[MCOH-EH] MCOH-EH Digest, Vol 250, Issue 148 Masking after FluMist?

[Harriman, Kathleen (CDPH-CID-DCDC-IMM)]

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

kathleen.harriman at cdph.ca.gov<mailto:kathleen.harriman at cdph.ca.gov>





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Today's Topics:



   1.  FluMist and patient contact (Subin, Kenneth MD)

   2. Re:  FluMist and patient contact (Thrasher, Terri)





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Message: 1

Date: Thu, 8 Oct 2015 15:13:18 -0400

From: "Subin, Kenneth MD" <ksubin at aomc.org<mailto:ksubin at aomc.org>>

To: <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>

Subject: [MCOH-EH] FluMist and patient contact

Message-ID:

                <80408DEC021F134D81B1D0689E6E6C720357F187 at AOMCEXCH1.arnot_nt.aomc.org<mailto:80408DEC021F134D81B1D0689E6E6C720357F187 at AOMCEXCH1.arnot_nt.aomc.org>>

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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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Message: 2

Date: Fri, 9 Oct 2015 00:20:21 +0000

From: "Thrasher, Terri" <Terri.Thrasher at cchmc.org<mailto:Terri.Thrasher at cchmc.org>>

To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>

Subject: Re: [MCOH-EH] FluMist and patient contact

Message-ID:

                <6D0F651D183C00439FDA321943976C13455BEE07 at MCEXMB1.chmccorp.cchmc.org<mailto:6D0F651D183C00439FDA321943976C13455BEE07 at 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 at mylist.net] On Behalf Of Subin, Kenneth MD

Sent: Thursday, October 08, 2015 3:13 PM

To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>

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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End of MCOH-EH Digest, Vol 250, Issue 148

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