The impact of mass school immunization on school attendance.

The purpose of this study was to assess the impact a free, on-site influenza immunization program could have on attendance in Title 1 schools. Four Title 1 elementary schools participated in the study. Students at 2 schools were offered free FluMist immunizations on site, and students at 2 control schools were not. Compliance on receiving FluMist was measured on the percentage of students participating after evaluating for medical exclusions. Documentation on the reason for absences at all 4 schools included self- or parent-reported influenza. Attendance rates for the year also were compared with the previous year for all 4 schools. A comparison was done of total days absent versus total days enrolled between schools receiving FluMist and schools not receiving the vaccine. Despite the fact that FluMist is a new vaccine and is not required for children, 57% of those medically eligible to receive it had parental permission and received the vaccine. The 2 schools receiving FluMist increased their attendance rates from 95.3% and 93.9% to 96.1% and 95.8%. Previously, the comparison schools each had a 94.6% attendance rate; one fell to 94.4% and the other rose very slightly to 94.7%. The differences in self- or parent-reported influenza absences were not significant. However, the difference in days absent between individual vaccinated and nonvaccinated schools was statistically significant.     

RESULTS OF PROPHYLACTIC VACCINATION AGAINST PNEUMONIA AT CAMP WHEELER

1. 13,460 men, or about 80 per cent of the entire camp strength, were vaccinated against pneumonia with pneumococcus lipovaccine. 2. The dosage employed in all cases was 1 cc. of the lipovaccine containing approximately 10 billion each of Pneumococcus Types I, II, and III. 3. Both the local and general reactions produced by the vaccine were usually mild. Only 0.7 per cent of those who received the vaccine were sufficiently affected to need hospital care. None of these was seriously ill, and a majority of them returned to duty on the 2nd or 3rd day after admission. 4. Most of the troops inoculated were under observation for 2 or 3 months after vaccination. During this period there were 32 cases of Pneumococcus Type I, II, and III pneumonia among the vaccinated four-fifths of camp, and 42 cases of pneumonia of these types among the unvaccinated one-fifth of camp. If, however, all cases of pneumonia that developed within 1 week after vaccination are excluded from the vaccinated group, there remain only 8 cases of pneumonia produced by fixed types, and these were all secondary to severe attacks of influenza. This exclusion is justified by the fact that protective bodies do not begin to appear in the serum until the 8th day after injection of pneumococcus lipovaccine. 5. There is no evidence whatever that pneumococcus vaccine predisposes the individual even temporarily toward either pneumococcus or streptococcus pneumonia. 6. The weekly incidence rate for pneumonia (all types) among the vaccinated troops was conspicuously lower than that for the unvaccinated troops. 7. The pneumonia incidence rate per 1,000 men during the period of the experiment was twice as high for unvaccinated recruits as for vaccinated recruits, and nearly seven times as high for unvaccinated seasoned men as for vaccinated seasoned men. 8. Influenza causes a marked reduction in resistance to pneumonia even among vaccinated men. Of the 155 cases of pneumonia (all types) developing 1 week or more after vaccination, 133 were secondary to influenza. 9. The death rate for 155 cases of pneumonia (all types) that developed among vaccinated men 1 week or more after vaccination was only 12.2 per cent, whereas the death rate for 327 cases of all types that occurred among unvaccinated troops was 22.3 per cent. The death rate for primary pneumonia among vaccinated troops was 11.9 per cent. Among unvaccinated, it was 31.8 per cent, almost three times as great. On the other hand, the mortality rate in pneumonia secondary to influenza is about the same for the vaccinated and unvaccinated groups. 10. In conclusion, it must be admitted that the results of pneurnococcus vaccination at Camp Wheeler have not been so striking as those obtained at Camp Upton in 1918, largely on account of the influenza epidemic; but, although influenza obscured to some extent the effect of pneumococcus vaccination at Camp Wheeler, the results are sufficiently encouraging to justify its further application in civil as well as in military life.     

Poor uptake of influenza vaccinations in patients receiving cytotoxic chemotherapy

This audit was designed to assess whether existing UK vaccination programmes mean that patients receiving chemotherapy are being vaccinated against influenza. One hundred and ten adult patients receiving chemotherapy at a south London tertiary referral centre were interviewed when they attended for their chemotherapy. Thirty-six of the 110 (33%) patients had received their influenza vaccination at the time of the study. Vaccination rates were significantly higher in those patients older than 65 years (53% vs 17%, p<0.001), and in those with co-morbidities (49% vs 25%, p<0.05). The vaccination rate in this at-risk population is lower than the overall national uptake in those aged 65 and over. Those patients most likely not to receive their influenza vaccination are those who have no indication for vaccination other than the fact they are receiving chemotherapy. Increased awareness of the benefits of influenza vaccine and its safety is needed among general practitioners, patients and oncologists.     

