natural treatment for influenza illness disease

(music) in compliance with continuingeducation requirements, all presenters must disclose anyfinancial or other associations with the manufacturersof commercial products, suppliers of commercialservices, or commercial supportersas well as any use of unlabeled product(s)or product(s) under investigational use. cdc, our planners,content experts,

and their spouses/partners wish to disclose they haveno financial interests or other relationshipswith the manufacturers of commercial products, or commercial supporters. planners have reviewed contentto ensure there is no bias. content will not include anydiscussion of the unlabeled use of a product or a productunder investigational use with the exception of dr.grohskopf's discussion

of influenza vaccines. she will be discussinguse of influenza vaccines in a manner recommendedby the advisory committee on immunization practices,but not approved by the food and drug administration. cdc did not acceptcommercial support for this continuingeducation activity. welcome to influenza vaccinationrecommendations 2015-2016. during this program we willdescribe the advisory committee

on immunization practices'influenza vaccine recommendations. describe the benefits ofinfluenza vaccination. describe best practices forinfluenza vaccine storage, handling, and administration. implement disease detection andprevention health care services for example, smokingcessation, weight reduction, diabetes screening,blood pressure screening, immunization services,

to prevent health problemsand maintain health. influenza is a highlyinfectious viral illness that can cause seriousillness and even death. it is estimated that in anygiven year, between five and twenty percent of the u.s.population become infected with an influenza virus. most cases will cause severaldays of illness but will resolve without the needfor medical care. the severity of influenzaillness depends

on a person's priorimmunologic experience with influenza viruses, anyunderlying chronic diseases, and the strain of influenzawith which they get infected. the incubation period forinfluenza is usually two days, but varies from oneto four days. classic influenzaillness is characterized by the abrupt onset offever, myalgia, sore throat, nonproductive cough,and headache. additional symptoms may includerhinorrhea or runny nose,

headache, substernal chestburning, and ocular symptoms such as eye pain andsensitivity to light. children are morelikely than adults to have nausea and vomiting. the most frequent complicationof influenza is pneumonia, either as a direct viralinfection of the lungs or a secondary bacterialpneumonia caused most commonly by streptococcus pneumoniaeor staphylococcus aureus. the risk for complicationsand hospitalizations

from influenza is higher amongpersons fifty years of age and older, children youngerthan five years of age, persons of any age with certainunderlying medical conditions, pregnant women, and americanindians and alaska natives. an average of more thantwo hundred thousand hospitalizations per yearare related to influenza, more than fifty percent of whichoccur among persons sixty five years of age and older. cdc recommends a fluvaccine as the best way

to protect against influenza. flu vaccines protectagainst three or four differentinfluenza viruses, depending on which vaccineformulation is administered. influenza vaccination can reducethe number of flu illnesses and prevent serious outcomes like flu-relatedhospitalizations. vaccination is especiallyimportant for persons at high risk of seriousflu-related complications

and their close contacts,including health care personnel. during the 2014-2015 influenzaseason, flu vaccines were not as effective as usual. the circulating h3n2virus was very different from the h3n2 virusin the vaccine, and it was the most commoninfluenza virus which circulated in the u.s. this resultedin vaccine effectiveness of only twenty three percentoverall, thirteen percent against h3n2 virusesand fifty five percent

against less commoninfluenza b viruses. vaccine effectiveness is usuallyapproximately sixty percent when the circulatingviruses are well-matched to the viruses in the vaccine. this means that usuallya vaccinated person is about sixty percent lesslikely to get sick with the flu and need a doctor's visitthan an unvaccinated person. cdc is optimistic that the2015-2016 vaccine will offer good protection againstthe flu this season.

two of the vaccine viruscomponents from last season, the influenza a h3n2 virusand the influenza b virus, were updated for the2015-2016 vaccine. laboratory data as ofseptember fifth, 2015, suggest that mostcirculating viruses are like the vaccine virusesincluded in the vaccines for the upcoming season. the advisory committee onimmunization practices, or acip, has published recommendationsfor the use

of seasonal influenza vaccinesfor the 2015-2016 season. for an overview of therecommendations we spoke to dr lisa grohskopf withthe influenza division of the national centerfor immunization and respiratory diseases. routine annual influenzavaccination is recommended for all persons sixmonths of age and older who do not havecontraindications. optimally, vaccinationshould occur before the onset

of influenza activity. vaccination should continueto be offered as long as influenza viruses arecirculating in the community. the 2015-2016 u.s.-licensedtrivalent influenza vaccines contain hemagglutinin derived from an a/california/7/2009h1n1-like virus, an a/switzerland/9715293/2013h3n2-like virus, and a b/phuket/3073/2013-likevirus from the yamagata lineage. quadrivalent influenza vaccinescontain these vaccine viruses

and a b/brisbane/60/2008-likevirus from the victoria lineage. various influenza vaccineproducts are available for the 2015-2016 season. a table listing theproducts is available online. inactivated influenzavaccines, abbreviated as iiv, are available as trivalentand quadrivalent products. age indications vary by product,formulation, and presentation. live attenuated influenzavaccine, abbreviated as laiv, is available only as aquadrivalent product.

