Influenza Disease & Vaccination: Current Perspective with special reference to India<br />Dr. Gaurav Gupta, Practising Ped...
Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemic...
Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemic...
H1<br />H1N1<br />A<br />16 HA proteins<br />H2<br />H1N2<br />Orthomyxoviridae family<br />B<br />H2N1<br />N1<br />9 NA ...
Influenza A is divided into subtypes based on the HA and NA proteins
HA and NA genes can be reassorted (switched) between strains generating novel subtypes</li></ul>Different influenza A subt...
Influenza infection has a variety of symptoms! <br />Clinical symptoms<br />Influenza infections are asymptomatic in30–50%...
Clinical Differentiation Between the Common Cold and the Flu<br />The following symptoms are more commonly seen in influen...
Influenza viruses are spread by virus-laden aerosols! <br />How influenza viruses are spread:<br />From person to person p...
Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemic...
Influenza virus changes due to antigenic drift or shift!<br />Antigenic drift<br />Antigenic shift<br />NA<br />HA<br />NA...
1918Spanish<br />1957<br />Asian<br />1968<br />Hong Kong<br />1977<br />Russian<br />1999<br />Hong Kong<br />1997<br />H...
Transmission dynamics are described using the reproductive number (R0) and case fatality ratio, which may vary depending o...
Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemic...
Swine<br />New Reassorted<br />virus<br />Emergence of Swine Flu Virus<br />Avian <br />virus<br />Avian <br />Reservoir<b...
Pandemic H1N1 rapidly spread worldwide: April 2009<br />April 2009<br />START<br />March 2009<br />Cumulative cases <br />...
Phase 4 of pandemic alert was declared on 27 April, and Phase 5 on 29 April
By 30 April, 257 cases including eight deaths had been reported in 11 countries</li></ul>WHO, H1N1 number of laboratory co...
Pandemic H1N1 rapidly spread worldwide: May 2009<br />April 2009<br />May 2009<br />START<br />March 2009<br />Cumulative ...
Pandemic Influenza : Status in 2010<br />http://www.who.int/csr/don/2010_07_09/en/index.html<br />
Influenza virological Surveillance (ILI) from 1st week Dec 2010 till now<br />http://gamapserver.who.int/GlobalAtlas/share...
Influenza : % positive cases & virus subtypes<br />http://www.who.int/csr/don/2010_07_09/en/index.html<br />
Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemic...
Seasonal Influenza : elevated risk for complications is associated with both age extremes! <br />Infection rates for seaso...
Complication rate higher for subjects with chronicheart disease (46.9%) vs. those without (22.8%)4</li></ul>In hospitalize...
The majority of pandemic H1N1 cases have occurred in subjects <20 years of age!<br />Seasonal influenza attack rates and p...
Age sex pattern of H1N1 cases in India<br />http://mohfw-h1n1.nic.in/documents/PDF/EpidemiologicalTrendsInIndia.pdf<br />
Win – Win Situation vaccinating Pregnant Women<br />ACIP/ CDC/ ACOG recommend Flu vaccination during pregnancy<br />Can be...
Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemic...
Methodology-Clinical Effectiveness Study<br />25<br />
Continued…..<br />Methodology-Clinical Effectiveness Study<br />26<br />
Continued…..<br />Methodology-Clinical Effectiveness Study<br />27<br />
Overall Results<br />
Clinical Effectiveness of Influenza vaccine-1<br />Fully vaccinated cohort (n=154) vs. Unvaccinated cohort (n=330)*<br />C...
Clinical Effectiveness of Influenza vaccine-2<br />Partially vaccinated cohort (n=16) vs. Unvaccinated cohort (n=330)*<br ...
Clinical Effectiveness of Influenza vaccine-3<br />Age-wise efficacy for prevent of ILI*<br />Conclusion: Children aged 3-...
Comparative Vaccine Effectiveness <br />* Singh H, Gupta G, Tiwari P. Clinical effectiveness of the 2009-2010 seasonal inf...
Safety and Tolerability of Influenza vaccine-1<br />Singh H, Gupta G, Tiwari P. Safety and tolerability of trivalent inact...
Safety and Tolerability of Influenza vaccine-2<br />*Singh H, Gupta G, Tiwari P. Safety and tolerability of trivalent inac...
