Delayed supply of influenza vaccine and adjunct ACIP influenza vaccine recommendations for the 2000-01 influenza season. Advisory Committee on Immunization Practices

Annual vaccination against influenza is the primary means for minimizing serious adverse outcomes from influenza virus infections. These infections result in approximately 20,000 deaths and 110,000 hospitalizations per year in the United States (1). The amount of trivalent inactivated influenza vaccine produced for distribution in the United States has increased substantially; in 1999, four manufacturers produced a combined total of 80 to 85 million doses.     

Considerations of strategies to provide influenza vaccine year round

There is potential for influenza vaccine programmes to make a substantial impact on severe disease in low-resource settings, however questions around vaccine composition and programmatic issues will require special attention. Some countries may benefit from immunization programmes that provide year-round supply of vaccine; however the best way to ensure adequate vaccine supply has yet to be determined. In this report, we discuss vaccine composition, availability, and programmatic issues that must be considered when developing year-round influenza immunization programmes. We then explore how these considerations have influenced immunization practices in the Latin American region as a case study. We identify three different approaches to achieve year-round supply: (1) alternating between Northern Hemisphere and Southern Hemisphere formulations, (2) extending the expiration date to permit extended use of a single hemisphere formulation, and (3) local vaccine manufacture with production timelines that align with local epidemiology. Each approach has its challenges and opportunities. The growing data suggesting high influenza disease burden in low resource countries underscores the compelling public health need to determine the best strategies for vaccine delivery.     

Myocardial infarction survival: how important are patients' attitudes and adherence behaviors?

Positive attitudes toward and adherence to prescribed medical regimens among patients recovering from initial episodes of myocardial infarction (MI) intuitively have been viewed as beneficial. A cohort of 157 post-MI patients who participated in a cardiac rehabilitation program was tested for compliance with the Health Adherence Scale and Miller Attitude Scale during hospitalization and again six months later. This study reports on follow-up conducted two to five years after initial MI to determine whether patients' attitudes and adherence behaviors had a significant effect on subsequent cardiovascular morbidity and overall mortality after controlling for known risk factors. The data were analyzed using the Cox proportional hazard regression model. Neither positive patient attitudes nor adherence behaviors were associated with a reduced risk of a morbid or fatal event. However, this study found, as have many others, that the known risk factors of alcoholism, widowhood, cigarette smoking, and diabetes were significantly associated with repeat episodes of MI, while the only risk factor associated with mortality was repeat MI. The study suggests that the benefits of positive attitudes and adherence behaviors are outweighed by the influence of existing cardiovascular risk factors. Thus, the prevention of these risk factors remains the primary determinant in the reduction of MI.     

First year allopathic medical student attitudes about vaccination and vaccine hesitancy

First year medical students at an allopathic medical school regional campus were asked to complete a 10-question survey at both the beginning and the conclusion of a required course on immunology, hematology and oncology. The survey was designed to solicit student attitudes about vaccination and the students’ level of comfort with and exposure to vaccine hesitant patients. Surveys were administered to five consecutive classes from 2013 to 2017. Total response rate for completion of both surveys was 58.0% (178/307). Pre- and post-course surveys were administered to assess whether curricular experiences altered the students’ perceptions about vaccinations and their ability to counsel vaccine hesitant patients. Curricular elements were presented in several different formats aimed at increasing student knowledge about vaccinations and student capacity to work with vaccine hesitant patients and families (problem-based learning, didactic lecture and interactive panel discussion). In the pre-survey, the majority of students reported having already encountered people who decline vaccinations (78.8%). Additionally, in the pre-survey the majority of medical students expressed strong support for vaccination (99.6% agreed with the statement that Vaccinations are a great public health accomplishment) and strong disagreement with both of the assertions that childhood vaccines cause autism and vaccine preservatives cause adverse health effects. In response to questions about comfort level while talking with patients about vaccine choices, baseline responses demonstrated a moderately high level of comfort. Post-course surveys revealed a statistically significant increase in student-rated comfort level in talking with patients about vaccine choices (pre-survey 79.2% report comfort versus post 97.8%; p < 0.001). Though this study is limited to student self-reporting, survey responses suggest that targeted curricular elements can improve medical student confidence in counseling patients about vaccinations. Future curricular elements designed to directly observe student performance could provide verification of counseling skill acquisition.     

