influenza H1N1 vaccine

influenza H1N1 vaccine

(H1N1 vak-seen) , (trade name)

Classification

Therapeutic: vaccines immunizing agents
Pregnancy Category: C

Indications

Intramuscular: Active immunization against the pandemic H1N1 virus with inactivated virus. Intranasal: Active immunization against the pandemic H1N1 virus with live virus.

Action

Vaccine causes the production of antibodies against infection from the H1N1 virus.

Therapeutic effects

Protection against H1N1 influenza disease with less time lost from work and school and decreased complications of influenza disease.

Pharmacokinetics

Absorption: Vaccine is absorbed following intramuscular and intranasal administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Unknown.

Time/action profile (antibody production)

ROUTEONSETPEAKDURATION
IM, Intranasalwithin dayswithin weeksunknown

Contraindications/Precautions

Contraindicated in: Severe hypersensitivity to egg protein or previous life-threatening reaction from influenza vaccination; Hypersensitivity to eggs, egg protein, gentamicin, gelatin, arginine or previous life-threatening reaction from influenza vaccination; Concurrent aspirin therapy in children/adolescents 2–17 yr (↑ risk of Reye's Syndrome); Children <24 mo (↑ risk of wheezing/hospitalization); Children <5 yr with recurrent wheezing (↑ risk of wheezing post-vaccination).
Use Cautiously in: Immunosuppressed patients (may have ↓ antibody response); Recent (within 6 wk) Guillian-Barré Syndrome; consider risks and benefits; Geriatric: Elderly patients may have ↓ antibody response; Obstetric: Use in pregnancy only if clearly needed; Lactation: Use cautiously during breastfeeding; consider possible shedding of virus in milk and proximity during breast feeding for intranasal form; Pediatric: Safe and effective use in children <6 mo not established for IM dose form, safe use in children <2 yr not established for intranasal form; Underlying medical conditions that predispose to wild-type influenza infection complications.

Adverse Reactions/Side Effects

Intramuscular

Central nervous system

  • headache (most frequent)
  • malaise (most frequent)

Local

  • pain (most frequent)
  • swelling
  • soreness
  • tenderness

Musculoskeletal

  • myalgia

Intranasal

Central nervous system

  • headache
  • weakness

Ear, Eye, Nose, Throat

  • nasal congestion (most frequent)
  • runny nose (most frequent)
  • sore throat

Respiratory

  • cough

Musculoskeletal

  • muscle aches

Miscellaneous

  • fever (most frequent)
  • chills

Interactions

Drug-Drug interaction

Intramuscular: Intranasal: Concurrent immunosuppressants or radiation therapy may ↓ antibody response. Intranasal: The use of antivirals active against influenza A or B will ↓ effectiveness; avoid immunization within 48 hours of discontinuing; treatment with antivirus should not be initiated for 2 weeks following immunization.

Route/Dosage

Intramuscular (Adults) 0.5 mL single dose.
Intramuscular (Children > 10 yr) 0.5 mL single dose.
Intramuscular (Children 3–9 yr) 0.5 mL, repeat one month later.
Intramuscular (Children 6–35 mo) 0.25 mL, repeat one month later.
Intranasal (Children 2–9 yr) 0.2 mL, repeat one month later.
Intranasal (Adults and Children 10–49 yr) 0.2 mL single dose.

Availability

Sterile suspension for IM injection (prefilled syringes preservative-free): 0.25 mL, 0.5 mL
Sterile suspension for IM injection (single dose vial preservative-free): 0.5 mL
Sterile suspension for IM injection (multidose vial-thimerosal preservative): 5 mL (contains 25 mcg mercury/0.5 mL dose)
Suspension for intranasal use (prefilled intranasal sprayer): 0.2 mL

Nursing implications

Nursing assessment

  • Monitor patient for signs of allergic reaction (rash, pruritus, laryngeal edema, wheezing) following administration. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction.
  • Lab Test Considerations: May cause thrombocytopenia.

Potential Nursing Diagnoses

Risk for infection (Indications)
Deficient knowledge, related to disease process and medication regimen (Patient/Family Teaching)

Implementation

  • Intramuscular: Shake well before administering single dose and before withdrawing dose from multi-dose vial. Administer IM.
    • Do not mix with other vaccines in the same syringe or vial.
  • Intranasal: To administer, remove rubber tip protector. Do not remove dose-divider clip at the other end of sprayer. With patient in an upright position, place tip just inside nostril. Depress plunger as rapidly as possible with a single motion until dose-divider clip prevents from going further. Pinch and remove dose-divider clip and repeat procedure in other nostril until remaining vaccine is administered. Dispose of sprayer at completion of procedure. Store in refrigerator; do not freeze.

Patient/Family Teaching

  • Explain to patient and parent the purpose of the vaccination. Inform patient that there are two vaccine formulations for this influenza season, the H1N1 vaccine and the seasonal trivalent influenza vaccine.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
  • Intranasal: Advise patient to avoid contact with patients who are immunocompromised for at least 21 days.

Evaluation/Desired Outcomes

  • Prevention of influenza resulting in fewer lost days from work and school.
References in periodicals archive ?
Many pregnant women report not knowing about the importance of flu shots, even though the Centers for Disease Control and Prevention identified pregnant women as one of the five initial target groups to receive the 2009 influenza H1N1 vaccine.