Evaluation of influenza vaccination in health-care workers, using rapid antigen detection test

A study was conducted to assess the effectiveness of trivalent influenza vaccine in preventing influenza and reducing absenteeism in health-care workers of Gifu Red Cross Hospital during the 2002–2003 influenza season. Questionnaires were distributed to 370 health-care workers, and 366 were returned showing that 237 had received influenza vaccine and 129 were unvaccinated. The criterion for influenza was febrile episodes with a positive reaction on a rapid antigen detection test. Among vaccine recipients, the number of influenza infections was 3.4 per 100 subjects, compared with 8.5 per 100 subjects in nonrecipients (P = 0.034), and the number of days absent from work per 100 subjects was 9.5, compared with 15.1 per 100 subjects in nonrecipients (P = 0.0003). The prevalence of adverse reactions to the vaccine was rather low. No serious adverse reactions were recorded and no one was absent from work because of adverse reactions. It is concluded that influenza vaccine is effective in preventing influenza and reducing absenteeism in health-care workers. The results of this study support recommendations for influenza vaccination in health-care workers.     

Molecular characterization of influenza viruses from women and infants in Sarlahi,Nepal

We used RT-PCR-electrospray ionization-mass spectrometry to identify subtypes and strains of influenza viruses detected during a maternal influenza immunization study in Nepal from May 2011 to April 2014. Hemagglutinin (HA) gene amino acid (aa) sequences of inferred reference strains were compared to those of the vaccines to determine impact of aa relatedness on vaccine efficacy (VE) and disease severity. Three influenza subtypes and many strains were identified. A(H3N2) strains with less than 13 aa differences in HA compared to vaccine strains (matched) showed higher VE than strains with 13 or more differences (mismatched). Yamagata lineage B strains, which were mismatched to the Victoria strain in the vaccine, demonstrated lower VE compared to Victoria strains. Differences in VE were not statistically significant. All A(H1N1pdm) matched the vaccine strain, with 10 or fewer aa differences. Except for women infected with vaccine-matched strains of influenza A, clinical signs and symptoms did not differ between vaccinated and unvaccinated participants.     

Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems

Influenza is a major problem both in the community and hospital and elderly people who are at particular risk should be included in vaccination programmes. In August 1998 the Chief Medical Officer for England extended the current influenza immunization policy to include all those aged 75 years or over. However, prior to this date only those patients with co-existing cardiac or respiratory diseases at increased risk of influenza were vaccinated routinely. In order to determine whether such patients had been immunized, we approached all patients admitted to Care of the Elderly wards during an 8-week period in January and February. The study additionally identified factors that may have influenced patients' participation in this immunization programme. Six hundred and forty-nine patients on Care of the Elderly wards with acute medical illness were questioned with regard to vaccination against influenza during the previous year. Of the 649 patients 279 were suitable for entry into the study. Of these 39% had been vaccinated against influenza. When considering the 171 who were not vaccinated, 25% (44 patients) had actually been offered and declined vaccination, in 46% of these cases due to previous side-effects, or fear of anticipated side-effects. In those unvaccinated three-quarters considered that the influenza vaccine was not efficacious. Unfortunately, patients with co-existing cardiac, respiratory or endocrine diseases were no more likely to have been vaccinated than were those without these diseases. Many older patients admitted with acute medical problems had not been vaccinated against influenza and the reasons for this included not being offered vaccination, a belief that influenza vaccination was not efficacious and concerns about possible side-effects. The role of community doctors and nurses in facilitating the vaccination of such an at-risk group is evident and should be incorporated into resource planning.     

Technology evaluation: FluMist, University of Michigan

FluMist is an intranasal influenza vaccine, which has been developed by Aviron. The genetically engineered, live, attenuated, cold-adapted virus vaccine produces influenza infection without the symptoms. The product has been field for approval in the US, where Merrill Lynch expects it to be marketed by mid-2000 [336561].     

