Recently, I was sitting in my dentist's chair when an assistant remarked she could not receive flu vaccine due to her allergy to eggs and egg products.
I listened intently and replied,
After the assistant removed all the stuff in my mouth, I then translated: I would check this out and get back to her.
Well, I happened upon the insert to the monovalent H1N1v vaccine manufactured by Medimmune. Medimmune manufactures a live virus, intranasal vaccine principally for youth, and they are one of the four FDA-approved pandemic vaccines.
But I noticed this entry:
Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal is contraindicated in individuals with a history of hypersensitivity, especially anaphylactic reactions, to eggs, egg proteins, gentamicin, gelatin, or arginine or with life-threatening reactions to previous influenza vaccinations.
Likewise, I also saw this factoid:
• Antiviral agents active against influenza A and/or B: Do not administer Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal until 48 hours after antiviral cessation. Antiviral agents should not be administered until 2 weeks after Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal administration unless medically necessary.
So, you have to be off Tamiflu and Relenza for at least two days prior to accepting this vaccine into your schnozz. Probably because FluMist is live virus, and the antivirals might kill the virus before it helps you.
Finally, immunocompromised persons should not receive the vaccine intranasally.
5.4 Altered Immunocompetence
Administration of Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal, or FluMist live virus vaccine, to immunocompromised persons should be based on careful consideration of potential benefits and risks. Although FluMist was studied in 57 asymptomatic or mildly symptomatic adults with HIV infection [see Clinical Studies (14.3)], data supporting the safety and effectiveness of FluMist administration in immunocompromised individuals are limited.
I had never realized that FluMist was not for persons with sensitivity to eggs. So in the event others thought as I did (or did not), this is offered as a helpful; and potentially lifesaving reminder.
Buit wait, you say! Wasn't there word Novartis was making a vaccine from cells, rather than eggs, and they had whipped up a whopping ten liters of vaccine?
That's what the media ballyhooed. But again, directly from the Novartis package insert:
History of systemic hypersensitivity reactions to egg proteins, or any other component of Influenza A (H1N1) 2009 Monovalent Vaccine, or life-threatening reactions to previous influenza vaccinations. (4, 11)
So there you go. None of the four vaccines can be taken by persons sensitive to eggs. I am unsure how much of the US population falls into that category, but I am betting it is a significant number. Better save the antivirals for them! Easpecially persons with egg allergies and under age 50.
PS. I will try to blog from the CIDRAP Summit in Minneapolis. Mostly, I hope FLA_MEDIC and I get around to some used book and comic stores! FLA_MEDIC should be quite the celebrity after this is all said and done! He is appearing with Robert Bazell of NBC News, one of my favorite correspondents, and Katie Couric's producer. The print editors are no slouches, either.
I think I will tell Mike some Katie Couric stories when she was a cub reporter at Channel 4 in Miami and I ws running for office......