Giuseppe
Emeritus
[Source: World Health Organization, full PDF document: (LINK). Extracts, edited.]
Weekly epidemiological record / Relev? ?pid?miologique hebdomadaire
25 MAY 2012, 87th year / 25 MAI 2012, 87e ann?e
No. 21, 2012, 87, 201?216 - http://www.who.int/wer
Meeting of the Strategic Advisory Group of Experts on immunization, April 2012 ? conclusions and recommendations
The Strategic Advisory Group of Experts (SAGE) on immunization(1) met on 10?12 April 2012 in Geneva, Switzerland.(2) This report provides a summary of the discussions, conclusions and recommendations.
(...)
Seasonal influenza vaccine
The working group on influenza vaccines and immunization presented SAGE with a comprehensive review of the influenza disease burden, vaccine performance, and safety in populations of all ages and at-risk groups, incorporating available data from low and middle-income country settings.
Based on the review, the working group proposed specific recommendations with the objective of revising the 2005 WHO position paper on influenza vaccines.
SAGE recommended pregnant women as the most important risk group for inactivated seasonal influenza vaccination. Other risk groups to be considered, in no specific priority order were: health-care workers, children aged 6?59 months, the elderly and those with highrisk conditions.
SAGE recommended that countries with existing influenza vaccination programmes targeting any of these groups should continue to do so and should incorporate immunization of pregnant women into such programmes. Countries should decide which other risk groups to prioritize for vaccination based on burden of disease, cost-effectiveness, feasibility and other appropriate considerations.
The priority accorded to pregnant women was based on compelling evidence of substantial risk of severe disease in this group and evidence that seasonal influenza vaccine is safe and effective in preventing disease in pregnant women as well as their young infants, in whom disease burden is also high. Additional considerations for targeting this group included operational feasibility and the opportunity to prioritize and strengthen maternal immunization programmes.
Health-care workers are recognized as a target group for whom vaccination would protect not only the individual but also vulnerable patients, and for whom a vaccination programme is an important element of infection control and pandemic preparedness. It was suggested that immunization of health-care workers should be considered as part of a broader infection control package for health-care facilities.
Children aged 6?23 months experience a high burden of severe disease.
Protection in this immunologically na?ve group requires 2 doses of vaccine, and vaccine effectiveness is particularly dependent on the matching of vaccine strains to circulating viruses. Children aged 2?5 years also have a high burden of disease, although less than the burden in those <2 years of age, and may respond better than younger children to influenza vaccines, both trivalent inactivated vaccines (TIV) and liveattenuated influenza vaccines.
Increasing evidence demonstrates that vaccines may be less effective in the elderly than in younger adults. However elderly persons have the highest risk of severe disease and mortality associated with influenza and they continue to be the main focus of influenza vaccine policies in many countries.
Persons with specific chronic medical conditions, who are also at high risk for severe influenza illness and often targeted for vaccination, continue to be an appropriate target group. However, identification of these individuals in many settings is often challenging and may require considerable ongoing investment. In the 2009 pandemic, some indigenous populations were identified as important high-risk groups with higher rates of predisposing chronic conditions and higher rates of severe influenza disease and complications. Indigenous populations are often identifiable and accessible for vaccination programmes and should be considered a priority.
SAGE provided additional suggestions for these recommendations, including inclusion of relevant safety data for the targeted populations, particularly for pregnant women, and a clear delineation of recommended vaccine types for each target group (e.g. TIV for pregnant women).
Clarification was also requested for the possible indirect benefits of vaccinating health-care workers on patients at risk of severe disease, the indirect effects of vaccinating children aged 6 months to 5 years at community-level, and the potential for influenza vaccine to improve childhood survival through prevention of secondary bacterial pneumonias.
Finally, quadrivalent influenza vaccines that could potentially provide wider protection against influenza B viruses are becoming available and recommendations should not be limited to trivalent vaccine formulations.
SAGE recommended that the prioritization of specific target groups, local implementation timelines and target coverage goals should be determined at regional and country levels, as influenza immunization programmes are dependent on country-specific epidemiology, capacity and resources.
SAGE noted that strengthening seasonal influenza programmes would assist in programmatic preparedness for pandemic vaccine introduction.
Successful introduction of influenza vaccines to healthy younger populations, including pregnant women and young children, would require educational programmes and social messaging. Year-round availability of influenza vaccines, including both northern and southern hemisphere formulations, is another critical element of programme implementation for pregnant women.
Modeling of the potential impact of influenza vaccine introduction on morbidity and mortality and its economic consequences in the recommended risk groups, particularly in developing countries, should be pursued.
(...)
(1) See http://www.who.int/immunization/sage/en/index.html
(2) The complete set of presentations and background materials used for the SAGE meeting of 10?12 April 2012 together with summarized declarations of interests provided by SAGE members are available at http://www.who.int/immunization/sage/meetings/2012/april/en/index.html ; accessed in May 2012.
