6. Choice of vaccine strains procedure Hannoun C. Role of international networks for the surveillance of influenza. Eur Journal of Epidemiol 1994;10:459-61 Sentinel Doctors National influenza Centers (112 national laboratories in over 80 countries) World Health Organisation (WHO - Geneva) Collaborating Reference Centers for Research against influenza (London, Atlanta, Melbourne and Tokyo) Vaccine Manufacturers Global Influenza Surveillance Network
19. Overall Results Vaccinated (198) vs Unvaccinated Cohort (397) # Parameter RR CI p value VE (%) 1 ILI 0.65 0.49-0.84 0.001 35 2 ARI 0.98 0.96-1.01 0.88 3 Unsch. Visit 0.75 0.52-0.99 0.003 25 4 Absenteeism 0.97 0.70-1.32 0.86
20. Clinical Effectiveness of Influenza vaccine-1 Fully vaccinated cohort (n=154) vs. Unvaccinated cohort (n=330)* 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. *Renuka R, Gupta G, Tiwari P. Clinical effectiveness of the 2010-2011 seasonal influenza vaccine among healthy Indian children. WSPID-2011, Melbourne. Sr.No Parameters Odds Ratio CI VE % P-value 1 Influenza like illness 0.58 0.24-0.92 42 0.009 2 Visits to Physician 0.71 0.33-1.09 29 0.039
21. Clinical Effectiveness of Influenza vaccine-2 Partially vaccinated cohort (n=16) vs. Unvaccinated cohort (n=330)* Conclusion: Partially vaccinated children had no significant protection against ILI and visits to physician as compared to unvaccinated children . *Renuka R, Gupta G, Tiwari P. Clinical effectiveness of the 2010-2011 seasonal influenza vaccine among healthy Indian children. WSPID-2011, Melbourne. Sr.No Parameters Odds Ratio CI P-value 1 Influenza like illness 0.69 0.39-0.99 0.20 2 Visits to Physician 0.64 0.29-1.01 0.64
22. *Ritzwoller DP, Bridges CB, Shetterly S, Yamasaki K, Kolczak M, France EK. Effectiveness of the 2003-2004 influenza vaccine among children 6 months to 8 years of age, with 1 vs 2 doses . Pediatrics. 2005;116:153-159. # ILI Parameters Present study Ritzwoller et al* 1 Fully vaccinated vs. Unvaccinated OR (CI) 0.58 (0.24-0.92) 0.77 (0.66-0.90) P value P=0.009 <0.001 VE% 42% 23% 2 Partially vaccinated vs. Unvaccinated OR(CI) 0.69 ( 0.39-0.99 ) 0.93 (0.82-1.04) P value 0.20 <0.01 VE% NA 7%
24. Clinical Effectiveness of Influenza vaccine-3 Age-wise efficacy for prevent of ILI * Conclusion: Children aged 3-9 year had the best protection rates against ILI as compared to unvaccinated children . *Renuka R, Gupta G, Tiwari P. Clinical effectiveness of the 2010-2011 seasonal influenza vaccine among healthy Indian children. WSPID-2011, Melbourne. Sr.No Age group (no.) Odds Ratio CI P-value VE % 1 6 m – 3 y (78) 0.57 0.46-1.31 0.55 2 3 y – 9 y (64) 0.48 0.17-0.72 0.002 52 % 3 9 y – 18 y (28) 0.69 0.39-1.03 0.06
25. Authors' conclusions Influenza vaccines are efficacious in children older than two but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. This version first published online: January 25. 2006 Last assessed as up-to-date: September 30. 2007
26. Results_ (Comparison of 2009-10 v/s 2010-11) Comparison of VE in 2 years in our center * Singh H, Gupta G, Tiwari P. Clinical effectiveness of the 2009-2010 seasonal influenza vaccine among healthy Indian children. ISPOR 4 th Asia Pacific Conference, Phuket, Thailand. Fully vaccinated (154) vs Unvaccinated Cohort (330) ( 2010-11 ) # Parameter RR CI p value VE (%) 1 ILI 0.65 0.48-0.86 0.003 35 2 Unsch. Visit 0.74 0.51-0.99 0.007 26 Fully vaccinated (101) vs Unvaccinated Cohort (141) * ( 2009-10 ) # 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
27. 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).
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29. *Delore V, Salamand C, Marsh G, Arnoux S, Pepin S and Saliou P. Long-term clinical trial safety experience with the inactivated split influenza vaccine, Vaxigrip®. Vaccine 2006; 24 : 1586-1592 . Reactions after vaccination The Present Study Delore et al* Local reactions (Inj. site tenderness) >6-35 months 8.5 % 6-36 months 8.6 % 3-9 years 24.1 % 3-10 years 32.1 % >9-18 years 46.6 % - - Systemic reaction >6-35 months 26.7 % 6-36 months 21.2 % 3-9 years 13.3 % 3-10 years 4.3 % >9-18 years 6.6 % - -
34. # Knowledge of parents of vaccinated children Percentage 1 Influenza is a serious problem and influenza vaccine prevents influenza 90% 2 Starting of winters is right time to get influenza vaccine 61% 3 Pediatrician is source of information about influenza vaccine 99% 4 Children and elderly with complications can be given influenza 15% 5 Influenza vaccine is an annual vaccine 76%
35. # Practices of parents of vaccinated children Percentage 1 Parents want to take Influenza vaccine next year also 48% 2 Find that influenza vaccine was not very effective and don’t want to get their child vaccinated next year 16% 3 Influenza vaccine prevents all ailments like cough or cold or runny nose or fever 28% 4 Health of the child was much better than before 44%
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38. The European vaccine study involved an antibody that neutralizes all the influenza-A subtypes.
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Editor's Notes
slide: 7 International surveillance network - The isolation and identification of influenza virus strains circulating in different regions of the world are made possible by a complete surveillance system, established by WHO since 1947. - Sentinel doctors carry out naso-pharyngeal swabs on patients showing influenza like syndromes. The samples are sent rapidly for primary laboratory identification to the National Influenza Centers. - When a new strain is detected, samples are sent to the WHO collaborating centers for further identification and detailed antigenic analysis. - Information regarding new antigenic variants of influenza virus are sent to the WHO in Geneva. - Each year at the end of february, the WHO commitee of experts holds a meeting and recommends the strains to be included in the vaccine for the upcoming influenza season. At the end of september, the Melbourne Collaborating Reference Center organizes a meeting to review and adapt composition of the vaccine to local epidemiology. To date, three countries participate to that meeting: Australia, New Zealand and South Africa. - The early tracking and identification of influenza strains by the WHO surveillance network allows manufacturers to incorporate in the vaccine, antigenic variants that will accurately match with the ones that will circulate. The vaccine will therefore have an optimal efficacy. [40]