Pandemic influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and...
Influenza Vaccines are representative of  virus strains circulating in India as well<br />WHO Influenza Global Surveillanc...
Currently, WHO have 128 institutions from 99 countries as recognized National Influenza centers</li></ul>Objectives:<br />...
Pandemic Flu protection added to Seasonal flu vaccine<br />WHO Influenza strain for Northern Hemisphere 2010 – 2011 season...
ACIP Recommendations for seasonal Influenza vaccination 2010-11<br />1. A recommendation that annual vaccination be be adm...
! Have chronic pulmonary, cardiovascular, renal, hepatic, cognitive, neurologic/neuromuscular,
hematological or metabolic disorders (including diabetes mellitus)
! Are immunosuppressed (Caused by medications or by HIV)
! Are receiving long-term aspirin therapy and therefore might be at risk for experiencing Reye syndrome after influenza va...
! Are residents of long-term care facilities; and
! Will be pregnant during the influenza season.</li></ul>Source: CDC recommendation available at http://www.cdc.gov/flu<br />
Pandemic influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and...
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Seasonal influenza - current perspective with special reference to India - aug 2011

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This presentation is more for the general doctors, including Ob/gyn, medical specialists etc. and was formulated as a presentation for Chandigarh Nursing Home Association meeting in Aug 2011 using material provided by Chiron/ Novartis

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Seasonal influenza - current perspective with special reference to India - aug 2011

  1. 1. Influenza Disease & Vaccination: Current Perspective with special reference to India<br />Dr. Gaurav Gupta, Practising Pediatrician<br /> Member AAP, IAP<br /> Charak Clinics, Mohali, Punjab<br />
  2. 2. Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccine – Data from Chandigarh<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  3. 3. Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccine – Data from Chandigarh<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  4. 4. H1<br />H1N1<br />A<br />16 HA proteins<br />H2<br />H1N2<br />Orthomyxoviridae family<br />B<br />H2N1<br />N1<br />9 NA proteins<br />C<br />H2N2<br />N2<br />Influenza virus has several subtypes!<br />Influenza is a member of the Orthomyxoviridae family of viruses <br /><ul><li>Influenza A and B cause seasonal epidemics, C mainly causes mild respiratory illness
  5. 5. Influenza A is divided into subtypes based on the HA and NA proteins
  6. 6. HA and NA genes can be reassorted (switched) between strains generating novel subtypes</li></ul>Different influenza A subtypes result from differentcombinations of the HA and NA proteins<br />HA, hemagglutinin; NA, neuraminidase<br />
  7. 7. Influenza infection has a variety of symptoms! <br />Clinical symptoms<br />Influenza infections are asymptomatic in30–50% of cases<br />Common symptoms include abrupt onset of fever (38–40°C), sore throat, unproductive cough, runny or stuffy nose, headache, myalgia, chills, anorexia and extreme fatigue<br />Uncommon symptoms include photophobia, abdominal pain and diarrhea<br />Illness improves in under 7 days, cough and malaise may persist for weeks<br />Children may experience high fevers that can lead to febrile seizures<br />Fever may be absent in the elderly; presenting signs may include anorexia, lassitude or confusion<br />Virus shedding<br />Adults: from the day before symptoms appear until 5 days after illness onset <br />Young children: several days before illness onset until >10 days afterwards <br />Severely immunocompromised patients: weeks to months<br />Influenza virus particles (brown) invade cilia (blue) in the airways<br />Symptoms associated with seasonal influenza are well defined and can vary between individuals<br />Zambon MC. J Antimicrob Chemother 1999; 44 (Suppl. B):3-9; CDC, Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR Recomm Rep 2007; 56:1-54.<br />
