History of influenza vaccination

History of influenza vaccination

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• History of influenza vaccination

A year-round disease affecting everyone

 

What is influenza?

We know now that influenza, or flu, is caused by a virus – but for
many years it was thought to be caused by a bacterial infection. In 1892, German scientist Richard Pfeiffer isolated a small bacterium from the noses of patients with flu, naming it ‘bacillus influenzae’. 

Early attempts at a vaccine during the 1918 influenza pandemic were based on this understanding, and it was not until the 1930s, when the influenza virus was identified, that progress towards an effective vaccine could really begin. 

Influenza – also known as the ‘flu’ – is a highly contagious respiratory illness, which spreads easily through the air or when people touch contaminated surfaces. In many cases the disease is mild, with symptoms such as chills,
fever and fatigue, and it can also be spread through asymptomatic infections in people who do not even know they are sick. 

But the flu can also result in serious complications, particularly in vulnerable people like young children, older persons, pregnant women and people with medical conditions such as asthma, diabetes or heart disease. The most common complication is
pneumonia, typically caused by a secondary bacterial infection.  

Flu viruses mutate very rapidly, and uncontrolled spread gives rise to many different strains, which fall into 2 main types affecting humans – influenza A and influenza B.

 

© National Museum of Health and Medicine

Emergency hospital during influenza epidemic, Camp Funston, Kansas (1918).

©
Credits

 

“The mother of all pandemics”

The h2N1 influenza pandemic that swept across the world from 1918 to 1919, sometimes called “the mother of all pandemics”, involved a particularly virulent new strain of the influenza A virus. The first wave of infections in early 1918
resulted in mild illness, but a second wave later that year was more deadly. 

The 1918 pandemic is estimated to have infected 500 million people worldwide, killing between 20 and 50 million. The resulting death rates were so high that life expectancy rates around the world dropped by several years, and more people are thought
to have died as a result of the flu pandemic than over the course of the entire First World War.  

Researchers in the United States and Europe raced to find an effective vaccine against influenza during the pandemic years, and their efforts produced hundreds of thousands of doses – but they were targeting the wrong pathogen. 

 

© WHO, Eric Schwab

The day starts at the World Influenza Centre, London, with a conference between Dr C.E. Andrews, Director (right), and his assistant Dr A.A Isaacs

©
Credits

 

Progress toward a vaccine

In 1933, British researchers Wilson Smith, C.H. Andrewes and P.P. Laidlaw at London’s National Institute for Medical Research (NIMR) made a breakthrough when they isolated and identified the influenza virus. They found no bacteria in throat
washings from patients with influenza and discovered that the disease was caused by a virus. 

With support from the US Army, the first inactivated flu vaccine was developed by Thomas Francis and Jonas Salk at the University of Michigan. The vaccine was tested for safety and efficacy on the US military, before being licensed for wider use in
1945.

 

© WHO, Eric Schwab

Miss H.B. Donald of Melbourne, Australia at the Siemeus electron microscope

©
Credits

 

Multiple strains

Researchers had long suspected that different types of influenza viruses existed, as the blood of some influenza patients did not develop antibodies to the strain isolated in 1933. During the testing period, scientists also discovered the existence
of another strain of the virus: influenza B. 

In 1942, a new bivalent vaccine was developed that protected against both the h2N1 strain of influenza A and the newly discovered influenza B virus. 

During the 1947 flu season, researchers discovered that existing vaccines were ineffective against the flu viruses circulating at the time. To investigate the viruses in circulation, the World Health Organization (WHO) established the Worldwide Influenza Centre in 1948 and the Global Influenza Surveillance and Response System (GISRS) in 1952.  

Scientists could now manufacture vaccines based on the monitoring of virus strains in circulation around the world, updating the strains targeted by the vaccine in response. 

Efforts to track the evolution and emergence of flu viruses continue today, and scientists monitor both seasonal and potentially pandemic flu strains. Because new strains appear frequently, the seasonal flu vaccine usually changes each year, as scientists
determine how the virus has mutated and spread. 

Each year, WHO recommends virus strains for inclusion in flu vaccines for each hemisphere, and different vaccines are developed, targeting 3 or 4 strains of the virus predicted to be most commonly circulating in the coming flu season. 

 

© CDC

This historic image depicts a line of people each awaiting a New Jersey Influenza vaccination. Also known as the Swine Flu, this image was captured during a 1976 immunization campaign

©
Credits

 

Potential for pandemics

Influenza pandemics have occurred throughout history: records document at least 3 well before the 1918–19 pandemic, and another 3 have taken hold after, in 1957–58, 1968–69 and 2009–10.  

Influenza viruses with pandemic potential regularly emerge, but not all go on to cause a pandemic. WHO works to monitor influenza viruses with pandemic potential and to prepare for future influenza pandemics.

