....

1. 1

3. By

8. I’m a healthy person, I never get the flu, I don’t need the
flu shot , I think that natural immunity is better than
vaccine immunity , I want to fight it off on my own …
Is it better to get sick than get vaccinated ?

9. Just because you’ve been fortunate in the past doesn’t
mean you’ll be so this year.
Remember “Millions of people have never gotten into car
accidents. They still wear seat belts and carry insurance.”

16. 16

20. Any one can get the flu

25. Unfortunately, a flu-free history does not guarantee a flu-free
future. Flu strains evolve and change over time, which means
you are at risk every year you avoid getting vaccinated.
In addition, when you skip your shot you can still carry and pass
flu germs to others.?

39. What is the difference between trivalent and quadrivalent
flu vaccine? And Why was quadrivalent flu vaccine
developed?

55.  Since 1985, 2 antigenically distinct lineages of influenza B viruses
(Victoria and Yamagata) have been co-circulating globally.
 Trivalent influenza vaccines contain only one B-strain; therefore,
mismatch can occur between the recommended lineage for TIV
and the circulating B-strain.

56.  Vaccine mismatch for circulating B strain was noted in 5 of
the 10 previous influenza seasons (2001–2002 through
2010–2011).
 QIV with 4 influenza virus strains potentially offers a wider
protection in case of vaccine strain mismatch.

57.  Quadrivalent influenza vaccines offer broader protection than
trivalent influenza vaccines since they contain four strains of
the influenza virus, 2 influenza A strains and 2 B strains.
 The trivalent and quadrivalent influenza vaccines provide similar
protection against the three strains they share in common.

58. If I got a flu vaccination last year, do I need one
again this year?

60. Why the Flu Vaccine Is Reformulated Every Year?

65. How do yearly epidemics occur?
• Answer: A process called antigenic DRIFT.
• Imperfect “manufacturing” of virus
Small changes in H and N
Partial immunity in population
• Incomplete protection; still get sick
• Need new flu vaccine every year
H3N2 H3N2
Immune
System: “Do I
know you? You
look vaguely
familiar!”

67. As a virus replicates, its genes undergo random “copying errors” (i.e. genetic mutations).
Over time, these genetic copying errors can, among other changes to the virus, lead to
alterations in the virus’ surface proteins or antigens.

68. In influenza viruses, genetic mutations accumulate and cause its antigens to “drift”— meaning the surface of the mutated virus
looks different than the original virus.
When influenza virus drifts enough, vaccines against old strains of the virus and immunity from previous influenza virus
infections no longer work against the new, drifted strains. A person then becomes vulnerable to the newer, mutated flu viruses.

70. Why does flu vaccine change every year?
 Whether the strains change or not, it’s important to get a flu
vaccine every year since immunity decreases over time..

71. Which influenza vaccines will be available during the
2022–2023 influenza season in Egypt?

76. All 2022 -2023 seasonal influenza vaccines available
for use in Egypt are quadrivalent influenza vaccines.

78. The following quadrivalent vaccines will be available on the private
market for 2022:
1) Influvac Tetra for children aged 6 months and older
2) Vaxigrip Tetra for children aged 6 months and older
 For both Influenza vaccine doses for all ages is 0.5 mL

82. 82

83. When should I get the influenza vaccine and when is
it too late in the season to get it?

84. 84

86.  Peak influenza activity generally occurs in the Northern
Hemisphere in January or February.
 Providers should continue vaccinating patients throughout the
influenza season, including into the spring months, as long as they
have unexpired vaccine in stock and unvaccinated patients in their
office.

87.  Flu vaccination should ideally be offered during September or
October. However, vaccination should continue throughout the
season as long as influenza viruses are circulating.
 Continue to vaccinate throughout the season until you run out of
vaccine, or it expires.

88.  While protection is generally expected to last throughout the
year, the highest level of protection occurs in the first 3 to 4
months after vaccination.
 Vaccination should continue to be offered as long as influenza
viruses are circulating and a valid vaccine (before expiration
date) is available.

89.  If a person had a 2021 influenza vaccine in late 2021 or
early 2022, they are still recommended to receive a 2022
formulation of influenza vaccine when it becomes available.

