Drugs List

Therapeutic Indications

Uses

Influenza - prophylaxis

Prophylaxis of influenza, especially in those who are at an increased risk of associated complications.

Influenza vaccine will not control epidemics. Immunisation is recommended for individuals over 6 months of age with the following conditions:
Chronic respiratory disease, including asthma
Chronic cardiac disease
Chronic renal disease
Chronic liver disease
Chronic neurological disease
Diabetes mellitus
Immunosuppression due to disease or treatment
Asplenia or dysfunction of the spleen
HIV infection (regardless of immune status)
Pregnancy - all trimesters
Morbid obesity

Immunisation should be considered for those living in long-stay residential care homes where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality. Additionally, those who are in receipt of a carer�s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill.

Immunisation should be considered for household contacts of immunocompromised individuals, as well as healthcare and social care workers who are directly involved in patient care.

For comprehensive information or advice on this product or the immunisation programme in the UK, the following website should be accessed.
Available at https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book

Administration

For subcutaneous or intramuscular injection depending on the brand.

Contraindications

Acute infection
Children under 6 months
Febrile disorder

Precautions and Warnings

Children aged 6 months to 18 years
Immunosuppression
Coagulopathy
Immunodeficiency syndromes
Thrombocytopenia

Egg allergy: Use products containing less than 120 nanograms/ml ovalbumin
Postpone immunisation if there is active or suspected infection
Impaired response possible in immunocompromised patients
Not all available brands are licensed for all age groups
Vaccine may not be effective in 100% of patients
May contain trace amounts of formaldehyde
May contain trace amounts of gentamicin
May contain trace amounts of neomycin
May contain trace amounts of octoxinol 9
Do not mix with other vaccines in the same syringe
Do not use if any signs of precipitate or particulate matter apparent
Inject other vaccines at different sites
Record name and batch number of administered product
Resuscitation facilities must be immediately available
Warm to room temperature prior to use
Establish full medical history and health status prior to vaccine
May give transient false +ve results in serology using the ELISA method
Follow national immunisation guidelines

Individuals who have egg allergy may be at increased risk of reaction to some influenza vaccines. Patients with either confirmed anaphylaxis to egg or egg allergy with uncontrolled asthma (BTS SIGN step 4 or above) can be immunised with an egg-free influenza vaccine if available. If no egg-free vaccine is available, patients should be referred to specialists for vaccination in hospital using an inactivated influenza vaccine with an ovalbumin content less than 120nanograms/ml (equivalent to 60nanograms for 0.5ml dose). A split dose schedule may be required at the discretion of the supervising physician. Vaccines with ovalbumin content more than 120nanograms/ml (equivalent to 60nanograms for 0.5ml dose) or where the content is not stated should not be used in egg-allergic individuals.

Syncope may occur as a psychogenic response to the needle injection. Ensure procedures are in place to prevent injury from fainting and manage syncopal reactions.

Pregnancy and Lactation

Pregnancy

Influenza (inactivated, split virion) is considered safe for use during pregnancy.

The manufacturer states influenza (inactivated, split virion) may be used safely during pregnancy. Available reports indicate no increased risk of teratogenic or developmental effects.

Lactation

Influenza (inactivated, split virion) is considered safe for use during breastfeeding.

The manufacturer states influenza (inactivated, split virion) may be used safely when breastfeeding. However, the presence of influenza (inactivated, split virion) high dose in human breast milk is unknown.

Side Effects

Abdominal pain
Acute disseminated encephalomyelitis
Allergic dermatitis
Allergic reaction
Anaphylactic reaction
Angioedema
Arthralgia
Asthenia
Bruising at injection site
Chest pain
Chills
Convulsions
Cough
Decreased appetite
Diarrhoea
Dizziness
Drowsiness
Dyspnoea
Ecchymosis (injection site)
Encephalomyelitis
Erythema
Erythema at injection site
False positive results in serology tests using the ELISA method
Fatigue
Febrile convulsions
Fever
Flushing
Gastro-intestinal symptoms
Guillain-Barre syndrome
Haematoma (injection site)
Headache
Henoch-Schonlein purpura
Hot flushes
Hyperhidrosis
Hypersensitivity reactions
Induration (injection site)
Influenza-like syndrome
Irritability
Local pain (injection site)
Local reaction at injection site
Lymphadenopathy
Malaise
Myalgia
Myelitis
Nausea
Neuralgia
Neuritis
Neurological disorders
Ocular hyperaemia
Painful extremities
Paraesthesia
Pharyngitis
Pruritus
Rash
Restlessness
Rhinitis
Sensation of warmth
Shivering
Skin reactions
Somnolence
Swelling (injection site)
Syncope
Throat tightness
Thrombocytopenia (transient)
Transverse myelitis
Urticaria
Vasculitis
Vasodilatation
Vomiting
Wheezing

Presentation

Vaccine containing inactivated influenza vaccine (split virion).

Drugs List

Therapeutic Indications

Uses

Influenza - prophylaxis

Prophylaxis of influenza, especially in those who are at an increased risk of associated complications.

Influenza vaccine will not control epidemics. Immunisation is recommended for individuals over 6 months of age with the following conditions:
Chronic respiratory disease, including asthma
Chronic cardiac disease
Chronic renal disease
Chronic liver disease
Chronic neurological disease
Diabetes mellitus
Immunosuppression due to disease or treatment
Asplenia or dysfunction of the spleen
HIV infection (regardless of immune status)
Pregnancy - all trimesters
Morbid obesity

Immunisation should be considered for those living in long-stay residential care homes where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality. Additionally, those who are in receipt of a carer�s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill.