Update: influenza activity--United States and worldwide, 1999-2000 season, and composition of the 2000-01 influenza vaccine

Influenza A (H3N2) viruses were the predominant viruses isolated in the United States and worldwide during 1999-2000. This was the third consecutive year that influenza A/Sydney/05/97-like (H3N2) viruses were the most prevalent viruses isolated in the United States. Influenza activity in the United States was similar to the previous two seasons, although mortality measurements attributed to pneumonia and influenza (P&I) were unusually high. Overall, the 1999-2000 influenza vaccine was well matched to circulating influenza viruses. The 2000-01 influenza season will be the first for which influenza vaccination is recommended for all persons aged > or =50 years. This report summarizes surveillance for influenza in the United States and worldwide during the 1999-2000 influenza season, describes the composition of the 2000-01 influenza vaccine, and highlights changes in the recommendations for prevention and control of influenza.     

Effects of social supports on attitudes and behaviors of pregnant adolescents

The influence of social support on maternal attitudes and behaviors was assessed in 57 third-trimester adolescent women attending an urban prenatal clinic. Sociodemographic characteristics, social support, self-esteem, and feelings about pregnancy were measured by questionnaire. The support and influence of the adolescent father was emphasized. Social support was measured as a multidimensional construct derived by a priori and empirical procedures. The outcomes measured were the amount of prenatal care, attendance at scheduled postpartum appointments, and pleasure with the pregnancy. Stepwise multiple-regression analyses were used to assess the contributions of the predictor to criterion variables. Pleasure with pregnancy was positively associated with the receipt of assistance from the adolescent's mother, favorable opinions of friends, and satisfaction with living arrangements. Attendance at postpartum visits was associated with high self-esteem. Notably absent as significant contributors were sociodemographic characteristics, receipt of emotional and tangible support from the adolescent father, and expectation of aid from social-assistance programs.     

Safety and immunogenicity of MF59-adjuvanted influenza vaccine in the elderly

Safety and immunogenicity of the influenza vaccine adjuvanted with MF59 (FLUAD) were compared to those of a non adjuvanted subunit vaccine in elderly subjects during three consecutive influenza seasons. Geometric mean titres and proportions of subjects with either a > or = four-fold increase in antibody titres or with an HI titre > or = 128 after immunisation were higher in FLUAD recipients. The adjuvant effect on the magnitude of the responses was most pronounced in subjects with pre-vaccination titres < or = 40. Although associated with more frequent mild local reactions, the adjuvanted vaccine was well tolerated. Thus, the addition of MF59 increased the immunogenicity of the subunit influenza vaccine in elderly persons with low pre-vaccination titres, who are at greatest risk of developing severe influenza disease and vaccine failure, without a clinically important increase in reactogenicity.     

Effects of a psychosocial intervention on breast self-examination attitudes and behaviors

An educational intervention to promote breast self-examinations (BSEs) among young women was tested. In a group (intervention versus control) x time (Session 1 versus Session 2) mixed design, 172 college females were randomly assigned to either an intervention or control condition. Both groups attended two sessions; the second session was 48 hours after the first. The intervention consisted of an essay, lecture, video portraying young survivors of breast cancer, group discussions, self-test and instructions on performing BSEs. The control group had the same format; however, the information was focused on nutrition and exercise. Participants in the intervention group scored higher on rational problem solving and behavioral intentions, suggesting that the intervention increased adaptive responses to breast cancer threat. Conversely, control participants scored significantly higher on maladaptive reactions (e.g. hopelessness, avoidance and fatalistic religiosity) to breast cancer threat. For intervention participants, the initial decline in maladaptive reactions remained stable at 3-month follow-up, but adaptive reactions decreased. Intervention participants had greater confidence in performing BSEs compared with controls but performed them on an irregular basis. Results were interpreted in terms of protection motivation theory, a model that applies the social psychology of persuasion to preventive health.     

Immunosenescence: role and measurement in influenza vaccine response among the elderly

Immunosenescence refers to the inability of an aging immune system to produce an appropriate and effective response to challenge. This immune dysfunction may manifest as increased susceptibility to infection, cancer, autoimmune disease, and vaccine failure. Mounting biological evidence supports the potential clinical relevance and impact of immunosenenscence. We briefly review immunosenescence with a focus on replicative senescence in cytotoxic T cells and recent clinical studies examining its association with influenza and infectious disease outcomes.     

