TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. TechNet Admin
  2. Service delivery
  3. Monday, 02 November 2009
Dear colleagues, According to your experience, what is the main target (and steps) population for H1N1 vaccine? In my country, first healthcare professionals (this week) followed by school children (age definition not described yet). For childhood population: you prefer to first vaccinate the high risk group (
TechNet Admin Accepted Answer
Admin
There were three different objectives identified that countries could adopt as part of their pandemic vaccination strategy:1. - To protect the integrity of the health care system and the country's critical infrastructure;2. - To reduce morbidity and mortality;3. - To reduce the transmission of the pandemic virus within communities.Countries could use a variety of vaccine deployment strategies to reach these objectives but any strategy should reflect the country’s epidemiologic situation, resources and ability to access vaccine, to implement mass vaccination in the targeted groups, and to use other non-vaccine mitigation measures. Such measures include both non pharmaceutical measures, and pharmaceutical interventions, including antivirals. Under all circumstances, strengthening influenza surveillance in developing countries and in particularly in Africa was considered important.Here are WHO recommendations of this, based on advice from SAGE1. All countries should immunize their health care workers (1-2% population) as a first priority to protect the essential health infrastructure. Significant pandemic-related morbidity in such workers will compromise the capacity of health services to care for patients sick with influenza and other life-threatening conditions. Health workers need to be able to protect their own lives while they are putting themselves at risk through caring for sick influenza patients. Furthermore, infected healthcare workers can spread the virus to vulnerable patients and initiate nosocomial outbreaks. There is a need to maintain general health services as the pandemic unfolds.2. As insufficient vaccine will be available initially, a stepwise approach to vaccinate particular groups may be considered. SAGE suggests the following groups for consideration, noting that countries need to determine their order of priority based on country-specific conditions:- Pregnant women (2% of the world population). This group appears to be at increased risk for severe disease potentially resulting in spontaneous abortion and/or death, especially during the second and third trimesters of pregnancy. Inactivated non-adjuvanted vaccine similar to most seasonal influenza vaccines are considered the preferred option because there is extensive safety data on use of these vaccines in pregnant women. However, if such a product is not available, pregnant women should be vaccinated with another pandemic influenza vaccine available at that time, e.g., an adjuvanted inactivated influenza vaccine or a live attenuated influenza vaccine.- Those aged >6 months with one of several chronic medical conditions in order to reduce morbidity and mortality. This group includes persons with asthma and other chronic conditions such as morbid obesity.- Healthy young adults (>15 years and 49 years and = 65 years to reduce morbidity and mortality
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TechNet Admin Accepted Answer
Admin
It is always an epidemiological data driven exercise. Children and pregnant women though form the target group, it may vary from place to place. In India for example people involved in the first bout are young adults - productive age group, 15 - 35 yrs. Health care professionals though argue that they are the first group to be protected, they have ample opportunities to protect themselves other wise from droplet infection - in fact if you target them first, there is a panic in the community. Vaccine is not the first line of defense after all in management of influenza pandemic. One should realize that the novel strain finally settles down to be responsible only for seasonal flu. Currently it could be highly virulent. In fact kindly go back to history of the disease. by now the virulence should have come down considerably. Kindly look into the cases declared positive. How many give the history of contracting a positive case to get droplet infection? How many of the contacts have developed the disease? How many health care providers have contracted infection - especially primary care physicians who not knowing the cause of disease may not have used protectives while managing positive cases. Some how the present pandemic may have lost its epidemiological threads due to panic reaction among the doctors on the first hand and other health care providers next. This is precisely the reason for the demand for the vaccine which is coming from health professionals before public. Nagaraj
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