Immunisation should be considered for household contacts of immunocompromised individuals, as well as healthcare and social care workers who are directly involved in patient care.

For comprehensive information or advice on this product or the immunisation programme in the UK, the following website should be accessed.
Available at https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book

Dosage

Refer to product information, dosage and licensing in different age populations vary.

Adults

Children

Administration

For subcutaneous or intramuscular injection depending on the brand.

Contraindications

Acute infection
Children under 6 months
Febrile disorder

Precautions and Warnings

Children aged 6 months to 18 years
Immunosuppression
Coagulopathy
Immunodeficiency syndromes
Thrombocytopenia

Egg allergy: Use products containing less than 120 nanograms/ml ovalbumin
Postpone immunisation if there is active or suspected infection
Impaired response possible in immunocompromised patients
Not all available brands are licensed for all age groups
Vaccine may not be effective in 100% of patients
May contain trace amounts of formaldehyde
May contain trace amounts of gentamicin
May contain trace amounts of neomycin
May contain trace amounts of octoxinol 9
Do not mix with other vaccines in the same syringe
Do not use if any signs of precipitate or particulate matter apparent
Inject other vaccines at different sites
Record name and batch number of administered product
Resuscitation facilities must be immediately available
Warm to room temperature prior to use
Establish full medical history and health status prior to vaccine
May give transient false +ve results in serology using the ELISA method
Follow national immunisation guidelines

Individuals who have egg allergy may be at increased risk of reaction to some influenza vaccines. Patients with either confirmed anaphylaxis to egg or egg allergy with uncontrolled asthma (BTS SIGN step 4 or above) can be immunised with an egg-free influenza vaccine if available. If no egg-free vaccine is available, patients should be referred to specialists for vaccination in hospital using an inactivated influenza vaccine with an ovalbumin content less than 120nanograms/ml (equivalent to 60nanograms for 0.5ml dose). A split dose schedule may be required at the discretion of the supervising physician. Vaccines with ovalbumin content more than 120nanograms/ml (equivalent to 60nanograms for 0.5ml dose) or where the content is not stated should not be used in egg-allergic individuals.

Syncope may occur as a psychogenic response to the needle injection. Ensure procedures are in place to prevent injury from fainting and manage syncopal reactions.

Pregnancy and Lactation

Pregnancy

Influenza (inactivated, split virion) is considered safe for use during pregnancy.

The manufacturer states influenza (inactivated, split virion) may be used safely during pregnancy. Available reports indicate no increased risk of teratogenic or developmental effects.

Lactation

Influenza (inactivated, split virion) is considered safe for use during breastfeeding.

The manufacturer states influenza (inactivated, split virion) may be used safely when breastfeeding. However, the presence of influenza (inactivated, split virion) high dose in human breast milk is unknown.

Side Effects

Abdominal pain
Acute disseminated encephalomyelitis
Allergic dermatitis
Allergic reaction
Anaphylactic reaction
Angioedema
Arthralgia
Asthenia
Bruising at injection site
Chest pain
Chills
Convulsions
Cough
Decreased appetite
Diarrhoea
Dizziness
Drowsiness
Dyspnoea
Ecchymosis (injection site)
Encephalomyelitis
Erythema
Erythema at injection site
False positive results in serology tests using the ELISA method
Fatigue
Febrile convulsions
Fever
Flushing
Gastro-intestinal symptoms
Guillain-Barre syndrome
Haematoma (injection site)
Headache
Henoch-Schonlein purpura
Hot flushes
Hyperhidrosis
Hypersensitivity reactions
Induration (injection site)
Influenza-like syndrome
Irritability
Local pain (injection site)
Local reaction at injection site
Lymphadenopathy
Malaise
Myalgia
Myelitis
Nausea
Neuralgia
Neuritis
Neurological disorders
Ocular hyperaemia
Painful extremities
Paraesthesia
Pharyngitis
Pruritus
Rash
Restlessness
Rhinitis
Sensation of warmth
Shivering
Skin reactions
Somnolence
Swelling (injection site)
Syncope
Throat tightness
Thrombocytopenia (transient)
Transverse myelitis
Urticaria
Vasculitis
Vasodilatation
Vomiting
Wheezing

Effects on Laboratory Tests

False positive results in serology tests using the ELISA method to detect antibodies against HIV1, hepatitis C and especially HTLV1 have been observed. The Western Blot technique should be used to confirm or disprove the ELISA test result. The transient false positive reactions could be due to the IgM response induced by the vaccine.

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: June 2021

Reference Sources

Summary of Product Characteristics: Fluarix Tetra. GlaxoSmithKline UK. Revised July 2020
Summary of Product Characteristics: Quadrivalent Influenza vaccine (Split virion, inactivated). Sanofi Pasteur. Revised February 2021
Summary of Product Characteristics: Trivalent Influenza Vaccine (Split Virion, Inactivated) High Dose, suspension for injection in pre-filled syringe. Sanofi Pasteur. Revised August 2020

Immunisation against infectious disease - The Green Book.
Available at https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
Last accessed: 09 June 2021

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 09 June 2021