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Weekly epidemiological record / Relev? ?pid?miologique hebdomadaire
25 MAY 2012, 87th year / 25 MAI 2012, 87e ann?e
No. 21, 2012, 87, 201?216 - http://www.who.int/wer
Meeting of the Strategic Advisory Group of Experts on immunization, April 2012 ? conclusions and recommendations
The Strategic Advisory Group of Experts (SAGE) on immunization(1) met on 10?12 April 2012 in Geneva, Switzerland.(2) This report provides a summary of the discussions, conclusions and recommendations.
(...)
Seasonal influenza vaccine
The working group on influenza vaccines and immunization presented SAGE with a comprehensive review of the influenza disease burden, vaccine performance, and safety in populations of all ages and at-risk groups, incorporating available data from low and middle-income country settings.
Based on the review, the working group proposed specific recommendations with the objective of revising the 2005 WHO position paper on influenza vaccines.
SAGE recommended pregnant women as the most important risk group for inactivated seasonal influenza vaccination. Other risk groups to be considered, in no specific priority order were: health-care workers, children aged 6?59 months, the elderly and those with highrisk conditions.
SAGE recommended that countries with existing influenza vaccination programmes targeting any of these groups should continue to do so and should incorporate immunization of pregnant women into such programmes. Countries should decide which other risk groups to prioritize for vaccination based on burden of disease, cost-effectiveness, feasibility and other appropriate considerations.
The priority accorded to pregnant women was based on compelling evidence of substantial risk of severe disease in this group and evidence that seasonal influenza vaccine is safe and effective in preventing disease in pregnant women as well as their young infants, in whom disease burden is also high. Additional considerations for targeting this group included operational feasibility and the opportunity to prioritize and strengthen maternal immunization programmes.
Health-care workers are recognized as a target group for whom vaccination would protect not only the individual but also vulnerable patients, and for whom a vaccination programme is an important element of infection control and pandemic preparedness. It was suggested that immunization of health-care workers should be considered as part of a broader infection control package for health-care facilities.
Children aged 6?23 months experience a high burden of severe disease.
Protection in this immunologically na?ve group requires 2 doses of vaccine, and vaccine effectiveness is particularly dependent on the matching of vaccine strains to circulating viruses. Children aged 2?5 years also have a high burden of disease, although less than the burden in those <2 years of age, and may respond better than younger children to influenza vaccines, both trivalent inactivated vaccines (TIV) and liveattenuated influenza vaccines.
Increasing evidence demonstrates that vaccines may be less effective in the elderly than in younger adults. However elderly persons have the highest risk of severe disease and mortality associated with influenza and they continue to be the main focus of influenza vaccine policies in many countries.
Persons with specific chronic medical conditions, who are also at high risk for severe influenza illness and often targeted for vaccination, continue to be an appropriate target group. However, identification of these individuals in many settings is often challenging and may require considerable ongoing investment. In the 2009 pandemic, some indigenous populations were identified as important high-risk groups with higher rates of predisposing chronic conditions and higher rates of severe influenza disease and complications. Indigenous populations are often identifiable and accessible for vaccination programmes and should be considered a priority.
SAGE provided additional suggestions for these recommendations, including inclusion of relevant safety data for the targeted populations, particularly for pregnant women, and a clear delineation of recommended vaccine types for each target group (e.g. TIV for pregnant women).
Clarification was also requested for the possible indirect benefits of vaccinating health-care workers on patients at risk of severe disease, the indirect effects of vaccinating children aged 6 months to 5 years at community-level, and the potential for influenza vaccine to improve childhood survival through prevention of secondary bacterial pneumonias.
Finally, quadrivalent influenza vaccines that could potentially provide wider protection against influenza B viruses are becoming available and recommendations should not be limited to trivalent vaccine formulations.
SAGE recommended that the prioritization of specific target groups, local implementation timelines and target coverage goals should be determined at regional and country levels, as influenza immunization programmes are dependent on country-specific epidemiology, capacity and resources.
SAGE noted that strengthening seasonal influenza programmes would assist in programmatic preparedness for pandemic vaccine introduction.
Successful introduction of influenza vaccines to healthy younger populations, including pregnant women and young children, would require educational programmes and social messaging. Year-round availability of influenza vaccines, including both northern and southern hemisphere formulations, is another critical element of programme implementation for pregnant women.
Modeling of the potential impact of influenza vaccine introduction on morbidity and mortality and its economic consequences in the recommended risk groups, particularly in developing countries, should be pursued.
(...)
(1) See http://www.who.int/immunization/sage/en/index.html
(2) The complete set of presentations and background materials used for the SAGE meeting of 10?12 April 2012 together with summarized declarations of interests provided by SAGE members are available at http://www.who.int/immunization/sage/meetings/2012/april/en/index.html ; accessed in May 2012.
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