Comparative immunogenicities of frozen and refrigerated formulations of live attenuated influenza vaccine in healthy subjects

The frozen version of live attenuated influenza vaccine (LAIV; FluMist) was compared with a newly licensed, refrigerated formulation, the cold-adapted influenza vaccine, trivalent (CAIV-T), for their immunogenicity, safety, and tolerability in healthy subjects 5 to 49 years of age. Eligible subjects were randomized 1:1 to receive CAIV-T or frozen LAIV. Subjects 5 to 8 years of age received two doses of vaccine 46 to 60 days apart; subjects 9 to 49 years of age received one dose of vaccine. Equivalent immunogenicities were defined as serum hemagglutination inhibition (HAI) geometric mean titer (GMT) ratios >0.5 and <2.0 for each of the three vaccine-specific strains. A total of 376 subjects 5 to 8 years of age and 566 subjects 9 to 49 years of age were evaluable. Postvaccination HAI GMT ratios were equivalent for CAIV-T and LAIV. The GMT ratios of CAIV-T/LAIV for the H1N1, H3N2, and B strains were 1.24, 1.02, and 1.00, respectively, for the 5- to 8-year-old age group and 1.14, 1.12, and 0.96, respectively, for the 9- to 49-year-old age group. Seroresponse/seroconversion rates (fourfold or greater rise) were similar in both age groups for each of the three vaccine strains. Within 28 days, the most frequent reactogenicity event in the CAIV-T and LAIV groups was runny nose/nasal congestion, which occurred at higher rates after dose 1 (44% and 42%, respectively) than after dose 2 (41% and 29%, respectively) in the 5- to 8-year-old group. Otherwise, the rates of adverse events (AEs) were similar between the treatment groups and the two age cohorts, with no serious AEs related to the study vaccines. The immunogenicities, reactogenicity events, and AEs were comparable for refrigerated CAIV-T and frozen LAIV.     

新型冠状病毒Delta变异株感染同船海员的临床特点分析

目的 探讨新型冠状病毒Delta变异株感染同船海员的临床特点及接种疫苗的保护作用。方法 回顾分析2021年8-11月广西防城港市第一人民医院定点隔离病区收治的新型冠状病毒Delta变异株境外输入感染者5例及同船海员17例。依据是否接种疫苗分为接种疫苗组(10例)及未接种疫苗组(12例),回顾性分析两组临床资料。结果 同船22例海员中新型冠状病毒感染共14例(63.6%);其中未接种疫苗组感染比例高于接种疫苗组(P<0.05)。除外2例为无症状感染,其余12例出现发热、嗅味觉减退、咳嗽、胸闷、咳痰、乏力及全身酸痛等。未接种疫苗组发热持续时间为(7.62±2.32)天,接种疫苗组发热持续时间为(6.25±2.50)天,差异无统计学意义(P=0.368)。经治疗后未接种疫苗组核酸转阴时间为(65.75±25.81)天,而接种疫苗组为(44.00±28.32)天,差异无统计学意义(P=0.211)。结论 我国生产疫苗对新型冠状病毒Delta变异株具有一定的保护作用。同船海员新型冠状病毒Delta变异株感染患者核酸转阴时间明显延长,但接种疫苗与核酸转阴时间无相关性。     

Influenza vaccination with a live attenuated vaccine

Influenza is a highly contagious, acute respiratory illness with a long history of outbreaks dating back several centuries. Although immunization is an effective means of protection against influenza, vaccination rates have been suboptimal, especially among certain high-risk groups, including children and health care personnel. This article reviews basic information about influenza and immunization, discusses the relevance of children as vectors of disease, and highlights current information on FluMist, an intranasally administered, live attenuated influenza vaccine, including studies of its use compared with trivalent inactivated vaccine and in children.     

Attitudes Toward Influenza Vaccination Administration in the Emergency Department Among Patients: A Cross-Sectional Survey

IntroductionInfluenza is a serious, vaccine-preventable illness. The current vaccination rates in Canada are below target rates, highlighting the potential need for more convenient ways to receive vaccinations. Wait times to be seen in Canadian emergency departments are escalating, and using the time spent waiting to offer and administer an influenza vaccine could potentially improve ease of access to immunization for some Canadians.MethodsThe aim of this cross-sectional study was to gauge public interest and identify perceived barriers and facilitators to influenza vaccine availability in a Canadian emergency and trauma center. Anonymous questionnaires were completed by a convenience sample of adult patients classified as low acuity (n = 151) as 1 arm of a 2-arm study.ResultsOf the unvaccinated patients, 34.6% expressed willingness to be vaccinated in the emergency department. The patients who had received a vaccine in the previous year were significantly more willing to accept the vaccine in the emergency department (χ² [1] = 23.78, P < 0.001). The 3 top factors associated with having received vaccination in the previous year include trust in vaccine information (χ² [2] = 27.34, P < 0.001), immunity preferences (χ² [2] = 32.25, P < 0.001), and beliefs about efficacy (χ² [2] = 44.90, P < 0.001).DiscussionPatients classified as low acuity were supportive of ED influenza vaccination. In addition, some of the unvaccinated participants had unmet education needs (ie, regarding trustworthy sources of vaccine information, immunity, and vaccine efficacy) that would require addressing before they would likely consider receiving influenza vaccination in future during their ED visit.     

