Influenza Vaccine Are We In The Same Page?

Jehad Abdalla.M.D Infectious Diseases Consultant

Al Rahba HospitalAbu Dhabi - UAE

Objectives.• Recognize Influenza types and characteristics .• Recognize Influenza serious complications• Recognize how influenza spreads in hospitals.• Recognize importance of Influenza vaccine in preventing

influenza infection.• Recognize importance of mandatory Influenza vaccine among

HCW.

•

Remembering the 1918 Influenza Pandemic

The 1918 Influenza Pandemic

• This year marks the 100th anniversary of the 1918 influenza (flu) pandemic that swept the globe in what is still one of the deadliest disease outbreaks in recorded history

• CAN YOU GUESS HOW MANY PEOPLE DIED ?

Marks the 100th anniversary

The 1918 Influenza Pandemic

• At least 50 million deaths worldwide

• More people died during the 1918 pandemic than the total number of military and civilian deaths in World War I

• An estimated 1/3 of the world’s population was infected with the 1918 flu virus

Marks the 100th anniversary

life expectancy is 54 years of age for

women and 48 years of age for

men

Spring and fall waves of influenza (”flu”) activity cause the average life

expectancy in the United States to fall by 12 years.

42 female and 36 the male

Third wave of pandemic flu activity occurs.

Pandemic subsides, but virus (H1N1) continues to circulate seasonally for 38

years.

First isolation of influenza, proving that flu is caused by a virus not a

bacterium

H2N2 flu virus emerges to trigger a pandemic, replacing

the 1918 H1N1 pandemic virus.

The U.S. Public Health Service recommends annual flu vaccination for people at high risk of serious flu

complications.

H3N2 flu virus emerges to trigger a pandemic, replacing

H2N2 virus

Genome of the 1918 pandemic flu virus is fully

sequenced

H1N1 viruses distantly related to the 1918 virus emerge to trigger a pandemic.

Let us wake you up !

•An old person above the age of 65 should not take Influenza vaccine ?

• If I have egg allergy I can not take Influenza vaccine ?

Let us wake you up !

• If I develop face swelling and breathing problem after an

• Influenza vaccine , then I should not take it again?

Let us wake you up !

• Influenza can kill only people with weak immunity ?

Let us wake you up !

A, B and C influenza viruses

• Influenza A and B viruses cause seasonal epidemics, while type C viruses cause mild respiratory illness

• Influenza B viruses can be classified into two antigenically distinct lineages, Yamagata and Victoria like viruses

• Influenza A and B strains are included in each year's influenza vaccine

• The vaccine does not protect against influenza C viruses

Influenza Types – A and B

Type A (Seasonal, Avian, Swine influenza) Type B (Seasonal influenza)

Can cause significant disease Generally causes milder disease but may also cause severe disease

Infects humans and other species (e.g. birds; H5N1 or Swine; H1N1)

Limited to humans

Can cause epidemics and pandemics (worldwide epidemics)

Generally causes milder epidemics

Signs and symptoms of influenza

• Sudden onset

• Headache, fever ,chills and cough, followed rapidly muscle aches and fatigue.

• Also runny nose, sneezing, watery eyes and throat irritation

• Nausea, vomiting and diarrhea may also occur, especially in children

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How serious is influenza?

Complications can include

• Pneumonia (bacterial and viral)

• Ear and sinus infections

• Dehydration

• Worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes

Burden of Seasonal Influenza • Prevalence

• Annual global attack rate estimated at

• 5-10% in adults

•20-30% in children

• Complication

• WHO estimates that 290 000 - 650 000 respiratory deaths occur each year associated to seasonal influenza

• Up to 3 to 5 million cases of severe illness

• Annual cost of Influenza

Annual cost of Influenza in the USA is $ 8.3 billion

• Reference: *McLaughlin, JM., Tan, L., et al. 2015. J Prim Prev. 2015 Aug;36(4):259-73: Estimated Human and Economic Burden of Four Major Adult Vaccine-Preventable Diseases in the United States, 2013

Influenza Mortality-Abu Dhabi DOH Influenza Report

How serious is the issue of influenza vaccine ?

• The CDC (US) conducted a study to assess the effectiveness of influenza vaccine in decreasing influenza related deaths in children (6 months to 17 years of age)

• Between July 2010 and June 2014, 358 children died from infection with influenza; researchers were able to confirm the vaccine status of 291 of these children.

• Of the 291 children 74% were unimmunized .

• Flannery B, Reynolds SB, Blanton L, et. al. Influenza Vaccine Effectiveness Against Pediatric Deaths. Pediatrics. 2017. DOI: 10.1542/peds.2016-4244).

