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I ran across this thought-provoking post to ProMED:
Date: Thu, 16 Jul 2009 19:06:16 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH> Influenza pandemic (H1N1) 2009 (05): vaccine
INFLUENZA PANDEMIC (H1N1) 2009 (05): VACCINE
********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 15 Jul 2009
From: Noel Miranda <letgo59@gmail.com>
[In the ProMED-mail post entitled: Influenza pandemic (H1N1) 2009
(03): vaccine, archive number 20090713.2505, it was stated that:
"As vaccines available initially will not be sufficient, a step-wise
approach to vaccinate particular groups may be considered."
Noel Miranda commented subsequently that:
"If we are concerned about shortage of supply of pandemic H1N1 2009
vaccines, it would be good to read about WHO recommending the use of
the proven and safe intradermal (ID) route of administration using
1/5th, or even 1/10th of the full intramuscular dose (or 0.1 ml per ID
dose). In this crisis, economy is very important. As the use of
adjuvants is under question because of safety issues, then using
non-adjuvanted pandemic flu vaccines intradermally should be discussed
and considered seriously, and WHO should take that lead soon.
"The following is one good study in support of the intradermal
administration of flu vaccines: "Dose sparing with intradermal
injection of influenza vacc!
ine. Kenney RT, Frech SA, Muenz LR, Villar CP, Glenn GM. N Engl J Med.
2004 Nov 25;351(22):2295-301."
Noel Miranda has sent the following additional comment in support of
this approach - Mod.CP]
I wish to inform you of my personal experience of pioneering ID
[intradermal] administration of rabies vaccines since the early 90s, a
method that has been well established as the routine regimen in
Thailand and in the Philippines since 1984 and 1993, respectively,
offering now perhaps millions of patients significant amounts of
savings of up to 60-80 percent compared with the application of the
standard full-course regimen. With savings there is also the benefit
of accessibility to a greater number. The WHO Expert Committee on
rabies has recommended the use of the ID regimen for rabies
post-exposure prophylaxis since 1991.
After this experience with rabies, other vaccines (including
influenza) have been tested along the same rationale (see the
references below). The immunological principles/bases are the same
regardless of the immunogen.
References
- --------------
(1) WHO Expert Committee on Rabies, 8th report, TRS 824, World Health
Organization, Geneva, 1992.
(2) World Health Organization, Report of a WHO consultation on
intradermal application of human rabies vaccines, Geneva, 13-14 March
1995.
(3) Kempegowda Institute of Medical Sciences. A Guide to Intradermal
Rabies Vaccination. Bangalore, India:
<http://www.kimscommunitymedicine.org,2006>.
(4) WHO recommendations on rabies post-exposure treatment and the
correct technique of intradermal immunization against rabies. Geneva:
World Health Organization, 1997. WHO/EMC/Zoo.96.6
(5) Francois-Xavier Meslin. (2003 : The challenge to provide
affordable rabies post-exposure treatment:: Vaccine, 21, 27-30,
October 4122-4123.
(6) Briggs BJ, Banjhoff A, Nicolay U, Sinlkwin S, Dumavibhat B,
Tongswas S, and Wasi C. (2000) Antibody response of patients after
post exposure rabies vaccination with small intradermal doses of
purified chick embryo cell vaccine or Purified Vero cell rabies
vaccine.: Bull World Health Organization , 78 (5) : 693-8.
(7) Mary J. Warrell, Anna Riddell, Ly-Mee Yu, Judith Phipps, Linda
Diggle, Herve Bourhy, Jonathan J. Deeks, Anthony R. Fooks, Laurent
Audry, Sharon M. Brookes, Francois-Xavier Meslin, Richard Moxon,
Andrew J. Pollard, and David A. Warrell (2008): Simplified 4-Site
Economical Intradermal Post-Exposure
Rabies Vaccine Regimen: A Randomized Controlled Comparison with
Standard Methods; Trop Dis. April; 2(4): e224.
