CDC h2N1 Flu | Questions & Answers Novel h2N1 Influenza Vaccine

Content on this page was developed during the 2009-2010 h2N1 pandemic and has not been updated.

• The h2N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide.
• The English language content on this website is being archived for historic and reference purposes only.
• For current, updated information on seasonal flu, including information about h2N1, see the CDC Seasonal Flu website.

Questions & Answers

Recommendations for Vaccine against 2009 h2N1 Influenza Virus

Will the vaccine against 2009 h2N1 influenza virus (also called “swine flu”) be the same vaccine in 2010?

Yes, the vaccine to protect against the 2009 h2N1 influenza virus will be the same for the entire 2009-2010 influenza season, which extends into the spring of 2010. The “2009” in the name only relates to the year the virus was first identified; it does not have to do with how long the vaccine will work or the year in which it should be administered. The 2009 h2N1 virus is not included in the 2009-2010 seasonal flu vaccine because it was identified after manufacturers had started making the seasonal flu vaccine.

Who should get the 2009 h2N1 influenza vaccine?

When vaccine to protect against 2009 h2N1 first became available, supplies were limited. For this reason, CDC’s Advisory Committee on Immunization Practices (ACIP) recommended that people at highest risk for complications from this virus, or those caring for high risk individuals who cannot receive vaccination, receive the vaccine first. These target groups included pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel, anyone 6 months through 24 years of age, and people ages of 25 through 64 years of age at higher risk for 2009 h2N1 influenza because of certain chronic health conditions or compromised immune systems.

ACIP recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these target groups had been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Studies at that time indicated that the risk for infection among people 65 and older was less than the risk for younger age groups so people 65 and older were not initially targeted to receive early doses of vaccine. However, ACIP noted that as vaccine supply increased and demand for vaccine among younger age groups is being met, programs and providers should also offer vaccination to people over the age of 65. At this time, many states have already opened up vaccination to anyone who wants it and while people 65 and older are still less likely to get sick with 2009 h2N1, severe infections and deaths have occurred in every age group, including older people. CDC is now encouraging those who have been patiently waiting to receive the 2009 h2N1 vaccine, including people 65 and older, to get vaccinated depending on local supply.

Separate recommendations are available for seasonal influenza, (Who Should Get Vaccinated Against Seasonal Influenza?)

How many doses of vaccine are required?

The U.S. Food and Drug Administration (FDA) has approved the use of one dose of vaccine against 2009 h2N1 influenza virus for persons 10 years of age and older. For children who are 6 months through 9 years of age, two doses of the vaccine are recommended. These two doses should be separated by 4 weeks. Infants younger than 6 months of age are too young to get any influenza vaccine.

Why does my child need two doses of the 2009 h2N1 vaccine dose?

The recommendation that children younger than 10 years old receive 2 doses of 2009 h2N1 vaccine was based on studies of immune response to the vaccine as measured by levels of protective antibodies in the blood. After 1 dose of vaccine, infants and young children do not make as many antibodies compared with older children and adults who get 1 dose.  

In addition, effectiveness of seasonal flu vaccine is much less for young children who have never been vaccinated before and only get 1 dose, compared with young children who have never been vaccinated before and get 2 doses. 

Persons who have some antibody from previous vaccination or exposure to infection with another related flu strain will have much greater increases in antibody to flu vaccines. Studies that looked at blood samples taken from children before the pandemic indicate that very few children had any measurable immunity against 2009 h2N1 prior to the outbreak Therefore, all children younger than 10 should get 2 doses regardless of whether they ever have been given seasonal influenza vaccine

What is the recommended interval between the first and second dose for children 6 months through 9 years of age?

CDC recommends that the two doses of vaccine against 2009 h2N1 influenza virus be separated by 4 weeks. However, if the second dose is separated from the first dose by at least 21 days, the second dose can be considered valid.

A few months have past since my child received the first 2009 h2N1 vaccine, should I have her receive the 2nd dose?

CDC recommends that the two doses of vaccine against 2009 h2N1 influenza virus be separated by 4 weeks. If the second dose is administered beyond 4 weeks, the body’s immune system still remembers the first dose and develops antibodies or protection against 2009 h2N1 influenza virus.  Research shows that the immune system will not develop adequate protection if the vaccine dosing interval is < 21 days.

Can people who are allergic to eggs receive the vaccine against 2009 h2N1 influenza virus?

People who are allergic to eggs might be at risk for allergic reactions from receiving any influenza vaccine. People who have had any of the following symptoms or experiences should consult with a doctor or other medical professional before considering any influenza vaccination:

• hives or swelling of the lips or tongue after eating eggs
• acute respiratory distress (trouble breathing) after eating eggs
• documented hypersensitivity to eggs, including those who have had asthma related to egg exposure at their workplace or other allergic responses to egg protein

Because children with severe asthma are at high risk of serious complications from influenza, a regimen has been developed for giving influenza vaccine to children with severe asthma and egg hypersensitivity.

Late Season Recommendations

Why should flu be taken seriously?

Flu should never be dismissed as “just the flu.” It’s a serious disease, and while most cases are mild, some can be deadly.  So far this flu season, most flu activity has been caused by the 2009 h2N1 virus, which was first identified in April 2009 and caused the first flu pandemic in 40 years.

Because many people with influenza illness are not tested for flu or are tested late in their illness, methods have been developed to estimate the numbers of people with influenza illness and with influenza-related complications, including hospitalizations and deaths.  CDC estimates that from April to January 16, 2010, approximately 57 million cases of 2009 h2N1 occurred in the United States, including 257,000 h2N1-related hospitalizations and about 11,690 deaths. 

With 2009 h2N1, approximately 90% of estimated hospitalizations and 87% of estimated deaths from April through January 16, 2010 occurred in people younger than 65 years old.   In contrast, with seasonal influenza, about 60% of seasonal flu-related hospitalizations and 90% of flu-related deaths occur in people 65 years and older.   This data confirms that the 2009 h2N1 impacted younger adults and children more than older adults compared to seasonal flu.  However, people in all age groups can develop severe illness from either seasonal flu or from 2009 h2N1.

Flu season seems to be dying down—Why do people still need a vaccination against 2009 h2N1?

The flu season is not over yet. As recently as January 15, 7 states were still reporting regional flu activity, so flu is still out there. Also, seasonal flu typically peaks in February and March and influenza activity can occur as late as May. So, increased activity from either seasonal flu, 2009 h2N1 or both are still possible this season.

For example, during the 1957-58 pandemic, flu activity dropped in December and January. Public health officials assumed the worst was over, and stopped encouraging people to get vaccinated. Then flu activity increased abruptly in February and March, and hospitalizations and deaths increased as well.

That was an important lesson—even if flu activity dies down in January, as it has this year, the season is not over. It’s still important to get vaccinated against the flu and be as prepared as possible if activity increases again this season.

Is there anyone who should take priority when it comes to getting a flu vaccination?

Right now there is enough vaccine for everyone who hasn’t been vaccinated and wants to be. Children who are 9-years old or younger need two doses of vaccine about a month apart. There is enough vaccine for them as well.

But it is especially important for certain groups of people to get vaccinated. If you have certain underlying health conditions—such as asthma, heart disease, or diabetes—or if you’re pregnant, you’re at greater risk of complications from flu. If you’re over 65, you’re also at risk of complications.

If you’re a health care worker, you should get vaccinated. If you care for or live with an infant under 6 months of age (babies less than 6 months old are too young to be vaccinated), you should get vaccinated, too, to prevent spreading the flu to people who are vulnerable.

Where should I go to get vaccinated against 2009 h2N1?

This is a very good time to get vaccinated. Right now not many people are sick, and there is enough vaccine for everyone who hasn’t been vaccinated yet—including kids 9 years old and younger who need a second dose.

An easy way to find out where vaccine is available in your area is by going to www.flu.gov and clicking on the vaccine locator. In addition, Flu.gov has a new Facebook application—the “Flu Fighter.” It’s one of the site’s many “viral” communication tools to help spread the word that getting a vaccine against 2009 h2N1 is the best way to protect yourself and your friends. When you go to flu.gov please check it out.

If the second dose of 2009 h2N1 flu vaccine for children under 10 years of age is given over a month after the first dose, is it still considered effective?

Yes. CDC recommends that the two doses of vaccine against 2009 h2N1 influenza virus be separated by 4 weeks. However, if the second dose is separated from the first dose by at least 21 days, the second dose can be considered valid.

Supply and Distribution

How do “project areas” know how much vaccine is available for them to order?

CDC distributes vaccine to 62 “project areas.” These project areas include 50 states, the District of Columbia, 8 U.S. territories and freely associated states, and 3 large metropolitan areas. CDC sends these project areas an allocation report each morning on how much of each formulation of vaccine against 2009 h2N1 influenza virus is available for them to order.

What is the number of doses “allocated” for ordering?

The number of doses “allocated” for ordering is the amount that is at the distribution depots and ready for states to order. The quantity of vaccine allocated is based on the project area’s population size. As an example, if 6 million doses total (3 million doses of nasal spray vaccine AND 3 million doses of injectable vaccine) are ready for ordering nationally (as of today) and a state has 10% of the US population, then their allocation for today is 600,000 doses total (300,000 doses of the nasal spray vaccine and 300,000 doses of injectable vaccine).

How is vaccine shipped to project areas?

CDC’s contractor for centralized distribution ships vaccine directly to hospitals, clinics, doctor’s offices, health departments, and other providers of vaccines that have been designated by the project area.

What kind of providers can be designated by project areas to receive vaccine?

Project areas are responsible for registering vaccine providers in their jurisdiction. Providers may include, but are not limited to, individual clinicians, provider offices, clinics at places of work, hospitals, local health departments, retail pharmacies, and community vaccinators. Providers or facilities receiving vaccine must be capable of receiving and properly storing vaccine.

What is the number of doses “allocated” for ordering?

The number of doses “allocated” for ordering is the amount that is at the distribution depots and ready for states to order. The quantity of vaccine allocated is based on the project area’s population size. As an example, if 6 million doses total (3 million doses of nasal spray vaccine AND 3 million doses of injectable vaccine) are ready for ordering nationally and a state has 10% of the US population, then their allocation for today is 600,000 doses total (300,000 doses of the nasal spray vaccine and 300,000 doses of injectable vaccine).

Who determines which providers receive the vaccine?

Specific determinations about where vaccine will be shipped and how it will be distributed to providers are made at the state and local level. The federal government allocates vaccine based on population to public health departments in the 62 project areas. These public health departments then make decisions about how to distribute vaccine to providers equitably and efficiently within their jurisdictions with the goal of reaching the priority groups first. State and local immunization programs have planned their efforts according to local capacity and needs. CDC continues to encourage state and local health officials to review and revise their vaccine distribution plans in response to changing needs.

How does CDC ensure that providers’ vaccination practices are consistent with ACIP recommendations?

Providers who offer the vaccine against 2009 h2N1 influenza virus must sign an agreement stating that they will adhere to recommendations issued by the U.S. Advisory Committee on Immunization Practices (ACIP).

How many sites can a project area designate to receive vaccine?

There is a maximum of 150,000 sites to which vaccine can be shipped via the centralized distribution system. Project areas have received information about their allocation of sites.