91. How long does it take influenza vaccine to work?

97. The effectiveness of influenza vaccine depends primarily on:
1 . The age and health status of the person getting the vaccine .
2 . The similarity or "match" between the viruses in the vaccine and
those in circulation
Vaccine effectiveness is not 100%, and some people can still
get the flu after being vaccinated.

99. How effective is flu vaccine?
 While the vaccine won’t prevent every case of flu, it is the most
specific tool we have against the flu.
 Even in years when efficacy is low, influenza vaccination prevents
severe disease and death..

100. How effective is flu vaccine?
 Although, there is no guarantee that you won’t get it ,The flu
vaccination protects around five to six adults out of every
ten from flu viruses.
 It also makes you more likely to have a milder version of the
flu in the event that you develop it.

102. How long does immunity from influenza vaccine last?
For how long does protection last?

104.  Protection from influenza vaccine is thought to persist for at least
6 months.
 Protection declines over time because of waning antibody levels
and because of changes in circulating influenza viruses from
year to year.

105.  Because flu vaccines' effectiveness starts to wane after about six
months, it's not a good idea to get it too early, such as in July or
August.
 You want to make sure you're protected through the winter months
and into spring.

109. 109

116. I had influenza infection recently, do I still need to
get the influenza vaccine?

117. “Yes even if you have had influenza infection recently, you
should get the influenza vaccine as it can lower your risk
of becoming ill from other strains of the influenza virus.

118. Because more than one type or subtype of influenza virus can
circulate in any given influenza season, providers should offer
influenza vaccination to unvaccinated people throughout the
influenza season, including people who may have had an
influenza illness already in the season...

119. Can influenza vaccine cause influenza?

122. Should people being evaluated for TB also be tested
for COVID19 and vice-versa?

125. Some of my patients refuse influenza vaccination because
they insist they "got the flu" after receiving the injectable
vaccine in the past…What can I tell them?

126.  Less than 1% of people who are vaccinated with the flu shot
develop flu-like symptoms, such as mild fever and muscle aches,
after vaccination. .
 These side effects are not the same as having influenza, but people
confuse the symptoms.

127.  Since it takes about two weeks to build protective antibodies
after receiving the flu shot, it is possible for someone to become
infected in that time period or shortly before getting vaccinated.
 You may be exposed to a to a flu virus strain not included in the
vaccine and develop illness.

128.  Respiratory pathogens that are not related to influenza viruses
can cause “flu-like” symptoms (such as rhinovirus).
 The influenza vaccine does not protect you against these pathogens.

129.  Unfortunately, some people can remain unprotected from flu
despite getting the vaccine, this is more likely to occur among
people that have weakened immune systems,
 However, even among people with weakened immune systems,
the flu vaccine can still help prevent influenza complications.

130. For flu shots. Protection is never 100%, , especially in older
persons and some people can still get the flu after being
vaccinated...

132. What is the preferred anatomic site for administration
of inactivated influenza vaccine (IIV) influenza vaccine?

136. The preferred sites for intramuscular injection are the anterolateral
aspect of the thigh (or the deltoid muscle if muscle mass is adequate)
in children 6 months through 35 months of age, or the deltoid muscle
in children from 36 months of age and adults....

137. 137

141. Place three fingers from the top of the shoulder. Have the patient
lift their arm (you should be able to see and feel the deltoid muscle
contract).
Once you have located the middle of the muscle, have the patient
relax their arm and give the injection at a 90-degree angle at that
point.

142. 142

143. 143
Standard Technique for Injection

144. 144

146. How should influenza vaccines be stored?

147. 147
Vaccine Storage
Store vaccine between 2º and 8º C in a refrigerator at all times.
Vaccine should be placed on the middle shelves of the refrigerator.
Influenza vaccine should never be exposed to freezing temperature!.
Store the product in the original package in order to protect from light.
The vaccine effectiveness can be decreased by exposure to light

148. 148
Note: Influenza Vaccine must not be frozen.
It should never come into direct contact with ice.
Transporting Vaccine
Use insulated containers with a temperature monitoring
device and appropriate cooling agents
Keep vaccine in insulated bags – do not carry it in your pocket!

152. Which children will need 2 doses of influenza vaccine
in this influenza season?

155. Number of doses needed for ages 6 months through 8 years

156. No

157. Should children only receive a half dose of the
influenza vaccine?

158.  No… The dose of influenza vaccines for all ages is 0.5mL. It is
safe for children to receive the full dose (0.5ml) of an age
appropriate influenza vaccine.
 The 0.25mL dose that was previously recommended for young
children is no longer available/recommended.

