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Flu season is just around the corner can you tell us who should be getting vaccinated with the influenza well currently from a number of years now the recommendations have been if you are older than six months of age you should get a flu shot if you want to that's given to healthy persons up to the age of 50 and then there are inactivated injectable forms of which there are a number of different varieties that have they're kind of subtle advantages or disadvantages and what about for patients that have severe egg allergies so as of last year the American College of practices has stated based on the current data that none of the influenza available now are contraindicated even for those individuals who have had anaphylaxis to egg products however you know those of us in clinical practice recognize they're still going to be those patients who will refuse the because of their remaining concern there is now one recombinant that has no egg protein flu block that could be an alternative for these patients so herpes zoster or shingles cause of significant morbidity in the US and a new formulation or a new was recently approved by the FDA can you tell us a little about the new guidelines for shingles so shin Grid is a killed, so that's different from the old zoster backs which was a live weakened virus and thus had some concerns when you were trying to immunize immune compromised patients so now that this one is killed we don't have those concerns, and it's also more amino Jet ix so the age of when we should initiate shingles now has moved down to age 50 it used to be 60 with the older because immunity waned generally seven to nine years after receipt, and we were concerned if we gave it too early you would not have immunity when you were older and an even more at risk of reactivation chickenpox disease and what about the efficacy behind Shane Rex vs zoster, so the data also indicates the new is more amino genie and in the studies that led to the licensure of jingle's pretty much in all persons that were vaccinated the efficacy was not over 90 compared to an overall efficacy of the exhaustive X of only about 51 is there any data surrounding immunocompromised individuals and the use of shingles there are some data and there will be more coming there was one recent article that was published looking at the use of it in autologous stem cell transplant patients, and it was shown to reduce the risk of shingles compared to placebo, so I think that even though it might be off-label one could consider vaccinating immunocompromised...
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