What should project areas expect with respect to frequency of vaccine shipments?

Vaccine is shipped as it becomes available, taking into account state allocations and orders. The process is modeled after that utilized by immunization programs to order seasonal influenza vaccine off the federal contract. Details about CDC’s ordering/allocation process for seasonal influenza are described in the all-grantee message sent to immunization program grantees on August 11, 2009 (Grantee message for allocation).

What is the minimum dose order for shipments of 2009 h2N1 vaccine?

For each vaccine formulation (identified by its National Drug Code) the minimum dose order is 100 doses and all orders must be placed in increments of 100 doses. Each ancillary supply kit contains supplies to support 100 doses of vaccine, with different kits available for prefilled syringe products and for multi-dose vial products.

When was the vaccine against the 2009 h2N1 virus first available and how much was available?

Both the injected vaccine (flu shot) and nasal spray forms of the vaccine against the 2009 h2N1 virus were produced and licensed by the Food and Drug Administration. The vaccine first became available in early October, and more doses are becoming available every week. Vaccine availability, however, depends on many factors so these numbers are updated often. The first doses of the nasal spray, or live, attenuated intranasal vaccine (LAIV), were administered on October 5, 2009, and the first doses of the influenza shot were administered the week of October 12.

Where is the vaccine available?

Every state has developed a vaccine delivery plan. Vaccine has been available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces. For more information, see State/Jurisdiction Contact Information for Health Care Providers Interested in Providing h2N1 Vaccine.

For information on seasonal vaccine supply and distribution, visit Seasonal Influenza Vaccine Supply for the U.S. 2009-2010 Influenza Season.

Can I get vaccinated against the 2009 h2N1 virus at my workplace?

CDC has recommended that when possible worksites offer both influenza vaccines. It also suggests that workplaces consider granting employees time off from work to get vaccinated if not offered at the worksite. For more information on CDC’s influenza guidance for businesses and employers visit: “CDC Guidance for Businesses and Employers To Plan and Respond to the 2009–2010 Influenza Season”.

Vaccines for the 2009-2010 Influenza Season

Does the seasonal influenza vaccine also protect against 2009 h2N1 influenza?

The seasonal influenza vaccine will not protect you against 2009 h2N1 influenza. For more information about the seasonal flu vaccine, read Key Facts About Seasonal Flu Vaccine.

Is this vaccine made differently than the seasonal influenza vaccine?

No. The vaccine against the 2009 h2N1 virus is made using the same processes and facilities that are used to make the currently licensed seasonal influenza vaccines

Can both flu vaccines be given at the same time?

Inactivated vaccine against the 2009 h2N1 flu virus (the flu shot) can be given at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. The LAIV (nasal spray vaccine) against the 2009 h2N1 virus can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.

Prior Vaccination or Illness

Should I get vaccinated against 2009 h2N1 if I have had flu-like illness since the Spring of 2009?

The symptoms of influenza (flu-like illnesses) are similar to those caused by many other viruses. Even when influenza viruses are causing large numbers of people to get sick, other viruses are also causing illnesses. Specific testing, called “RT-PCR test,” is needed in order to tell if an illness is caused by a specific influenza strain or by some other virus. This test is different from rapid flu tests that doctors can do in their offices. Since most people with flu-like illnesses will not be tested with RT-PCR this season, the majority will not know whether they have been infected with 2009 h2N1 flu or a different virus.

Therefore, if you were ill but do not know if you had 2009 h2N1 infection, you should get vaccinated if your doctor recommends it. So, most people recommended for 2009 h2N1 vaccination should be vaccinated with the 2009 h2N1 vaccine regardless of whether they had a flu-like illness earlier in the year. If you have had 2009 h2N1 flu, as confirmed by an RT-PCR test, you should have some immunity against 2009 h2N1 flu and can choose not to get the 2009 h2N1 vaccine. However, vaccination of a person with some existing immunity to the 2009 h2N1 virus will not be harmful. For more information on flu tests, see Influenza Diagnostic Testing During the 2009-2010 Flu Season.

Any immunity from 2009 h2N1 influenza infection or vaccination will not provide protection against seasonal influenza. All people who want protection from seasonal flu should still get their seasonal influenza vaccine.

Prevention

Are there other ways to prevent the spread of illness?

Take everyday actions to stay healthy.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose or mouth. Germs spread that way.

Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (temperature of 100° F [37.8°C] or more), or signs of a fever without the use of fever-reducing medications.

Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures are still important, even with the availability of the vaccine against 2009 h2N1 virus, because they can prevent the spread of other viruses that cause respiratory infections.

What about the use of antivirals to treat 2009 h2N1 infection?

CDC has issued interim guidance for the use of antiviral drugs for this season. CDC also has published Questions & Answers related to the use of antiviral drugs for this season.

Are natural remedies (also referred to as “complementary” or “alternative” medicine) recommended to prevent the 2009 h2N1 Influenza virus?

The first and most important step to prevent influenza is to get vaccinated. Vaccination stimulates an immune response using a killed or weakened virus that uses the body’s own defense mechanisms to prevent infection. CDC’s current recommendations to protect against 2009 h2N1 virus do not include natural remedies as a sole prevention method. If you want to use a natural remedy to reduce symptoms, CDC recommends that you talk to your health care provider about options.

Alternative medicine should not be used as a replacement for proven conventional care, or to postpone seeing a doctor about a medical problem. The National Institutes of Health (NIH) provides information on specific alternative options, including scientific information, potential side effects, and cautions for each.

The Federal Trade Commission (FTC) warns consumers to be cautious about products that claim to prevent, treat, or cure 2009 h2N1 influenza, specifically products like pills, air filtration devices, and cleaning agents can kill or eliminate the virus.

What is the role of vaccination in the prevention of h2N1 influenza (swine flu)?

h2N1 vaccines

Safety of pandemic A (h2N1) influenza vaccines

Extract from report of GACVS meeting of 3-4 December 2009, published in the WHO Weekly Epidemiological Record on 29 January 2010

Since its emergence in March 2009, influenza A (h2N1) 2009 virus has caused significant morbidity and mortality. For example, the United States Centers for Disease Control and Prevention (CDC) estimates that in the USA there have been about 100 000 hospitalizations and nearly 4000 deaths caused by pandemic (h2N1) 2009 virus during the period April to 17 October 2009. In response to the pandemic, >30 pandemic (h2N1) 2009 vaccines have been developed and licensed. Since September 2009, >50 countries have implemented immunization programmes targeting various populations. These populations include health-care workers, children, pregnant women, and individuals with certain underlying medical conditions, including chronic lung disease, diabetes, and heart disease, as well as those whose immune systems are compromised.^3,4

From 21 September to 2 December 2009, tens of millions of doses of the pandemic (h2N1) 2009 vaccine were administered, thereby providing the basis for this first safety review by the GACVS. The review is mainly based on passive surveillance data.⁵ Under the coordination of WHO, there is an unprecedented, ongoing exchange of safety information among regulatory and public health authorities from many countries around the world.

Pandemic influenza vaccines include live attenuated vaccines, inactivated unadjuvanted vaccines (split, sub-unit virion, or whole virion) and inactivated adjuvanted vaccines (split or sub-unit virion). At the time of the GACVS review, it was estimated that nearly 150 million vaccine doses had been distributed in many countries around the world. Approximately 30% of those 150 million doses are adjuvanted vaccines. No unexpected safety concerns have been identified for any of the pandemic (h2N1) 2009 vaccines. Product labelling for each vaccine contains a summary of expected side-effects.⁶

In the ongoing immunization campaigns, deaths in temporal association with vaccination have been reported in many countries. Given the large number of people who have been vaccinated, it is expected that deaths that were unrelated to vaccination would occur in temporal association with vaccination.⁷ Investigation of deaths that have been reported after immunization have identified that the cause of death has been unrelated to vaccination in all but a few instances. There have been a few individual reports of deaths associated with anaphylactic reactions to vaccination.

Immediate hypersensitivity reactions have been reported after the use of all types of pandemic (h2N1) 2009 vaccines. These events include urticaria, angioedema and anaphylaxis, with reactions ranging from mild to serious. The overall reporting rates for anaphylaxis range from 0.1 to 1.0 per 100 000 doses distributed. Anaphylaxis is a known, potentially life-threatening adverse effect of all vaccines and is a very rare event. Nonetheless, immunization providers must be prepared to recognize and appropriately treat such reactions.⁸

Although some cases of Guillain–Barré syndrome have been reported after receipt of pandemic (h2N1) 2009 vaccines, the evidence to date is reassuring, with no increase in reporting rates above what is expected, based on background rates. Active surveillance for GBS has been instituted in several countries and should provide additional information by the first quarter of 2010.

Concerns have been raised about the use of adjuvanted pandemic vaccines in patients with immune disorders, such as immunodeficiency, autoimmune disorders and solid organ transplants. To date, post-marketing surveillance has not found evidence for causality of any safety issues in such patients. Viral infections, such as influenza, can lead to severe complications in immunocompromised patients. Thus, the benefit of pandemic (h2N1) 2009 vaccines, adjuvanted or unadjuvanted, far outweighs the potential risks in these patients.

Programmatic errors have also been reported, including erroneously administering other drugs instead of vaccine, or errors in mixing adjuvant and antigen components as required for some of the vaccines. Immunization programmes should take appropriate measures to prevent such errors. In summary, GACVS concluded that:

Ten weeks into the worldwide immunization campaign against pandemic (h2N1) 2009, the GACVS reviewed the safety of pandemic (h2N1) 2009 vaccines currently in use. To date, the safety data are reassuring.

Most of the adverse events that have been reported after immunization have not been serious. To date, no unexpected safety concerns have been identified.

Reporting mechanisms have been enhanced. Ongoing vaccine safety monitoring (pharmacovigilance) is critical, including regular information-sharing with WHO by national regulatory and health authorities. Most of the safety information to date is from passive surveillance. Data from active surveillance will be assessed as they become available.³

^{3See No. 30, 2009, pp. 301–308.}

⁴ See No. 49, 2009, pp. 505–516.

⁵Passive surveillance refers to a system designed to collect adverse events that follow vaccination. This type of surveillance typically relies on health professionals noting and reporting to the appropriate authority adverse events that occur in individuals after vaccination. This system relies on spontaneous reporting by health-care staff. By contrast, active surveillance is a mechanism through which specific health conditions are monitored through a systematic and continuous review of medical records.

⁶The Committee noted the recent warning from the European Medicines Agency (EMEA), after review of data from an ongoing clinical trial submitted by the manufacturer, that a higher proportion of young children may experience fever after their second dose of an adjuvanted pandemic influenza vaccine, Pandemrix, than after their first dose. The EMEA recommended that prescribers and parents should monitor the temperature of the vaccinated child and, if necessary, take measures to lower the fever. Additional information is available at: http://www.emea.europa.eu/pdfs/general/direct/pr/78440409en.pdf (accessed January 2010).

⁷Black S et al. Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic h2N1 influenza vaccines. Lancet, 2009 (doi:10.1016/S0140-6736(09)61877–8).