Vaccine influenza: knowledge, attitudes and practices of elderly in Teresina

This objective study to raise the knowledge, practical and attitudes of the aged ones of an area of the Program of Health of Familia (PSF) on the vaccine it counts influenza and to identify the reasons that had taken some not to be vaccinated. It consists of a domiciliary inquiry, an area of the PSF of Teresina, with 74 aged ones from 60 years. The result had evidenced that even so 85.3% have inadequate knowledge on the vaccine, 89.1% is favorable. The reasons most frequent for the vaccination had not been illness and fear of the adverse events. It is concluded that the favorable attitude regarding the vaccination can modify the practical front it, restoring behavior of self-protection and greater adhesion.     

Relation of chronic disease and immune response to influenza vaccine in the elderly

The ability of elderly patients to mount an adequate immune response to influenza vaccine has been debated. We studied the serum haemagglutination inhibition (HI) antibody response in elderly persons to determine whether different degrees of chronic illness were a critical factor in immune response. In autumn 1986, trivalent split virus vaccine was used to immunize 87 healthy ambulatory elderly adults and 53 institutionalized elderly adults. The pre-vaccination health status of the healthy elderly group was significantly better as measured by the incidence of chronic disorders and drug use (p less than 0.02) and by the Chronic Health Evaluation component of the APACHE severity of disease classification (p less than 0.001). No group differences were observed in serum HI antibody after immunization with the trivalent influenza vaccine. However, in 28 patients from each group who received the monovalent A/Taiwan/86(H1N1) vaccine 1 month after the trivalent vaccine, the percentage with a postvaccination HI titre greater than or equal to 40 was 57% (16 of 28) for the healthy elderly vs 7% (2 of 28) for the institutionalized elderly (p = less than 0.001). Geometric mean postvaccination HI titres were 31 and 13, respectively (p = 0.004). We concluded that the institutionalized elderly in our study mounted an inferior immune response against the new heterotypic influenza A/Taiwan strain when compared to healthy elderly adults. The Chronic Health Evaluation score may be an effective predictor of a poor immune response to new influenza vaccine strains in the elderly. Increasing age per se and lack of a history of prior influenza immunization did not adversely affect the development of protective levels of serum antibody.(ABSTRACT TRUNCATED AT 250 WORDS)     

The virosomal influenza vaccine Invivac: immunogenicity and tolerability compared to an adjuvanted influenza vaccine (Fluad in elderly subjects

Several approaches are currently being pursued in order to improve the efficacy of influenza vaccines in elderly individuals and others who have impaired immune responses to conventional influenza vaccines. There are two influenza vaccines available for elderly subjects: Fluad (Chiron) and Invivac (Solvay Pharmaceuticals). The present clinical study was a randomized, endpoint-blind, parallel group study in elderly subjects aged 61 years and older to investigate the safety and immunogenicity of these vaccines as compared to a standard influenza vaccine Invivac (Solvay Pharmaceuticals). The three vaccines had similar immunogenicity results, whereas the tolerability profile of Invivac was better as compared to Fluad.     

MF59-佐剂流感亚单位疫苗在中国老年人中的免疫原性和安全性研究

目的 比较MF59-佐剂流感亚单位疫苗与传统的非佐剂流感亚单位疫苗在老年人中的安全性和免疫原性.方法 采用随机、研究者设盲的对照研究,按照2:1的比例分别给予600名60岁以上老年人接种MF-59佐剂流感亚单位疫苗(复立达TM,简称佐剂流感疫苗)和传统的非佐剂流感亚单位疫苗(爱阁力保(R),简称传统亚单位疫苗),观察接种日和接种后7天内的局部反应和全身反应;使用血凝抑制试验检测接种老年人免疫前后的血凝抑制抗体(HI)滴度,计算基线无免疫保护状态受试者的抗体4倍增长阳转率、免疫后HI抗体达到保护水平(≥1:40)的保护率以及抗体GMT值和增长倍数.比较两者在安全性和免疫原性的差异.结果 两组疫苗的局部反应和全身反应相似,但传统亚单位疫苗组(n=200)中注射部位的硬结相对常见(P＜0.05),而佐剂流感疫苗组(n=400)中注射部位轻度疼痛和发热则相对较常见.对于基线无免疫保护状态的受试者,免疫后针对A/H3N2病毒株的抗体阳转率,佐剂流感疫苗组显著高于传统亚单位疫苗组(P＜0.001);除A/H1N1病毒株外,与基线相比,两组疫苗的保护率均有显著提高,但针对A/H3N2病毒株的保护率方面,佐剂流感疫苗显著高于传统亚单位疫苗(P＜0.001);两组疫苗接种后的GMT均比基线明显增加(P＜0.001),但佐剂流感疫苗组明显高于传统亚单位疫苗组.结论 中国老年人对佐剂流感疫苗耐受性良好,佐剂流感疫苗诱导的免疫原性水平比传统亚单位疫苗高,可使免疫力低下的老年人获益更大.     

