With regard to the use of live attenuated influenza vaccine (LAIV) in healthcare personnel, there appears to be a bit of a discrepancy in the guidance.
The
2011 ACIP guidance for vaccination of HCP at
http://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf states that:
HCP who care for severely immunosuppressed persons who require a protective environment should receive TIV rather than LAIV.
Use of LAIV for HCP who care for patients housed in protective inpatient environments has been a theoretic concern, but transmission of LAIV in health-care settings has not been reported. LAIV can be
used for HCP who work in any setting, except those who care for severely immunocompromised hospitalized persons who require care in a protective environment. HCP who themselves have a condition that confers high risk for influenza complications, who are pregnant,
or who are aged ™50 years should not receive LAIV and should be administered TIV instead.
TIV refers to trivalent inactivated vaccine. Only trivalent inactivated vaccines were available when the 2011 guidance was written. Of course, now there are also quadrivalent inactivated vaccines.
However, the
2013 ACIP guidance at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6207a1.htm?s_cid=rr6207a1_w states that:
Health-care personnel and persons who are contacts of persons in these groups and who are not contacts of severely immunocompromised persons (those living in a protective environment; see Close Contacts
of Immunocompromised Persons) may receive any influenza vaccine that is otherwise indicated. Persons who care for the severely immunocompromised should receive either IIV or RIV3. The rationale for avoiding use of LAIV among health-care personnel or close
contacts of severely immunocompromised patients is the theoretical risk that a live attenuated vaccine virus could be transmitted to the severely immunosuppressed person. In addition, to further reduce the theoretical risk of vaccine virus transmission,
ACIP/HICPAC has recommended that health-care personnel who receive LAIV should avoid providing care for severely immunosuppressed patients requiring a protected environment for 7 days after vaccination,
and that hospital visitors who have received LAIV should avoid contact with severely immunosuppressed persons (i.e., persons requiring a protected environment) for 7 days after vaccination. However, such visitors should not be restricted from visiting
less severely immunosuppressed patients (362). Healthy nonpregnant persons aged 2 through 49 years, including health-care personnel, who have close contact with persons with lesser degrees of immunosuppression (e.g., persons with chronic immunocompromising
conditions such as HIV infection, corticosteroid or chemotherapeutic medication use, or who are cared for in other hospital areas such as neonatal intensive care units) can receive LAIV.
In either document, there is no recommendation that HCP who receive LAIV wear a mask.
Kathleen Harriman
Immunization Branch
California Department of Public Health
-----Original Message-----
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Sent: Friday, October 09, 2015 12:00 PM
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Subject: MCOH-EH Digest, Vol 250, Issue 148
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Message: 1
Date: Thu, 8 Oct 2015 15:13:18 -0400
From: "Subin, Kenneth MD" <ksubin@aomc.org>
To: <mcoh-eh@mylist.net>
Subject: [MCOH-EH] FluMist and patient contact
Message-ID:
<80408DEC021F134D81B1D0689E6E6C720357F187@AOMCEXCH1.arnot_nt.aomc.org>
Content-Type: text/plain; charset="us-ascii"
List,
Is anyone requiring hospital employees with patient contact (particularly immunocompromised) to wear a mask for any period of time after receiving FluMist due to possible viral shedding?
Thanks.
Ken
Kenneth P. Subin, MD, MPH, CIME, CMRO
Clinical Medical Director
Occupational Medicine
ArnotHealth
Elmira, NY
(607) 737-4539 (p)
(607) 737-7783 (f)
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Message: 2
Date: Fri, 9 Oct 2015 00:20:21 +0000
From: "Thrasher, Terri" <Terri.Thrasher@cchmc.org>
To: MCOH/EH <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] FluMist and patient contact
Message-ID:
<6D0F651D183C00439FDA321943976C13455BEE07@MCEXMB1.chmccorp.cchmc.org>
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We require it if you work the Hem Onc Bone Marrow units
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Subin, Kenneth MD
Sent: Thursday, October 08, 2015 3:13 PM
Subject: [MCOH-EH] FluMist and patient contact
List,
Is anyone requiring hospital employees with patient contact (particularly immunocompromised) to wear a mask for any period of time after receiving FluMist due to possible viral shedding?
Thanks.
Ken
Kenneth P. Subin, MD, MPH, CIME, CMRO
Clinical Medical Director
Occupational Medicine
ArnotHealth
Elmira, NY
(607) 737-4539 (p)
(607) 737-7783 (f)
This message (including any attachments) is intended only for the use of the individual or entity to which it is addressed and may contain information that is non-public, proprietary, privileged, confidential, and exempt from disclosure
under applicable law. If you are not the intended recipient, you are hereby notified that any use, dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, notify the sender immediately
by telephone and delete this message
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