⁸The Public Health Agency of Canada identified a higher-than-normal rate of anaphylaxis (4.1/100 000 doses distributed) linked to one particular lot of the adjuvanted pandemic (h2N1) 2009 vaccine. Pending further investigation of adverse event reports linked to the lot, unused vaccines from this lot were withdrawn from use on 24 November 2009.

Full report of GACVS meeting of 3-4 December 2009, published in the WHO Weekly Epidemiological Record on 29 January 2010

Ten years ago, h2N1 swine flu ushered in drug-store flu shots — Quartz

Ten years ago, the United States was in the middle of a particularly devastating flu season. A version of h2N1, the so-called swine flu, was circling the globe in 2009—a virulent strain that, uncharacteristically for the virus, targeted the young. Hundreds of thousands died, more than 10,000 in the US alone. 

The h2N1 pandemic was a shock to global public health systems, which realized they were woefully unprepared for a more serious viral threat. But the challenges faced by distributing a limited number of crash-landed vaccines around the country helped set the stage for a significant shift in vaccination practices in the US: the acceptance of store-based flu shots. Today, close to a third of all adult flu shots in the US are given at retail pharmacies. 

Pharmacists in the US were able to give vaccines long before 2009: That trend started in 1996, when the American Pharmacists Association started certifying pharmacists in shot-giving. By 2004, about 15,000 pharmacists had been trained to give vaccines. But the practice got a huge boost as state laws changed to allow more of those trained pharmacists to actually do the job of giving shots. 

By 2007, 46 states had allowed pharmacists to give shots to adults. And in the face of the h2N1 pandemic all 50 gave the go-ahead, in addition to Washington, DC and Puerto Rico. “During the pandemic, many new partnerships between public health agencies and medical and non-medical vaccination providers were formed, increasing the number of vaccination providers,” details a CDC report. In 2009, Walgreens and its associated clinics, for example, gave out 5.4 million seasonal flu shots, along with 2 million more h2N1 shots.

Since then, Americans have increasingly turned to stores to get their annual flu shots. In the 2010-2011 flu season, 18.4% of adult flu shots were given in stores—less than half the share administered in doctor’s offices, but still a sharp increase over previous years. (Unpublished data from the National Immunization Survey shows store vaccinations accounting for just 7% of all flu shots in the 2006-2007 season.) In the 2011-2012 season, the proportion was up to 20.1%, surpassing workplace vaccinations. By the 2014-2015 season, it was up to 22.2%. Then 24.3%. Then 28.2%. 

In the last three flu seasons, the CDC reports, the projected number of adult flu shots billed in stores increased an average of 20% per year (compared to 4% annual growth in doctor’s offices). Children are still more likely to get their shot from a physician—they visit doctors more regularly than adults on average, and some states still prohibit pharmacist-administered shots below a certain age—but the rate of store shots for kids has been increasing, too. 

The service has become a business worth $4 billion to $5 billion for big box pharmacies and stores, from Walgreens and CVS to Target and Publix. Some stores have even offered discounts to draw customers in from competitors. Last year was the first Walgreens offered the flu shot at every single one of its pharmacy locations—including Walgreens-owned Duane Reade and Rite Aid pharmacies. And access keeps on getting easier: North Carolina, for one, just lowered the minimum age of patients able to get shots in pharmacies. 

Public health advocates hope that pharmacy-based flu shots will improve overall vaccination rates, thanks to the convenience of accessing local care during non-work hours—though evidence of a direct impact on vaccination or infection rates is lacking.

Last year’s flu season was especially severe, resulting in a count of flu-related visits to emergency rooms and doctor’s offices not seen since the 2009 pandemic. And while flu vaccinations in adults jumped by 8.2% over the previous year, the overall vaccination rate—45.3%—was still dismally low. Public health officials are hoping that increased awareness of the risks of the flu will continue the upward trajectory of flu vaccinations, no matter where they’re acquired.

The h2N1 Vaccine Is A Cautionary Tale For The Coronavirus

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People wait in line to receive an h2N1 flu vaccination in San Francisco in December 2009.

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First reports of the outbreak were dire, spreading from a foreign country with a 41% mortality rate and triggering a crash race for a vaccine.

The year was 2009, and the illness was the h2N1 flu, the last time the US rolled out a new nationwide vaccine in response to a pandemic.

That 2009 h2N1 flu vaccine, produced in a $2 billion sprint from April to November of 2009, has now emerged as a political football in the 2020 presidential election. Last week, White House press secretary Kayleigh McEnany tweeted that the Obama and Biden team’s response to the emergence of the pandemic flu strain — which ultimately killed more than 12,000 Americans — was “FAILED.”

Obama touts FAILED response to “N1h2” (Biden code for h2N1 Swine Flu)

FACTS:

❌ Biden SHUT DOWN testing

❌ Biden FAILED to get vaccine in time

❌ Biden COS: “purely fortuity that this isn’t one of the great mass casualty events..had nothing to do with us doing anything right”

02:45 AM – 20 Aug 2020

Scientists stress that the comparison is not entirely valid, in large part because of the vast differences between the flu strain and the novel coronavirus. But as the US prepares an unprecedented national rollout of SARS-CoV-2 vaccines, with millions of doses already being manufactured in preparation, the story of the 2009 vaccine — with its low coverage rates, up-and-down demand, and initial shortages followed by oversupply — serves as a cautionary tale for both Joe Biden and President Donald Trump.

“Nothing went flawless or perfect, and the deaths were tragic and disappointing,” said Howard Koh, a former Obama administration Department of Health and Human Services official. “There were a lot of challenges, but everyone pulled together, which I worry about now.”

On Wednesday, the CDC’s Advisory Committee on Immunization Practices met to discuss two Operation Warp Speed coronavirus vaccines and outline strategies for inoculating the first wave of people — most likely healthcare workers — with their first doses, if they prove safe and effective.

“The h2N1 vaccine experience is only partly applicable to COVID-19, but it does offer the lesson that a strong communication plan needs to be in place ahead of time, starting, well, now,” said health communications expert K. Viswanath of Harvard’s T. H. Chan School of Public Health.

Biden has pledged to add $25 billion toward vaccine development and distribution, if elected. (His campaign did not provide a response when asked about the 2009 vaccine, which was largely managed by federal science officials.) The Trump administration’s Operation Warp Speed has invested around $8 billion in developing vaccines and treatments for COVID-19 so far and promised to deliver 300 million doses of a coronavirus vaccine to the US by January. (Operation Warp Speed’s federal leaders backtracked on this pledge in a New England Journal of Medicine report on Wednesday, setting the goal as 300 million doses, where many of its candidates are two-shot inoculations, by July.)

“A huge lesson from h2N1 is that it takes just a tremendous amount of work and preparation that all has to be done ahead of time to roll out a new vaccine,” former HHS official Nicole Lurie of the Coalition for Epidemic Preparedness Innovations told BuzzFeed News. (Lurie is a medical adviser to Biden but emphasized she was not speaking on behalf of the campaign.) “You really have to be ready months before the vaccine is ready for shipment.”

In reality, the Obama administration response to h2N1 was well run, University of Michigan medical historian Howard Markel told BuzzFeed News, featuring regular updates from medical officials to the public and producing a vaccine in record time. “There really was terrific communication and coordination between state, local, and federal health officials,” said Markel, who sat on an outside expert panel monitoring the response as it happened.

Markel added that the Trump criticism of Biden for the Obama administration’s handling of the 2009 pandemic seemed misplaced, since the Trump administration has overseen a pandemic response that has led to more than 177,000 Americans dying.

Despite those deaths, public confidence in a coronavirus vaccine’s safety is in poor shape, with 35% of Americans saying they wouldn’t take a free vaccine from the FDA, according to a recent Gallup poll. Similar safety concerns led to a disappointing rollout of the h2N1 vaccine, amid dissipating alarm about an influenza strain that turned out less deadly than was initially feared.

“It was a success, but a lot less people ended up getting the vaccine than they should have, ” Markel said. “That’s the first lesson of any vaccination program: You have to get people on board with getting the vaccine.”

The White House / Getty Images

A White House nurse prepares to administer the h2N1 vaccine to then-president Barack Obama at the White House in December 2009.

The 2009 Vaccine

In some ways, the 2009 h2N1 outbreak was a reverse image of the novel coronavirus pandemic: While it wasn’t even clear to the world that SARS-CoV-2 spread from person to person until weeks into the outbreak, the earliest cases of h2N1 emerged in a report from Mexico in March of 2009, with news of a disease that struck 6.5% of patients with critical cases and killed 41% of those.

The h2N1 outbreak spread to the US, Canada, and Europe by April of 2009, with the CDC releasing a successful test for the virus globally on the first day of May. (In the case of SARS-CoV-2, the CDC’s first batch of tests turned out to be botched.) By June, the flu virus had reached 75 countries, leading the World Health Organization to declare it a pandemic. “The demand for a vaccine was borne from those first few months — April, May, June, everyone wanted a vaccine,” said Markel.

In another difference from COVID-19, the 2009 flu targeted the young rather than the old, with 85% of deaths occurring to people younger than age 60. The elderly turned out to have greater immunity due to childhood infections with a distantly related h2N1 influenza strain.

Clinical trials of h2N1 vaccines began in July of 2009, with federal officials planning to have 120 million doses for a rollout. But since the flu virus is heavily seasonal, cases faded in the northern hemisphere with summer, and with it, public concern over the virus faded as well. By August, a poll found that only 40% of parents planned to get the h2N1 shot for their children. Meanwhile, right-wing radio host Rush Limbaugh and comedian Bill Maher were among those bad-mouthing the risks of the rapidly developed vaccine, raising popular fears. The US h2N1 vaccine was just as safe as the regular flu shot, subsequent studies have shown.

In early October, the Obama administration first began distributing the vaccine with only 2.4 million doses available and, facing an early fall flu season, recommended children and pregnant women be prioritized for the two-shot vaccine. The result was a surge in demand in some places with not enough supply. Former HHS official Lurie said the agency ended up placing observers in manufacturing facilities to oversee production. “There are going to be delays no matter whatever happens,” Lurie said.

By the end of the month, HHS had distributed only 23 million doses. When hundreds of millions of doses later became available, demand for the vaccine died down, leaving a patchwork of coverage around the country. In Rhode Island, about 85% of children were vaccinated while in Georgia, home to the CDC, only 21% were.

“One lesson of h2N1 is that when supply is more plentiful, people are less likely to want it,” said Lurie. “It’s just human nature to really want something more when it is scarce. But it means you have to keep working to get people vaccinated even after you have ironed out supply problems.”

In the end, while 40% of adults got the single shot for the seasonal flu in the 2009 flu season, only 23% were vaccinated against h2N1, according to the CDC. “That was a failure, and a main driver was a perception of safety,” said Rally Health behavioral scientist Ezequiel Galarce, who led a 2011 study finding low vaccination rates among Black and Latino communities in 2009.

“There’s a risk-to-benefit calculation that people make about vaccinations, with a huge emotional aspect,” he added. “I think we will see that now, just like then.”

Pool / Getty Images

Francis Collins, Director of the National Institutes of Health, testifies before the Senate about Operation Warp Speed in July.

The 2020 Vaccines

“What keeps me up at night is that the first vaccines are going to roll off the assembly line, or gonna roll off first, because they were the easiest to construct and the fastest to mass-produce,” not the most effective or best ones, Children’s Hospital of Philadelphia vaccine expert Paul Offit said at a medical press briefing on Monday.

The FDA has set the bar for approval of a COVID-19 vaccine at 50% effectiveness in blocking transmission of the virus. But to halt an epidemic, a coronavirus vaccine should prevent at least 70% of infections as long as at least three-quarters of the population is inoculated, according to an American Journal of Preventive Medicine analysis released on Tuesday.

“We are facing mountains of misinformation we didn’t have then,” said Viswanath. Like any vaccine, coronavirus inoculations will doubtless have side effects like sore arms or occasional fevers. That’s normal. But how will reports of those totally foreseeable side effects play out in today’s social media–amplified world of viral conspiracy theories and organized anti-vaccine campaigns?

“I worry all of these things will come together to undermine a coronavirus vaccine,” said Viswanath.

What’s more, the politicization of the pandemic, with masks, hydroxychloroquine, and death rates from COVID-19 all becoming matters of partisan disagreement, points to a likely politicization of vaccines as well, with some imagining attitudes toward a vaccine flipping with ownership of the White House.

Others fear Trump pressuring the FDA to release a shoddy vaccine in a desperate bid for reelection. The chaos of FDA scientists likely resigning over the decision, vaccine trial scientists protesting, and loud blowback from outside vaccine experts, all of them facing off with a Trump campaign now down by more than 7% in an average of national polls, would be awful, said Koh, wrecking the trust in vaccines that is the first condition needed for a successful rollout.

The Infectious Diseases Society of America warned FDA commissioner Stephen Hahn against taking such a step in a letter released on Wednesday. “Making a vaccine available before sufficient safety and efficacy data are available could significantly undermine COVID-19 vaccination efforts and seriously erode confidence in all vaccines,” it read.

Hahn’s credibility has come under fire in his handling of an emergency authorization for use of blood plasma as a treatment for COVID-19, where he bungled the statistics about its effectiveness amid political pressure from Trump. He apologized for the statistical mistake, but then raised eyebrows on Wednesday by promoting a vaccine advisory committee meeting on Oct. 22, in a Twitter thread touting enrollment in the vaccine candidate trials.

“We really will need national unity of some kind, to have high vaccination rates,” said Galarce. “Sometimes the messenger matters more than the message,” he added.

Short of the “October surprise,” there are plenty of pitfalls pointed out by the 2009 experience. Both the CDC and the National Academies of Science, Engineering, and Medicine are looking at making COVID-19 vaccines more easily available to Black and Latino people, trying to avoid disparities seen in the 2009 vaccine rollout. The key to that effort will be reaching out to community leaders and finding out how to make the vaccines more accessible, so that people don’t have to take three buses and stand in line for hours to get a shot.

“It’s a lot easier to remove barriers than to increase people’s motivation,” said Galarce.

At Wednesday’s CDC vaccine advisory panel meeting, requirements for refrigeration raised concerns about the shelf life of the first two vaccines in the Operation Warp Speed pipeline, one made by Pfizer and one made by Moderna, which could lead to the kinds of shortages that plagued the h2N1 vaccine rollout.

Advisory committee members were asked to consider scenarios for the rollout of the two vaccines as soon as October. If both vaccines were successful, that would provide 35 to 45 million doses — enough to inoculate half that many people because the vaccines require two shots — by the end of December.

CDC/ACIP

Vaccination scenarios presented at the CDC advisory panel meeting (–70°C is –94°F).

Given local COVID-19 outbreaks and varied capabilities to store vaccines, the CDC’s Nancy Messonnier said federal officials will need to “leave state local health departments some flexibility to deal with their own local situations” during the coronavirus vaccine rollout. She recalled the h2N1 experience to make this point, calling it “very different but with certain similarities.”

The individual calculus that people did in 2009 drove older folks away from getting a shot, because h2N1 was widely seen as dangerous only to the young. Galarce expects to see the flip side of that calculation for a coronavirus vaccine, with young people deciding to skip a shot because of their lowered risk, potentially undermining herd immunity. The rise of anti-vaccination attitudes among parents, as well as the drastically lower chances of serious illness in children, could also reduce inoculations among kids. Such decisions undermine herd immunity to the virus, because infected kids can pass along the coronavirus.

One important step is letting people know right now that the FDA and CDC are planning an intense vaccine safety monitoring effort, said Vanderbilt University’s Kathryn Edwards, scientific director of the Vanderbilt Vaccine Research Program. Her program will be headquarters for a consortium with six other schools running a 24-hour hotline for doctors with any safety questions once a coronavirus vaccine is available.

At the CDC’s vaccine meeting, officials described a number of FDA, CDC, and Defense Department programs to watch for any signs of adverse events in vaccines, ranging from the Vaccine Adverse Event Reporting System (VAERS), created in 1986, which tallies reports from manufacturers, to the PRISM system, stood up by Lurie and other officials in the h2N1 crisis, which collects rapid reports of adverse vaccine events from Medicare and insurers, feeding them directly to federal overseers.

On top of building the vaccine safety hotline system, Edwards also participates in the safety monitoring of one Operation Warp Speed vaccine that is currently in clinical trials and planned for testing in 30,000 patients.

“We are really seriously looking for any concerns. I work from Sunday to Saturday, and so do a lot of other people,” Edwards said. “People should know this.”

As COVID-19 vaccines arrive, Europe looks back at swine flu side effects | Science | In-depth reporting on science and technology | DW

Vaccines have saved tens of millions of lives and eradicated a host of diseases that would otherwise continue to plague humanity. They can, however, have unintended side effects that, although statistically infrequent, cause fear in populations that would benefit from taking them. DW’s Science unscripted podcast team spoke to Matti Sällberg, a vaccine expert at Sweden’s Karolinska Institute, about whether the side effects of the swine flu vaccine are cause for any legitimate concerns regarding the coronavirus vaccines.

Listen to the full interview on Spotify or Apple Podcasts.

DW: We keep seeing vaccine skeptics referencing the swine flu pandemic in 2009 as the reason they won’t be taking a COVID-19 vaccine. Let’s rewind — what happened?

Matti Sällberg: In March of 2009, we had an outbreak of a new flu virus. It stemmed, probably, from pigs in Mexico, and then it spread as a pandemic all over the world. The major difference to many other flu outbreaks was that young people tended to become very sick. And alarm bells rang all over, it looked like the 1917 Spanish flu outbreak. A vaccine was therefore developed against swine flu and was administered in 60 or 90 million doses globally. In Europe — and particularly in the Nordic countries, almost exclusively — cases of narcolepsy appeared after these vaccinations. It was around 300 cases.

So these vaccines against the swine flu were being administered, people were getting shots, and then, suddenly, people started noticing that a startling number —

No, no. First of all, you have to realize that we’re distributing, globally, 60 to 90 million doses. We’re talking 300 cases of narcolepsy. So this is an extremely rare event. An extremely rare event. 

I understand that it was rare, but still, that 300 people get narcolepsy — this didn’t come up in any of the trials? When did the cases emerge?

I don’t remember exactly when they emerged in relation to the vaccines.

So what happened next? Did the immunizations stop? Did people stop getting the vaccines? Or was this considered a normal, or acceptable, side effect of handing out these vaccines?

It’s totally not a normal side effect. The confounding factor is that the [swine flu] virus itself causes narcolepsy. And then it’s very often hard to dissect whether this was caused by the viral infection or the vaccine. Still, the Swedish authorities decided to compensate those who developed narcolepsy.

Swine flu death estimates range from 150,000 to more than a half million

Why should people not be scared that something similar won’t happen with a COVID-19 vaccine? Is there any reason that these new vaccines are different and shouldn’t have that happen, as compared to the swine flu vaccines?

Absolutely. First of all, the clinical trials now are much bigger. We’ve now vaccinated over 100,000 people already. There’s yet to be a severe adverse event associated with these vaccinations. There is no evidence, as far as I know, that COVID-19 causes narcolepsy. That’s certainly not one we’re going to see — if we’re going to see any severe side effects.

One of our listeners, Stefan, wrote in to us, “I’m not an anti-vaxxer. But my early inclination is NOT to take the COVID-19 vaccine, as I’m not convinced that enough research has been done on possible side effects.” He’s talking about long-term side effects.

Yeah, but — I understand that. But then the other option is that we stay in a lockdown. So the research that has been done — I really need to emphasize that — the safety studies that have been performed now with these vaccines are quite exceptional. They’re extremely large studies. So I would say that the probability of these vaccines causing common side effects that are actually worse than the COVID-19 pandemic, it’s extremely rare. At least in the Northern Hemisphere, where we have an old population at risk of dying. We have a lot of people in the hospital right now. So, I mean, one has to put this in perspective.

Vaccine expert Matti Sällberg

Our listener Stefan’s question, if I can come back to it, is — “Has this been rushed?” He’s talking about long-term side effects. Has it gone too fast?

No, I don’t think it’s gone too fast if you look at the clinical trials. The clinical trials started in March, they’ve been running until now, so they’re going to run for a year. So no, in that respect, absolutely not, it hasn’t been rushed.

I know that we can’t compare apples to oranges, and comparing an mRNA vaccine to the flu vaccine that was taken back in 2009 is unscientific and idiotic… But IF something were to happen, like the narcolepsy outbreak, because of the mRNA vaccines now, and you look back at it in 10 years — would you say that things were rushed this time around?

You have to define what you mean by “rushed.” You have to look at the clinical trials that have been performed. It’s over 100,000 people that have received these vaccines. So far, we haven’t seen any unusual severe adverse events. One can never ever exclude that.

Matti Sällberg is a professor and biomedical analyst at Sweden’s Karolinska Institute. His primary area of research is vaccines.

Swine study suggests flu vaccination may sometimes backfire

During the 2009 h2N1 pandemic, Canadian researchers identified a greater risk of infection in those who had been vaccinated against seasonal flu, a puzzling finding that researchers are still unraveling, including a group yesterday that revealed more about a mechanism for the process through experiments on pigs.

The heightened risk identified during the 2009 pandemic threatened to disrupt vaccination efforts in Canada, and the findings raised tough issues for policymakers, especially when studies in the United States and other countries contradicted the Canadian findings. However, in 2010 a large study by a Canadian team put an exclamation point on the earlier findings, reporting that the risk of needing treatment for pandemic flu was 1.4 to 2.4 times greater in those who had been vaccinated against seasonal flu in the previous year.

In the new study, researchers explored the phenomenon in pigs that were infected with the 2009 h2N1 virus after receiving a vaccine against h2N2 influenza. The team, headed by scientists from the US Food and Drug Administration (FDA) and the US Department of Agriculture (USDA), published its findings yesterday in Science Translational Medicine.

The results raise concerns about an approach eyed for developing next-generation vaccines, including a “universal” version targeting multiple strains.

The interaction between the vaccine and respiratory disease, called vaccine-associated enhanced respiratory disease (VAERD), has been seen before, for example with formaldehyde-inactivated respiratory syncytial virus (RSV) vaccination followed by wild-type RSV infection.