Exploring vaccination coverage and attitudes of health care workers towards influenza vaccine in Cyprus

Seasonal influenza is a major public health problem. Nosocomial influenza is particularly concerning as it may affect patients at high risk for complications. Unvaccinated health care workers (HCWs) are an important source of nosocomial influenza and therefore a priority target group for vaccination. Despite the fact that some European countries have high coverage rates such as UK (76.8% in season 2020/21), others continue to have low coverage rates for influenza vaccines. This study aims to estimate vaccination coverage in HCWs in Cyprus, an island country located in the Eastern Mediterranean region and describe their attitudes towards influenza vaccination.MethodsThis is a questionnaire based, nation-wide study assessing flu vaccination coverage in 2019–2020 and attitudes related to vaccination acceptance, of 962 HCWs in both public and private health care facilities. Multivariable logistic regression was used to investigate factors associated with flu vaccination status.ResultsFlu vaccination coverage was estimated as 31.8%. The top two reasons for getting vaccinated were to protect their family (81.4%) and themselves (77.4%). The top two reasons for not getting immunised, besides “no particular reason” (25.7%), included disbelief for vaccine effectiveness (21.5%) and safety (29.3%). The regression model showed that doctors compared to nurses had 10 times the odds of being vaccinated. Other factors positively associated with flu vaccination were encouragement by the supervisor, having sufficient knowledge on flu and flu vaccination and easy access to vaccination. A percentage of 54.8% of participants stated that COVID-19 pandemic strongly or somewhat influenced their decision to get vaccinated.ConclusionFlu vaccination coverage in HCWs in Cyprus is rather low, similar to some other European countries. Barriers and facilitators in this study can be considered in strategies to increase flu vaccination uptake. Such questionnaire-based surveys should be repeated in order to evaluate effectiveness of targeted vaccination campaigns.     

Adolescent attitudes toward influenza vaccination and vaccine uptake in a school-based influenza vaccination intervention: a mediation analysis

BACKGROUND: School‐based vaccination programs may provide an effective strategy to immunize adolescents against influenza. This study examined whether adolescent attitudes toward influenza vaccination mediated the relationship between receipt of a school‐based influenza vaccination intervention and vaccine uptake. METHODS: Participants were recruited from 2 counties participating in a school‐based influenza vaccination intervention trial in rural Georgia (N = 337). Data were collected from surveys distributed to adolescents at pre‐ and post‐intervention time points and from documents indicating vaccine uptake. Guided by the Health Belief Model and the Integrated Behavioral Model, surveys assessed demographic, behavioral, and psychosocial variables. A mediation analysis was used to test whether changes in psychosocial variables from baseline to follow‐up mediated the relationship between study condition and influenza vaccine uptake. RESULTS: Controlling for background variables, step 1 of the mediation analysis revealed a significant relationship between study condition and vaccine uptake (odds ratio = 1.77, p = .038). Step 2 of the mediation analysis revealed a significant relationship between study condition and changes in psychosocial variables from baseline to follow‐up. Steps 3 and 4 of the mediation analysis revealed that there was full mediation of the relationship between study condition and receipt of an influenza vaccination by intention to receive an influenza vaccination. CONCLUSION: Findings suggest that the success of our school‐based influenza vaccination intervention in increasing vaccine uptake was mediated by adolescents' intention to receive an influenza vaccination. Future influenza vaccination efforts geared toward rural adolescents may benefit from addressing adolescent attitudes toward influenza vaccination, particularly increasing intention to receive a vaccine.     

