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CASE 8.1

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Flu season is right around the corner and you are preparing your clinic for the onslaught. First things first … you need to know how much vaccine to order and who will be receiving it. The Centers for Disease Control and Prevention (CDC) annually publishes recommendations for administering influenza vaccine to the American public.

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Question 8.1.1 The CDC recommends vaccination for all of the following groups, EXCEPT:

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A) Healthcare workers

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B) Nursing home residents

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C) Egg-allergic, febrile neonates

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D) Diabetics

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E) The elderly

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Answer 8.1.1 The correct answer is "C." We start this chapter with an easy one. Patients 6 months of age or younger should not be vaccinated nor should children who are febrile. The only other absolute contraindication to influenza vaccination is a known hypersensitivity to eggs or to other components of the influenza vaccine. Patients with an egg allergy can get the recombinant flu vaccine. The egg based vaccine can still be used in those who's only reaction to eggs is hives if they are observed for thirty minutes after the injection (CDC 2016).

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Vaccinate all persons older than 6 months annually. There are several types of vaccine available: trivalent and quadrivalent inactivated influenza vaccines (the old-fashioned flu shot), intradermal vaccine (e.g., Fluzone) for patients 18 to 64 years of age, high-dose intramuscular vaccine for the elderly, and the intranasal live attenuated influenza vaccine (e.g., FluMist). Live attenuated influenza vaccine is indicated for healthy, nonpregnant persons aged 2 to 49 years, including healthcare workers—except for healthcare workers caring for very immunosuppressed patients such as bone marrow transplant patients. Contact with patients with HIV is not a contraindication to the live attenuated virus.

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Oh, no! The virus has struck. Like a zombie apocalypse, it started with just a few cases, but now it's out of control. Every other patient who calls complains of influenza-like illness.

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Question 8.1.2 During this outbreak, what intervention(s) is/are most appropriate for all your unvaccinated, frail nursing home patients who have no symptoms of febrile respiratory illness?

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A) Antiviral prophylaxis with oseltamivir

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B) Antiviral prophylaxis with amantadine

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C) Influenza immunization

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D) A and C given together

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E) B and C given together

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Answer 8.1.2 The correct answer is "D." Persons at high risk for complications of influenza can still be vaccinated after an outbreak of influenza has begun in the community, but ...

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