Voiceover: There are currently two kinds of influenza vaccines available. We have the flu shot and
we have the nasal spray, also known as flu-mist. So, let's talk about
some of the differences between these two kinds of vaccines. The most obvious difference
between these two is the method of delivery. So, the flu shot is given as
an intramuscular injection. This often occurs in the deltoid muscle and this happens because
it's easily accessible and also there's a low
risk of complication. However, the flu shot
is also able to be given in the gluteus maximus,
although in these modules we only teach the deltoid method. The flu shot can also be given as an intradermal injection, but again, we're only teaching the intramuscular
injection in the deltoid. The nasal spray is, obviously,
sprayed in the nose. So, that's the most obvious difference between the flu shot and the nasal spray. The most important difference is the condition of the
virus used in each vaccine. So, the flu shot is sometimes called an inactivated vaccine. We call it inactivated because the virus that's used in this vaccine
is effectively killed. It's not able to
replicate inside of humans and as a result, there's no infection. The nasal spray is sometimes referred to as a live attenuated influenza vaccine. We use this word, attenuated,
which means altered because the virus that's
used in this vaccine is changed, although it's
technically still alive. So, the changes or the
alterations that occur in this virus, make it weaker, so in healthy people, their immune system is still able to defend against the virus and produce antibodies. In the future, if our vaccinated patient is exposed to a stronger
version of the same virus, their immune system
remembers how to defend against the virus and our patient is hopefully protected against infection. So, the reason why this
difference is so important is because it determines who
can get which kind of vaccine. So, can you get infected
from the inactivated virus that's in the flu shot? Absolutely not. It's inactivated, it's
not able to replicate and there's no infection. Can you get a full blown influenza illness from the live attenuated form? In most cases, the answer is likely not. Our immune systems are strong enough to defend against this weakened virus relatively easily, but there is some risk of getting a full blown influenza illness because this is still a live virus that's used in this vaccine. So, we have two groups
of patients who should be vaccinated with the flu shot instead of the live attenuated form. So, those two groups are those who have an immune system that's
not operating at 100%, they have weakened immunity. So, for these people, they
have a greater likelyhood of getting sick from this attenuated virus than a normal healthy person would. The second group of people are patients who have a medical condition that places them at
high risk of developing a complication from an
influenza infection. So, these people get a much worse illness than a normal, healthy person would and as a result we really need to avoid any chance of infection whatsoever. So, given that we need to keep an eye out for these two groups
of patients, let's talk about them in more detail
starting with age group. So, because we require a fully developed and strong immune system
in order to respond to the live attenuated
virus, the nasal spray is only recommended for patients between the ages of 2 and 49 years of age. Outside of this age
range, you are more likely to have a weaker immune system, so with the nasal spray is not recommended. However, there is no risk of infection with the flu shot because it uses a killed or inactivated virus. So, we can give the flu shot to anyone who is over the age of six months. Okay, so who else might have
a weakened immune system? What about patients who have
an immunodeficiency disease caused by HIV? Or patients who have
had a medical procedure that leaves them immuno-suppressed. So, let's say a patient
has an organ transplant and are taking medication
that lowers their immunity on purpose. We call these patients immuno-suppressed. Pregnancy can also
weaken the immune system and then people who have close contact with patients who are immuno-suppressed. We're also going to put
them in this category because we want to make
sure that they don't transmit the influenza virus to someone who has a weakened immune system. Okay, so these patients
have even more reason to do everything they
can to protect themselves from infection since their immune systems are weak, so we really
want to get them vaccinated with the flu shot, which we
know won't cause an infection. So, definitely vaccinate
with the flu shot, but let's avoid the nasal
spray in this situation. Okay, so now let's look more closely at this other group of patients. Those who have a high risk
of developing complications from influenza. So, who might these people be? Well, any patient who has asthma. Patients who have
problems with their heart or their kidney or any
other pulmonary problems in addition to asthma. Patients who have diabetes. Now, there are also some
other medical conditions that can lead to a high
risk of complication with the flu, but these
are the most common and most likely what you'll
see in a vaccine clinic. So, for these patients, again, we absolutely should vaccinate
them with the flu shot because we want to protect them
from getting a bad illness, since their flu illness can
lead to much more trouble than a normal, healthy person. So, absolutely give them the flu shot, but avoid the nasal spray here as well. Finally, let's talk about kids. There are a few circumstances that we need to look for in kids. Any child who has had
a history of wheezing, even if they're not diagnosed with asthma should get the flu shot
instead of a nasal spray. And then any kid or teenager, actually, who has been receiving aspirin, there's a complication
known as Rye Syndrome that's associated with the aspirin and the influenza virus. So, we want to make sure that kids don't get the flu if
they're taking aspirin. So, here again, definitely
vaccinate with the flu shot, but no nasal spray. Okay, so now let's talk about patients who should consult
their doctor before they get either vaccine, either the
flu shot or the nasal spray. There are a few things to watch out for, so I like to use a mnemonic called FRAG to remember these patients. So, F stands for fever. Any patient actually with or without fever who has been sick in the last 24 hours, they should talk to their doctor
before getting vaccinated. R stands for reaction. If your patient has received
an influenza vaccine in the past and then had
an emergency reaction as a result, they should
also talk to their physician before getting vaccinated. A stands for allergy. The influenza vaccines
are made in chicken eggs, so patients who are allergic
to eggs or egg proteins should probably see an
allergist before they get vaccinated. So, finally, G stands for Guillain-Barre'. This is a syndrome that I talked about in another module and
basically all we need to know here is if your
patient has received an influenza vaccine
and then they developed Guillain-Barre' syndrome afterwards, they should consult a physician
before getting vaccinated.