The researchers vaccinated piglets that were younger than 6 months old and hadn’t been exposed to flu before against h2N2 to explore whether vaccine-induced antibodies might play a role in exacerbating respiratory symptoms. They found some of the piglets got sick with severe pneumonia and had severe lung damage after they were infected with the 2009 h2N1 virus, suggesting that cross-reactive antibodies triggered by the flu vaccine made symptoms worse after infection with a different flu strain.

The part of the experiments that focused on the mechanism responsible for the effect found that h2N2 antibodies in the sick pigs bound to the hemagglutinin (HA) stem rather than the HA head of the 2009 h2N1 virus, and thus weren’t able to block the virus from attaching to cells. Instead, the strong cross-reactive antibodies helped the pandemic virus fuse to cell membranes, which appeared to worsen respiratory problems in the vaccinated pigs.

In the search for a new flu vaccine approach, the HA stem is a compelling target, because it is conserved across a range of flu viruses and could be part of strategy to target many flu strains with one vaccine.

The authors cautioned that the pig model might not extrapolate to human flu scenarios, but that in the past, pig experiments have been a good model for studying human flu and conducting vaccine studies. They noted that the use of young pigs, which generate limited antibody profiles like those seen in young infants, might hint at different outcomes in adults. However, they noted that the study may be relevant at the population or risk-group level when a markedly different flu virus emerges to spark a pandemic.

Health officials should keep the proposed VAERD mechanism in mind when monitoring human vaccination during the response to new influenza viruses that have low cross-reactivity with seasonal flu strains, the researchers concluded. They added that the antibodies should be analyzed in the immune response during the development of universal flu vaccines that target the HA stem.

In an editorial on the new findings, published in the same issue, James Crowe Jr, MD, wrote that the new findings show why health leaders should consider the principle “First, do no harm” when pursuing new ways to battle flu epidemics and pandemics. Crowe is a microbiologist and professor of pediatrics at Vanderbilt University and is director of the Vanderbilt Vaccine Center.

He noted that achieving a flu vaccine that would provoke lasting protection across a range of virus subtypes would be a major medical achievement, but eagerness to move forward with next-generation flu vaccines should be tempered with a focus on safety and minimizing risk.

The need to understand the molecular forces that direct antibody-enhanced virus replication or altered immune response isn’t limited to vaccine effects, given that antibody-enhanced disease can occur in nature, Crowe wrote. He added that studies during the 2009 h2N1 pandemic suggested that cross-reactive antibodies may have played a role in severe disease seen in otherwise healthy young adults.

More experiments to help detail the molecular basis of how antibodies neutralize or enhance influenza infection are the next step, and several mechanisms are possible, including one that is commonly studied in dengue virus experiments, according to Crowe He noted that work on universal flu vaccines should continue, especially given the emergence of new techniques that can help chart the balance within diverse antibody populations.

Nick Kelley, PhD, coauthored a comprehensive CIDRAP analysis of flu vaccines in 2012 that pointed out the shortcomings of current vaccines and noted that vaccines targeting the HA stalk could be a path to designing better, more effective ones.

“There’s a lot we don’t understand about influenza, influenza vaccines, VAERD, and influenza immunology,” he said. “This is exactly the type of studies that help move the field forward.”

The new findings raise several questions that need to be explored, such as the balance between neutralizing and nonneutralizing antibodies,” said Kelley, who is currently a research associate for CIDRAP’s BioWatch program. “That’s an issue that will need to be fleshed out more as novel non-HA-head antigens are developed, particularly for the HA stem.”

Khurana S, Loving CL, Manischewitz J, et al. Vaccine-induced anti-HA2 antibodies promote virus fusion and enhance influenza virus respiratory disease. Sci Transl Med 2013 Aug 28;5(200) [Abstract]

Crowe JE. Universal flu vaccines: primum non nocere. (Editorial) Sci Transl Med 2013 Aug 28;5(200) [Abstract]

See also:

Aug 28 Canadian Press story

Apr 6, 2010, CIDRAP News story “New Canadian studies suggest seasonal flu shot increased h2N1 risk”

Oct 15, 2012, CIDRAP Comprehensive Influenza Vaccine Initiative report

Sleepy vaccine – Mir – Kommersant

Anti-vaccinations are found everywhere. But in Sweden and several other European countries, those who do not want to get vaccinated against COVID-19 have a serious argument. Following the 2009-2010 h2N1 influenza mass vaccination campaign, these countries saw a dramatic increase in the number of patients with a rare but incurable disease, narcolepsy.

Pan-European choice

Against the backdrop of the COVID-19 pandemic, the first pandemic of the 21st century was practically forgotten.On June 11, 2009, World Health Organization (WHO) Director-General Margaret Chan announced the start of the h2N1 (swine flu) pandemic. By the end of the year, 22 companies had licensed swine flu vaccines. Nearly all of these vaccines have been approved for use by the entire population over one year of age, including pregnant women. Some of them were registered on an expedited basis.

Mass vaccination started in September 2009. In the same month, the European Commission, on the recommendation of the European Medicines Agency (EMA), approved Pandemrix, an adjuvant vaccine from GlaxoSmithKline (GSK).It contained the influenza A / California / 7/2009 (h2N1) strain, as well as the AS03 adjuvant, which included tocopherol (vitamin E), squalene, and the preservative thiomersal (used in other vaccines). The vaccine was produced in Dresden (Germany).

In 19 countries of the European Union and the European Economic Area, a total of about 31 million people were vaccinated by it. The most active vaccinations were in Ireland, Norway, Sweden and Finland. In particular, in these countries, a large number of vaccinations have been given to schoolchildren.

WHO officially announced the end of the pandemic on 10 August 2010. A few days later, a less victorious announcement from the Swedish State Pharmaceutical Agency followed.

Sweden

Sweden was one of the first to start mass vaccination. Vaccinations were free. More than 60% of the country’s inhabitants were vaccinated – the highest rate in the world. In certain age groups, the percentage of those vaccinated was even higher.

In the summer of 2010, the State Pharmaceutical Administration of Sweden received reports from six doctors about a possible adverse reaction when using the Pandemrix vaccine.It was about the fact that some adolescents aged 12-16 years, one to two months after vaccination, showed signs of narcolepsy. On August 16, the department issued a press release announcing the start of an investigation into the situation.

By 27 January 2011, 61 new cases of narcolepsy had been reported in Sweden, 53 of which were under the age of 20.

On June 30, 2011, the State Pharmaceutical Administration published the results of its investigation.Among unvaccinated children and adolescents, the prevalence of narcolepsy was 0.64 cases per 100 thousand person-years. Among those vaccinated – 4.2 per 100 thousand person-years. The vaccine-related risk of developing the disease was estimated at 1: 27,800, which is one case in 27,800 vaccinations (with a confidence interval of 1: 40,000 to 1: 21,300).

One of the experts who made the decision on mass vaccination against swine flu was Anders Tegnell, who is now Sweden’s chief epidemiologist and the author of the Swedish model for combating COVID-19.In a recent interview with AFP, he stated: “Of course, the solution would be very different if we knew about the side effects. But they were completely unknown, they were a surprise for everyone. For many years there was an international consensus: it was believed that the best thing to do during a pandemic was vaccination, this is the only long-term solution. ”

Finland

Neighboring Finland promptly responded to alarming messages from Sweden. Moreover, the Finnish doctors also noted the increased incidence of narcolepsy.On August 24, 2010, the Finnish National Institute for Health and Welfare (THL) recommended that vaccination be suspended pending an assessment of its possible link to narcolepsy.

On 27 August, the European Medicines Agency (EMA) launched an investigation into the possible link between vaccinations and an increase in cases of narcolepsy.

WHO also joined. The WHO Global Advisory Committee on Vaccine Safety (GACVS) has begun to monitor the situation.

On February 1, 2011, THL issued a statement indicating an increased risk of narcolepsy seen in children and adolescents following the Pandemrix vaccine.

As of 10 February 2011, 62 cases of narcolepsy following vaccination were reported in Finland, including 59 in children and adolescents.

In March 2012, the journal Plos One published the results of a study funded by THL and the Finnish Ministry of Social Affairs and Health.

The authors studied the medical records of all children living in Finland and born between January 1, 1991 and December 31, 2005.75% of them received the Pandemrix vaccine.

The prevalence of narcolepsy among unvaccinated representatives of this age group was 0.7 per 100 thousand person-years, among those vaccinated – 9 per 100 thousand person-years. The vaccine-related risk of developing the disease was estimated at 1:16 000.

UK

Following the publication of studies from Finland and Sweden, it has been suggested that the link between vaccination and illness may be due to some factor not yet identified, such as genetic or environmental.But this theory has been refuted.

A team of British scientists led by epidemiologist Elizabeth Miller of the Health Protection Agency (HPA) published the results of a study in February 2013 in The British Medical Journal on the risk of narcolepsy in children and adolescents vaccinated with Pandemrix.

By March 2010 in England, about 37% of children and adolescents aged 2 to 15 had received the Pandemrix vaccine.

The study showed that, compared with unvaccinated children and adolescents, the vaccinated had a 14.4 times higher risk of getting sick.The chances of getting sick for vaccinated English children and adolescents were approximately 1 in 52,000–57,500.

The study authors suggested that the effect would be stronger in Ireland, where vaccination rates were higher than in the UK.

Studies in France, Ireland and Norway have also indicated a possible link between vaccinations and an increase in the incidence of narcolepsy.

On December 18, 2013, Science Translational Medicine published an article by an international team of scientists led by immunologist Elizabeth Mellins and narcolepsy specialist Emmanuel Migno of Stanford University School of Medicine.It argued that the surface protein of the influenza virus, which is part of vaccines, can induce an immune response in patients with narcolepsy by T cells that recognize the neurotransmitter hypocretin. Hypocretin is responsible for the state of wakefulness. In patients with narcolepsy, the level of hypocretin in the body is usually below normal.

However, in July 2014, the study was withdrawn by its authors, because they were unable to reproduce the results on which their main conclusion was based – that the immune response of patients with narcolepsy to hypocretin is stronger than that of people without the disease.

No demand

As of January 27, 2011, the EudraVigilance database of adverse reactions to EU-approved medicinal products had 162 reports of narcolepsy cases associated with the Pandemrix vaccine: 55 from Finland, 20 from France, 8 from Germany, 2 from Ireland, 1 from the Netherlands, 10 from Norway, 1 from Portugal, 61 from Sweden and 4 from Switzerland.

In July 2011, Pandemrix’s GlaxoSmithKline announced that it had received reports of 335 cases of narcolepsy and would work with health authorities to benefit patients.In the same month, the European Medicines Agency announced that children and adolescents should only receive Pandemrix vaccine if no other vaccines are available. In the fall of 2011, all vaccine stocks were destroyed.

By January 2015, the number of narcolepsy cases reported in the EudraVigilance database had reached 1,379.

In August 2015, the license for the Pandemrix vaccine expired and GSK Biologicals did not apply for an extension due to lack of demand.

Sleep compensation

In 2014, people with narcolepsy in Finland, whose illness arose after vaccination, began to receive monetary compensation. The country’s authorities have decided to channel about € 100 million for these purposes: € 30 million from the compulsory health insurance system and € 70 million from the state budget. The first payments amounted to just over € 10 thousand per person, but the victims received payments several times. The total amount of payments depended on the severity of the illness and the age of the beneficiary.

