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Seasonal flu vaccination programme (2010/2011)

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Seasonal flu vaccination programme (2010/2011) September 2010 Dr Syed Ahmed Consultant in Public Health Medicine and Immunisation Coordinator NHS Greater Glasgow and ... – PowerPoint PPT presentation

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Title: Seasonal flu vaccination programme (2010/2011)


1
Seasonal flu vaccination programme (2010/2011)
  • September 2010
  • Dr Syed Ahmed
  • Consultant in Public Health Medicine
  • and Immunisation Coordinator
  • NHS Greater Glasgow and Clyde

2
Seasonal flu vaccination programme 2010-2011
  • Background information about flu viruses
  • Epidemiology of Flu A viruses
  • Vaccines against flu viruses and their
    indications and safety
  • Rationale for policy in 2010/11 flu season
  • Programme implementation issues and good practice
    guidance

3
Influenza viruses three types
  • Type A
  • Causes epidemics and pandemics
  • 3 pandemics in the last century in 1918, 1957,
    1968 and the latest in 2009
  • Type B
  • Do not cause pandemics but may cause localised
    epidemics
  • Type C
  • Do not cause pandemics or epidemics
  • Minor respiratory illness only

4
Influenza A viruses (1)
  • 1918 pandemic by H1N1 and became the established
    Flu A until 1956
  • 1957 pandemic by H2N2 and became the established
    Flu A until 1967
  • 1968 pandemic by H3N2 and became the established
    Flu A until 1976

5
Influenza A viruses (2)
  • 1977 outbreaks of H1N1 (Red Flu) but did not
    cause a pandemic and did not replace H3N2
  • From 1977 to 2008 a combination of H3N2 and H1N1
    (Red Flu) in circulation
  • 2009 pandemic by H1N1 (2009)
  • Which Flu A is going to be the dominant strain
    from 2010?

6
Flu A lessons from the Southern Hemisphere
  • In 2010 winter
  • In Chile, mainly H1N1 (2009) in peak winter
    (June/July) but also emergence of H3N2 in late
    winter (Aug/Sept)
  • In Australia, mainly H1N1 (2009)
  • In New Zealand, mainly H1N1 (2009)
  • In South Africa, mainly H3N2 in early winter but
    increasing proportion of H1N1 (2009) in late
    winter.

7
Influenza A virus in 2010/2011?
  • ?Best guess
  • Flu A viruses behaviour
  • Experience from Southern Hemisphere
  • In the Northern Hemisphere probably main Flu A
    would be H1N1 (2009) but also H3N2.

8
Influenza Vaccine (2010/2011)
  • Trivalent (seasonal flu) vaccine
  • Flu A H1N1 (2009) strain
  • Flu A H3N2 strain
  • Flu B
  • Monovalent H1N1 (2009) vaccine available since
    2009

9
Trivalent Seasonal Flu (2010/2011) and monovalent
H1N1 (2009) vaccines (1)
  • Trivalent seasonal flu vaccine
  • traditional flu vaccine
  • Protect against 3 different flu strains
  • No adjuvant present
  • Give short term protection
  • Poor immunological response to children under 5
    years, those immunocompromised and older people
  • Tried and tested technology
  • Long track record on safety
  • Easy to deliver as come in single dose prefilled
    syringe

10
Trivalent Seasonal Flu (2010/2011) and monovalent
H1N1 (2009) vaccines (2)
  • Monovalent H1N1 (2009) vaccine
  • Protects against only single strain
  • Has adjuvant in it with longer protection
  • Initial concern about safety as brought in
    quickly to stem pandemic last year
  • Tenuous historical links between previous swine
    flu vaccine and Guillain-Barré syndrome
  • Comes in 10 dose vial with thiomersal
  • BUT
  • Over 6 million doses used in the UK including in
    pregnant women
  • Immunologically better response including in
    children under 5 and those immunocompromised.