  8. 8. Clinical Differentiation Between the Common Cold and the Flu<br />The following symptoms are more commonly seen in influenza rather than the common cold:<br />High fever lasting 3 to 4 days<br />Headache<br />Myalgia<br />Fatigue and weakness<br />Extreme exhaustion<br />Severe chest discomfort and cough<br />The following symptoms are more commonly seen in the common cold rather than influenza:<br />Stuffy nose is common<br />Sneezing is common<br />Cough is generally mild to moderate<br />Symptoms such as fever, headache, aches and pains and exhaustion are rare in those with colds.<br />
  9. 9. Influenza viruses are spread by virus-laden aerosols! <br />How influenza viruses are spread:<br />From person to person primarily through large-particle respiratory droplet transmission<br />Requires close contact betweensource and recipient as droplets only travel <1m<br />By contact with surfaces contaminated with respiratory droplets<br />By airborne transmission of evaporated droplets that may remain in the air for long periods of time (data are limited)<br />Virus transmission may be slowed by social distancing<br />CDC, Epidemiology and prevention of vaccine-preventable diseases. Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds. 10th ed. Washington DC: Public Health Foundation; 2007:235-56; Rust MJ, et al.Nat Struct Mol Biol 2004; 11:567-573; CDC, Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR Recomm Rep 2007; 56:1-54.<br />
  10. 10. Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccine – Data from Chandigarh<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  11. 11. Influenza virus changes due to antigenic drift or shift!<br />Antigenic drift<br />Antigenic shift<br />NA<br />HA<br />NA<br />HA<br />A/H1N2<br />Geneticmutations<br />A/H1N1<br />A/H1N1<br />Geneticressortment<br />A/H3N2<br />A/H3N1<br />Antigenic drift occurs when there are small changes in the virus <br />Antigenic drift produces new virus clades that may not be recognized by the immune system, meaning reinfection can occur<br />Drifted strains may be mismatched with seasonal influenza vaccine<br />Antigenic shift is a major change in the influenza A virus, altering the HA and/or NA proteins<br />Antigenic shift leads to the emergence of a new influenza A subtype<br />Most people have little or no protection against the new virus<br />Antigenic drift can lead to epidemics; antigenic shift can lead to pandemic influenza<br />Cox NJ, Subbarao K. Annu Rev Med 2000; 51:407-421; Zambon MC. J Antimicrob Chemother 1999; 44 (Suppl. B):3-9; Koelle K, et al. Science 2006; 314:1898-1903.<br />
  12. 12. 1918Spanish<br />1957<br />Asian<br />1968<br />Hong Kong<br />1977<br />Russian<br />1999<br />Hong Kong<br />1997<br />Hong Kong<br />2003-2008<br />Global<br />2003<br />Dutch<br />2009<br />Global<br />H1N1<br />H2N2<br />H3N2<br />H1N1<br />H9N2<br />H5N1<br />H7N7<br />H5N1<br />H1N1<br />2 cases<br />18 cases <br />82 cases<br />387 cases<br />~30,000 cases<br />>50 million deaths<br />~2 million deaths<br />~1 million deaths<br /><1 million deaths<br />Six deaths<br />One death<br />245 deaths<br />145 deaths<br />1918<br />1957<br />1977<br />2000<br />2008<br />1968<br />2009<br />Pandemic outbreaks<br />Pandemic<br />Recent outbreaks of influenza <br />Influenza pandemics & emerging new pandemic threats exist since 1900!<br /><ul><li>The circulation of H5N1 in poultry and its high fatality rate have raised concerns over an H5N1 pandemic if this virus acquires the capacity for sustained human-to-human transmission
  13. 13. Transmission dynamics are described using the reproductive number (R0) and case fatality ratio, which may vary depending on country and season </li></ul>The emergence of H1N1 has demonstrated the difficulty in predicting pandemics<br />Nicholson KG, Wood JM, Zambon M. Lancet 2003; 362:1733-1745; WHO, Cumulative number of confirmed human cases of avian influenza A/(H5N1), available at: http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_09_10/en/index.html(accessed 5 November 2008); CDC, Avian Influenza, available at: http://www.cdc.gov/flu/avian/outbreak.htm (accessed 5 November 2008).<br />