laiv is indicated forhealthy persons two through forty nine years ofage who are not pregnant. there is new andupdated information on influenza vaccine productsfor the 2015-2016 season. first, afluria iiv is approved for intramuscular administrationvia the stratis needle-free jet injector for persons eighteenthrough sixty four years of age. next, the age indication for therecombinant influenza vaccine, flublok, which waspreviously eighteen

through forty nineyears, has been expanded to persons eighteenyears of age and older. and finally, fluzone intradermalquadrivalent is approved for persons eighteen throughsixty four years of age. it is expected that thequadrivalent formulation will replace the previously availabletrivalent fluzone intradermal. in cases where more than onetype of vaccine is appropriate and available, acip does notexpress a preference for use of any particular product.

a severe allergic reaction to influenza vaccineis a contraindication to future receiptof the vaccine, regardless of thecomponent suspected of being responsiblefor the reaction. severe allergic and anaphylacticreactions can occur in response to various influenzavaccine components, but such reactions are rare. with the exceptions

of the recombinantinfluenza vaccine flublok, and the cell culture-basedinactivated influenza vaccine flucelvax, influenza vaccinesare prepared by propagation of virus in embryonated eggs. recommendations for influenzavaccination of persons who report an allergyto eggs remain unchanged from last season. a flow chart to assisthealth care personnel in assessing egg allergyis available online.

children six monthsthrough eight years of age require two doses ofinfluenza vaccine, administered at least four weeks apart, during their firstseason of vaccination. some children in this age group who have received influenzavaccine previously will also need two doses. for the 2015-2016 season,children six months through eight years of age whohave previously received a total

of two or more dosesof trivalent or quadrivalent influenzavaccine before july first 2015, require only one dose. it does not matter if the twoprevious doses were administered during the same seasonor consecutive seasons. children in this age group who have not previously receiveda total of two or more doses of trivalent or quadrivalentinfluenza vaccine before july first 2015, requiretwo doses administered

at least four weeks apart. a flow chart to assisthealthcare personnel in determining the number of doses needed isavailable online. last season, acip recommendations stated apreference for laiv versus iiv for healthy children twothrough eight years of age. data from subsequentstudies of laiv and iiv vaccine effectivenessindicated

that laiv did not performas well as expected. for the 2015-2016 season, laivis no longer preferred to iiv for healthy children twothrough eight years of age who have no contraindicationsor precautions, either laiv or iiv is an appropriate option. no preference is expressed forlaiv or iiv for any person two through forty nine years of age when either vaccineis appropriate. an age-appropriate formulationof vaccine should be used.

beginning in the2010-2011 influenza season, acip recommended annualinfluenza vaccination for all persons sixmonths of age and older. but, protection ofpersons at higher risk for influenza-relatedcomplications or those with increased riskof transmission to others should continue to bea focus of vaccination efforts. these persons include childrenyounger than five years, adults fifty yearsof age and older,

persons with chronic medicalconditions, pregnant women, american indiansand alaska natives, and health care personnel. the full recommendationsand additional resources, including patient educationmaterials, are available at www.cdc.gov/flu health carepersonnel continue to demonstrate their commitmentto combating influenza disease. as more influenzavaccines become available,

immunization providers willneed to choose the type of vaccine most appropriatefor their patient population. in this section of ourprogram, we will focus on frequently asked questionsabout influenza vaccine storage, during influenza season wereceive a number of questions from health care personnel. let's address some of the mostfrequently asked questions. what are cdc's recommendationsfor storing influenza vaccines? cdc recommends storinginfluenza vaccine

in a stand-alone refrigerator or a pharmaceuticalpurpose-built unit. these units can vary in size, from compact under-thecounter style to large stand-alone units. if a household combinationrefrigerator/freezer is used to store vaccines, cdc recommends using onlythe refrigerator compartment for refrigerated vaccines.

