicare beneficiaries are eligible for enrollment in Part D prescription plans beginning on October 15, 2015 through December 7, 2015.  Prescription drug plan premiums will remain stable at about $32.50 per month, up from $32 in 2015.  Premiums for specific plans and regions may vary from year to year. It's important for Medicare beneficiaries to examine their annual notice of change (ANOC) carefully to determine if and how their plan's costs or benefits may be changing and if it makes financial sense to explore other options
 
In 2016, beneficiaries will continue to get a 55% discount on brand-name drugs during the coverage gap (donut hole)which now begins after $3,310 in prescription expenses for the beneficiary and their plan. The discount on generic drugs will increase from 35% to 42%.
Beneficiaries should review their ANOC and the summary of the new formulary in particular to make sure their prescriptions are still on the list. People who want to change plans should make sure the plans they are considering cover their prescriptions. If the summary of the new formulary does not include a beneficiary's prescriptions, patients may find the full formulary online or call the plan to request it.
The Medicare on-line plan finder tool can be helpful for beneficiaries with questions or changes in their medications. www.medicare.gov/find-a-plan.
In 2016, CMS will expect Part D plans to use more transparent names for drug tier labels. As the prices of some generic drugs rise, plans may move the highest-cost generic drugs into nonpreferred brand tiers that require beneficiaries to share more of the cost.
Produced by Northeast PHO.  For more information contact: 
Carol Freedman, RPh, MAS, CGP 
Clinical Pharmacist NEPHO 
Les Sebba M.D., Northeast PHO Medical Director 
September  2015
     Volume 5 :  Issue 6      
In This Issue
 Choosing Wisely Snapshot 
American Academy of Asthma, Allergy and Immunology
 
Don't routinely avoid influenza vaccination in egg-allergic patients
 
  Of the vaccines that may contain egg protein (measles, mumps, rabies, influenza and yellow fever), measles, mumps and rabies vaccines have at most negligible egg protein; consequently no special precautions need to be followed in egg-allergic patients for these vaccines. Studies in egg-allergic patients receiving egg-based inactivated influenza vaccine have not reported reactions; consequently egg-allergic patients should be given either egg-free influenza vaccine or should receive egg-based influenza vaccine with a 30-minute post-vaccine observation period. Egg-allergic patients receiving the yellow fever vaccine should be skin tested with the vaccine and receive the vaccine with a 30-minute observation period if the skin test is negative. If positive, the vaccine may be given in graded doses with appropriate medical observation.
Egg protein is present in influenza and yellow fever vaccines and in theory could cause reactions in egg-allergic patients. However, in 27 published studies collectively 4,172 patients with egg allergy received 4,729 doses of egg-based inactivated influenza vaccine (IIV) with no cases of anaphylaxis, including 513 with severe egg allergy who uneventfully received 597 doses. The CDC's Advisory Committee on Immunization Practices recommends that egg-allergic persons receive IIV as a single dose without prior vaccine skin testing and be observed for 30 minutes afterwards for any possible allergic reaction. If the reaction to the ingestion of eggs was hives only, the vaccine can be administered in a primary care setting, whereas if the reaction to the ingestion of eggs was more severe, the vaccine should be administered in an allergist/immunologist's office. Two new IIVs not grown in eggs have been approved for patients 18 years and older: Flucelvax, prepared from virus propagated in cell culture, and Flublok, recombinant hemagglutinin proteins produced in an insect cell line. For egg-allergic patients 18 years of age and older, either egg-based IIV can be used with the precautions above or egg-free IIV can be used.
Measles and mumps vaccines (and Purified Chick Embryo Cell [PCEC] rabies vaccine) are grown in chick embryo fibroblast cultures and contain negligible or no egg protein. Thus, MMR and PCEC rabies vaccine can be administered to egg-allergic recipients in the usual manner.
Per the Yellow Fever vaccine package insert, egg-allergic recipients should be skin tested with the vaccine prior to administration. If negative, the vaccine can be given in the usual manner, but the patient should be observed for 30 minutes afterward. If the vaccine skin test is positive, the vaccine can be given in graded doses under appropriate medical observation.
  
 
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