 

© WHO, Noor Images, Olga Kravets

Lyon, France, 9 March 2022; Institute of infectious agents, University Hospital Lyon. A lab technician at work, seen through the automated PCR system instrument

©
Credits

 

Continued efforts

Researchers are constantly working to develop new vaccine technologies to keep a step ahead of the viruses.

A live attenuated vaccine delivered in the form of a nasal spray was first licensed in 2003, a vaccine using recombinant DNA technology was approved in 2013, and additional influenza vaccines based on newer technologies are being tested in clinical
trials. 

Despite these efforts, seasonal influenza still kills up to 650 000 people a year globally. Influenza is a constantly evolving virus, and immunity to a single strain through infection or vaccination does not necessarily protect against new strains
that develop. 

We know from experience there is likely to be another flu pandemic, and we should be as well prepared as possible when it happens. That’s why monitoring the virus and keeping up with vaccination is crucially important. 

Watch this video to learn more about the history, symptoms and treatment of Influenza.

 

Related history of vaccination stories

Influenza Historic Timeline | Pandemic Influenza (Flu)






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Below is a historical timeline of major scientific and public health events and milestones in influenza prevention.

• Timelineicon

  1930s

  • Influenza viruses are isolated from people, proving that influenza is caused by a virus not a bacterium.
    • Smith, Andrewes, and Laidlaw isolate influenza A virus in ferrets in 1933
    • Francis isolates influenza B virus in 1936
    • In 1936, Burnet discovers that influenza virus can be grown in embryonated hens’ eggs.

• Timelineicon

  1940s

  • 1940s: Thomas Francis, Jr., MD and Jonas Salk, MD serve as lead researchers at the University of Michigan to develop the first inactivated flu vaccine with support from the U.S. Army. Their vaccine uses fertilized chicken eggs in a method that is still used to produce most flu vaccines today. The Army is involved with this research because of their experience with troop loss from flu illness and deaths during WWI. This original vaccine only includes an inactivated influenza A virus.
  • 1940s: First-generation mechanical ventilators become available. These machines support breathing in patients suffering respiratory complications.
  • 1940: Influenza B viruses are discovered.
  • 1942: A bivalent (two component) vaccine that offers protection against influenza A and influenza B viruses is produced after the discovery of influenza B viruses.
  • 1944: Use of cell cultures for virus growth is discovered. This allows viruses to be cultured outside the body for the first time. The ability to culture influenza from respiratory secretions allows diagnosis of influenza.
  • 1945: Inactivated influenza vaccine is licensed for use in civilians.
  • 1942: The Communicable Disease Center (CDC) opens in the old offices of the Malaria Control in War Areas, located on Peachtree Street in Atlanta, Georgia with a satellite campus in Chamblee. Launched with fewer than 400 employees, the organization—today the Centers for Disease Control and Prevention–moves to its current main campus on Clifton Road in Atlanta in 1947 after paying $10 to Emory University for 15 acres of land.
  • 1947: During the seasonal flu epidemic of 1947, investigators determine that changes in the antigenic composition of circulating influenza viruses has rendered existing vaccines ineffective, highlighting the need for continuous surveillance and characterization of circulating flu viruses.
  • 1948: The World Health Organization (WHO) Influenza Centre is established at the National Institute for Medical Research in London. The primary tasks of the organization are to collect and characterize influenza viruses, develop methods for the laboratory diagnosis of influenza virus infections, establish a network of laboratories, and disseminate data accumulated from their investigations.

• Timelineicon

  1950s

  • 1952: The Global Influenza Surveillance and Response System (GISRS) is created by WHO to monitor the evolution of influenza viruses. The GISRS network originally includes 26 laboratories.
  • 1956: The CDC’s Influenza Branch in Atlanta is designated a WHO Collaborating Centre for Surveillance, Epidemiology & Control of Influenza.
  • 1957: A new h3N2 flu virus emerges to trigger a pandemic. There are about 1.1 million deaths globally, with about 116,000 in the U.S.

• Timelineicon

  1960s

  • 1960: In 1960, the US Surgeon General, in response to substantial morbidity and mortality during the 1957–58 pandemic, recommends annual influenza vaccination for people with chronic debilitating disease, people aged 65 years or older, and pregnant women.
  • 1961: An outbreak in South Africa raises possibility of wild birds as a possible reservoir for influenza A viruses.
  • 1962: CDC launches the 122 Cities Mortality Reporting System. Each week, the vital statistics office of 122 cities across the U.S. report the total number of death certificates processed and the number of those for which pneumonia or influenza is listed as an underlying or contributing cause of death by age group. The system is retired in October 2016.
  • 1966:  The FDA licenses amantadine, a new antiviral medication, as a prophylactic (preventive medicine) against influenza A. It isn’t effective against influenza B.
  • 1967: Dr. H.G. Pereira and colleagues propose a relationship between human and avian flu viruses after a study shows an antigenic relationship between the 1957 human pandemic A virus and an influenza A virus isolated from a turkey. The study raises the question and triggers the body of work on whether human influenza viruses are of avian origin.
  • 1968: A new h4N2 influenza virus emerges to trigger another pandemic, resulting in roughly 100,000 deaths in the U.S. and 1 million worldwide. Most of those deaths are in people 65 and older. h4N2 viruses circulating today are descendants of the h4N2 virus that emerges in 1968.

