[MCOH-EH] Duration of protection from the flu vaccine

[Hudson, T. Warner]

Thanks Carolyn!  That was speedy!!  Warner

T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health
UCLA Health System and Campus
Office 310.825.9146
Fax 310.206.4585
Pager 800.233.7231  ID 27132
E-mail twhudson at mednet.ucla.edu<mailto:twhudson at mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: Bridges, Carolyn (CDC/OID/NCIRD) [mailto:ctb1 at cdc.gov]
Sent: Wednesday, October 28, 2015 11:00 AM
To: Hudson, T. Warner; Abhijay Karandikar; MCOH/EH
Subject: RE: [MCOH-EH] Duration of protection from the flu vaccine

Dear Warner and Abhijay,

The latest influenza vaccine recommendations can be found at:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a3.htm. I am pasting below the section about the timing of vaccination.

The highest priority is to avoid missed opportunities – many patients will not come back for a next visit.  Some decline in vaccine effectiveness may occur (evidence is conflicting), as noted in the studies cited below, mostly in older adults, but beginning vaccination planned clinics in October is still recommended as is not missing opportunities to vaccinate earlier.  It is a balance, but, again, highest priority is vaccination and not missing vaccination opportunities.  While is most years, influenza peaks in January or February, we can see peaks of disease in the US in December and can see disease activity that starts to pick up late October and early November in some years.

Note that many older studies looked at the benefit of twice yearly vaccination (repeating vaccination at 3 months) and found some small increase in antibody titers, but did not appear to be a significant benefit.

I hope that this information is helpful.

Thank you,

Carolyn


Carolyn B Bridges, MD
CAPT, USPHS
Associate Director for Adult Immunizations
Immunization Services Division
NCIRD, CDC
1600 Clifton Rd., MS A-19
Atlanta, GA 30329-4027
404-639-8689
cbridges at cdc.gov<mailto:cbridges at cdc.gov>


______________________________

Groups Recommended for Vaccination and Timing of Vaccination

Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Optimally, vaccination should occur before onset of influenza activity in the community. Health care providers should offer vaccination by October, if possible. Vaccination should continue to be offered as long as influenza viruses are circulating. Children aged 6 months through 8 years who require 2 doses (see "Vaccine Dose Considerations for Children Aged 6 Months through 8 Years") should receive their first dose as soon as possible after vaccine becomes available, and the second dose ≥4 weeks later. To avoid missed opportunities for vaccination, providers should offer vaccination to unvaccinated persons aged ≥6 months during routine health care visits and hospitalizations when vaccine is available.

Antibody levels induced by vaccine decline after vaccination (3–5). Although a 2008 literature review found no clear evidence of more rapid decline among older adults (6), a 2010 study noted a statistically significant decline in antibody titers 6 months after vaccination among persons aged ≥65 years (5). A case-control study conducted in Navarre, Spain, during the 2011–12 influenza season revealed a decline in vaccine effectiveness, primarily affecting persons aged ≥65 years (7). While delaying vaccination might permit greater immunity later in the season, deferral might result in missed opportunities to vaccinate, as well as difficulties in vaccinating a population within a more constrained time period. Vaccination programs should balance maximizing the likelihood of persistence of vaccine-induced protection through the season with avoiding missed opportunities to vaccinate or vaccinating after influenza virus circulation begins.


From: Hudson, T. Warner [mailto:TWHudson at mednet.ucla.edu]
Sent: Wednesday, October 28, 2015 1:18 PM
To: Abhijay Karandikar <dr_abhik at yahoo.com>; MCOH/EH <mcoh-eh at mylist.net>; Bridges, Carolyn (CDC/OID/NCIRD) <ctb1 at cdc.gov>
Subject: RE: [MCOH-EH] Duration of protection from the flu vaccine

On flu vaccine calls over the years with CDC the time they usually cite is 6 months. Carolyn Bridges from CDC is a great expert in this area and will know the details, so I’ve copied her.

Thank you in advance Carolyn.

Warner

T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health
UCLA Health System and Campus
Office 310.825.9146
Fax 310.206.4585
Pager 800.233.7231  ID 27132
E-mail twhudson at mednet.ucla.edu<mailto:twhudson at mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Abhijay Karandikar via MCOH-EH
Sent: Wednesday, October 28, 2015 9:59 AM
To: MCOH/EH
Cc: Abhijay Karandikar
Subject: Re: [MCOH-EH] Duration of protection from the flu vaccine

List,

Some employees routinely delay receiving the flu vaccine because they have heard that "the flu shot loses its effectiveness in 3 months", so the later it is taken in the season, the better chances of protection in the months of February and March.

Literature search reveals that antibody levels / vaccine effectiveness declines with time, but the time period is dependent on many factors including immunity levels, age group, etc.

Does anyone have or can anyone point out to studies/abstracts or cite anecdotal evidence of flu vaccine effectiveness with time? How do you decide flu vaccine deadlines for your organization?

Thanks,



Abhijay Karandikar, MD, MPH, FACOEM
Medical Director - Occupational Medicine
CONNcare / Backus Hospital
Norwich, CT.

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