Of the 702 people in Sweden who applied for compensation for narcolepsy that could be caused by the vaccine, 440 received it. In total, they were paid about 100 million Swedish kronor ($ 11.6 million).

According to the non-governmental organization Narcolepsy UK, the number of victims of the vaccine in the UK could reach 120.

The issue of compensation for patients with narcolepsy after swine flu vaccination has been repeatedly raised in the British Parliament.In 2014, Birmingham hosted a conference on the Pandemrix vaccine, which was attended by families of children with narcolepsy and medical professionals.

In February 2016, the British families of vaccine victims won their first victory. A three-year lawsuit has ended, as a result of which the family of 12-year-old Josh Hedfield received compensation in the amount of £ 120 thousand for narcolepsy provoked by the swine flu vaccine. Josh received the Pandemrix vaccine in January 2010.He cannot take a shower on his own or ride the bus unaccompanied; he falls asleep several times a day during school lessons. The boy has only one friend – it is difficult for him to communicate with other children. Due to the loss of muscle tone, he spends a lot of time in bed, which led to obesity.

State representatives tried to prove in court that the boy’s illness was not serious enough to qualify for compensation. The UK Department of Labor and Pensions pays a fixed amount of £ 120,000.those who have received a severe disability as a result of vaccination. To receive compensation, a loss of work capacity of at least 60% is required, which roughly corresponds to the loss of one hand. The British authorities, while acknowledging the link between swine flu vaccination and narcolepsy, were reluctant to admit that narcoleptic patients were so severely disabled that they were eligible for compensation. The lawyers representing Josh Hedfield were able to prove a 72% decrease in working capacity.

As of December 2020, only six families in the UK received compensation in the amount of £ 120,000. More than 100 families are still waiting in line to receive it. Including the family of Katie Kluck, who was unable to live with narcolepsy.

Following the UK, the first compensation was achieved by patients with narcolepsy in Ireland.

Ifa Bennett from Nais, County Kildare was vaccinated in December 2009. She was then 16 years old, she was an energetic sports teenager.Soon her life changed a lot. The first time she noticed this was during a trip to Dublin. She was so tired that she could not walk from the central bus station to the Halfpenny Bridge (about 900 m). The return home took several hours longer than usual. At Christmas, it was difficult for her to reach the festive table from her room. Soon, Ifa began to spend most of the day in bed.

In March 2011, Ifa’s mother, Mary Bennett, came across an article in the newspaper that described the same symptoms as her daughter’s.After being examined by a doctor, she was diagnosed with narcolepsy, and Ifa Bennett was the first victim of narcolepsy in Ireland to win and receive compensation. She has sued the Department of Health, the Chief Health Officer (HSE), the Medicines Regulatory Authority (HPRA) and GlaxoSmithKline Biologicals.

Court hearings were held in October-November 2019. They lasted 21 days. The defendants pleaded not guilty, but Ife Bennett was paid compensation, the amount of which was not announced.Also, the defendants must pay her legal fees. Michael Boylan Litigation Law Firm, representing Bennett’s interests, estimated its costs at € 6 million

After the trial, in an interview with the popular Irish TV presenter Sean O’Rourke, Ifa told how her life had changed: “At the slightest experience, I lose control of my muscles, roll my eyes, drop my arms, buckle my knees, sometimes I can fall to the floor.” She needs to constantly take pills, thanks to which she manages to sleep for about five hours at night.If she wakes up ahead of time, she can no longer fall asleep, she has hallucinations. She is receiving a teacher education, but realizes that she will not be able to work as a full-time teacher. The medicines that Ifa takes are completely incompatible with alcohol. She communicates with people mainly during the day, late entertainment allows herself three or four times a year.

Benjamin Blackwell was vaccinated on February 22, 2010 when he was five years old. Soon after, he began to complain of headaches and squeaking in his ears.Parents noticed changes in his behavior – sudden mood swings and drowsiness. He could fall asleep at any time in the most inappropriate place. In 2012, he was diagnosed with narcolepsy and associated cataplexy. During the daytime, Benjamin sleeps three times (including once at school, on a mattress in the prayer room). He is unable to play sports and is constantly tired.

The Blackwell family sued the same defendants as Ifa Bennett. On November 4, 2020, a court ruling was announced, similar to that in the Bennett case.The defendants, without admitting guilt, agreed to pay compensation. Its size was not disclosed, but, according to one of the Blackwell family lawyers, it was half the amount claimed by the plaintiffs. In addition, Benjamin Blackwell will be reimbursed for the costs of higher education and paid for the maximum extended health insurance.

On May 1, 2014, an Irish study was published in the journal Eurosurveillance on a possible link between Pandemrix vaccine and narcolepsy.It confirmed the observations of Swedish, Finnish and British researchers. Among children and adolescents who received the vaccine, the prevalence of narcolepsy was 5.7 per 100,000 person-years. Among the unvaccinated – 0.4 per 100 thousand person-years. Thus, in the case of the vaccine, the risk of contracting narcolepsy increased 13.9 times.

In total, more than 100 narcolepsy patients in Ireland are trying to obtain compensation through the courts for attributing their condition to the Pandemrix vaccine.

No one is to blame

On 28 March 2020, Reuters published an exclusive message from GlaxoSmithKline.The company’s press service said “science has moved ahead” and no longer links the outbreak of narcolepsy to the use of the Pandemrix vaccine. According to the company, the narcolepsy was caused not by the vaccine, but by the swine flu virus.

The company announced plans to large-scale production of the AS03 adjuvant used in this vaccine for COVID-19 vaccines. The adjuvant can be used in at least seven different candidate vaccines for the new coronavirus.

It is, in particular, part of a vaccine jointly developed by GSK and Sanofi.According to the agreements concluded by these companies, 60 million doses of the vaccine are to be supplied to the UK, 100 million doses to the United States and 300 million doses to the EU countries.

In December 2020, companies announced a delay in the development of their vaccine and the need for more research and testing due to the weak immune response in the elderly. In February 2021, GSK and Sanofi began new clinical trials. In case of a positive result, the final stage of clinical trials is scheduled for the second quarter of 2021.

Vaccination against vaccination

In Sweden, hardest hit by an outbreak of narcolepsy, a new mass vaccination campaign is making some people feel déjà vu. 26% of Swedes will not be vaccinated against COVID-19, another 28% have not yet made a decision on this matter. These are the data of a public opinion poll published in November 2020, conducted by Novus Group International.

In Finland, according to a poll published by THL in December 2020, the number of opponents of vaccination against the new coronavirus is less than in Sweden.20% of respondents are not going to be vaccinated, 16% have not yet made a choice.

In Ireland and the UK, the number of people opposed to the COVID-19 vaccine is much lower. A poll published in January 2021 by Ipsos MRBI commissioned by the Irish Pharmaceutical Healthcare Association (IPHA) showed that only 7% of Irish people do not want to be vaccinated, and 18% did not make a decision about this. Great Britain is generally ahead of the whole planet in terms of the number of people who want to be vaccinated.This was shown by the latest Ipsos MRBI survey conducted in cooperation with the World Economic Forum and covering 15 countries of the world. Its results were published on February 9, 2021. 89% of Britons surveyed expressed full or partial agreement with the statement “If the vaccine against COVID-19 is available to me, I will get vaccinated.” The absolute opponents of vaccination turned out to be 5% of the number of respondents, uncertain – 6%.

Alexey Alekseev

90,000 Vaccinations – Topics – Avian influenza and the threat of a pandemic

Vaccination

Vaccination can be used as one of the tools to kill the virus or control the disease and reduce its harmful effects on the environment.

In countries where the spread of the virus has become endemic, vaccination is an appropriate means of reducing this spread, but it is not the best choice for every country.

Effective control

It is important to note that awareness of the threat of a disease, its early detection and appropriate warning measures are prerequisites for effective control programs aimed at eradicating the virus in birds. Biosafety is an important element in controlling the spread of avian influenza virus and must be considered in planning control methods.

Early containment of disease remains the primary method for controlling the spread of highly pathogenic avian influenza (HPAI) virus and should be used when clinical disease is present in all poultry. It is also important to note that vaccination alone cannot be considered the only and simplest way to control the spread of avian influenza.

Optimal choice

In some situations where mass culling is undesirable or not feasible, vaccination may be the best choice.This is because vaccination reduces susceptibility to infection and plumage change.

This is why vaccination is an appropriate tool to reduce the number of new outbreaks and viral load on the environment, and thus can be considered as an additional measure to reduce the likelihood of transmission of avian influenza virus to humans.

Complex of measures

Disease control through vaccination can be a preliminary step in eradicating the virus.Virus eradication and vaccination are not mutually exclusive, and the package or sequence may differ from production systems and control program steps. Vaccination should be used strategically, with close attention to the selection of target groups and areas based on the results set by the government.

An approach called Differentiation of Infected and Vaccinated Animals (DIVA) is recommended to ensure that the virus is present in the poultry population.Another method is to regularly monitor unvaccinated marker birds in vaccinated flocks.

These two methods, as well as the identification of the virus in specialized areas such as markets, have made it possible to detect the presence of the virus in areas where vaccination programs are being implemented.

Vaccination should be carried out in parallel with observation, for the timely detection of any changes in the properties of viruses, and should be carried out using correctly selected equipment, produced in accordance with international standards of the OIE.

Source: FAO / OIE Global Strategy for the Progressive Control of HPAI

90,000 A to B: New Strains Added to Influenza Vaccine | Articles

Vaccination against influenza may begin as early as September – drug supplies have begun, Rospotrebnadzor told Izvestia. They noted that in the composition of the vaccine recommended by the WHO changed two strains of the influenza A virus, which had not previously circulated in the population . Before the start of the seasonal flu epidemic, the department proposes to vaccinate at least 60% of Russians – adults and children and at least 75% of people at risk.At the same time, experts emphasize that it is necessary to be more actively vaccinated against COVID-19. The time interval between flu and coronavirus shots must be at least month. According to doctors, it is difficult to catch both infections at the same time, but it has been proven that, having protection from influenza, a person is easier to tolerate COVID-19.

Recommended coverage

Deliveries of influenza vaccines have already begun, the press service of Rospotrebnadzor told Izvestia. Therefore, it will be possible to get vaccinated from the first days of autumn. “The optimal time for vaccination against influenza is September-November, before the seasonal circulation of the virus begins,” advised the agency .

Head of the Laboratory of Influenza Etiology and Epidemiology, N.N. N.F. Gamalei Elena Burtseva believes that getting a flu shot is better at the beginning of autumn, since it still takes time to develop immunity. From the point of view of a doctor, it is too early to start with anti-influenza vaccination in early September, but there are reasons for that.

– After all, we have a big country and we need to have time to vaccinate everyone by the end of November.

Photo: RIA Novosti / Vitaly Belousov

In the decree of the chief state sanitary doctor (registered by the Ministry of Justice on August 11) is recommended to cover “at least 60% of the population of the constituent entity of the Russian Federation and at least 75% of the number of people from risk groups provided for by the national calendar , as well as other population groups, including the contingents of stationary social service organizations ”.

