title: Acceptability of fluzone intradermal vaccine to patients and vaccine administrators.
abstract: BACKGROUND
  Fluzone Intradermal (ID) vaccine was licensed in the United States in May 2011 and uses a microinjection device with a 1.5-mm, 30-gauge needle that delivers a smaller volume and antigen load than the Fluzone Intramuscular (IM) vaccine. The same ID microinjection system has been used in Argentina and Australia since 2010 with documented acceptance by both patients and vaccine administrators.
  
  
  OBJECTIVE
  To evaluate the acceptability of Fluzone ID influenza vaccine in clinical practice in the United States among patients and vaccine administrators and to compare the ID and IM influenza vaccines in terms of patient preference, preinjection anxiety, postinjection pain, and vaccine selection in future years.
  
  
  METHODS
  The authors developed 3 surveys-an initial and a follow-up survey for recipients of the ID vaccine and another survey for administrators-to assess opinions of ID administration. Vaccine recipients were surveyed at the time of injection concerning vaccine acceptability, vaccine preference, preinjection anxiety, and postinjection pain. Recipients who had received the IM influenza vaccine within the past 3 years were asked to compare the ID vaccine with their prior IM vaccine experience. Vaccine administrators were also surveyed after administering the ID vaccine at their assigned clinic. Recipients were then surveyed 7 days later.
  
  
  RESULTS
  Vaccine clinic participants were offered 3 vaccines: the ID and the IM Fluzone vaccines and Flumist (Medimmune) intranasal vaccine. Of the 367 participants vaccinated, 249 (67.8%) chose the ID vaccine and 117 (31.9%) chose the IM vaccine. Immediately after ID vaccination, 234 of 235 recipients (99.6%) reported being satisfied with the method of administration. One hundred seventy-five of 178 ID vaccine recipients (99.4%) who had also received the IM vaccine in the past 3 years reported being satisfied. Previous IM recipients reported a preference for the ID vaccine over the IM vaccine. They also reported less preinjection anxiety and postinjection pain compared with the IM vaccine administration, both immediately and 7 days after vaccination. All vaccine administrators reported satisfaction with the ID vaccine.
  
  
  CONCLUSIONS
  The current study demonstrates the overall acceptability of the Fluzone ID vaccine in clinical practice in the United States by both patients and vaccine administrators. Additionally, the study is the first to our knowledge to document a patient preference for ID influenza vaccine over IM influenza vaccine.
authors: Touro University California, College of Osteopathic Medicine, Division of Pediatrics, 1310 Club Dr, Vallejo, CA 94592-1187, USA. james.foy@tu.edu
authors: James E
authors: JE
authors: Foy
authors: Tami
authors: T
authors: Hendriksz
authors: Philip
authors: P
authors: Malouf
authors: Allison
authors: A
authors: Tobin
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009980:Influenza A virus / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D007271:Injections, Intradermal; D008297:Male; D008845:Microinjections; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014611:Vaccination / Q000379:methods*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines