Key facts about influenza vaccine

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1 Key facts about influenza vaccine Dr Wan Noraini Wan Mohamed Noor Head of Surveillance Sector Disease Control Division, MOH Malaysia 4 May 2018 drwnoraini@moh.gov.my

2 The Outline: Introduction: Influenza Vaccine The Evolving History of Influenza Vaccines Annual WHO Recommendation for Influenza Vaccine Formulation Trivalent (TVI) & Quadrivalent (TIV) Influenza Vaccines WHO Position Paper (November 2012): Vaccines Against Influenza Cycle Of Annual Influenza Vaccine Strain Selection, Production And Campaign Influenza Vaccination: Malaysian Scenario Conclusions

3 Introduction: Influenza Vaccine The best way to protect against influenza is to get vaccinated annually Administration: intramuscular injection Providing protection 2 weeks after vaccination Seasonal influenza vaccine only works for the targeted influenza subtypes and will not work on pandemic strains Contraindications Younger than 6 months People with severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine

4 The Evolving History of Influenza Vaccines Monovalent Bivalent Trivalent Quadrivalent H1N1 H1N1 + B H2N2 + B H3N2 + B H1N1+ H3N2 + B H1N1+ H3N2 + B/Vict. + B/Yam Since 1973, the WHO has issued annual recommendations for the composition of the influenza vaccine based on results from surveillance systems that identify currently circulating strains 1) Hannoun, Expert rev. Vaccines 12(9), (2013) 2)

Trivalent (TIV) & Quadrivalent (QIV) Influenza Vaccine The current influenza B

current influenza vaccines also include 4 strains, to better fit with this

H3N2 VICTORIA YAMAGATA 1) Ambrose CS, Levin MJ.

Hum Vaccin Immunother 2012 Jan; 8 (1). 2) WHO 2009. Influenza Factsheet 211.

7 Trivalent (TIV) & Quadrivalent (QIV) Influenza Vaccine The current influenza B epidemiology supports the need to broaden the spectrum of protection 1 The current influenza vaccines also include 4 strains, to better fit with this evolving epidemiology of influenza infection 2 : 2 A strains 2 B strains H1N1 H3N2 VICTORIA YAMAGATA 1) Ambrose CS, Levin MJ. The rationale for quadrivalent influenza vaccines. Hum Vaccin Immunother 2012 Jan; 8 (1). 2) WHO Influenza Factsheet ) WHO. Recommendations 2012;

8 WHO Position Paper (November 2012): Vaccines Against Influenza Although influenza vaccination aims primarily at protecting vulnerable high risk groups against severe influenza-associated disease and death, influenza causes considerable morbidity worldwide even beyond these groups and therefore represents a public health problem with significant socioeconomic implications

Vaccines Against Influenza: WHO Position &

should be vaccinated with inactivated influenza

particular order of priority: Additional risk

individuals aged 6 59 months, the elderly,

9 Vaccines Against Influenza: WHO Position & Recommendations Highest priority: Pregnant women should be vaccinated with inactivated influenza vaccine at any stage of pregnancy In no particular order of priority: Additional risk groups to be considered for vaccination are individuals aged 6 59 months, the elderly, individuals with specific chronic medical conditions and health care workers

The Northern & Southern Hemisphere By DLommes - Own work, CC BY-SA 3.0, https://commons.wikimedia.

curid=31855519 Annual human influenza epidemics occur during the respective winter seasons in the

10 The Northern & Southern Hemisphere By DLommes - Own work, CC BY-SA 3.0, Annual human influenza epidemics occur during the respective winter seasons in the temperate zones of the northern & southern hemispheres: Winter season of the Northern Hemisphere: December March annually Winter season of the Southern Hemisphere: June September annually

11 Months of Peak Influenza Activity in 10 Countries of Southern and South-Eastern Asia, NOTE: The map illustrates the months in which influenza activity peaks in each country, as well as the latitudes for the capital cities Source: Siddhartha Saha et al. Influenza seasonality and vaccination timing in tropical and subtropical areas of southern and south-eastern Asia. Bulletin of World Health Organization 2014; 92:

12 Cycle Of Annual Influenza Vaccine Strain Selection, Production And Campaign

13 Cycle Of Annual Influenza Vaccine Strain Selection, Production And Campaign

Meta-analysis of 29 studies with 58,245 subjects from 1957-2009 Unvaccinated HCWs 3.43 times as likely (1.2-5.

Vaccinated 6.49 [4.63-9.09, 95% CI], Unvaccinated 18.69 [15.80-22.

15 Meta-analysis of 29 studies with 58,245 subjects from Unvaccinated HCWs 3.43 times as likely ( , 95% CI) to experience influenza infections as unvaccinated health adults Incidence rate among HCWs: Vaccinated 6.49 [ , 95% CI], Unvaccinated [ , 95% CI] Rates of asymptomatic infections higher in HCWs Compared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza

17 Influenza Vaccination Program For Health Care Workers Healthcare workers are often exposed to the virus during the course of their work. Furthermore, infected healthcare workers may spread the virus to vulnerable patients and initiate nosocomial outbreaks Hence, vaccination of healthcare workers against influenza is a patient safety and a quality-of-care issue The policy of Ministry of Health (MOH) Malaysia: MOH Malaysia advises all medical practitioners (i.e. government & private) to use the most recent vaccine formulation recommended by WHO, respectively For personnel of MOH Malaysia: Provision of annual influenza vaccination to health care workers, mainly for the direct care staff within critical high-risk areas

18 Conclusions Influenza is a vaccine preventable disease vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses. Understanding of the evolution of the virus (for more than 80 years since the isolation of the first influenza virus) has contributed to the evolution of influenza vaccine from a monovalent live attenuated vaccine to the latest quadrivalent inactivated vaccine. Patients remain at risk for nosocomial influenza infection as long as HCWs remain unvaccinated. So, it is important to ensure that HCWs receive influenza vaccination and that the interests of patients are being met.

WHO posi)on paper on influenza vaccines*

WHO posi)on paper on influenza vaccines* Geneva, Switzerland Published in the Weekly Epidemiological Record on 23 November 2012 * This posi(on paper is concerned mainly with vaccines and vaccina(on against