159.  For children, 2 vaccines are available from 6 months and over,
Influvac Tetra and Vaxigrip Tetra.
 The dose of influenza vaccines for all ages is 0.5 mL.

160.  Influvac Tetra® is a quadrivalent influenza vaccine that was
previously registered for use in children and adults from 3 years
of age.
 The age indication for this vaccine has now been extended to
include children from 6 months of age.

161. `

163.  Children that require two doses should get the first dose when
the vaccine becomes available to allow the second dose (which
must be administered ≥4 weeks later) to be received ideally by
the end of October..

164.  For children aged 8 years who require 2 doses, both doses should
be administered even if the child turns age 9 years between dose
1 and dose 2.
 Children aged ≥9 years need only one dose.

166. Can a child age 6–35 months who needs 2 doses of
influenza vaccine this season receive a combination
of 2 different Quadrivalent vaccines?

167. Yes. The two doses do not have to be the same brand. It is
important to make sure they are receiving the correct dosage
for their age....

168. Can a child who needs 2 doses of flu vaccine this season
receive a combination of 2 different products for their
shots?

169. Yes. The two doses do not have to be the same brand. It is
important to make sure they are receiving the correct dosage
for their age....

170. If a child age 8 years or younger has had one dose
of trivalent and one dose of quadrivalent influenza
vaccine in the past, do they need one or two doses
for the upcoming season?

171. They need just one dose of any appropriate influenza
vaccine annually....

172. A 1-year-old was inadvertently given a 0.25 mL dose
of vaxigrip tetra rather than the recommended 0.5 mL
dose. What should we do?

173. If the error is discovered on the same clinic day you can
administer the other "half" of the vaxigrip Quadrivalent dose.
If the error is discovered the next day or later, the dose should
not be counted......

184. It is safe for pregnant women to get a quadrivalent flu
vaccine? At what stage of pregnancy should women
receive the flu shot ?

195. Does ACIP recommend one influenza product over
another for pregnant women?

196. Pregnant women may receive any inactivated or recombinant
influenza vaccine.
They should not be given Flumist Quadrivalent because it is
a live-attenuated virus vaccine..

197. ACIP does not state a preference for one influenza vaccine
over another for people for whom more than one vaccine
is recommended..

198. Can a pregnant woman receive two influenza
vaccines in the same pregnancy?

199. Women who received the previous year's seasonal influenza
vaccine early in their pregnancy can receive the current
seasonal influenza vaccine (when it becomes available) later
in the same pregnancy.

200. Should a woman who was pregnant at the end of the 2021-22
campaign, who received influenza vaccine then, and who has
not yet delivered her baby receive 2022-2023 influenza vaccine ?

201. Pregnant women who received an influenza vaccine at the
end of the 2021-22 campaign, should receive a 2022-2023
influenza vaccine if it becomes available before the end of
pregnancy..

202. If a patient was vaccinated earlier in the influenza season
and later becomes pregnant during the same season,
should she be revaccinated due to her pregnancy?

203. No. The Advisory Committee on Immunization Practices (ACIP)
does not routinely recommend more than one dose of influenza
vaccine per season, except for certain children being vaccinated
for the first time..

204. I had the influenza vaccine while I was pregnant,
does my baby still need the vaccine?

205.  All pregnant women are recommended to have the influenza
vaccine during their pregnancy.
 Some of the antibodies that your body makes in response to
the vaccine pass to your baby during your pregnancy, and this
helps protect your baby from influenza in the crucial first few
months of life before they can receive the vaccine themselves..

206. Unfortunately, this protection does not last beyond six months
of age. This is why the influenza vaccine is recommended and
for all children from six months of age...

209. Can a woman who is breastfeeding receive a quadrivalent
flu vaccine ?

210. Quadrivalent Influenza vaccine can safely be
given to breastfeeding women.

211.  Pregnant women should get a flu shot; NOT the live attenuated
vaccine (LAIV or nasal spray).
 Postpartum women, even if they are breastfeeding, can receive
either type of vaccine.