• Timelineicon

  1970s

  • An h2N1 (swine flu) outbreak among recruits at Fort Dix leads to a vaccination program to prevent a pandemic. Within 10 months, roughly 25% of the US population is vaccinated (48 million people), about twice the level needed to provide coverage for the at-risk population. Cases of Guillain-Barre syndrome, a neurologic condition that in rare instances has been associated with vaccination, among vaccine recipients appeared to be in excess of what was expected, so officials determine the vaccination program should be halted.  1981: CDC begins collecting reports of influenza outbreaks from state and territorial epidemiologists.

• Timelineicon

  1990s

  • 1993: The Vaccines for Children (VFC) Program is established as a result of a measles outbreak to provide vaccines at no cost to children whose parents or guardians might not be able to afford them. The program increases the likelihood of children getting recommended vaccinations on schedule.
  • 1993: The costs of influenza vaccine become a covered benefit under Medicare Part B.
  • 1994: Rimantadine, derived from amantadine, is approved by the FDA to treat influenza A.
  • 1996: An avian influenza H5N1 virus is first isolated from a farmed goose in China.
  • 1997: The first human infection with an avian influenza A H5N1 virus is identified in Hong Kong.
  • 1997: FluNet, a web-based flu surveillance tool, is launched by WHO. It is a critical tool for tracking the movement of flu viruses globally. Country data is updated weekly and is publically available.
  • 1998: Influenza virus surveillance in swine, conducted by the US Department of Agriculture, begins in the United States. A virus that is a hybrid of human, bird and swine flu viruses is detected in pigs. This virus becomes the dominant flu virus in U.S. pigs by 1999.
  • 1999: A pandemic planning framework is published by WHO emphasizing the need to enhance influenza surveillance, vaccine production and distribution, antiviral drugs, influenza research and emergency preparedness
  • 1999: The neuraminidase inhibitors oseltamivir (Tamiflu®) and zanamivir (Relenza®) are licensed to treat influenza infection.

• Timelineicon

  2000s

  • April 2002: The Advisory Committee on Immunization Practices (ACIP) encourages that children 6 to 23 months of age be vaccinated annually against influenza.
  • 2003: Public health officials are concerned about a re-emergence of H5N1 avian influenza reported in China and Vietnam.
  • June 2003: The first nasal spray flu vaccine is licensed.
  • 2004: The National incident Management System (NIMS) is established to coordinate response for public health incidents that require actions by all levels of government, as well as public, private, and nongovernmental organizations.
  • 2005: The US. Government National Strategy for Pandemic Influenza is published
  • 2005: The entire genome of the 1918 h2N1 pandemic influenza virus is sequenced
  • 2006: CDC stops recommending adamantanes during the 2005-2006 season after high levels of resistance among influenza A viruses. In the US, resistance increased from 1.9% during the 2003-2004 season to 11% in the 2004-2005 season.
  • 2006: The National Strategy for Pandemic Influenza Implementation Plan is published. The document outlines U.S. preparedness and response to prevent the spread of a pandemic.
  • 2007: The American Veterinary Medical Association (AVMA) establishes the One Health initiative Task Force, an effort to attain optimal health for people, animals, and the environment.
  • 2007: The American Medical Association unanimously approves a resolution calling for increased collaboration between human and veterinary medical communities. The term ‘one health,’ which looks at the interactions between animal and human health, enters the medical and scientific lexicon.
  • 2007: The One Health approach is recommended for pandemic preparedness during the International Ministerial Conference on Avian and Pandemic Influenza
  • 2007: FDA approves the first U.S. vaccine for people against an avian influenza A(H5N1) virus.
  • 2007: Human infection with a novel influenza virus is added to the nationally notifiable disease list
  • 2008:  ACIP expands its influenza vaccination recommendation to include vaccination of children ages 5-18 years.
  • 2008: HHS Pandemic Influenza Operational Plan is published
  • 2008: CDC receives US Food and Drug Administration approval for a highly sensitive influenza polymerase chain reaction (PCR) assay. These tests can detect influenza with high specificity that enhances diagnosis and treatment options.
  • 2008: The Influenza Reagent Resource (IRR) is established by CDC to provide registered users with reagents, tools, and information to study and detect influenza viruses
  • April 17, 2009:  A new h2N1 virus is detected in the U.S.
  • CDC begins working to develop a virus (called a candidate vaccine virus) that could be used to make vaccine to protect against this new virus.
  • April 25, 2009: The World Health Organization (WHO) declares a public health emergency of international concern.
  • June 11, 2009: WHO officially declares the new 2009 h2N1 outbreak a pandemic.
  • 2009: CDC begins a complex and multi-faceted response to the h2N1 pandemic which lasts more than a year.
  • 2009: Physicians use point of care rapid immunoassay tests to provide influenza results within 15 minutes during the h2N1 pandemic
  • October 5, 2009: The first doses of monovalent h2N1 pandemic vaccine are administered.

• Timelineicon

  2010s

  • August 10, 2010: WHO declares an end to 2009 h2N1 influenza pandemic.
  • 2010:  The ACIP recommends annual influenza vaccination for those 6 months of age and older.
  • 2012: Vaccines containing cell-cultured virus become available. Even though eggs continue to be the primary means of production, cell culture emerges as an alternative method for producing influenza vaccines.
  • 2012: WHO makes first vaccine composition recommendation for a quadrivalent vaccine.
  • 2012: CDC partners with Association of Public Health laboratories to define the optimal right size for influenza virologic surveillance. The project produces right-size calculators; statistical tools that help states determine the optimal amount of influenza testing needed for desired confidence levels of surveillance.
  • 2014: The FDA approves peramivir (Rapivab) to treat influenza in adults. It is the first IV flu medication.
  • 2017: CDC updates guidelines for use of non-pharmaceutical measures to help prevent spread of pandemic influenza based on latest scientific evidence. These are actions that individuals and communities can take to help slow spread of the flu like staying home when sick, covering a cough or sneeze, and frequently washing hands.






Why you should get a flu shot

Influenza is an acute viral disease that can affect the upper and lower respiratory tract, is accompanied by severe intoxication and can lead to serious complications and deaths, mainly in the elderly and children. In temperate areas, seasonal epidemics occur mainly during the winter season, while in tropical areas, influenza viruses circulate all year round, leading to less regular epidemics.

Influenza is ubiquitous globally, with annual infection rates estimated at 5%-10% in adults and 20%-30% in children.

The flu has been known to mankind for centuries. The first documented influenza epidemic occurred in 1580. True, at that time nothing was known about the nature of this disease. The pandemic of respiratory infection in 1918-1920, which took over the globe, and was called the “Spanish flu”, most likely was nothing more than an epidemic of severe influenza. It is known that the Spaniard was distinguished by incredible mortality – with lightning speed it led to pneumonia and pulmonary edema, even in young patients.

Reliably the viral nature of influenza was established in England only in 1933 by Smith, Andrews and Laidlaw. In 1940, Francis and Magil discovered the influenza B virus, and in 1947, Taylor isolated another new variant of the influenza virus, C. Since 1940, it became possible to actively study the influenza virus and its properties – the virus began to be grown in chicken embryos. Since then, a big step forward has been made in the study of influenza – the ability to mutate has been discovered, and all parts of the virus capable of variability have been identified. An important discovery, of course, was the creation of a vaccine against influenza.

Influenza can cause severe complications in high risk groups such as:

• pneumonia (bacterial and hemorrhagic), pleural empyema, lung abscess (may lead to lung failure),

• from the cardiovascular system – myocarditis, pericarditis (may lead to heart failure),

• from the nervous system – meningitis, meningoencephalitis, encephalitis, neuritis, neuralgia, polyradiculoneuritis,

• from the ENT organs – otitis media, sinusitis, rhinitis, tracheitis,

• from the muscular system – myositis,

• glomerulonephritis, Reye’s syndrome, toxic-allergic shock, etc.

The most effective way to prevent the disease or its severe consequences is vaccination .

Vaccination is especially important for people from high-risk groups development of serious complications of influenza, as well as for people living with or caring for people from high-risk groups.

The Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor) recommends annual vaccination for the following population groups:

• Persons suffering from chronic cardiovascular diseases: especially congenital and acquired heart defects (especially mitral stenosis).

• Persons suffering from chronic lung diseases (including bronchial asthma).

• Patients with diabetes.

• Patients with chronic diseases of the kidneys and blood.

• Pregnant women.

• Older people over 65 years of age, because in most cases they have chronic diseases in varying degrees.

• Children under 2 years old.

Influenza vaccination minimizes not only the likelihood of getting sick, but also, most importantly, the possibility of complications. In addition, vaccination facilitates the course of the disease. Influenza vaccines have been shown to be effective in all age groups.