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Mandated, Highly Recommended, and Other Vaccines for Oral Healthcare Personnel

Course Number: 479


Human influenza is caused by two influenza viruses, types A and B. They are spread by airborne droplets generated when an infected person coughs and sneezes, by direct contact with nasal or throat secretions of infected persons, and less frequently by freshly contaminated articles. Uncomplicated influenza is characterized by the abrupt onset of fever, myalgia, headache, nonproductive cough, sore throat, and rhinitis. Complications include secondary bacterial sinusitis and otitis, and primary viral and secondary bacterial pneumonia.21

Active Immunization: Influenza Vaccines 4,6,22

It is strongly recommended that all OHCP, including those in training, be vaccinated annually against influenza. Vaccination not only protects the provider, but very likely reduces the risk of healthcare-associated transmission. The annual trivalent influenza vaccines are antigenic equivalents of influenza-A (H3N2), influenza-A (H1N1), and an influenza-B virus. Each year one or more virus strains in the vaccine might change on the basis of global surveillance and the emergence and spread of new strains.22

Three types of influenza vaccines are available in the U.S.: multiple inactivated influenza vaccines (IIVs) one recombinant influenza vaccine (RIV), and one live attenuated influenza vaccine (Table 2).22 The live attenuated intranasal vaccine (Flumist™) is approved for use by healthy persons between the ages of 19-49 years. OHCP who choose to use Flumist™ in lieu of an inactivated influenza vaccine should refrain from contact with immunosuppressed persons for 7 days. Three IIVs are specifically formulated for patients ≥65 years of age.

Table 2. Influenza Vaccines.4,22

Vaccine TypeVaccinesSchedulesAdverse Effects


Afluria Quadrivalent
Fluarix Quadrivalent
FluLaval Quadrivalent
Fluzone Quadrivalent
Flucelvax Quadrivalent *
Fluzone High-Dose Quadrivalent 
Fluad Quadrivalent

1 IM dose annuallyPain at injection site (most common); fever; anaphylaxis in persons with history of allergic reaction to baker’s yeast.
RIVFlublok Quadrivalent †

1 IM dose annually Pain at injection site (most common); fever; anaphylaxis in persons with history of allergic reaction to baker’s yeast.
LAIVFlumist Quadrivalent

1 intranasal dose annuallyMild rhinorrhea, nasal congestion, and sore throat; may exacerbate asthma; anaphylaxis in persons with history of allergic reaction to egg.
* cell culture-based
† recombinant, egg-free

Antiviral Chemoprophylaxis: Antiviral Agents

Four antiviral agents are available to treat influenza: the neuraminidase inhibitors (oral oseltamivir [Tamiflu], inhaled zanamivir [Relenza], IV peramivir [Rapivab]) and the oral polymerase acidic endonuclease inhibitor baloxavir [Xofluza]. All of these agents are active against influenza A and B viruses and are most effective if initiated within 48 hours of the onset of symptoms.23