H1N1 Influenza vaccineAna María López Moreno María Belén Moreno RiscoSandra Manzano del Amo

María Macías EspinosaSoledad Llavador Guerrero

Giovanna Martín GómezCarlos Lopes Carrilho

Helena Mata CanilhasCarmen Lavado Pérez

What is 2009 H1N1 influenza?

H1N1 (Swine) flu is a new influenza virus causing illness in people. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia, plus avian genes and human genes. Scientists call this a “quadruple reassortant” virus.The virus spreads from person to person through coughing and sneezing.

As of 11 October 2009, worldwide there have been more than 399232 laboratory confirmed cases of

pandemic influenza H1N1 2009 and over 4735 deaths reported to WHO.

How is 2009 H1N1 different from regular (seasonal) flu?

Description Pandemic H1N1

Influenza

Seasonal Influenza

Virus Pandemic H1N1 is a new strain of influenza A. Most people have no immune protection.

Unlike the seasonal flu virus, adults older than 64 do not yet appear to be at increased risk of H1N1 (Swine) flu-related complications.

Influenza A or B strains same as previous years or minor variation only. Many people may have some immune protection from exposure in previous years.

Description Pandemic H1N1

Influenza

Seasonal Influenza

Symptoms Same as seasonal influenza, but may include: Nausea; Vomiting; Diarrhea.

Seasonal influenza symptoms: Fever greater than 38 C; and Cough; and Fatigue; and Muscle aches; or Lack of appetite; or Runny or stuffy nose.

The "flu shot" — an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

The nasal-spray flu vaccine — a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "live attenuated influenza vaccine" or FluMist®). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age who are not pregnant.

INACTIVATED (THE “FLU SHOT”)

LIVE, ATTENUATED(THE NASAL SPRAY VACCINE)

CONTRAINDICATIONS:• THE FLU SHOT: -severe allergy to chicken

eggs - Guillain-Barré syndrome - Children <6 months - A severe reaction to an

influenza vaccination.

• THE NASAL SPRAY FLU VACCINE:

- younger than 2 years of age - pregnant women - people 50 years of age and

older -people with chronic desease -children<5 years with

weezing -children or

adolescent→aspirine

H1N1 vaccine adverse effects

H1N1 vaccine adverse effects

Very rare:Very rare:

•Neurological disorders: EncephalomyelitisNeuritisGuillain Barré Syndrome 1976

•Allergic reactions and shock

Who should get 2009 H1N1 influenza vaccine?

• Pregnant women • People who live with or care for infants younger than

6 months of age • Health care and emergency medical personnel• Anyone from 6 months through 24 years of age • Anyone from 25 through 64 years of age with certain

chronic medical conditions or a weakened immune system

Health care and emergency medical personnel

Because…

• Infections among healthcare workers have been reported• Can be a potential source of infection for vulnerable patients.• Is a very effective strategy for the prevention of influenza infection and

the potentially associated complications. • Increased absenteeism among healthcare professionals could reduce

healthcare system capacity• Acceptance of vaccination include: older age, having had pneumococcal

or hepatitis B vaccination in the past, or having visited a health-care professional during the previous year.

sanitary personnel have the illness

Increased absenteeism

collapse in the centres of sanitary assistance

potential source of infection for vulnerable patients

People get the flu

infection

more mortality Less sanitary attention

PREGNANT WOMEN: QUESTIONS AND ANSWER FOR PATIENTS

Should pregnant women get the H1N1 flu shot? CDC recommends that yes they should get the shot.A pregnant woman who gets any type of flu has a greater chance for serious health problems. When a pregnant woman gets a flu shot, it can protect both her and her baby.

Will the seasonal flu shot also protect against the H1N1 flu? The seasonal flu vaccine will not protect against the H1N1 flu. Also, the 2009 H1N1 flu vaccine will not protect against seasonal flu.

Can the seasonal flu shot and the 2009 H1N1 flu shot be given at the same time? Seasonal and 2009 H1N1 flu shots can be given on the same day but should be given at different sites.

Is the 2009 H1N1 flu shot safe for pregnant women? Flu shots have not been shown to cause harm to pregnant women or their babies.

Can the 2009 H1N1 flu shot be given at any time during pregnancy? Healthy pregnant women in the second or third trimester and those with comorbilities in any trimester.

How many flu shots will a pregnant woman need to get? Pregnant woman is recommended to get one dose of the flu shot.

Is the flu shot expected to be associated with Guillain-BarreSyndrome (GBS)? This risk is estimated to be no more than 1 case of GBS per 1 million persons vaccinated.

If a pregnant woman delivers her baby before receiving her seasonal flu shot or her H1N1 flu shot, should she still receive them? Yes. Besides protecting her from infection, the shot may also help protect her young infant.

Personal opinion: Both seasonal flu shots and 2009 H1N1 flu shots arerecommended to pregnant women at any time during pregnancy.