  14. 14. Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccine – Data from Chandigarh<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  15. 15. Swine<br />New Reassorted<br />virus<br />Emergence of Swine Flu Virus<br />Avian <br />virus<br />Avian <br />Reservoir<br />Human<br /> virus<br />Other <br />mammals?<br />
  16. 16. Pandemic H1N1 rapidly spread worldwide: April 2009<br />April 2009<br />START<br />March 2009<br />Cumulative cases <br />1-10<br />11-50<br />51-500<br />>500<br /><ul><li>The H1N1 pandemic was first reported by the US and Mexico on 26 April 2009
  17. 17. Phase 4 of pandemic alert was declared on 27 April, and Phase 5 on 29 April
  18. 18. By 30 April, 257 cases including eight deaths had been reported in 11 countries</li></ul>WHO, H1N1 number of laboratory confirmed cases, available at http://gamapserver.who.int/h1n1/atlas.html (accessed 30 April 2009); WHO, H1N1 cases, situation update 6, available at http://www.who.int/csr/don/2009_04_30_a/en/index.html (accessed July 2009).<br />
  19. 19. Pandemic H1N1 rapidly spread worldwide: May 2009<br />April 2009<br />May 2009<br />START<br />March 2009<br />Cumulative cases <br />1-10<br />11-50<br />51–500<br />500-5,000<br />>5,000<br />29 May *, 15,510 cases including 99 deaths reported by 53 countries<br />* Date of last report for May 2009. WHO, H1N1 number of laboratory confirmed cases, available at: http://gamapserver.who.int/h1n1/atlas.html (accessed 29 May 2009); WHO, H1N1 cases situation update 41, available at http://www.who.int/csr/don/2009_05_29/en/index.html (accessed July 2009).<br />
  20. 20. Pandemic Influenza : Status in 2010<br />http://www.who.int/csr/don/2010_07_09/en/index.html<br />
  21. 21. Influenza virological Surveillance (ILI) from 1st week Dec 2010 till now<br />http://gamapserver.who.int/GlobalAtlas/sharedFunction/sharedFunctionInterface.asp?displayType=map<br />
  22. 22. Influenza : % positive cases & virus subtypes<br />http://www.who.int/csr/don/2010_07_09/en/index.html<br />
  23. 23. Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of current pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccine – Data from Chandigarh<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  24. 24. Seasonal Influenza : elevated risk for complications is associated with both age extremes! <br />Infection rates for seasonal influenza are highest among children1<br />Elderly are at high risk of complications from seasonal influenza<br /><ul><li>Exacerbation of underlying chronic pulmonary and cardiovascular diseases3
  25. 25. Complication rate higher for subjects with chronicheart disease (46.9%) vs. those without (22.8%)4</li></ul>In hospitalized children:<br />Febrile seizures reported by 6-20%1<br />Intensive care required by 4-11%1<br />80% were <5 years of age; 27% were <6 months of age1<br />Cumulative hospitalization rates for laboratory-confirmed influenza among children 0-4 and 5-17 years of age, by season, US2<br />Annual rates of influenza-associated cardiorespiratory hospitalizations in those ≥50 years of age, US5<br />Age range (years)<br />Season<br />1,000<br />5<br />2004-05 0-4<br />2005-06 0-4<br />2006-07 0-4<br />2007-08 0-4<br />800<br />4<br />600<br />3<br />Hospitalization rate per 10,000 person-years<br />2004-05 5-17<br />2005-06 5-17<br />2006-07 5-17<br />2007-08 5-17<br />Population-based rate<br />2<br />400<br />1<br />200<br />0<br />0<br />50-64<br />65-69<br />70-74<br />75-79<br />80-84<br />40<br />42<br />44<br />46<br />48<br />50<br />52<br />2<br />4<br />6<br />8<br />10<br />12<br />14<br />16<br />18<br />Age (years)<br />Week<br />1. CDC, 2010 Yellow Book, available at http://wwwn.cdc.gov/travel/yellowbook/2010/chapter-2/influenza-seasonal-avian-pandemic.aspx (accessed August 2009). 2. CDC, Mortality and Morbidity Weekly Report 2009; 58:369-374. 3. Bridges CB, et al. Inactivated influenza vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia: Saunders; 2008. 4. Irwin DE, et al. BMC Health Serv Res 2001; 1:8. 4. Thompson WW, et al. JAMA 2004; 292:1333-1340.<br />
