Effectiveness of Adjuvanted Influenza Vaccination - Free Samples

Question: Discuss about the Effectiveness of Adjuvanted Influenza Vaccination. Answer: Introduction: Influenza can be defined as one of the most highly reported infectious diseases of Australia and other developed as well as developing nations; for Australia, this year the nation has seen the highest activity level since the pandemic year of 2009. One of the greatest concerns for the recent flu outbreaks is the common antibiotic resistant strains that do not respond to common antibiotics and become very difficult to control once the disease spreads. Hence, the most effective prevention option that the health care industry has is the variety of different vaccines available. This assignment will discuss the burden of influenza, the causes and risk factors, and vaccine requirements for the most vulnerable age groups (over 65 years of age) along with a brief description of the disease, types of vaccines, type of vaccine suitable for the target vulnerable population (over 65), rationale for the choice of the type of vaccine, contraindication, herd immunity, management of negative respons e in patients and the critical review of the need for community nurses to have vaccinations in Influenza prevention. Influenza can be defined as one of the most contagious viral infections. This disease affects the upper respiratory apparatus. Influenza outbreak is a very common phenomenon and it still occurs every three to five years resulting in death of a least 5 to 10 % of the total population of Australia (Duncan, 2016). There are different types of influenza pathogen strains and each strain varies with respect to virulence. The mode of transmission in Influenza is by the droplet transfer between individuals. This pathogen is generally inhaled; it attacks the respiratory tract of the host and gives rise to the typical symptoms. These typical symptoms include fever, chilling tremors, fatigue and hacking coughs, and in certain cases even acute body pain (Duncan, 2016). Although, 20% of the Influenza risk is at the children, although for the age group of the older adults aged over 65 years also are at around 10 % of total risk for influenza (Domnich et al., 2017). Since the older adults (aged ove r 65) are considered a vulnerable population (a population which is extremely at risk to acquiring the disease), it is strongly recommended that they receive targeted flu vaccines. There are different types of influenza vaccines, of which the live attenuated influenza vaccine is administered intranasally and sold under the trade name of FluMist and Fluenz. On the other hand, inactivated vaccines are administered at the intramuscular junction. Subconjugate vaccines are also used for influenza, in the form of injections (Sridhar, Brokstad Cox, 2015). The vulnerable population under focus for this assignment will be on the older adults (over 65). Adults over the 65 years of age have compromised immune system and hence they have lesser immunity towards diseases like influenza, hence they are considered the vulnerable population. As per Demicheli et al. (2018), the risk of flu and flu related complications like the influenza is at least 2 to 3 times higher than the rest of the patient populations, in the older adults (over 65). In this age group, the influenza increases the risk for heart attacks by 3-5 times and stroke or TIA by 2-3 times, just within 2 weeks of infection. As a result, more targeted preventative measures designed with the particular needs of the older patient population in mind, such as Flu shots designed specifically targeting the compromised immunity of this population. The influenza vaccine for the older adults are generally high dose vaccines and contains at least 4 times more concentrated antigens than the ant igen concentration of the standard vaccine doses. It has to be mentioned that for the older adults, the adjuvanted flu vaccines can also be taken (DiazGranados et al., 2014). For the children aged 6-35 months, FluQuadri junior is recommended while the children older than 36 months receive Fluarix Tetra or Fluquadri (Health.nsw.gov.au., 2018). For the age group of 18 to 64 years of age, the standard flu vaccine that is recommended is Afluria Quad. However, for the age group of 65 and above, the most suitable flu vaccine recommended is the Fluzone high dose (or Fluad) vaccine, and it is usually given on an annual basis. It is given from September until mid November given the fact that the flu season runs from October to May in Australian demographics (Grohskopf et al., 2016). Fluzone high dose or Fluad are the booster vaccines that are formulated specifically for the older adults over the age of 65 years. These vaccines contain 4 times dose of influenza A(H1N1), A(H3N2) and B-Yamagata strains. Older adults require higher antibody strength in order to attain immunity against the Flu outbreaks than the other age groups (Grohskopf et al., 2014). This is because older adults that are 65 or above have been reported to produce 50-75 % lesser antibodies than the younger adults leading to ineffective protection. 