(8) Stephen Nirmal, Thomas Cherian, Benjamin U. Samuel, J. Rajasingh,
P. Raghupathy and T. Jacob John. (1998) Immune response of infants to
fractional doses of intradermally administered inactivated poliovirus
vaccine: Vaccine, 16, 928-931.
(9) Belshe RB, Newman FK, Cannon. (2004) : Serum antibody responses
after intradermal vaccination against influenza. N Engl J
Med;351:2286-2294.
(10) Kenney RT, Frech SA, Muenz LR, Villar CP, Glenn GM (2004): Dose
sparing with intradermal injection of influenza vaccine. N Engl J Med;
351:2295-2301.
(11) Ghabouli MJ, Sabouri AH, Shoeibi N, Bajestan SN, Baradaran H.
(2004) High seroprotection rate induced by intradermal administration
of a recombinant hepatitis B vaccine in young healthy adults:
comparison with standard intramuscular vaccination.: Eur J Epidemiol;
19: 871-875
(12) Whittle HC, Lamb WH, Ryder RW (1987) .Trials of intradermal
hepatitis B vaccines in Gambian children. Ann Trop Paediatr; 7: 6-9.
- --
Communicated by:
Noel Miranda
One Health advocate/EID consultant
Santa Rosa, Laguna, Philippines
<letgo59@gmail.com>
[Further comments in favour or against this proposition would be welcomed.
- - Mod.CP]
[see also:
Influenza pandemic (H1N1) 2009 (04): pandemic origins 20090715.2527
Influenza pandemic (H1N1) 2009 (03): vaccine 20090713.2505
Influenza pandemic (H1N1) 2009 (02): obesity risk factor 20090711.2482
Influenza pandemic (H1N1) 2009 - Viet Nam: patient data 20090708.2450
Influenza A (H1N1) - worldwide (86): official nomenclature 20090706.2430]
.................................................. ..cp/msp/jw
Date: Thu, 16 Jul 2009 19:06:16 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH> Influenza pandemic (H1N1) 2009 (05): vaccine
INFLUENZA PANDEMIC (H1N1) 2009 (05): VACCINE
********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 15 Jul 2009
From: Noel Miranda <letgo59@gmail.com>
[In the ProMED-mail post entitled: Influenza pandemic (H1N1) 2009
(03): vaccine, archive number 20090713.2505, it was stated that:
"As vaccines available initially will not be sufficient, a step-wise
approach to vaccinate particular groups may be considered."
Noel Miranda commented subsequently that:
"If we are concerned about shortage of supply of pandemic H1N1 2009
vaccines, it would be good to read about WHO recommending the use of
the proven and safe intradermal (ID) route of administration using
1/5th, or even 1/10th of the full intramuscular dose (or 0.1 ml per ID
dose). In this crisis, economy is very important. As the use of
adjuvants is under question because of safety issues, then using
non-adjuvanted pandemic flu vaccines intradermally should be discussed
and considered seriously, and WHO should take that lead soon.
"The following is one good study in support of the intradermal
administration of flu vaccines: "Dose sparing with intradermal
injection of influenza vacc!
ine. Kenney RT, Frech SA, Muenz LR, Villar CP, Glenn GM. N Engl J Med.
2004 Nov 25;351(22):2295-301."
Noel Miranda has sent the following additional comment in support of
this approach - Mod.CP]
I wish to inform you of my personal experience of pioneering ID
[intradermal] administration of rabies vaccines since the early 90s, a
method that has been well established as the routine regimen in
Thailand and in the Philippines since 1984 and 1993, respectively,
offering now perhaps millions of patients significant amounts of
savings of up to 60-80 percent compared with the application of the
standard full-course regimen. With savings there is also the benefit
of accessibility to a greater number. The WHO Expert Committee on
rabies has recommended the use of the ID regimen for rabies
post-exposure prophylaxis since 1991.