– People who are susceptible to infection need to get vaccinated against influenza first. First of all, children and people living in organized groups , for example, in nursing homes, residential institutions, etc. It is necessary to vaccinate people with chronic somatic diseases, mainly people over 65 years old, as well as pregnant women, – said Elena Burtseva.

Last spring, there was little flu in Russia – quarantine measures against COVID-19 played a positive role .There were practically no cases of simultaneous COVID-19 and influenza in the country, the expert says, “because last year the coronavirus came on the tail of the influenza epidemic and the flu did not spread on a large scale.” Elena Burtseva added that these viruses are completely different. True, the flu-free period brought negative consequences to .

Photo: RIA Novosti / Nikolay Khizhnyak

– Last year, influenza activity was low, so the immune layer did not strengthen, as usual in the years of intensive circulation of influenza viruses, – explained to Izvestia in Rospotrebnadzor. – In addition, two strains of influenza A virus, which were not previously circulating in the population, have changed in the composition of the vaccine recommended by the WHO.

Victoria, Cambodia and others

According to the service, for this season for the countries of the Northern Hemisphere, WHO recommended using the following combination of strains in the influenza vaccine: two variants of the A strain in the trivalent vaccine (Victoria / 2570/2019 (h2N1) pdm09 and Cambodia / e0826360 / 2020 (h4N2)) and strain B (Washington / 02/2019) plus another B strain (Phuket / 3073/2013) in the quadrivalent vaccine .

In the winter season 2020/21, the same strains of group B, but different A-strains (Guangdong-Maonan / SWL1536 / 2019 (h2N1) pdm09 and Hong Kong / 2671/2019 (h4N2)) were used to vaccinate the northerners.

It is difficult to say which strain of the influenza virus will come to us this year. But the 2021 vaccine differs in composition from last year, and, according to the expert, it will protect against the current flu.

Photo: RIA Novosti / Nikolay Khizhnyak

– According to the results of the previous year and a half, when we faced the coronavirus epidemic, the A-virus was more common in countries where the influenza virus circulated, in particular in the regions of Southeast Asia, – said Elena Burtseva.- Now in India they are actively detecting H1N1 – a strain of swine flu. In China, influenza B prevails. In general, the activity of the influenza virus in the world is low, so it is difficult to say which strain will dominate this season in Russia. But our influenza vaccines are three- and four-component, which means they contain two influenza A viruses and one or two influenza B viruses, which means the entire set of strains.

Experts remind that the anti-influenza vaccination campaign should not distract from vaccination against COVID-19 .According to the resource gogov.ru, which accumulates official data from the regions of the Russian Federation on the situation with the coronavirus, as of August 23, 29% of Russians were vaccinated with at least one component of the vaccine, and 23.8% with two components.

– Coronavirus and influenza infections can occur jointly or in turn , – the chief physician of the Leader-Medicine clinic, infectious disease specialist Yevgeny Timakov, told Izvestia. – If together, then COVID-19 is more severe, causes more complications, the mortality rate increases .A flu shot does not save 100%, but it reduces the severity of the disease.

The doctor refers to an American study published in July that confirmed the hypothesis that influenza vaccination significantly reduces the number of severe cases of coronavirus.

– The research was carried out on a group of 75 thousand people, – said the interlocutor of Izvestia. – The results showed that people who received the flu shot had significantly less severe consequences of COVID-19, such as strokes and heart attacks .

Yevgeny Timakov recommended, simultaneously with the anti-influenza vaccine, to be vaccinated against pneumococcal infection, “protecting against the severe course of pneumonia and complications of coronavirus.”

Rospotrebnadzor clarifies that between vaccinations against influenza and against any other infections, including covid, it is recommended to maintain an interval of at least one month .

Annual vaccination of Russians against seasonal flu has begun

A campaign to vaccinate the population against influenza has begun in Russia.This was announced on Monday by the head of Rospotrebnadzor Anna Popova, speaking at the Eastern Economic Forum (EEF).

“We are announcing the start of a vaccination campaign against influenza in the Russian Federation,” Popova said. This year the situation is special: after all, two vaccination campaigns – against COVID-19 and against influenza – will continue to be held together.

As noted by Popova, the situation with the incidence of influenza in the country is still stable. Nevertheless, the first cases of infection with the group A virus (h4N2) (swine flu virus) have already been reported, which is considered one of the most dangerous, since it causes a rather severe course of the disease.Recall that this particular strain caused a severe epidemic in the winter season 2009-2010. “This is not the best prognostic sign,” Popova added.

Although there was little flu in the last epidemic season – quarantine, removal, wearing masks helped. But the flu vaccination also made its contribution – last fall, not yet being able to get vaccinated against COVID-19, people actively defended themselves “at least” from the flu. After all, even without the advice of doctors, it is clear: if you are “lucky” to become infected with two infections at once, it can be very dangerous.Rospotrebnadzor recommended that the regions vaccinate at least 60% of the population this season. And in the risk groups defined by the national immunization schedule, it is planned to protect at least 75% by vaccination. Recall that we are talking about the most vulnerable: children, the elderly, pregnant women, people with chronic diseases, as well as representatives of professions where contact with a large number of people is inevitable.

As explained to “Rossiyskaya Gazeta” in Rospotrebnadzor, the strain composition of vaccines this season has been changed.

According to WHO recommendations, the following strains of influenza viruses are included in the trivalent vaccine this season: A / Victoria / 2570/2019 (h2N1) pdm09, A / Cambodia / e0826360 / 2020 (h4N2), B / Washington / 02/2019, B / Phuket / 3073/2013. “In the composition of the vaccine recommended by the WHO, two strains of the influenza A virus have changed, which had not previously circulated in the population,” the department noted. The emergence of new strains of influenza is associated with a more intense and sometimes more severe incidence of influenza – since the population does not have immunity against these strains.Unless, of course, you are vaccinated. In creating such a collective “shield” is the meaning of widespread vaccination.

All vaccinations within the national calendar are free of charge.

Most regions are ready for vaccination. In the northern territories, where the weather is already in the fall, they will be invited for vaccination in the coming days, in the southern territories, where the infection usually comes later, the terms are slightly shifted. At the same time, the regions have already received and continue to ship vaccine stocks – about 33 million doses have already been sent, and another 27.3 million doses will be shipped by mid-November.In total, more than 60 million doses of anti-influenza drugs are expected to be used for vaccinations in the current epidemic season. All vaccinations within the national calendar are free for people.

As for the possibility of getting vaccinated with an imported vaccine, it will most likely be difficult this year. For several years, after the “third extra” rule was introduced on the procurement of drugs, foreign manufacturers of influenza vaccines have not been able to participate in government tenders.But small volumes of vaccines were still received in Russia – they were purchased for their patients by private clinics. It was possible to vaccinate on a paid basis.

RG sent inquiries to the two largest manufacturers of influenza vaccines: Abbot (produces the Influvac vaccine) and Sanofi (supplied us with the Vaxigrip vaccine for many years) to find out whether Russians will have the opportunity to be vaccinated with a foreign drug this year … Abbot did not respond promptly to the request, but promised to clarify the situation in the near future.And in Sanofi “RG” gave a clear explanation. “The supply of trivalent influenza vaccine Vaxigrip produced by Sanofi Pasteur S. A. France to the Russian Federation has been discontinued in 2021,” Yuri Mochalin, director of corporate relations at Sanofi in the Eurasian region, told RG. the supply of Vaxigrip trivalent vaccine was adopted in connection with plans to completely switch the production of influenza vaccines in syringes to tetravalent vaccine, in order to provide broader protection against influenza virus strains.We have submitted this vaccine for registration in Russia, and now the authorized bodies are carrying out the appropriate procedure. When the quadrivalent vaccine is registered, we will be able to additionally inform about the possible delivery times and when it will be available in Russia. “

Vaccination against influenza for children and adults: season 2021-2022. Influenza vaccination in Moscow: prices and clinics.

The risk of getting the flu increases in the fall and winter.The peak incidence of ARVI, which includes influenza, in Moscow usually falls on the end of November – early December or mid-January – early February. Quite often, the incidence of influenza approaches or even exceeds the epidemic threshold. In other words, almost every year we are threatened by a flu epidemic.

How the

flu shot works

Getting the flu vaccine prepares you for an epidemic by making your body less susceptible to the virus.The influenza vaccine contains proteins from the influenza virus. The immune system reacts to their entry into the body, starting to produce specific antibodies to this virus. And when a person who has been vaccinated against influenza encounters a source of influenza infection, the influenza virus meets in the body a defense already tuned to it.

How often should you get flu shots

A feature of influenza is the frequent mutations of the virus – the causative agent of the disease.Therefore, it is impossible to get a vaccine that would protect against any modification of the influenza virus. Vaccine manufacturers are monitoring the current epidemiological situation by updating the vaccine annually to take into account the latest most massive influenza mutations. This means a new vaccine is needed every year to get the most robust immunity against the flu that will spread this year. In addition, the number of antibodies to the virus decreases over time, and after 6-12 months their number can no longer resist the infection.

A flu shot should be done beforehand. Vaccination against influenza cannot be considered an emergency measure: it takes time (at least a week) to develop immunity to the virus.

It should also be borne in mind that influenza vaccination does not mean that the vaccinated person is guaranteed not to get sick with ARVI in a given season. But the likelihood of getting sick is significantly reduced. Also, if the disease does happen, it will most likely be in a weakened form.

Who needs flu vaccination

First of all, influenza vaccination is necessary for those who, by the nature of their work, have to communicate a lot with people: they are at risk of getting sick more than others, especially medical workers. Also, the World Health Organization recommends getting vaccinated against influenza and those for whom influenza poses the greatest danger – persons predisposed to ARVI, the elderly, as well as those suffering from chronic diseases of the heart, lungs, kidneys, endocrine and nervous systems.

Influenza vaccination of children

Children attending educational institutions are also at risk. Infants can be vaccinated against influenza from 6 months of age. WHO recommends vaccinating all children between the ages of 6 months and 5 years.

Contraindications for vaccination against influenza

The flu shot is contraindicated if:

• chicken protein allergies;

• an allergic reaction to a previous flu shot;

• in the case of an acute illness, or with an exacerbation of a chronic illness.An increased temperature may indicate that the immune system is tense. At elevated temperatures, the flu vaccine is not given.

Where to get a flu shot at a private clinic in Moscow?

If you want to get yourself or your child vaccinated against influenza in Moscow, contact the Family Doctor JSC. You can check the price of influenza vaccination services at the bottom of the page.

At the Family Doctor, influenza vaccination is carried out with Flu-M, Grippol Plus, Sovigripp vaccines

Flu-M flu vaccine

Developed by the St. Petersburg Research Institute of Vaccines and Serums of the FMBA of Russia (SPbNIIVS).

Flu-M is a trivalent vaccine containing inactivated split strains of influenza A (h2N1), A (h4N2) and B viruses, the composition of the vaccine complies with the WHO recommendations for the current season.

The vaccine forms the development of specific immunity to actual strains of influenza A and B. Immunity is developed 8-12 days after vaccination and lasts up to 12 months.

Suitable for the immunization of adults and children from 6 years of age.