  26. 26. The majority of pandemic H1N1 cases have occurred in subjects <20 years of age!<br />Seasonal influenza attack rates and proportionof population at high risk of serious complications, by age (US)1<br />Age distribution and travel status of pandemic H1N1 2009 cases in EU and EEA countries2<br />Higher incidence of pandemic H1N1 than seasonal influenza<br />in age group 10-19 years<br />2,500<br />60<br />Gross attack rate<br />At high risk ofserious complications<br />50<br />2,000<br />Travel related<br />Domestic<br />The high level of domestic cases indicates community-level spread of the virus, meeting the WHO criteria for Phase 6 pandemic alert3<br />40<br />1,500<br />Proportion of population (%) <br />Number of cases<br />30<br />1,000<br />20<br />500<br />10<br />0<br />0<br />0-4<br />5-17<br />18-49<br />50-64<br />65+<br />≥60<br />50-59<br />40-49<br />30-39<br />20-29<br />10-19<br />0-9<br />Age group<br />Age group<br />N=7,681 cases reported by 28 EU/EEA countries as of 6 July 2009<br />H1N1 pandemic influenza is predominantly found in patients <20 years of age; in contrast, the very young and the elderly are most at risk from seasonal influenza<br />1. Molinari NA, et al. Vaccine 2007; 25:5086-5096. 2. ECDC Surveillance Report, Analysis of Influenza A(H1N1)v individual case reports in EU and EEA countries, Update 9 July 2009. 3. WHO, Current WHO phase of pandemic alert, available at http://www.who.int/csr/disease/avian_influenza/phase/en/ (accessed July 2009).<br />
  27. 27. Age sex pattern of H1N1 cases in India<br />http://mohfw-h1n1.nic.in/documents/PDF/EpidemiologicalTrendsInIndia.pdf<br />
  28. 28.
  29. 29. Win – Win Situation vaccinating Pregnant Women<br />ACIP/ CDC/ ACOG recommend Flu vaccination during pregnancy<br />Can be done at any gestational age, earlier the better.<br />Benefits mothers by reducing serious respiratory infections during pregnancy<br />Benefits fetus – Better weight gain & decreased incidence of SGA<br />Benefits infant – the most effective way to prevent influenza in the first 6 months of life.<br />
  30. 30. Influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of current pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccine – Data from Chandigarh<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  31. 31. Methodology-Clinical Effectiveness Study<br />25<br />
  32. 32. Continued…..<br />Methodology-Clinical Effectiveness Study<br />26<br />
  33. 33. Continued…..<br />Methodology-Clinical Effectiveness Study<br />27<br />
  34. 34. Overall Results<br />
  35. 35. Clinical Effectiveness of Influenza vaccine-1<br />Fully vaccinated cohort (n=154) vs. Unvaccinated cohort (n=330)*<br />Conclusion: Influenza vaccine is effective in reducing the ILI and visits to physician for ARI in fully vaccinated Indian children as compared to unvaccinated children.<br />*Renuka R, Gupta G, Tiwari P. Clinical effectiveness of the 2010-2011 seasonal influenza vaccine among healthy Indian children. WSPID-2011, Melbourne. <br />
  36. 36. Clinical Effectiveness of Influenza vaccine-2<br />Partially vaccinated cohort (n=16) vs. Unvaccinated cohort (n=330)*<br />Conclusion: Partially vaccinated children had no significant protection against ILI and visits to physician as compared to unvaccinated children.<br />*Renuka R, Gupta G, Tiwari P. Clinical effectiveness of the 2010-2011 seasonal influenza vaccine among healthy Indian children. WSPID-2011, Melbourne. <br />
  37. 37. Clinical Effectiveness of Influenza vaccine-3<br />Age-wise efficacy for prevent of ILI*<br />Conclusion: Children aged 3-9 year had the best protection rates against ILI as compared to unvaccinated children.<br />*Renuka R, Gupta G, Tiwari P. Clinical effectiveness of the 2010-2011 seasonal influenza vaccine among healthy Indian children. WSPID-2011, Melbourne. <br />
  38. 38. Comparative Vaccine Effectiveness <br />* 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. <br />