60% of the seniors that had been vaccinated with Fluzone vaccine had represented higher resistance to the Flu outbreak. According to the research, there is 25% reduction in the incidence of the regular Flu in the older adults that received Fluzone high dose or Fluad booster dose annually when compared to standard vaccine (Duncan, 2016). Hence, based on the above stated evidence, Fluzone high dose or Fluad is the most effective flu vaccination for the olde r adults belonging to the age group of 65 and above (Health.nsw.gov.au., 2018). The annual booster dose requirements for Fluad are 0.5 mL pre-filled syringe containing 15 g haemagglutinin of each of the three recommended influenza virus strains, adjuvanted with MF59C.1 (including 9.75 mg squalene and 1.175 mg polysorbate 80). He annual booster dose for Fluzone are 0.5 mL pre-filled syringe including 60 g haemagglutinin of each of the three recommended influenza virus strains; 1 g ovalbumin; 100 g formaldehyde; 250 g octoxinol 9 (Immunise.health.gov.au., 2018). The side effects of the Flu vaccine are not many, however, for the high dose variant, the impact of the side effects are enhanced. For instance the side effects of the regular or the standard such as the fever and inflammation of the injection site is more persistent and aggravated in case of the high dosage version of the Fluzone. These side effects generally persist for a week or more for the Fluzone high dose shots in the adults over 65 (Haq McElhaney, 2014). The dosage and administration needs to be accurate in case of the older age groups for their reduced immune strength and enhanced vulnerability. Fluzone high dose should always be administered as a single intramuscular dose and it should be given in the deltoid muscles of the patient. And the most preferable concentration of the dosage is generally 0.5 mL/Intramuscular for one dose in the age group of 65 and above (Demicheli et al., 2018). However, the most important contraindication for Fluzoen high dose is the aggravating hypersensitive reaction to egg proteins. Patients with a history of recent Guillain-Barr syndrome, this Flu shot cannot be provided. Along with that for the patients that are being given immunosuppressive therapy cannot be given Fluzone high dose either (Lau et al., 2012). Herd immunity can be defined as the herd effect on the community immunity. It is the kind of indirect protection given against the different communicable outbreaks. It is facilitated when a large portion of the entire community has attained immunity to a particular infection and in turn provides a small and indirect measure of protection for the individuals that have not taken the immunization. The main principle behind this concept is the fact that in a population where the majority is immune against a particular communicable outbreak, the chain of infection is more likely to be disrupted easily (Plans-Rubi, 2012). Herd immunity also acts like a significant evolutionary pressure on particular viruses forcing the disruption of the progression chain. Attaining immunity can also be difficult for some people due to genetic disorders or immuno-compromised patients. In such cases herd immunity also acts like a significant barrier for them as well providing them with some form of protectio n. The vaccines need to be effective as the goal for vaccinating people is to achieve herd immunity. When a community is actively and effectively vaccinated against the disease, it provides the unvaccinated or immuno-compromised individual with a safety net. Therefore, taking the timely age adjusted flu-shots is not just a measure for personal protection but also is a collective community protection measure (Haq McElhaney, 2014). As a community nurse, the risk of exposure to influenza virus is extremely high, it has to be mentioned that the 90% of the total deaths due to influenza is attributed to the age group of 65 and above (Yaqub, Castle-Clarke, Sevdalis Chataway, 2014). And close to 70% of the older adults get influenza infections in a yearly basis and along with that for more than 50% of the total instances the risk of further complications is always high that require the assistance and care intervention from the community nurses (Demicheli et al., 2018). And hence the burden of caring for the influenza patients and their further complication often outweighs the personal protection measures like hand-washing and infection control. Hence, the requirement of regular and effective immunization with respect to the age group to which the nursing professional belongs to is extremely important (Mannino et al., 2012). Many research studies have illustrated that annual vaccination has been recommended widely for both the health care staff and the target patient population. Many government and nongovernment health authorities have advocated the need for mandatory annual vaccination for the health care staff. Although there has been a significant decline in the compliance percentage of the staff to flu vaccination. According to Behrman and Offley (2013), a few most contributing factors identified to the noncompliance include underestimation of influenza morbidity, fear of vaccination causing illness and thinking clean living would prevent transmission. However authors have also illustrated that mandatory vaccination policies have contributed to improving the immunization status of the health care