-The study concluded that influenza vaccination was associated with reduced risk of laboratory-confirmed influenza-associated pediatric death .-Influenza vaccination could prevent influenza associated deaths among children and adolescents

Influenza-Epidemiology

• All age groups can be affected influenza.

• People at greater risk of severe disease or complications are:

• Children younger than age 2 years

• Adults aged 65 years or older

• Pregnant women

• People of any age with medical conditions such as chronic heart, lung, kidney, liver, blood, diabetes or weakened immune systems

Influenza-Epidemiology

• Health care workers are at high risk of acquiring influenza virus infection due to increased exposure to the patients and risk further spreadparticularly to vulnerable individuals.

Timing of Vaccine

• Optimally, vaccination should occur before onset of influenza activity in the community.

• Vaccination should be offered by September, if possible.

• Vaccination should be offered as long as influenza viruses are circulating and unexpired vaccine is available.

• Children aged 6 months through 8 years who require 2 doses should receive their first dose as soon as possible after vaccine becomes available, and the second dose ≥4 weeks later.

• https://www.cdc.gov/flu/professionals/acip/2017-18summary.htm

Pregnant Women

• All women who are pregnant or who might be pregnant during the influenza season should receive influenza vaccine.

• Any licensed, recommended, influenza vaccine may be used.

• Influenza vaccine can be administered at any time during pregnancy, before and during the influenza season

Immunocompromised Persons

• Immunocompromised persons should receive an age-appropriate vaccine

• Immune response to vaccines might be blunted in immunocompromised persons.

• Timing of vaccination might be a consideration (e.g., in some period before or after an immunocompromising intervention).

Persons with a History of Egg Allergy

• Persons who are able to eat lightly cooked egg (e.g., scrambled egg) without reaction are unlikely to be egg-allergic.

• Persons who have experienced only hives after exposure to egg should receive any licensed, recommended, age-appropriate influenza vaccine

• Persons reporting symptoms other than hives, vaccine should be administered in an inpatient or outpatient medical setting and supervised by a health care provider who is able to recognize and manage severe allergic conditions.

Severe allergic reaction to influenza vaccine

• A previous severe allergic reaction to influenza vaccine( such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention) is a contraindicationto future receipt of the vaccine

How influenza spread?

• from a person to person when those with influenza cough or sneeze (droplet spread) .

• The droplets are propelled about one meter through the air.

• People may also become infected by touching an object or a surface that has the influenza virus on it and then touching their mouth, eyes or nose

•

One meter

The time period from exposure to development of symptoms is about 1 to 4 days, with an average of about 2 days

For How Long Contagious ?

• The period when an infected person is contagious depends on the age and health of the person

• Young children and people with weakened immune systems may be contagious for longer than a week

Flu Myths & Facts

• Vaccines can be dangerous and may have adverse health effects

Almost all people who get an influenza vaccine do not experience serious problems. • My have sore arm. • May also experience fever, muscle pain, and feelings of discomfort or weakness. • If experienced at all, these side effects typically last 1-2 days after vaccination and are much

less severe than actual flu illness

The flu vaccine can cause the flu

Flu Myths & Facts

The flu vaccine is an inactivated (killed), therefore, the flu vaccine cannot cause the flu. However, it typically takes two weeks for the flu vaccine to become effective. During those two weeks, it is still possible for an individual to get the flu or another respiratory virus

Healthy people don’t need a flu vaccine

Flu Myths & Facts

-Anyone can get the flu; even young , healthy people are at risk.-Getting vaccinated every year is important, regardless of how healthy a person is. -Vaccination can help prevent the spread of the virus to others who are more vulnerable to the flu and related complications

• Immune protection from the flu vaccine declines over time, so annual vaccination is critical to provide the best protection.

• The vaccine may change each year to match circulating flu viruses, it is important to get vaccinated each year.

Flu Myths & Facts

Flu vaccination is not necessary each year

Flu Myths & Facts

The flu is nothing more than just a bad cold

-Flu is distinct from bad cold-it’s more serious, and can cause high fever, head and body aches, and severe fatigue for up to two weeks or more -Flu can also lead to more serious complications and even death

Asymptomatic spread !! • Those infected can be contagious

before any signs of the flu are present.

• Individuals with influenza are infectious 1 day before symptoms develop and up to 5 days after becoming ill.

• Some people can be infected but have no symptoms ,these individuals can still spread the virus to others

Asymptomatic Influenza infection among HCW

• In one published study, 59% of health care workers tested had evidence of recent influenza infection but could not recall having symptoms.

Effectiveness of influenza vaccine

• Depends on the similaritybetween vaccine strains and the strains in circulation during influenza season, as well as individual factors.