Vaccine Grippol Plus

Produced by LLC FC “Petrovax” and is an improved analogue of the Grippol vaccine, which has been used in domestic immunoprophylaxis since 1996. Grippol Plus is a preservative-free vaccine produced in an individual syringe dose in accordance with the GMP standard.

The vaccine contains purified antigens of current influenza virus strains recommended by WHO for the current epidemic season.

Can be used in children from 6 months of age.

Vaccine Sovigripp

Producer of JSC NPO Microgen. The drug has been produced since 2013.

The vaccine is a surface glycoprotein (hemagglutinin and neuraminidase) isolated from purified virions of influenza A and B virus types. trimesters of pregnancy.

90,000 How to get flu and covid shots? According to expert

The flu vaccination campaign starts this year at the usual time in October. But due to the COVID-19 vaccination, it will last a month longer – until January 2022. We figure out, together with a specialist, how to survive these two infections, from which in the first place to get vaccinated and which vaccine to choose.

Smash the enemy one by one

The Republican Scientific and Practical Center for Epidemiology and Microbiology recommends immediately getting vaccinated against coronavirus.And only then get a flu shot. The interval between them must be at least two weeks.

Can both vaccinations be combined? So far, doctors do not give such recommendations. You need to wait. That is, take a break between vaccinations against coronavirus and flu. So it is safer to smash the enemy one by one, one by one.

In the world, four influenza viruses circulate in the human population, of which two subtypes of the A virus and two B viruses. One of the A (h2N1) viruses in 2009 even caused a pandemic, popularly called “swine”, as it got to humans passing traditionally not only through waterfowl, but also pigs.Over time, it became seasonal and continues to circulate in the human population. Also among us for more than 50 years and the influenza A (H3N2) virus. Now one walks, then the second, and sometimes both together.

Three-component or four-component vaccinations are used for influenza vaccination, based on two type A viruses and one or two type B influenza viruses.

In our country, a trivalent influenza vaccine (two A viruses and one from group B).This year, two components of the influenza A virus have been changed in the vaccine, while component B has remained unchanged. The reason for this is as follows. In the process of circulation in the human population, the virus changes its composition and, as it were, disappears from the field of vision of our immune defense, which ceases to recognize it. For this reason, the composition of the vaccine is being updated – updated. 149 national centers are responsible for the circulation of influenza viruses in the world, including the laboratory of influenza and influenza-like diseases, which is headed by Natalya Shmeleva, an expert of the Republican Scientific and Practical Center for Epidemiology and Microbiology, Candidate of Medical Sciences.

Nobody canceled respiratory etiquette

Influenza, like coronavirus, is transmitted by airborne droplets. Doctors and scientists advise everyone to observe respiratory etiquette: wear masks in teams, observe social distance. It is imperative to use hand sanitizers: the contact route of transmission of the virus also takes place. This cannot be ruled out.

And more. Viruses prefer a humid environment, but it will not work to roll it into a jar along with pickles.Do not be afraid – do not give up the preparation of traditional cucumbers and tomatoes. Even if the virus gets there, it will not last even a minute there. During heat treatment, canning, changing the PH-negative environment, it loses its vitality and dies.

Without loss of smell and taste

By what signs can you determine whether a person has a coronavirus or influenza?

“It is difficult to answer unequivocally what kind of infection you have. The clinical manifestations of any respiratory disease are similar.However, influenza is characterized by an acute onset, severe headache, aching muscles and joints. The coronavirus has a more gradual increase … Much, including the form of the severity of the disease, depends on the state of the immune system. As a result, one has a mild, “erased” course of the COVID-19 disease, which can only be detected during random testing, that is, according to all characteristics, it can be a clinically healthy person, but in fact has an asymptomatic form. The other will take the infection hard. “

On the clinical manifestations of the coronavirus. A lot of them. Nowadays there is already a smaller percentage of people who have a loss of smell and taste and other previously typical symptoms.

Experts remind that you should always take care of your health, as well as regularly visit a doctor. But! “It is at least unreasonable to prescribe diagnostic procedures and treatment on your own,” Natalya Shmeleva believes. “Everything should be decided by a doctor, with whom you need to discuss your condition and concomitant diseases, if any.He decides if you need X-rays, fluorography or CT. Keep in mind that these procedures are associated with additional radiation. “

Russian or Chinese?

A plane from Beijing recently arrived in Belarus, carrying 1.5 million doses of COVID-19 vaccine, of which 500 thousand China has provided us with humanitarian aid and another 1 million doses have been supplied by purchase

What is the difference between the Chinese vaccine and the Russian Sputnik V, Sputnik Light, which one is better to be vaccinated, explains Natalya Shmeleva.

“Each of us has our own preferences. Someone likes the Chinese vaccine better, because it is made according to the old, proven technology based on the killed virus.” Sputnik V “and” Sputnik Light “are a modern vector vaccine. a human adenovirus, in which a fragment of the coronavirus gene encoding the S-protein SARS-CoV-2 is inserted into its genome, and the immune system produces antibodies to this protein, that is, antibodies against COVID-19. This is the immune response that we expected.But the purpose of each vaccine is to prevent infection, to reduce the likelihood of severe consequences if a person still gets sick. Both vaccines can cope with this task, “the specialist notes.

A few days earlier, the Sputnik Light vaccine, 250,000 doses, was also delivered to our country from Russia. How does it differ from the Chinese and known to us Sputnik V?” Sputnik V “and the Chinese vaccine is two-fold, that is, it consists of two components and is administered twice at regular intervals.

“Sputnik Light” is the first component of the “Sputnik V” antiviral vaccine, which is registered as a separate drug, ”noted Natalya Petrovna. – It is intended for the prevention of coronavirus infection in young people. It is also recommended for people who have had coronavirus, whose immune response is gradually fading away. “

” Sputnik Light “activates, spurts up the immune system. and they need revaccination.Immunity does not persist for a long time either after vaccination, or after an illness – after some time it is prone to extinction.

At the same time, the World Health Organization for the time being advises this group of people to refrain from revaccination: it is necessary to give everyone the opportunity to undergo a course of vaccination. This way we immunize more people faster.

They say that in every population there is a small layer of people with T-cell immunity, which prevents them from contracting COVID-19, and this is confirmed by genetic studies.It turns out that such people do not need a vaccine?

Here is what the scientists advise on this matter. In the fight against infection, it is inappropriate to examine the state of the immune system of all people. Yes, some people have individual immunity to infection. But one must take into account the fact that sometimes the state of the strongest immune system can give weakness under the influence of various reasons. So it’s better to get vaccinated.

It is planned to vaccinate about 40% of the country’s population against influenza.

In our country, the principle of voluntary vaccination is adhered to.And although vaccination against COVID-19 does not guarantee that you will not get sick, the disease will definitely be easier.

“All the time I appeal to the data – ours and international multicenter studies: hospitalization of the vaccinated is 29 times less than that of the unvaccinated! Therefore, we will do our best to recommend vaccinating those who have not done this yet!” – emphasized the Minister of Health Dmitry Pinevich.

In addition to COVID-19, we are attacked by four other types of human coronavirus, causing respiratory diseases every year! In the process of circulation, the virus gradually loses its aggressiveness, so that COVID-19, we hope, will also become seasonal over time.

When the new coronavirus emerged, scientists said that 70% of the population needed to be vaccinated to develop herd immunity. However, each mutation of the virus increases the efficiency of its transmission, and now it is necessary for the immune layer to be above 80-85%.

Delta strain is coming

The coronavirus is capable of rapidly mutating and mutating. “Its goal, like any virus, is not to kill a person, but to survive in our population, so it mutates, adapts, and so new strains appear,” Natalia Shmeleva reveals the strategy and tactics of the insidious virus.“COVID-19 is transmitted from person to person as a respiratory infection and causes massive morbidity, causing significant damage to human health.”

At the beginning of the pandemic, this infection was not transmitted so actively, but the mortality rate was higher. , including the most contagious – the delta strain COVID-19. Now the delta variant prevails on the European continent – more than 98% over the past week. Since Belarus is part of Europe, we also have a delta.It is more actively transmitted, which is confirmed by the statistics of morbidity, but mortality (the percentage of deaths from the number of cases) from it is less.

Plague of the XXI century

The other day, Deputy Prime Minister of Russia Tatyana Golikova said that today the new coronavirus infection is classified as a second group of pathogenicity, which also includes plague and anthrax. Have we underestimated COVID-19?

“All viruses that cause a pandemic (coronavirus, influenza virus) belong to this pathogenicity group.But this applies to the mode of operation with a live pathogen. When it comes to diagnostics, this is a common respiratory virus, that is, already the third group of pathogenicity, ”Natalia Shmeleva emphasized. – The higher the transmission efficiency of a particular virus (that is, how many people can infect an infected person), the higher the immune layer should be. For example, every year 75% of citizens from risk groups and 40% of the total population are vaccinated against influenza in our country. Since the transmission of the virus that causes COVID-19 is higher than that of influenza, vaccination coverage should also be higher.For example, when it comes to measles, the virus that causes it is one of the most contagious. Therefore, according to the WHO recommendations, the immune layer of the population should be 95% and higher. It is no coincidence that everyone is vaccinated against measles in childhood in order to create an immune layer. In this case, vaccination is voluntary. However, it must be remembered that the clinical course of the disease can be different. We must be responsible not only for ourselves, but also for those around us. “

Tamara MARKINA,

7 Days newspaper.-0-

SPb GBUZ ‘City polyclinic №76’

You can also get vaccinated after an appointment with a general practitioner at a polyclinic.

The medical worker of the pre-doctor’s office or the therapist will issue you an Informed Voluntary Consent to the vaccination and admission for health reasons.

To contact the polyclinic, we ask you to have with you:

– passport;

– compulsory medical insurance policy;

– SNILS.

For the vaccination, attachment to the SPb GBUZ “City Polyclinic No. 76” is not required.

If you have any questions, please contact the duty administrator by calling the contact center: 246-73-13

SPb GBUZ “City Polyclinic No. 76” strongly recommends that you protect yourself, your relatives and colleagues with a flu shot !!!

Vaccination is the most effective method of influenza protection !!!

The vaccine is intended for active annual prophylactic immunization against seasonal influenza.The vaccine forms a high specific immunity to influenza viruses of subtypes A ( H 1 N 1), A ( H 3 N 5), B.

The period of protection against influenza after vaccination is 7-9 months.

Contraindications for vaccination

1. Allergic reactions to chicken protein or other components of the vaccine.

2. Strong post-vaccination reactions (temperature above 40 ° C, the appearance of edema at the injection site, hyperemia over 8 cm in diameter) or post-vaccination complications (collapse, non-febrile convulsions, anaphylaxis) to the previous administration of the influenza vaccine.

3. Pregnancy (when using a vaccine with a preservative).

4. Acute febrile conditions, acute infectious and non-infectious diseases, including the period of convalescence. Vaccination is usually given 2-4 weeks after recovery.

5. Chronic diseases in the acute stage. Vaccination is carried out during remission. The possibility of vaccinating persons suffering from chronic diseases is determined by the attending physician, based on the patient’s condition.

If you vaccinated yourself, become an active supporter of vaccination, encourage students to get vaccinated against influenza.