For influenza vaccination, an inactivated vaccine (dead vaccine) is produced annually, made from the influenza viruses of the previous winter. This vaccine provides 50-80% protection. For children and adolescents between the ages of two and 17, inactivated vaccines are available for injection (“injection”) or live attenuated influenza vaccine (LAIV) for nasal administration (“nasal delivery,” i.e., nasal spray). As of November 14, 2017, the Standing Committee on Vaccination (Stiko) recommends a quadrivalent influenza vaccine with current antigen combination recommended by the WHO (World Health Organization) for seasonal influenza vaccination (rationale in Epidemiological Bulletin 02/2018). Influenza (flu) is an acute inflammation of the respiratory tract with the influenza virus. The following are the recommendations of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute on influenza vaccination:
Annual vaccination in the fall with a quadrivalent vaccine with current antigen combination recommended by the WHO (applies to all age groups).
Indications (areas of application)
- S: Persons ≥ 60 years
- I: All pregnant women from the 2nd trimester (third trimester); in the case of concomitant diseases with increased health risk from the 1st trimesterPersons of any age with increased health risk due to an underlying condition, such as:
- Chronic diseases of the respiratory system (including asthma and COPD).
- Chronic cardiovascular, liver and kidney diseases.
- Diabetes mellitus and other metabolic diseases.
- Chronic neurological diseases, e.g. multiple sclerosis with relapses triggered by infections.
- Individuals with congenital or acquired immunodeficiency with residual T- and/or B-cell function or immunosuppression.
- HIV infection
Residents of nursing or retirement homes
- B: Persons who may endanger risk persons living in the same household or cared for by them as a possible source of infection. At-risk persons here are persons with underlying diseases, where there is evidence of significantly reduced effectiveness of influenza vaccination, such as persons with renal failure requiring dialysis or persons with congenital or acquired immunodeficiency or suppression.
- Persons with increased risk, e.g., medical personnel, persons in facilities with extensive public traffic, and persons who may act as a potential source of infection for at-risk persons under their care. Persons with increased risk due to direct contact with poultry and wild birds* .
- R/I: For travelers aged 60 years and older and the groups of people mentioned in I (indication vaccination), who do not have current vaccine protection, vaccination is generally recommended, for other travelers, influenza vaccination is reasonable after risk assessment according to exposure and vaccine availability.
- I: If a severe epidemic is imminent based on experience in other countries or is expected after significant antigenic drift or antigenic shift and the vaccine contains the new variant.
* Vaccination with seasonal human influenza vaccines does not provide direct protection against infections caused by the avian influenza agent, but it may prevent double infections with currently circulating influenza viruses. Legend
- S: Standard vaccinations with general application.
- A: booster vaccinations
- I: Indication vaccinations for risk groups with individual (not occupational) increased risk of exposure, disease or complications and for the protection of third parties.
- B: Vaccinations due to an increased occupational risk, e.g., after risk assessment in accordance with the Occupational Health and Safety Act / Biological Substances Ordinance / Ordinance on Occupational Medical Precautions (ArbMedVV) and / or for the protection of third parties in the context of occupational activities.
- R: Vaccinations due to travel
Contraindications
- Persons with acute diseases requiring treatment.
- Allergy to vaccine components (eg, chicken egg white, see manufacturer’s supplements).
Implementation
Vaccination – with current antigen combination recommended by the WHO – should be done before the start of the flu season, if possible:
- Northern Hemisphere: November to April.
- Southern Hemisphere: May to October
- Time interval with other vaccinations is not required.
More hints
- In addition to the trivalent (IIV3) and quadrivalent inactivated vaccines (IIV4) for injection, a quadrivalent live attenuated vaccine (LAIV4) is also approved for the age group 2 to 17 years inclusive. In this age group, the inactivated vaccines or the live vaccine can be used. If there are barriers to injection (eg, syringe phobia, coagulation disorders), LAIV should be used preferentially.
- To achieve adequate vaccine protection, patients on methotrexate treatment should have a two-week drug break after influenza vaccination to improve protective efficacy.
Effectiveness
- Good to satisfactory efficacy (exception: individuals with immunodeficiencies or treatment with immunosuppressants).
- Vaccine protection after about 1-2 weeks after vaccination.
- Duration of vaccination protection depending on the vaccine at least 1 years
- Attenuated live vaccine: protective effect of up to 70% (more than adult vaccination).
Other notes
- In children aged two to six years, in whom vaccination is recommended because of an underlying disease, it is preferable to use a vaccine that is no longer administered by syringe, but sprayed into the nose (due toIncrease the acceptance of vaccination to be repeated annually and because of the better effect).
- For people over 60 years, there are now vaccines with improved immunogenicity through special adjuvants.
- Against avian influenza (avian influenza), the usual influenza vaccine is ineffective; here, the already available vaccine against H5N1 must be used
Side effects/vaccination reactions
- Mild fever (in up to 5%) and local reactions such as redness and swelling (in up to 30%) at the injection site may occur 8-24 hours after vaccination.
Vaccination status – control of vaccination titers
| Vaccination | Laboratory parameters | Value | Rating |
| Influenza | Influenza A/B-IgG-IFT | ≤ 1: 10 | No sufficient vaccination protection to be assumed |
| 1: > 10 | Assume sufficient vaccination protection |
Postexposure prophylaxis
Postexposure prophylaxis is the provision of medication to prevent illness in persons who are not protected against a particular disease by vaccination but who have been exposed to it. See influenza (influenza)/medical therapy.