• Influenza immunization prevents disease in 45-85% of healthy individuals.

Effectiveness of influenza vaccine

• A vaccine that is not perfectly matched can still offer protection against related viruses making illness milderand preventing complications

Effectiveness of influenza vaccine in the elderly

Effectiveness is about half of that of healthy adults; however influenza immunization decreases the incidence of pneumonia, hospital admission and death in the elderly.

Why annual vaccine ?

• First, the body’s immune response from vaccination declines over time, so an annual vaccine is needed for optimal protection.

• Second, Influenza viruses are constantly changing, the formulation of the flu vaccine is reviewed each year and sometimes updated to keep up with changing flu viruses.

Does flu vaccine work right away?

•No

• It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection.

• That’s why it’s better to get vaccinated early in the fall, before the flu season really gets under way

Health Care Workers

• Health care workers (HCWs) who have direct patient contact should consider it their responsibility to provide the highest standard of care, which includes annual influenza immunization

• In the absence of contraindications, refusal of HCWs who have direct patient contact to be immunized against influenza implies failure in their duty of care to patients

Facts about influenza vaccine for healthcare workers

• Most cases for influenza vaccine addiction by healthcare workers are based on wrong information or misunderstanding.

• The most common reason reported for not getting vaccinated was that they don’t think that flu vaccines work.

• The second most common reason was that they don’t need the vaccine.

Reasons HCW decline influenza vaccination:

• Misconception that vaccination can cause influenza (10-45%).

• Fear of adverse events (8-54%).

• Times/locations of vaccination were unsuitable (6-59%).

• Perception that they are not at risk (6-58%).

• Fear of injections (4-26%).

• Lack of vaccine efficacy (3-32%)

• Doubt that influenza is a serious disease (2-32%).

Hoffman et al. Infection, 2005; 34:142-147

Mandatory Vaccine :

Influenza-Prevention

• Vaccination is the most effective way to prevent the disease

Follow proper infection control practice

Regular hand hygiene

Good respiratory hygiene

Early self-isolation of those having influenza symptoms

Avoid close contact with sick people

THANK YOU

References• Centers for Disease Control and Prevention. Key Facts About Seasonal Influenza (Flu). Centers for Disease Control and

Prevention. March 11, 2013.

• Gu Y, Komiya N, Kamiya H, Yasui Y, Taniguchi K, Okabe N. Pandemic (H1N1) 2009 transmission during presymptomaticphase, Japan. Emerg Infect Dis. 2011 Sep. 17(9):1737-9. [

• Guharoy R, Gilroy SA, Noviasky JA, Ference J. West Nile virus infection. Am J Health Syst Pharm. 2004 Jun 15. 61(12):1235-41.

• Jefferson T, Di Pietrantonj C, Rivetti A, Bawazeer GA, Al-Ansary LA, Ferroni E. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2010 Jul 7. CD001269.

• Brooks M. FDA Okays 4-Strain Seasonal Influenza Vaccine. Medscape Medical News. December 17, 2012. March 5, 2013.

• FDA approves first quadrivalent vaccine to prevent seasonal influenza. US Food & Drug Administration, February 29, 2012. March 11, 2013.

• FDA Approves First U.S. Vaccine for Humans Against the Avian Influenza Virus H5N1. Center for Disease Control and Prevention.March 11, 2013.

• [Guideline] Grohskopf LA, Sokolow LZ, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices-United States, 2018-19 Influenza Season. MMWR Recomm Rep. 2018 Aug 24. 67 (3):1-20.

References

• Flu Vaccine and People with Egg Allergies. Centers for Disease Control and Prevention (CDC2016 Sep 2; August 16, 2017.

• Lee V, Yap J, Cook AR, et al. Effectiveness of public health measures in mitigating pandemic influenza spread: a prospective sero-epidemiological cohort study. J Infect Dis. 2010 Nov 1. 202 (9):1319-26.

• Kilbourne ED. Influenza pandemics of the 20th century. Emerg Infect Dis. 2006 Jan. 12(1):9-14.

• Seasonal Influenza (Flu): Guidance for Clinicians on the Use of RT-PCR and Other Molecular Assays for Diagnosis of Influenza Virus Infection. Centers for Disease Control and Prevention. March 13, 2013.

• Gubareva LV, Kaiser L, Hayden FG. Influenza virus neuraminidase inhibitors. Lancet. 2000 Mar 4. 355(9206):827-35.

• Drake JW. Rates of spontaneous mutation among RNA viruses. Proc Natl Acad Sci U S A. 1993 May 1. 90(9):4171-5.

• Avian influenza ("bird flu"): fact sheet. World Health Organization. August 14, 2012.