Pediatricians’ View Of Quadrivalent Vaccines
Influenza B is regarded as generally causing somewhat less severe illness than influenza A but as tending to hit children harder than adults. Thus, pediatricians might be expected to be interested in buying and administering the quadrivalent vaccines.
But Geoffrey Simon, MD, who chairs the American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, said he’s not sure that pediatricians will necessarily prefer quadrivalent vaccines over trivalent ones, and he predicted that the higher cost of quadrivalent vaccines may be a problem. Simon is physician in charge at Nemours duPont Pediatrics at Foulk Road in Wilmington, Del.
“I think that if they are available and pediatricians have verified that payment by insurance companies will be appropriate for this new product, they may prefer it,” Simon said in an interview by e-mail. He said he hasn’t seen any signs that the demand for quadrivalent vaccines is exceeding the supply.
When asked whether pediatricians think it’s important for children to receive a quadrivalent vaccine, he said, “I think that the most important thing is for children to receive any influenza vaccine. While in theory the quadrivalent vaccine should offer better protection against one additional strain of influenza B, this is the first time this vaccine will be used in the US for an influenza immunization campaign, so we really don’t have data demonstrating superiority over a vaccine that works pretty well, i.e., the trivalent vaccine.”
Who Should Not Have The Flu Vaccine
Most adults can have the flu vaccine, but you should avoid it if you have had a serious allergic reaction to a flu vaccine in the past.
You may be at risk of an allergic reaction to the flu vaccine injection if you have an egg allergy. This is because some flu vaccines are made using eggs.
Ask a GP or pharmacist for a low-egg or egg-free vaccine.
If you’re ill with a high temperature, it’s best to wait until you’re better before having the flu vaccine.
The Flu Shot Is Effective
The effectiveness of the vaccine varies from season to season. It depends on:
- how well the vaccine matches with the circulating flu viruses
- the health and age of the person getting the flu shot
The viruses circulating in the population can sometimes change during the time it takes to produce a vaccine. When this happens during the flu season, the flu shot may not work as well as expected.
It’s also important to remember that the flu shot protects against several different flu viruses each season. The seasonal flu shot can still provide protection against the remaining 2 or 3 viruses, even when theres:
- a less-than-ideal match
- lower effectiveness against one virus
If you do get the flu, the flu shot may reduce the severity of flu-related complications.
Getting your flu shot is still the most effective way to protect yourself against the flu and flu-related complications.
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Development Of Candidate Vaccine Viruses
- In general influenza wild type A viruses recommended for inclusion in vaccines do not grow efficiently in eggs for large scale production.
- Two technologies are being used for the development of suitable candidate reassortant vaccine viruses:
- classical reassortment, available since 1971 to generate hybrid viruses.
- reverse genetics, a patented technology, available to attenuate highly pathogenic viruses and reassort the attenuated HA and NA with backbone virus.
Flu Vaccine And Allergic Reactions
If you had an anaphylactic reaction to a previous flu vaccine, you may not be able to get the flu vaccine. The healthcare worker giving the flu vaccines will be able to tell you if this is the case.
If you have any other allergies, for example, egg or latex there may be only certain types of flu vaccines that you can get and you should discuss any allergies that you have with your GP or nurse administering the flu vaccine.
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The Holy Grail For Flu: A Universal Vaccine
The holy grail for flu, researchers say, is to find a universal vaccine that would render remaking the vaccine every year unnecessary. GSK’s Slaoui said he’s been thinking about the potential for a universal vaccine for almost 30 years, and some promising approaches have emerged recently.
The flu virus, he said, is “like a stem with a little balloon at the top of it.” That balloon is the part shown to the immune system, and it’s also the part that changes from strain to strain, enabling the virus to escape the immune system.
“The stem remains substantially the same,” Slaoui said. “So the technology that we are all pursuing now is to try to avoid the immune system looking at the balloon, and rather looking at the stem.”
Work is also being pursued at the National Institutes of Health. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he’s optimistic a universal vaccine is five to 10 years away.
“I think that we are making extraordinary progress and we can sort of see that light at the end of the tunnel,” Fauci said in an interview. “If we can successfully induce a response against that stem part of that protein, we’re going to be very close to developing a universal flu vaccine.”
CNBC’s Jodi Gralnick contributed to this report. Graphics by CNBC’s Mark Fahey.
What Vaccines Are Available For The 2021
There are nine vaccines that have been approved and released by the FDA for the 2021-2022 flu season. This year, all FDA-approved flu vaccines are quadrivalent meaning they protect against four different strains of influenza . Heres a rundown of the available flu vaccines for the year.
Its important to note that pharmacies and healthcare providers may only carry a few brands of flu vaccine not all nine that are FDA-approved. If you are interested in or know you need a certain flu vaccine, its best to call ahead and see if your preferred vaccine is available.