Children < 5 years old are at highest risk for hospitalization

Highest incidence of illness in this group

18% H1N1 flu´s mortality

High risk medical conditions: neurodevelopmental condition, chronic pulmonary condition,

congenital hearth disease, metabolic or endocrine condition,

inmunosuppresion, multiple neurodevelopmental condition,

neurodevelopmental condition with chronic pulmonary condition

Anyone from 6 months through 24 years of age

THE MOST SEVERE SYMPTOMS

COMPLICATIONS

ApnoeaTachypnoea

DyspnoeaCentral cyanosis

Dehydration Altered mental

status Extreme irritability

Secondary bacterial infections Respiratory failure

Death Neurologic sequelae ?

Source of infection for community and in

schools

CHILDREN´S VACCINATION WOULD

REDUCE:

Number of casesHospitalizations

MortalityEconomic cost

•Individuals responsible for caring for these children constitute a high-priority group for early vaccination

•Because children less then 6 months of age are too young to receive the seasonal or 2009 H1N1 influenza vaccine

Why?

Why?

•Week Immune system

People who live with or care for infants younger than 6 months of age

Get medical care right away if the child:

•Has purple or blue discoloration of the lips

•Is vomiting

•Is less responsive than normal•Shows signs of dehydration

Anyone from 25 through 64 years of age with certain chronic medical conditions or a weakened immune system

WHAT PATIENTS?

- Pulmonary diseases (+ asthma)- Hearth diseases- Metabolic diseases(+diabetes mellitus I and II)- Renal diseases- Chronic anemia- Cancer- Inmunossuppretion-Hemoglobinopathies-Asplen-Neuromuscular diseases

Documento elaborado por el Centro de Coordinación de Alertas y Emergencias Sanitarias (CCAES)

In Spain, until 23rd September, we can observe these risk factors in the people who has died…

ESPECIALLY

1.ASTHMA

2.HEART/CV DISEASE OR HYPERTENSION, SMOKINGAND OBESITY

3.HVI/ AIDS OR CANCER

4.DIABETES

PATIENTS WITH CHRONICAL DISEASES.BENEFITS IF THEY GET VACCINATED.

-VACCINE IS EFFECTIVE AND WELL TOLERATED IN THESE PATIENTS (studies)

-ASTHMA Respiratory infections like influenza are more serious in patients with asthma (pneumonia and acute respiratory disease) NO the inhaled "FluMist®" vaccine The most common underlying condition associated with severe cases of flu

-CARDIOVASCULAR DISEASE Increased risk of experiencing an acute exacerbation of disease Not before health care providers, the very young, elderly people, and the ill

-HIV/CANCER Can experience more severe complications of influenza Immunodepressed cancer patients under chemotherapy to an increased risk of mortality

-DIABETES Can raise the blood glucose Illness can prevent you from eating properly

ESTABLISHMENT OF PRIORITY FOR A SUBSET OF PERSONS WITHIN THE INITIAL TARGET GROUPS IN THE

EVENT THAT INITIAL VACCINE AVAILABILITY IS UNABLE TO MEET DEMAND

1. Health care and emergency medical services personnel.

2. Children and young adults aged 6 months-24 years.

3. Persons aged 25-64 years who have medical conditions that put them at higher risk for influenza-related complications

4. Pregnant women.5. Persons who live with or provide care for infants

aged <6 months

GUINDANCE ON USE OF VACCINE IN OTHER ADULT POPULATION GROUPS AS VACCINE AVAILABILITY

INCREASES

• No complications during the ill process• Side effects of vaccination• Funding: Spain: 37 million doses of vaccine (to inmunize 40% population) 1 dose = 10- 15 dollars 37 million doses = 370-555 million dollars

SPAIN

16 NOVEMBER

• Sanitary personnel• Chronic patients > 6 months old• Pregnant women• Security forces of the state

CONCLUSIONS? ...

• Is there really a pandemic or interest by major pharmaceutical companies?

• Importance in the global economy• Influence of media on people

YOU CAN DRAW YOUR OWN CONCLUSIONS

Websites:http://www.msps.es/http://www.ncbi.nlm.nih.gov/pubmed/http://www.thelancet.com/H1N1-fluhttp://content.nejm.org/http://www.who.int/en/http://www.flu.gov/http://www.cdc.gov/http://www.elpais.com/articulo/sociedad/vacunacion/gripehttp://www.swissinfo.ch/

Article: H1N1 infection in pregnant women in the USAThe Lancet,Volume 374, Issue 9688, Pages 451 - 458, 8 August 2009

Article: Influenza vaccination in pregnancy: current evidence and selected national policiesLancet Infect Dis. 2008 Jan;8(1):44-52.

Article: Update on influenza A (H1N1) 2009 monovalent Update on influenza A (H1N1) 2009 monovalent vaccines.vaccines.MMWR Morb Mortal Wkly Rep Oct 9;58(39):1100-1 Oct 9;58(39):1100-1

Article: H1N1 vaccine could staunch further financial lossThe Lancet Infectious Diseases - Volume 9, Issue 10 (October 2009)

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