Injectable Flu

Choices & Challenges in VaccinologyDr Gaurav Gupta,

Charak Clinics, Mohali

How to choose a vaccine ?

• Effectiveness• High risk categories• Side-effects• Availability• Indian Studies• Dosage Schedule• Ease of administration• Cost

Effectiveness

• Burden of Influenza is significantly higher in developing countries as compared to developed countries• The ‘swine flu’ or ‘A(H1N1)’ pandemic is on the wane but the virus continues to

circulate causing sporadic outbreaks even in 2013.• IAP recommends the ideal time for offering influenza vaccines is just before the

onset of rainy season.• The IAP maintains its earlier recommendations of using the current trivalent

inactivated influenza vaccine in all children with risk factors but not as a universal measure.

• The children below 2 years of age should be considered a target group for influenza immunization because of a high burden of severe disease in this group.

Availability

• IIV – Multiple Manufacturers, Year around availability virtually guaranteed (North & Southern Hemisphere Strain)

• LAIV – Single manufacturer – may lead to limited availability

Indian Data with IIV (Comparing VE 2008-09 to 2009-10)

Fully vaccinated (154) vs Unvaccinated Cohort (330) (2009-10)

# Parameter RR CI p value VE (%)

1 ILI 0.58 0.24-0.92 0.009 42

2 Unsch. Visit 0.71 0.33-1.09 0.039 29

Fully vaccinated (101) vs Unvaccinated Cohort (141) * (2008-09)

# Parameter RR CI p value VE (%)

1 ILI 0.57 0.32-0.09 0.05 43

2 Unsch. Visit 0.43 0.22-0.09 0.007 57

* Singh H, Gupta G, Tiwari P. Clinical effectiveness of the 2009-2010 seasonal influenza vaccine among healthy Indian children. ISPOR 4th Asia Pacific Conference, Phuket, Thailand.

Ease of Use

Most important reason to avoid IIV

How to choose a Flu vaccine ?Characteristics IIV (Injectable Flu) LAIV (Nasal Flu)

Effectiveness Proven Limited data

Use in high risk categories Yes No / Limited data

Use in extreme ages Yes No

Side-effects Lesser Slightly more

Availability All around the year Limited (Single manufacturer)

Indian data Yes, Limited Only for H1N1 Monovalent

Ease of administration Easier – PFS, Injection

Takes time to create, Longer to give

Dosage Schedule Same Same

Cost Same Same

The choice is yours!