Effects of social supports on attitudes,health behaviors and obtaining prenatal care

The influence of social support on attitudes, health behaviors and attaining prenatal care was assessed in 300 postpartum patients. Demographic, medical, sociocultural, attitudinal and behavioral factors were assessed by interview and review of the medical chart. Three discrete social support factors (intimacy, comfort, security) were identified by factor analysis. The presence of social support was correlated with positive prenatal attitudes, not using drugs, and adequate health resources. Stepwise multiple-regression analysis demonstrated that one social support factor (intimacy), two health behaviors (not drinking and not smoking while pregnant), and parity accounted for 22% of the variance in amount of prenatal care.Paul T. Giblin, PhD is an Associate Professor in the Department of Pediatrics; Marilyn L. Poland, PhD is an Associate Professor in the Departments of Obstetrics and Gynecology; Joel W. Ager, PhD is a Professor in the Department of Psychology Wayne State University Detroit, Michigan.This project was supported by a grant from the Department of Health and Human Services, Bureau of Health Care Delivery and Assistance No. MCJ-263811.     

Efficacy of influenza vaccine among elderly patients by physical activity status

Objective Although many studies have shown the usefulness of influenza vaccine in elderly in-patients, the efficacy of vaccination with regard to the daily physical activities of patients has not been fully evaluated. To address this issue, we correlated the use of medical resources with vaccination status in patients categorized according to their daily activity levels. Methods The subjects comprised 237 in-patients at or above 51 years of age, who were hospitalized in the long-term care unit of a Japanese hospital between January and March, 1999. The vaccination status and medical resources use (i.e., oral antibiotics, injected antibiotics, blood cell count, chest X-ray) of each patient were recorded, and the patients were assigned to three subgroups, based on daily life activity scores. Results Vaccinated in-patients in the ‘bed-bound’ category required fewer medical resources, i.e., oral antibiotics (−2.29 days,P<0.05), injected antibiotics (−5.02 days,P<0.001), blood cell counts (−4.66 times,P<0.001), and chest X-rays (−4.31 times,P<0.001), compared with unvaccinated in-patients. There were no significant differences in treatment parameters between vaccinated and unvaccinated patients in the ‘partly limited’ or ‘no limitation’ categories. Conclusions It is suggested that influenza vaccination significantly reduces the need for medical treatment only among those in-patients who are the least physically active. Further studies are required to replicate these findings, and to elucidate the underlying reasons for this reduction.     

Efficacy of inactivated trivalent influenza vaccine in alleviating the febrile illness of culture-confirmed influenza in children in the 2000-2001 influenza season

During the 2000/2001 influenza season in Japan, children ranging in age from 6 months to 13 years with fever exceeding 37.5 degrees C were recruited. Vaccine efficacy was evaluated by comparing the rates of pre-seasonal vaccination between groups stratified by fever severity. Seven hundred and sixty one patients (33.1%), culture positive for influenza were enrolled for analysis. The numbers of patients for A/H1N1 and A/H3N2 were insufficient for statistical analysis. For influenza B the odds ratio for vaccinated children to have a maximum fever exceeding 39.5 degrees C was 0.52 (95% CI, 0.30-0.92) Our findings suggest modest impact of influenza vaccination on limiting severity of disease symptoms.     

Retrospective assessment of influenza vaccine effectiveness among the non-institutionalized elderly population in Japan

To construct a framework for monitoring the effectiveness of influenza vaccine, we retrospectively surveyed elderly (> or = 65 years old) people living in rural areas of Kyoto prefecture, Japan, using a self-administered questionnaire, for their influenza-related symptoms during the peak influenza season of 2003-2004. A total of 2301 elderly individuals responded, of whom 1533 (66.6%) had been vaccinated. The odds ratio (OR) of vaccination for fever of > or = 38 degrees C, adjusted for sex, age and underlying conditions, was 0.77 (95% confidence interval (CI), 0.40-1.47), and the OR for a diagnosis of influenza in clinics was 0.81 (95% CI, 0.41-1.57). These findings suggested that the vaccine was 20% effective, although this effectiveness was not statistically significant.