Does vaccinating ED health care workers against influenza reduce sickness absenteeism?

This study aims to investigate the association between influenza vaccination of health care workers (HCWs) and sickness absenteeism. A retrospective cohort study was conducted in an emergency department (ED) of an acute care hospital. All full-time HCWs except physicians (73 nurses and health care attendants) were included. Influenza vaccine was administered to HCWs on a voluntary basis commencing November 2004. Absenteeism due to influenza-like illness during the period from January to October 2005 was noted. The mean number of cumulative sick leave days per person was smaller (1.0 days against 1.75 days) in vaccine recipients than in vaccine nonrecipients although the difference was not statistically significant. A significantly larger proportion of subjects took sick leave because of influenza-like illness in the vaccine nonrecipient group (55% against 30.3%, P = .034). Conclusion: Influenza vaccination of HCWs in the ED setting is significantly associated with a fewer number of HCWs requiring sick leave.     

White blood cell telomerase activity and incident respiratory illness among community-dwelling elderly vaccinated against seasonal influenza

Immune cell telomerase activity may impact vaccine response in the elderly. Fifty persons aged 60-100 years were tested for post-influenza vaccination telomerase RNA expression (TERT) in peripheral blood mononuclear cells to assess for an association with influenza antibody levels and influenza-like illness or incident respiratory infection (IRI) in the year following vaccination. High rates of seroprotective influenza antibody (> or = 1:40 titers) were observed post-vaccination (86-92% to vaccine viral strains), with no association to TERT. No IRI occurred among persons in the top quartile of TERT expression, whereas the IRI rate was 33% in the lower three quartiles (Kaplan-Meier P=0.028). TERT expression was also IRI significantly higher in those who did not experience IRI than those who did in the follow-up period (0.845 vs. 0.301, P=0.024). These data suggest that telomerase expression may correlate with immune capacity for vaccine response in the elderly and could represent a target for recognizing risk for vaccine failure.     

Efficacy of influenza vaccine in the elderly: reduction in risks of mortality and morbidity during an influenza A (H3N2) epidemic for the elderly in nursing homes

The effect of influenza vaccination on the occurrence and severity of influenza virus infection in elderly nursing home residents was studied during an influenza A (H3N2) epidemic in Japan. Of 22,462 individuals living in 301 welfare nursing homes, 10,739 received inactivated (subunit) influenza vaccine. Through the period November 1998 to March 1999, there were 950 cases of influenza infection diagnosed clinically, with virus isolation and/or serology. There were statistically significantly fewer cases of influenza, hospital admissions due to severe infection, and deaths due to influenza in the vaccinated cohort compared with the unvaccinated controls. No serious adverse reactions to vaccination were recorded. Thus influenza vaccination is safe and effective in this population, and should be an integral part of the routine care of persons aged 65 years and over residing in nursing homes.     

An influenza prevention campaign: the employee perspective

While the benefits of vaccinating health care workers against influenza are known, the number of vaccinated employees remains inadequate. This article describes survey results from 999 Advocate employees. Statistically significant differences were identified in receiving the influenza vaccine based on age, recommendation of the flu vaccine to others, working environment, and race. The major reason identified for receiving the vaccine was to stay healthy. The most common reason cited for not receiving the vaccine was receiving the vaccine before and getting sick anyway. Results of the study were used to refine education and communication strategies, improving the employee vaccination program.     

Assessment of individual vaccine status in a vaccinology experts' group

Rationale  Worldwide, experts in vaccinology have promoted the broad annual coverage of health care workers with the influenza vaccine. Furthermore, pertussis vaccination is now recommended for young adults and health care workers working with newborns.
Aim  To analyse the compliance with these guidelines among experts responsible for the development or dissemination of national immunization schedules.
Method  A cross-sectional survey was conducted in a vaccinology workshop group of French experts, using a self-administered questionnaire.
Results  Among 44 experts, the average rate of influenza vaccination was 69.5% (95% confidence interval, 61.6% to 77.3%) between the 2003/04 and 2005/06 flu seasons, whereas the rate of pertussis vaccination during this period was only 30%. The main reasons that the experts gave for not being vaccinated were a lack of time or simply not remembering to do so.
Conclusion  Experts had low coverage rates for influenza and pertussis vaccination. To improve these rates, a multifaceted intervention combining audit and feedback strategy with a vaccine day is planned.