The Medical Letter ® on Drugs and Therapeutics Volume 58 ISSUE ISSUE No 1433 1505 Volume 56 October 10, 2016 IN THIS ISSUE Influenza Vaccine for 2016-2017 p 127 Glycopyrrolate/Formoterol (Bevespi Aerosphere) for COPD p 130 In Brief: Nitisinone (Orfadin) for Hereditary Tyrosinemia online only Important Copyright Message FORWARDING OR COPYING IS A VIOLATION OF U.S AND INTERNATIONAL COPYRIGHT LAWS The Medical Letter, Inc publications are protected by U.S and international copyright laws Forwarding, copying or any distribution of this material is prohibited Sharing a password with a non-subscriber or otherwise making the contents of this site available to third parties is strictly prohibited By accessing and reading the attached content I agree to comply with U.S and international copyright laws and these terms and conditions of The Medical Letter, Inc For further information click: Subscriptions, Site Licenses, Reprints or call customer service at: 800-211-2769 Published by The Medical Letter, Inc • A Nonprofit Organization Revised 10/19/16 & 12/7/16: A sentence regarding Flublok Quadrivalent has been added to the "Quadrivalent vs Trivalent" section; a change in Table was made (see next page) The Medical Letter publications are protected by US and international copyright laws Forwarding, copying or any other distribution of this material is strictly prohibited For further information call: 800-211-2769 The Medical Letter ® on Drugs and Therapeutics Volume 58 October 10, 2016 Take CME Exams ISSUE ISSUE No 1433 1505 Volume 56 ▶ ALSO IN THIS ISSUE Glycopyrrolate/Formoterol (Bevespi Aerosphere) for COPD p 130 In Brief: Nitisinone (Orfadin) for Hereditary Tyrosinemia online only Influenza Vaccine for 2016-2017 Annual vaccination against influenza A and B viruses is recommended for everyone ≥6 months old without a specific contraindication.1 EFFECTIVENESS — The effectiveness of seasonal influenza vaccine in preventing influenza illness depends on the match between the vaccine and circulating strains Vaccine effectiveness is highest (50-60%) when the match is close, but even when the match is poor, vaccination has been shown to reduce the risk of laboratory-confirmed influenza, hospitalization for influenza, and death.2,3 For the 2015-2016 influenza season, the adjusted overall effectiveness of the seasonal influenza vaccine against influenza A and B viruses was 47%.4 Quadrivalent vs Trivalent – All of the trivalent and quadrivalent seasonal influenza vaccines available in the US contain the same two influenza A virus antigens Trivalent vaccines contain only one influenza B virus antigen Quadrivalent vaccines contain virus antigens from the two genetic lineages of influenza B that have been circulating globally since the 1980s, increasing the likelihood that the vaccine will provide protection against currently circulating strains.5 A quadrivalent cell culture-based influenza vaccine, Flucelvax Quadrivalent, has recently been approved by the FDA for use in persons ≥4 years old The new vaccine was immunologically noninferior to two trivalent cell culturebased vaccines, each containing a different influenza B strain, against all four vaccine strains and superior against the influenza B strains not included in the trivalent vaccines.6 Flublok Quadrivalent, a recombinant, egg-free influenza vaccine, was also recently FDA approved, but won't be available until the 2017-2018 season Live vs Inactivated – Comparative studies in persons 17-49 years old have generally found inactivated and live-attenuated influenza vaccines similarly effective or inactivated vaccines more effective in preventing Table 2016-2017 Influenza Vaccine Composition and Recommendations COMPOSITION Trivalent Vaccine A/California/7/2009 H1N1-like A/Hong Kong/4801/2014 H3N2-like B/Brisbane/60/2008-like (Victoria lineage) Quadrivalent Vaccine A/California/7/2009 H1N1-like A/Hong Kong/4801/2014 H3N2-like B/Brisbane/60/2008-like (Victoria lineage) B/Phuket/3073/2013-like (Yamagata lineage) WHO SHOULD BE VACCINATED Everyone ≥6 months old without a specific contraindication, including pregnant women TIMING Now through the end of the influenza season (May in the Northern Hemisphere)1 CHOICE OF VACCINE2 Healthy Children 2-17 years old Any inactivated vaccine3 Healthy Adults