  39. 39. Safety and Tolerability of Influenza vaccine-1<br />Singh H, Gupta G, Tiwari P. Safety and tolerability of trivalent inactivated influenza (TIV) vaccine in healthy Indian children. 62nd Indian Pharmaceutical Congress, 2010. Manipal, India. (Poster No. L-6).<br />
  40. 40. Safety and Tolerability of Influenza vaccine-2<br />*Singh H, Gupta G, Tiwari P. Safety and tolerability of trivalent inactivated influenza (TIV) vaccine in healthy Indian children. 62nd Indian Pharmaceutical Congress, 2010. Manipal, India. (Poster No. L-6).<br />
  41. 41. Pandemic influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of current pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  42. 42. Influenza Vaccines are representative of virus strains circulating in India as well<br />WHO Influenza Global Surveillance Network<br /><ul><li>The network was established in 1952
  43. 43. Currently, WHO have 128 institutions from 99 countries as recognized National Influenza centers</li></ul>Objectives:<br />Surveillance enables to recommend twice the content of Influenza vaccine for the season<br />Serves as a global alert mechanism for the emergence of Influenza virus with Pandemic potential<br />1 Laboratory<br />New Delhi<br />AIIMS<br />≥ 2 Laboratory<br />Dibrugarh<br />V P Chest<br />RMRC <br />No Laboratory<br />Nagpur<br />IGGMC<br />Kolkata<br />Mumbai<br />NICED <br />Haffkine Inst<br />Pune<br />NIV<br />RegionalCenters<br />Vellore<br />Chennai<br />CMC<br />NewCenters<br />KIPM<br />ReferralCenter<br />
  44. 44. Pandemic Flu protection added to Seasonal flu vaccine<br />WHO Influenza strain for Northern Hemisphere 2010 – 2011 season:<br />an A/California/7/09 (H1N1)-like virus; * <br />an A/Perth /16/2009 (H3N2)-like virus; ** <br />a B/Brisbane/60/2008-like virus.***  <br />*A/California/7/09 (H1N1)-like virus is the pandemic (H1N1) 2009 influenza virus.  A monovalent vaccine containing this strain was made available to the United States in the fall of 2009.<br />**A/Perth/16/2009 (H3N2)-like virus is a change from the 2009-2010 influenza vaccine formulation.<br />***and B/Brisbane /60/2008-like virus is a current vaccine virus.<br />http://www.who.int/csr/disease/influenza/recommendations201010north/en/<br />
  45. 45. ACIP Recommendations for seasonal Influenza vaccination 2010-11<br />1. A recommendation that annual vaccination be be administered to every individual aged ≥6 months for the 2010-11 influenza season<br />2. Children and adolescents at higher risk for influenza complications<br /><ul><li>! Are aged 6 months–4 years (59 months);
  46. 46. ! Have chronic pulmonary, cardiovascular, renal, hepatic, cognitive, neurologic/neuromuscular,
  47. 47. hematological or metabolic disorders (including diabetes mellitus)
  48. 48. ! Are immunosuppressed (Caused by medications or by HIV)
  49. 49. ! Are receiving long-term aspirin therapy and therefore might be at risk for experiencing Reye syndrome after influenza vaccination
  50. 50. ! Are residents of long-term care facilities; and
  51. 51. ! Will be pregnant during the influenza season.</li></ul>Source: CDC recommendation available at http://www.cdc.gov/flu<br />
  52. 52. Pandemic influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of current pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  53. 53. WHO Recommended strains 2011 -12 season<br />It is recommended that vaccines for use in the 2011-2012 influenza season (northern hemisphere) contain the following: <br />an A/California/7/2009 (H1N1)-like virus; <br />an A/Perth/16/2009 (H3N2)-like virus; <br />a B/Brisbane/60/2008-like virus. <br />A/H3N2<br />B<br />A/H1N1<br />California<br />Brisbane<br />Perth<br />Brisbane<br />Brisbane<br />Brisbane<br />2009-10<br />2011- 12<br />2010-11<br />2011-12 season WHO recommended strain are similar to 2010-11 season northern hemisphere strains<br />