11
Epidemiology/SurveillanceDistribution by age
group of influenza hospitalised casesEmerging
Infections Programme Pandemic H1N1 - 14 July
2009 in the USA
12
Influenza A risk factors for severe
complications
  • Flu A (H3N2)
  • Underlying chronic conditions
  • Predominantly affect older age groups
  • Immunocompromised individuals
  • Flu A (H1N1) 2009
  • Underlying chronic conditions
  • Predominantly affect younger age groups
  • Immunocompromised individuals
  • Pregnant women
  • Metabolic abnormality, eg obesity

13
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14
Pregnant Women and H1N1 (2009)
  • ANZIC Influenza Study Investigators carried out a
    detailed study of all critically ill patients in
    Australia and New Zealand with H1N1 infection,
    specially looked at pregnant and postpartum women
  • Pregnant women around 7x higher risk of admission
    to intensive care compared with non-pregnant
    women of childbearing age
  • 69 of pregnant women admitted to intensive care
    needed mechanical ventilatory support
  • Mortality for these critically ill pregnant women
    was 11 (33 for those requiring ECMO) and foetal
    loss was 12

15
Flu vaccination policy for 2010/2011 winter season
  • Those in at risk groups need protection from
    both H1N1 and H3N2
  • Pregnant women not in the at risk groups need
    protection mainly from H1N1 (for short term only)
  • Over 65s mainly need protection against H3N2
  • For immunocompromised and children under 5
    monovalent H1N1 vaccine gives much better
    protection against H1N1 (2009) than the trivalent
    vaccine.

16
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17
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18
Group 1 Summary
  • Not in high risk groups for H1N1 complications
  • Need one dose of trivalent vaccine to protect
    against all 3 strains

19
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20
Group 2 Summary
  • Children under 13 years need two doses of the
    trivalent seasonal flu vaccine if no seasonal flu
    vaccine in previous years
  • Children under 5 years need a single dose of
    monovalent H1N1 if they have not received a
    previous H1N1 as they do not respond well to
    trivalent flu vaccine

21
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22
Group 3 Summary
  • All immunocompromised patients need a dose of
    monovalent H1N1 vaccine if they have not had it
    previously to protect them against H1N1 (2009)
  • All immunocompromised under 13 years need two
    doses of trivalent flu vaccine if they had no
    previous seasonal flu vaccine
  • All immunocompromised over 13 years only need one
    dose of trivalent flu vaccine

23
Immunosuppressed individuals
  • As detailed in the Green Book
  • Due to disease or treatment
  • Patients undergoing chemotherapy
  • Asplenia or splenic dysfunction
  • HIV patients
  • Individuals on systemic steroids for more than a
    month at a dose equivalent to Prednisolone at
    20mg or more per day, or children under 20kgs at
    a dose of 1mg or more/kg/day

24
Immunosuppressed individuals
  • ? Patients on DMARD
  • Single dose unless evidence of immunosuppression

25
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26
Group 4 Summary
  • No monovalent H1N1 vaccine for pregnant women
    from October 2010 as they respond well to
    trivalent vaccine and also only need short term
    protection
  • Pregnant women in clinical at risk groups need a
    dose of trivalent flu vaccine
  • Pregnant women NOT in clinical risk groups ALSO
    need a dose of trivalent flu vaccine UNLESS they
    have already had a dose of H1N1, as they mainly
    need protection against H1N1.

27
Flu vaccines safety data
  • H1N1 monovalent vaccine contains thiomersal and
    adjuvant but over 6 million doses given last year
    with no safety concerns
  • Thiomersal adjuvants used in vaccines for over 60
    years and found to be safe
  • Seasonal flu vaccines have a long safety record
  • No increase in Guillain-Barré syndrome in the UK
    last year after H1N1 vaccination
  • Both H1N1 and trivalent vaccine found to be safe
    in pregnant women

28
Flu vaccine contraindications
  • Previous life-threatening allergic reaction to
    flu vaccines
  • Life-threatening reaction to any components of
    the vaccines
  • If severe life-threatening allergic reaction to
    egg and egg products

29
Flu vaccines adverse reactions
  • Headache, fatigue, fever, arthralgic myalgia,
    pain and redness at injection site
  • A small painless nodule may also form at the
    injection site
  • Enzira or CSL Biotherapies Generic Influenza
    vaccines should not be given to under 5s as
    higher than expected increase in febrile
    convulsions in Australia.
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