cdc does not recommendstoring any vaccine, including influenzavaccines, in a dormitory or bar-stylerefrigerator/freezer unit under any circumstances. using dormitory-style unitsto store vaccines for children or other vaccines purchasedwith public funds is prohibited. at what temperature shouldinfluenza vaccine be stored? and what type ofthermometers should be used for measuring temperaturesin a vaccine storage unit?

all influenza vaccines,including both inactivated and live attenuated,vaccines should be stored in the refrigeratorbetween thirty five and forty six degreesfahrenheit or two and eight degrees celsius. cdc recommends providersuse a calibrated continuous temperature monitoringdevice with a certificate of traceability andcalibration testing. digital data loggersare recommended

for continuous temperaturemonitoring. when conducting influenzavaccination clinics at an off-site orsatellite facility, what are the storagerecommendations for this situation? cdc does not recommendroutine transport of vaccines. if at all possible, have thevaccine delivered directly to the off-site orsatellite facility. if vaccines must betransported to the facility,

here are the do's and don'ts. do take a limitedamount of vaccine, only enough for the workday. transportation and workdaytime should not total more than eight hours. cdc does recommend using aportable refrigerator unit or qualified container. portable refrigerators and qualified containersare commercially available

for purchase. cdc also recommends usinga calibrated temperature monitoring device. the device should have a validcertificate of calibration, recording capabilities to monitor the temperaturecontinuously, and a digital displayand buffered probe. when transporting vaccine, do place it in thepassenger area of the vehicle.

upon arrival, promptly unpackthe vaccine and place it in an appropriate storageunit, if available. if the vaccine must be keptin the transport container, read and documenttemperatures hourly. now here are the don'ts. do not reuse manufacturershipping containers and supplies. do not use frozen gelpacks, ice, or dry ice. these can freeze the vaccine.

additional informationis available in the vaccine storageand handling toolkit. how do you correctly interpretexpiration dates on vaccine? and do all flu vaccines expireat the end of flu season? no, all flu vaccines do notexpire at the end of flu season. although most influenzavaccines expire on june 30th, some expire during flu season. for example, liveattenuated influenza vaccine, abbreviated laiv, generally hasa shelf life of eighteen weeks.

in addition, therecan be confusion about expiration datesfor multidose vials. most influenza vaccines inmultidose vials can be used through the expirationdate printed on the label, as long as the vaccine is storedproperly and not contaminated, or unless the manufacturerindicates otherwise. sometimes the manufacturerspecifies that once the multidosevial has been entered or the rubber stopper punctured,the vaccine must be used

within a certain number of days. this is commonly referred toas the beyond use date or bud. when using a multidosevial of influenza vaccine for the first time, check thepackage insert to determine if the vaccine has a bud. if it does, calculate the beyonduse date using the time interval found in the vaccine'spackage insert. initial and label thevaccine vial with the bud. between uses, store thevaccine appropriately

until the vial is empty or thebeyond use date is reached. any vaccine not used beforethe bud should be discarded, even if there isvaccine left in the vial. is it ok for a large clinic thatadministers lots of flu vaccine to draw up vaccines at thebeginning of the clinic day? cdc recommends only drawing up vaccine just beforeadministration. vaccine manufacturersdo not recommend that vaccines bepredrawn in advance.

these syringes arenot approved for use as a storage systemfor drug products. cdc recommends usingmanufacturer-filled syringes for large immunization clinics. if vaccine must be predrawn,it should not be drawn up in advance of the clinic. drawing up dosesof vaccine hours or even days before aclinic is not acceptable. at the clinic site, no morethan one multidose vial,

or ten doses, shouldbe drawn up at one time by each person administeringvaccine. at the end of the workday,any remaining vaccine in provider-predrawnsyringes should be discarded. what are the routesof administration for influenza vaccines? influenza vaccinesare administered by three differentroutes, intramuscular, intradermal and intranasal.

most inactivated influenzavaccine products are administered by intramuscular,or im, injection. there are only tworoutinely recommended sites for im administrationof vaccines. these are the vastuslateralis muscle in the anterolateral thigh and the deltoid musclein the upper arm. injection at these sites reducesthe chance of involving neural or vascular structures.

