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 (
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
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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