  54. 54. WHO monitors strain drifts and recommends strains for vaccine inclusion<br />Drift has led to 15 changes in recommended strains since 1997-19981,2<br />A/H3N2<br />B<br />A/H1N1<br />Bayern<br />Beijing<br />NewCaledonia<br />Brisbane<br />SolomonIslands<br />Brisbane<br />Wuhan<br />Sydney<br />Moscow<br />Fujian<br />Wisconsin<br />California<br />Sichuan<br />Beijing<br />Malaysia<br />Hong Kong<br />Florida<br />Shanghai<br />1997-98<br />2007-08<br />2005-06<br />2001-02<br />2002-03<br />2003-04<br />2006-07<br />1998-99<br />2004-05<br />1999-00<br />2000-01<br />2008-09<br />Influenza Season (year)<br />For the Northern hemisphere, the recommended strains have changed 12 times since 1997-1998<br />1. www.who.int; 2. http://www.fda.gov/cber/flu/flu2008.htm. <br />
  55. 55. Key Questions<br />Question 1<br />Is annual vaccination reqd. if the strain remains the same for consecutive years?<br />
  56. 56. Yes, we require annual Influenza Vaccination if vaccine strains remain the same which is well supported by:<br /><ul><li>Local guidance
  57. 57. International guidance
  58. 58. Guidance from a standard textbook</li></li></ul><li>Key Questions<br />Question 2<br />What is the best time to give the Influenza vaccine in India?<br />
  59. 59. Northern hemisphere<br />Tropics<br />Southern hemisphere<br />45<br />1<br />29<br />41<br />25<br />37<br />5<br />9<br />13<br />17<br />21<br />33<br />49<br />Week<br />Influenza spread occurs inseasonal patterns<br />10<br />Influenza activity peak: November-March2,3<br />8<br />6<br />ILI/1000 Population<br />4<br />2<br />0<br />E.g. India<br />1<br />3<br />5<br />7<br />9<br />11<br />13<br />15<br />40<br />42<br />44<br />46<br />48<br />50<br />52<br />Week<br />50<br />40<br />30<br />ILI/1000 Population<br />Year-round activity3,4<br />20<br />10<br />0<br /> J F M A M J J A S O N D<br />Month<br />20<br />18<br />16<br />14<br />ILI Consultations/1000 Population<br />12<br />Influenza activity peak: April-September4,5<br />10<br />8<br />6<br />Globe image: www.phimap.com<br />4<br />2<br />0<br />ILI = influenza-like illness. <br />1. Bridges et al. 2008; 2. EISS 2004; 2. Cox and Subbarao 2000; 4. CHP 2008; 5. Yohannes et al. 2003.<br />
  60. 60.
  61. 61. Pandemic influenza: An overview!<br />General introduction to influenza viruses and infection<br />Influenza outbreaks and pandemics<br />Analysis of current pandemic H1N1<br />Defining at-risk populations<br />Influenza Vaccines Recommendations 2010-11 season<br />Influenza Vaccines Recommendations 2011-12 season<br />Influenza Vaccines<br />
  62. 62. How Influenza vaccines are made<br />WHO Influenza Global Surveillance Network<br /><ul><li>The network was established in 1952
  63. 63. Currently, WHO have 128 institutions from 99 countries as recognized National Influenza centers</li></ul>Objectives:<br />Surveillance enables to recommend twice the content of Influenza vaccine for the season<br />Serves as a global alert mechanism for the emergence of Influenza virus with Pandemic potential<br />1 Laboratory<br />≥ 2 Laboratory<br />No Laboratory<br />Seasonal influenza vaccines are trivalent vaccines derived from the three viral types that are currently in global circulation<br />http://www.who.int/csr/disease/influenza/surveillance/en/index.html<br />
  64. 64. Types of Influenza Vaccines<br /><ul><li>Live Attenuated Influenza Vaccine
  65. 65. Inactivated Influenza Vaccine
  66. 66. Whole virus vaccines
  67. 67. Split-virion Vaccine
  68. 68. Subunit vaccine
  69. 69. Adjuvanted vaccines
  70. 70. Virosomal vaccines
  71. 71. Cell culture derived vaccines</li></ul>A) whole-virus, B) split-virion, C) subunit, D) virosomal, E) adjuvanted.<br />Amorij JP, Huckriede A, Wilschut J, Frijlink HW, Hinrichs WL. Development of stable influenza vaccine powder formulations: <br />Challenges and possibilities. Pharm Res. 2008;25(6):1256-1273. <br />
  72. 72. Comparison of Influenza Vaccines<br />+Low; ++ Medium; +++ High. <br />
  73. 73. Live vs Inactivated Influenza Vaccine<br />http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5213a1.htm<br />
  74. 74. Thank You<br />

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