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Northern Hemisphere Influenza Season
The composition of trivalent virus vaccines for use in the 2017â2018 Northern Hemisphere influenza season recommended by the Advisory Committee on Immunization Practices on August 25, 2017, was:
- an A/Michigan/45/2015 pdm09âlike virus
- an A/Hong Kong/4801/2014 -like virus
- a B/Brisbane/60/2008âlike virus
In addition to these components, quadrivalent vaccines will also include a B/Phuket/3073/2013âlike virus .
In California, some emergency systems were strained by a spike in H3N2 flu cases. In addition, some areas experienced local shortages of oseltamivir. The severity of the flu season seemed somewhat comparable to the 2009â10 swine flu outbreak. A February 2018 CDC interim report estimated the vaccine effectiveness to be 25% against H3N2, 67% against H1N1, and 42% against influenza B.
Why Influenza Vaccine Viruses Need To Be Updated
- Influenza vaccination is currently the principal means of reducing or counteracting influenza mortality and morbidity burden in the community.
- The constantly evolving nature of influenza viruses requires continuous global monitoring and frequent reformulation of influenza vaccines.
- Rapid spread of influenza viruses during seasonal epidemics and occasional pandemics tightly frames the whole process if vaccine is to be manufactured and delivered on time.
- A prerequisite of production and supply of an optimal influenza vaccine is the selection and development of optimal candidate vaccine viruses, and the development and availability of vaccine potency reagents.
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Where Can I Find Information About Vaccine Supply
Information about vaccine supply is available here.
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- The Centers for Disease Control and Prevention cannot attest to the accuracy of a non-federal website.
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Seasonal Influenza Vaccine Supply & Distribution
Note: Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices United States, 2021-2022 Influenza Season has been . More information on the 2021-2022 season is also available.
Influenza viruses change from year to year, so influenza vaccines must be updated annually to include the viruses that will most likely circulate in the upcoming season. Once the viruses are selected for the new formulation, private manufacturers produce, test, release and distribute influenza vaccine.
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People Who Should Get The Vaccine
Some people are at greater risk from the effects of flu and should get the vaccine when offered it. Theres an increased risk if you:
- are pregnant
- are aged 50 or over, even if you feel fit and healthy
- live in a residential or nursing home
- have an illness or underlying health condition
The annual flu vaccination programme also includes:
- pre-school children aged two years and over
- children at primary school and secondary school
- carers if you care for another person, you should ask your GP if you should be vaccinated so you can continue caring for them
- health and social care workers
- staff in independent care homes, hospices and domiciliary care providers
- close contacts of immunocompromised individuals
The $16 Billion Business Of Flu
Getting your flu shot seems exceedingly simple. But the path to its existence is anything but: Your vaccine may go through several countries and a chicken egg before it gets to your arm, all in a six-month race to be ready for influenza season.
That time of year is upon us, and the Centers for Disease Control and Prevention said manufacturers are distributing more flu vaccine in the U.S. than ever: a projected 171 million to 179 million doses this year.
That’s up from 147.8 million distributed last year, amounting to $1.61 billion in revenue, according to industry researcher IMS Health. Globally, manufacturer CSL estimates the market for influenza vaccines at $4 billion.
“Flu is unpredictable, but you can predict that the single-best thing you can do to protect yourself is to get a flu vaccine,” CDC Director Dr. Tom Frieden said at a news conference last month.
The market’s been growing along with a public health push for vaccination rates in the U.S. have been steadily rising, and five years ago the CDC expanded its recommendation for the flu shot to everyone in the U.S. older than 6 months.
That’s even as the vaccine proves to be just about 50 to 60 percent effective most years still, public health experts emphasize flu can be a serious illness, and the vaccine cuts down on infections and complications. Each year, millions of people get flu, more than 200,000 Americans are hospitalized with complications, and the virus kills thousands of people.
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Medimmune Going All Quadrivalent
MedImmune makes live attenuated flu vaccines delivered by nasal spray . The company’s quadrivalent vaccine was approved by the FDA in March 2012 and is being distributed for the first time this season. This year the company is producing only the quadrivalent formulation.
“We are on track to produce 13 to 15 million doses of FluMist Quadrivalent for the upcoming influenza season, 2013-2014, and have the capacity to make more if needed,” MedImmune spokeswoman Melissa Garcia told CIDRAP News.
She described the demand for the vaccine as strong, but declined to predict whether the company will sell out of it. The vaccine is approved for ages 2 through 49 years.
MedImmune announced on Jul 26 that it had begun shipping its vaccine to distributors.
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One of the main circulating influenza viruses has changed and the current flu vaccines don’t match it well any more — an indication they may not do much to prevent infection, researchers reported Thursday. But they are still likely to prevent severe illness.