the needle should be longenough to reach the muscle mass and prevent vaccine from seepinginto subcutaneous tissue, but not so long as toinvolve underlying nerves, blood vessels, or bone. health care personnel shouldbe familiar with the anatomy of the area where thevaccine will be injected. guidance on recommendedinjection sites and needle selectioncan be found in acip's generalrecommendations on immunization

and in the epidemiologyand prevention of vaccine-preventablediseases text book, also known as the pink book. because there are nolarge blood vessels in the recommended sites, acip states thataspiration before injection of vaccines is not necessary. as of august 2014, the pharmajetstratis needle-free injection system was approved by the foodand drug administration or fda

for use with oneinfluenza vaccine product - afluria vaccine. additional informationcan be found on the pharmajetstratis website. fluzone intradermalis administered by the intradermal, or id route. this formulation is not the sameas intramuscular formulations of inactivated influenzavaccine. other inactivated influenzavaccine formulations should not

be administered bythe intradermal route. for the intradermal injection, a manufacturer-filledmicroinjection syringe is used to administer a zeropoint one milliliter dose into the dermal layerof the skin in the deltoid regionof the upper arm. detailed administrationinstructions are included in the package insert. the third route used

to administer influenzavaccine is intranasal, abbreviated as nas. the live attenuatedinfluenza vaccine, flumist, is currently the only vaccineadministered by this route. the vaccine dose is insidea special sprayer device. a plastic clip on theplunger divides the dose into two equal parts, which should be administeredinto each nostril. detailed information on thenasal administration of laiv,

is included in the manufacturer'sproduct information. what guidance is therefor preventing injury if patients faintafter vaccination? since 2005, the vaccineadverse event reporting system or vaers has received anincreasing number of reports of syncope or fainting inadolescents and young adults. immunization providers shouldtake appropriate measures to reduce the risk ofinjury from syncope.

these include havingthe patient seated when administering the vaccineand knowing the symptoms that precede fainting such asweakness, dizziness, and pallor and take appropriatemeasures to prevent injuries if such symptoms occur. acip recommends providersstrongly consider observing patients for 15 minutesafter vaccination. information on thistopic is posted on the cdc's vaccinesafety webpage.

can pregnant health carepersonnel administer laiv? yes, a pregnant women maysafely administer l-a-i-v. health care personnel withunderlying medical conditions, those who are 50 yearsof age and older, may also safely administer laiv. the only exception to thiswould be health care personnel with immunosuppressionsevere enough to require a protectiveenvironment. a person with this level

of immunosuppression ishighly unlikely to be working. what should be documented inthe medical record when a dose of flu vaccine is administered? by federal law, certaininformation must be documented in the patient's paper orelectronic medical record or on a permanent office log. this includes: the vaccinemanufacturer; the lot number of the vaccine; the datethe vaccine is administered; the name and title of the personwho administered the vaccine

and the address of the facility where the permanentrecord will be kept; the vaccine informationstatement, or vis edition date which is located onthe back of the vis in the lower rightcorner; finally, the date the vis is given to thepatient, parent, or guardian. the national childhoodvaccine injury act requires that a vis be given toparents, legal representatives, or adult patients beforeadministering any vaccine.

best practice guidelinesalso include documenting the expiration date, route,dosage or volume, and site. health care personnel arealso strongly encouraged to document the dose in the immunizationinformation system, or iis. in addition, your facility mayrequire other documentation. follow your facility'spolicies and procedures for medical documentation. here's our final question,what strategies can be used

to help prevent influenzavaccine administration errors? a common error isinadvertent administration of expired vaccine. always check the expirationdate before preparing or administering vaccine. expired vaccine shouldnever be administered. a 2014 mmwr articlehighlighted vaers reports of expired laiv beingadministered. as noted earlier, laiv generallyhas an 18-week shelf life.

the vaccination occurred afterthe first week of november in 95 percent of the reports, which is approximately18 weeks from july first. this indicates that expirationdates were not being checked. fortunately, no adversehealth events were documented in 98 percent of the reports. in addition to administrationof expired vaccine, other administrationerrors we frequently hear about include wrongdosage or amount;

influenza vaccineadministered outside of the product's indications;and wrong route, among others. strategies to preventadministration errors include: educate all staffadministering vaccine about the influenza vaccineinventory; store vaccines with similar packagingon different shelves of the refrigerator; label thevaccine in the storage unit with age or otherunique indications; use standard acip abbreviations.

a link to the standardizedabbreviations list can be found on the acip web page. if you or your staff haveadditional questions, send them to us by e-mail at nipinfo@cdc.gov continuingeducation is available for this program onlythrough the cdc/atsdr training and continuing educationonline system at www2a.cdc.gov/tceonline. there are two very importantpieces of information

to receive ce for this program. first is the course number. the course number forthis program is wd2589. that's wd2589. you must alsohave a verification code to complete the evaluationand posttest. the verificationcode is flurecs. that's capital f,lowercase l and u, uppercase r, lowercase ecs. thank you for joining us.

it has been our pleasureto bring you this program.