After this experience with rabies, other vaccines (including
influenza) have been tested along the same rationale (see the
references below). The immunological principles/bases are the same
regardless of the immunogen.
References
- --------------
(1) WHO Expert Committee on Rabies, 8th report, TRS 824, World Health
Organization, Geneva, 1992.
(2) World Health Organization, Report of a WHO consultation on
intradermal application of human rabies vaccines, Geneva, 13-14 March
1995.
(3) Kempegowda Institute of Medical Sciences. A Guide to Intradermal
Rabies Vaccination. Bangalore, India:
<http://www.kimscommunitymedicine.org,2006>.
(4) WHO recommendations on rabies post-exposure treatment and the
correct technique of intradermal immunization against rabies. Geneva:
World Health Organization, 1997. WHO/EMC/Zoo.96.6
(5) Francois-Xavier Meslin. (2003 : The challenge to provide
affordable rabies post-exposure treatment:: Vaccine, 21, 27-30,
October 4122-4123.
(6) Briggs BJ, Banjhoff A, Nicolay U, Sinlkwin S, Dumavibhat B,
Tongswas S, and Wasi C. (2000) Antibody response of patients after
post exposure rabies vaccination with small intradermal doses of
purified chick embryo cell vaccine or Purified Vero cell rabies
vaccine.: Bull World Health Organization , 78 (5) : 693-8.
(7) Mary J. Warrell, Anna Riddell, Ly-Mee Yu, Judith Phipps, Linda
Diggle, Herve Bourhy, Jonathan J. Deeks, Anthony R. Fooks, Laurent
Audry, Sharon M. Brookes, Francois-Xavier Meslin, Richard Moxon,
Andrew J. Pollard, and David A. Warrell (2008): Simplified 4-Site
Economical Intradermal Post-Exposure
Rabies Vaccine Regimen: A Randomized Controlled Comparison with
Standard Methods; Trop Dis. April; 2(4): e224.
(8) Stephen Nirmal, Thomas Cherian, Benjamin U. Samuel, J. Rajasingh,
P. Raghupathy and T. Jacob John. (1998) Immune response of infants to
fractional doses of intradermally administered inactivated poliovirus
vaccine: Vaccine, 16, 928-931.
(9) Belshe RB, Newman FK, Cannon. (2004) : Serum antibody responses
after intradermal vaccination against influenza. N Engl J
Med;351:2286-2294.
(10) Kenney RT, Frech SA, Muenz LR, Villar CP, Glenn GM (2004): Dose
sparing with intradermal injection of influenza vaccine. N Engl J Med;
351:2295-2301.
(11) Ghabouli MJ, Sabouri AH, Shoeibi N, Bajestan SN, Baradaran H.
(2004) High seroprotection rate induced by intradermal administration
of a recombinant hepatitis B vaccine in young healthy adults:
comparison with standard intramuscular vaccination.: Eur J Epidemiol;
19: 871-875
(12) Whittle HC, Lamb WH, Ryder RW (1987) .Trials of intradermal
hepatitis B vaccines in Gambian children. Ann Trop Paediatr; 7: 6-9.
- --
Communicated by:
Noel Miranda
One Health advocate/EID consultant
Santa Rosa, Laguna, Philippines
<letgo59@gmail.com>
[Further comments in favour or against this proposition would be welcomed.
- - Mod.CP]
[see also:
Influenza pandemic (H1N1) 2009 (04): pandemic origins 20090715.2527
Influenza pandemic (H1N1) 2009 (03): vaccine 20090713.2505
Influenza pandemic (H1N1) 2009 (02): obesity risk factor 20090711.2482
Influenza pandemic (H1N1) 2009 - Viet Nam: patient data 20090708.2450
Influenza A (H1N1) - worldwide (86): official nomenclature 20090706.2430]
.................................................. ..cp/msp/jw