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What Is An Enhanced Influenza Vaccine
An enhanced flu vaccine is one that contains an adjuvant, an ingredient designed to increase the immune-system response to the vaccine. People aged 65 and older are often given an enhanced influenza vaccine because since the immune system weakens with age they dont respond as well to the flu vaccine as healthy, younger adults.
Fluad Quad is an enhanced flu vaccine recommended for people aged 65 and over in Australia.
Keeping Up With The Virus
Due to the influenza virus’ continuous antigenic changes, WHO updates its recommendations for the composition of the vaccine annually in order to target the viruses expected to be the most frequently circulating in the coming season. In the northern hemisphere, the influenza season usually occurs during autumn and winter.
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A New Kind Of Flu Vaccine
For the 2019-20 flu season, the majority of vaccines will be made from eggs, likely in one of the two prominent US flu-vaccine manufacturers: Sanofi Pasteur, which has a manufacturing plant in Swiftwater, Pennsylvania, and Seqirus, with a plant in Holly Springs, North Carolina.
However, the healthcare community is slowly, but surely, pushing for vaccines that are egg-free, latex-free, and mercury-free. That’s why cell cultures and another method, called recombinant, have become more popular in recent years as an alternative way to make flu vaccines for people with egg allergies.
Can I Get The Flu Vaccine If I Have An Egg Allergy
The influenza vaccine is typically grown in eggs. But the traces of egg protein that remain after the vaccine is made are so tiny that the Australasian Society of Clinical Immunology and Allergy says both adults and children with egg allergy can be safely vaccinated against the flu. The risk of anaphylaxis after vaccination is very low, estimated at 1.35 cases per 1 million doses.
It is rare for people with egg allergy to experience other side effects, such as hives, wheezing, vomiting or abdominal pain, after getting the flu shot. If you are concerned, ask your doctor if you, or your child, can be observed by staff for 30 minutes after receiving the vaccine .
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So That Means A Universal Flu Vaccine Is In The Works
Yes! The National Institute of Allergy and Infectious Diseases , a division of the NIH, is currently in the first stage of human testing of H1ssF_3928, a universal flu vaccine. Results on the safety and efficacy of the vaccine should be available in the next few monthsbut that means that it likely wouldnt be available to the general public for another decade.
The vaccine, currently being tested at the NIH Clinical Center in Bethesda, Maryland, is designed to teach the body to make protective immune responses against diverse influenza subtypes by focusing the immune system on a portion of the virus that varies relatively little from strain to strain. In February 2018, researchers at the NIH unveiled their agenda to develop a universal influenza vaccine, one that would provide long-lasting protection for all age groups from multiple influenza subtypes, including those that might cause a pandemic.
Seasonal influenza is a perpetual public health challenge, and we continually face the possibility of an influenza pandemic resulting from the emergence and spread of novel influenza viruses, said NIAID Director Anthony S. Fauci, M.D. This Phase 1 clinical trial is a step forward in our efforts to develop a durable and broadly protective universal influenza vaccine.
Quadrivalent Vaccines For Seasonal Flu
A quadrivalent flu vaccine administered by nasal mist was approved by the FDA in March 2012. Fluarix Quadrivalent was approved by the FDA in December 2012.
In 2014, the Canadian National Advisory Committee on Immunization published a review of quadrivalent influenza vaccines.
Starting with the 2018-2019 influenza season most of the regular-dose egg-based flu shots and all the recombinant and cell-grown flu vaccines in the United States are quadrivalent. In the 2019â2020 influenza season all regular-dose flu shots and all recombinant influenza vaccine in the United States are quadrivalent.
In November 2019, the FDA approved Fluzone High-Dose Quadrivalent for use in the United States starting with the 2020-2021 influenza season.
In February 2020, the FDA approved Fluad Quadrivalent for use in the United States. In July 2020, the FDA approved both Fluad and Fluad Quadrivalent for use in the United States for the 2020â2021 influenza season.
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The Best Flu Vaccine For People Over 65
As we get older, our immune systems have a harder time responding to illnesses and vaccines. To help provide better protection, there are a few recommended options for older adults this year:
Fluzone High-Dose Quadrivalent also known as the high-dose flu shot
If one of these three vaccines isnt available, you should still get vaccinated with another flu vaccine thats FDA-approved for your age range. All flu vaccines are effective against the flu. Its better to be vaccinated than to try to wait for a particular flu vaccine to become available.
Sometimes I Get The Flu Despite Having Had The Flu Shot Why Should I Bother
Flu vaccination prevents illness in up to 6 in 10 healthy adults under the age of 65. Because the vaccine is not effective in absolutely every case, some people may still catch the virus after having the flu shot. But the risk of illness is still reduced.
Although most people who get the flu recover without lasting effects, the flu can be very serious in some people and may require hospitalisation. In some cases, it can even be fatal. Its not possible to predict who will be severely affected.
Vaccination against the flu both reduces your chances of getting it and the severity of the symptoms if you do. So its still important to have the shot.
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