212. Why do we vaccinate pregnant women against influenza
when it is not recommended to vaccinate infants younger
than age 6 months?

213.  Influenza vaccine is not recommended for children younger than
age 6 months because it is not approved for this age group.
 However, vaccinating during pregnancy provides maternal antibodies
to the fetus; this helps protect the young infant against influenza
during the first 6 months of life.

215. What if I am breastfeeding, does that mean my baby
doesn’t need the vaccine from six months?

216. No.. Breastfeeding doesn’t provide enough antibodies to your
baby’s system to protect them against influenza after 6 months
of age.
so it’s important to protect them with influenza vaccine from
6 months of age..

231. During the COVID-19 pandemic, there has been reduced
circulation of influenza virus and lower levels of influenza
vaccine coverage compared with previous years.
With borders reopening, a resurgence of influenza is expected
in 2022...

233. Co-infection with ILI and COVID-19 increases risk for severe
disease
COVID-19 and influenza co-infections have resulted in higher
mortality rates compared to those who only tested positive for
COVID...

238. Can the influenza vaccine be given to children aged from
6 months to less than 5 years of age at the same time as
other immunisation program vaccines?

239.  Yes..inactivated influenza vaccine does not interfere with the
effectiveness of other vaccines.
 It can be given at the same time or at any time before or after
administration of other inactivated vaccines (e.g. Hepatitis B
vaccine) or live attenuated vaccines (e.g. Measles, mumps
and rubella vaccine)....

240. For concomitant parenteral injections, different injection sites and
separate needles and syringes should be used...

241. Giving pneumococcal conjugate vaccine and inactivated
influenza vaccine simultaneously to young children may
increase the risk of febrile seizures…
Can we continue to give these two vaccines at the same
time?

242.  All influenza vaccines can be administered at the same time as
other childhood recommended vaccines.
 There is a small increased risk of fever following administration
of pneumococcal and influenza vaccines at the same time.
Separating the doses by 3 days can be considered to reduce
this risk...

243. Some, but not all, studies have reported increased rates of febrile
seizures among children, especially those age 12 through 23
months, who received simultaneous vaccination with IIV and
pneumococcal conjugate vaccine (PCV13, Pfizer) , when
compared with children who received these vaccines separately.

244. The risk of febrile seizure with any combination of these vaccines
is small and ACIP recommends giving these vaccines at the same
visit if indicated and does not recommend administering them at
separate visits ....

245. Can someone who has received the influenza vaccine
early in the season receive an additional (booster) dose
later in the year?

246. Booster doses of flu vaccine during the influenza season do not
provide benefit and are not recommended..
Revaccination in the same year is not routinely recommended,
however some people may benefit due to personal circumstances .

247. Should our practice consider revaccinating our high risk
and older patients a second time during the year due to
concerns with waning immunity?

248. Would giving an older patient 2 doses of standard-dose
influenza vaccine be the same as administering the high
-dose product?

249. No, and this is not recommended, For people who have
already been fully vaccinated, revaccination later in the
season is not recommended...

250. No. The high dose flu vaccine has been specially formulated to
create a greater immune response amongst the elderly, who are
known to have a weaker response to immunisation.
However, if it is not available people aged 65 years and over can
safely receive other standard quadrivalent influenza vaccines...

255. Is it OK to get the flu vaccine more than once in
the same flu season?

256. Who needs to get more than one dose of
influenza vaccine within a year?

257.  1. Children under 9 years old who have not ever been vaccinated
against the flu.
 2. People who are having flu vaccination for the first time after a
stem cell transplant or organ transplant.
 3. Overseas travellers who are going to the southern hemisphere
winter.

258.  4. Women who received the previous year’s seasonal influenza
vaccine early in their pregnancy can receive the current seasonal
influenza vaccine (when it becomes available) later in the same
pregnancy.

259. How soon after bone marrow transplant do we
start to vaccinate our patients against influenza?

260. Inactivated influenza vaccine or recombinant influenza vaccine
should be administered beginning at least 6 months after bone
marrow transplant and annually thereafter for the life of the
patient. ...

261. A dose of an inactivated influenza vaccine can be given as early
as 4 months after transplant, but a second dose should be
considered in this situation. ...