staff, however lack of provable benefits, mistaken beliefs and ethical violations continue to be challenges to successful immunization of the staff. On the contrary, the authors have also discussed that comp ulsory vaccination is based an exaggerated threat, there is little scientific evidence that health care staff are the important transmission for influenza to patients. Hence, the compulsion of health care staff for vaccination violates the basic right of informed consent (Behrman Offley, 2013). However, in the community care facility, the patients are often aged and dealing with critical illness with a reduced immunity and hence are vulnerable to health care associated infections. If the nursing professionals providing care to them are not immunized themselves, the risk of infection is heightened multiple times. Hence, the need for mandatory flu shots for community nurses is not limited to their personal protection; it extends to providing some extent of protection to the patients receiving care from them as well (Demicheli et al., 2018). Furthermore, under the NSW Healths revised policy directivePD2018_009, the community care nurses and health professionals are required to take flu vaccinations on 1st June annually as a part of their professional and ethical requirements. Hence, the community care nurses are required to oblige with the vaccination policies in order to ensure ethical professional behaviour, preferably with informed consent (Health.nsw.gov.au., 2018). There has been a significant reluctant attitude observed in the health care professional towards the vaccination, especially the most threatening ones. According to the study, the hesitant attitudes are not just limited to those who do not get the vaccination, but it extends to those who influence others against vaccination as well (Yaqub, Castle-Clarke, Sevdalis Chataway, 2014). And the most important reasons behind the same can be the lack of health literacy in the different individuals and the lack of trust in the institution of vaccination. With proper information dissemination the community care professionals can be encouraged to maintain regular vaccination regime. It has to be mentioned that the community care professionals are exposed to high contamination risk to preventable communicable diseases hence the need for diligent and periodic vaccination is paramount (Felicilda-Reynaldo, 2014). As a community nurse, it is a significant part of the nursing roles and responsibilities to educate and inform the target population regarding the benefits of the Flu vaccination. In this case, if I am presented with a situation where an older individual refuses to take the vaccination, I would first and foremost try to calm him or her and will attempt to engage a relaxed therapeutic communication with them. In the following step I would like to understand the reason behind their non-compliance. For the older population belonging to aboriginal communities, the health literacy is low due to social exclusion, lack of education, and discrimination. These ethnic communities have a very different understanding of health and disease prevention; these groups can refuse to immunize themselves. In such situations I would be extremely respectful towards any cultural views that might be hindering the individual to opt for the vaccination and with optimal culturally safe communication practice I would share with him the benefits of Fluzone high dose using flyers and pamphlets. I would also share the evidence charts and records of the success of such vaccinations against communicable outbreaks (McElhaney et al., 2013). In case the patient does not feel confident enough I will even enrol him or her in peer support and influenza education programs to enhance his understanding of influenza prevention. On a concluding note, influenza poses the highest risk of infection borne diseases in the different countries. For the vulnerable population of the older adults (over 65), the risk for reoccurring flu infections are even higher. Influenza is the most impactful burden on the older communities and hence the need for Fluzone high dose administration following the quarantined protocol is extremely necessary for not only the older target group, but the entire community including the health care professionals. As discussed, the immunization procedure not only protects the immunized individuals but also generates an overall protection for the entire community by means of herd immunity. Influenza vaccinations are one of the most impactful preventive measures for influenza, hence, each and every individual will need to follow the immunization routine; including health care professionals. References: (2018).Health.nsw.gov.au.Retrieved25April2018,fromhttps://www.health.nsw.gov.au/immunisation/Documents/influenza-information-sheet.pdf Behrman, A., Offley, W. (2013). Should influenza vaccination be mandatory for healthcare workers?.BMJ,347, f6705. doi: 10.1136/bmj.f6705 Blasi, F., Aliberti, S., Mantero, M., Centanni, S. (2012). Compliance with anti-H1N1 vaccine among healthcare workers and general population.Clinical Microbiology and Infection,18, 37-41. doi: 10.1111/j.1469-0691.2012.03941.x Demicheli, V., Jefferson, T., Di Pietrantonj, C., Ferroni, E., Thorning, S., Thomas, R. E., Rivetti, A. (2018). Vaccines for preventing influenza in the elderly.The Cochrane Library. doi abs/10.1002/14651858.CD004876.pub4 DiazGranados, C. A., Dunning, A. J., Kimmel, M., Kirby, D., Treanor, J., Collins, A., ... Martin, E. (2014). Efficacy of high-dose versus standard-dose influenza vaccine in older adults.New England Journal of Medicine,371(7), 635-645. doi: 10.1056/NEJMoa1315727 Domnich, A., Arata, L., Amicizia, D., Puig-Barber, J., Gasparini, R., Panatto, D. (2017). Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis.Vaccine,35(4), 513-520. doi: 10.1016/j.vaccine.2016.12.011 Duncan, D. (2016). Stop the spread: prevention and reduction of influenza among older individuals.British journal of community nursing,21(9), 446-450. doi: 10.12968/bjcn.2016.21.9.446 Dunning, A. J., DiazGranados, C. A., Voloshen, T., Hu, B., Landolfi, V. A., Talbot, H. K. (2016). Correlates of protection against influenza in the elderly: results from an influenza vaccine efficacy trial.Clinical and Vaccine Immunology,23(3), 228-235. doi: 10.1128/CVI.00604-15 Felicilda-Reynaldo, R. F. D. (2014). Types of flu vaccines for yearly immunization.Medsurg Nursing,23(4),256.Retrievedfrom:https://search.proquest.com/openview/f1e8bdff2cc87ba62360c008072566ca/1?pq-origsite=gscholarcbl=30764 Frey, S. E., Aplasca-De Los Reyes, M. R., Reynales, H., Bermal, N. N., Nicolay, U., Narasimhan, V., ... Arora, A. K. (2014). Comparison of the safety and immunogenicity of an MF59-adjuvanted with a non-adjuvanted seasonal influenza vaccine in elderly subjects.Vaccine,32(39), 5027-5034. doi: 10.1016/j.vaccine.2014.07.013 Grohskopf, L. A., Olsen, S. J., Sokolow, L. Z., Bresee, J. S., Cox, N. J., Broder, K. R., ... Walter, E. B. (2014). Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)--United States, 2014-15 influenza season.Morbidity and Mortality Weekly Report,63(32), 691-697. Retrieved from: https://europepmc.org/articles/pmc4584910 Haq, K., McElhaney, J. E. (2014). Immunosenescence: influenza vaccination and the elderly.Current opinion in immunology,29, 38-42. doi: 10.1016/j.coi.2014.03.008 Haq, K., McElhaney, J. E. (2014). Immunosenescence: influenza vaccination and the elderly.Current opinion in immunology,29, 38-42. doi: 10.1016/j.coi.2014.03.008 Immunise - 4.7 Influenza. (2018).Immunise.health.gov.au. Retrieved 23 April 2018, from https://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part4~handbook10-4- Influenza. (2018).World Health Organization. Retrieved 23 April 2018, from https://www.who.int/immunization/diseases/influenza/en Ju, C. H., Blum, L. K., Kongpachith, S., Lingampalli, N., Mao, R., Brodin, P., ... Robinson, W. H. (2018). Plasmablast antibody repertoires in elderly influenza vaccine responders exhibit restricted diversity but increased breadth of binding across influenza strains.Clinical Immunology. Pp 7-9 doi: 10.1016/j.clim.2018.01.011 Lau, D., Hu, J., Majumdar, S. R., Storie, D. A., Rees, S. E., Johnson, J. A. (2012). Interventions to improve influenza and pneumococcal vaccination rates among community-dwelling adults: a systematic review and meta-analysis.The Annals of Family Medicine,10(6), 538-546. doi:10.1370/afm.1405 Mannino, S., Villa, M., Apolone, G., Weiss, N. S., Groth, N., Aquino, I., ... Rothman, K. J. (2012). Effectiveness of adjuvanted influenza vaccination in elderly subjects in northern Italy.American journal of epidemiology,176(6), 527-533. doi: 10.1093/aje/kws313 McElhaney, J. E., Beran, J., Devaster, J. M., Esen, M., Launay, O., Leroux-Roels, G., ... Durand, C. (2013). AS03-adjuvanted versus non-adjuvanted inactivated trivalent influenza vaccine against seasonal influenza in elderly people: a phase 3 randomised trial.The Lancet infectious diseases,13(6), 485-496. doi: 10.1016/S1473-3099(13)70046-X Osterholm, M. T., Kelley, N. S., Sommer, A., Belongia, E. A. (2012). Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis.The Lancet infectious diseases,12(1), 36-44. doi: 10.1016/S1473-3099(11)70295-X Plans-Rubi, P. (2012). The vaccination coverage required to establish herd immunity against influenza viruses.Preventive medicine,55(1), 72-77. doi: 10.1016/j.ypmed.2012.02.015 Seasonal Influenza Vaccination 2018 - Immunisation Programs. (2018).Health.nsw.gov.au. Retrieved16April2018,fromhttps://www.health.nsw.gov.au/immunisation/Pages/seasonal_flu_vaccination.aspx Sridhar, S., Brokstad, K. A., Cox, R. J. (2015). Influenza vaccination strategies: comparing inactivated and live attenuated influenza vaccines.Vaccines,3(2), 373-389. doi:10.3390/vaccines3020373 Van Bellinghen, L. A., Meier, G., Van Vlaenderen, I. (2014). The potential cost-effectiveness of quadrivalent versus trivalent influenza vaccine in elderly people and clinical risk groups in the UK: a lifetime multi-cohort model.PLoS One,9(6), pp 98437. doi: 10.1371/journal.pone.0098437 What you need to know about the new flu vaccines for over-65s. (2018). ABC News. Retrieved 23 April 2018, from https://www.abc.net.au/news/2018-02-19/fluad-fluzone-flu-vaccines-for-over-65s-what-you-need-to-know/9461766 Yaqub, O., Castle-Clarke, S., Sevdalis, N., Chataway, J. (2014). Attitudes to vaccination: a critical review.Social Science Medicine,112, 1-11. Retrieved from file:///C:/Users/absas/Downloads/2116447_1056399576_vacciation3.pdf