262. If a patient is undergoing treatment for cancer, is it
safe to vaccinate her or him against influenza?

264. People with cancer need to be protected from influenza, and
and they can and should receive inactivated or recombinant
influenza vaccine (but not live nasal spray vaccine) even if
they are immunosuppressed....

265. How long after COVID-19 infection can I have the
influenza vaccine?

266. CDC recommends deferring vaccination for people with suspected
or confirmed COVID-19 until they have met criteria for no longer
needing quarantine or isolation to avoid exposing healthcare
personnel and others. ....

267.  “You need to make a full recovery from a COVID infection before
you have the flu shot; as soon as symptoms have gone and you
feel back to normal, you would present for the flu vaccination,”
 For many people, this will be 10 days to two weeks after becoming
infected with COVID..

269. Is the Flu Vaccine Safe for People With Egg
Allergy?

270. Should my child with an egg allergy get the
flu shot?

271. Yes. If you have a current or past egg allergy, you can
get the flu vaccine, even if you have had severe allergic
reactions (anaphylaxis) to egg. The same is true for
children..

272. Flu Vaccine Safe for People With Egg Allergy .....This is true
no matter how severe your egg allergy was in the past.
This includes people who have had anaphylaxis (a severe allergic
reaction) to egg.

273. Does the Flu Vaccine Contain Egg?
 Most versions of the flu shot can contain a tiny amount of egg
protein.
 But studies show that the amount is so small it is unlikely that
you will have a severe allergic reactions to the vaccines if you
have an egg allergy....

274. 275

277. The following organizations recommend getting the flu shot
shot every year, even if you have an egg allergy:
1. Asthma and Allergy Foundation of America (AAFA)
2. Centers for Disease Control and Prevention (CDC)
3. American Academy of Pediatrics (AAP)
4. American Academy of Allergy, Asthma, and Immunology (AAAAI)
5. American College of Allergy, Asthma, and Immunology (ACAAI)

291. 292

292. Can the influenza vaccine be given to someone who
has had Guillain–Barré syndrome?

295.  It’s unlikely you'll redevelop Guillain-Barré syndrome symptoms
after a flu shot, but it's possible.
 Many people with a history of GBS and some doctors believe that
if they have had GBS, they cannot ever get the influenza vaccine.
However, this assumption is not correct. Here is the story

296.  History of GBS within six weeks of getting an influenza vaccine
— These individuals have what is called a “precaution” for
influenza vaccine.
 A precaution means that the individual and their doctor should
consider the potential risks and benefits before getting any
future doses of influenza vaccine.

297.  A history of GBS unrelated to influenza vaccine — These
individuals can get influenza vaccine, They have neither
contraindication or precaution to influenza vaccination.
 GBS within 6 weeks following a previous dose of influenza
vaccine is considered a precaution for use of influenza vaccines.

298.  As a precaution, medical guidelines recommend that some patients
who have had GBS avoid flu shots.
 If you have previously developed GBS within 6 weeks after receiving
a flu shot or if you are young, healthy, and not at risk for severe
complications from the flu, you should not have the flu vaccine.

299.  If a patient developed GBS within 6 weeks after having an
influenza vaccination, the small risk of recurrence of GBS
following revaccination may outweigh the benefit of vaccination.
 Repeat vaccination could be considered in special circumstances,
such as presence of risk factors for severe influenza illness,

300. When I was 5 years old, I had Guillain-Barré syndrome (GBS)
unrelated to vaccination. I am now 35 with no residual effects
of the GBS.
I am a nurse and my facility requires employees to receive
influenza vaccine. Is it safe for me to be vaccinated?

302. If my patient previously had a reaction to flu vaccine,
can I split a single dose and administer it over 2
different days?

303. No. It is not an acceptable practice to split a single dose over
different days.
Patients should never receive a “half-dose” for what they are
recommended...

304. Doses of influenza vaccine (or any other vaccine) should never
be split into "half doses ...
" If a "half dose" is administered, it should not be accepted as a
valid dose and should be repeated as soon as possible with a
full age-appropriate dose.

309. 1. Children younger than 6 months of age are too young to get a flu
shot.
2. People with severe, life-threatening allergies to any ingredient in a
flu vaccine (other than egg proteins) should not get that vaccine.
3. People who have had a severe allergic reaction to a dose of
influenza vaccine should not get that flu vaccine again and might
not be able to receive other influenza vaccines..

310. 311