Get the vaccine not the 'flu: Gearing up for influenza vaccine campaign 2000

Every year, at some point between November and April, influenza strikes Canada. The duration and timing of the influenza season vary from year to year, although the peak in illness rarely occurs before December. Mass influenza vaccination campaigns generally begin between October and mid-November to ensure that immunity in vaccinated persons is established before the height of the season but not so early that antibody levels decline before the end of the season. As this year's influenza season approaches, provincial and territorial public health departments, and the Canadian Coalition for Influenza Immunization (CCII) are preparing for the launch of their influenza immunization awareness campaigns. The CCII (originally called Flu-Alert by the Lung Association of Canada) is a coalition of national organizations (Table 1), including the Canadian Paediatric Society, with a primary aim of promoting immunization as the best way to prevent influenza. Physicians should watch for the CCII's brightly coloured posters, entitled “Who Needs It? You Do”, in mailings from the Canadian Paediatric Society and the Canadian Medical Association, and they should display the posters where the public can see them. Physicians and their patients can also download information about influenza and influenza vaccine from the CCII web site . Members of the Canadian Coalition for Influenza Immunization Members of the Canadian Coalition for Influenza Immunization During September, publicity events will be held to launch the CCII's influenza vaccine campaign, which will be staged in conjunction with provincial, territorial and CCII member organization events. CCII posters and other promotional materials (radio and print advertisements) are designed to prompt readers or listeners to ask doctors, nurses, pharmacists, and public health units and clinics whether they should get ‘the 'flu shot’. Influenza is recognized as an important cause of morbidity and mortality among the elderly and adults with conditions that place them at high risk of contracting the infection. Estimating the impact of influenza infection on young children has not been easy because infections from respiratory syncytial virus and other respiratory viruses tend to occur at a similar time as influenza. Recent studies from California and Tennessee that attempted to separate hospitalizations due to influenza from those due to respiratory syncytial virus suggest that healthy infants and toddlers are at increased risk of hospitalizations for acute respiratory disease attributable to influenza (1,2). In Tennessee, a substantial number of outpatient visits and courses of antibiotic treatment in children of all ages were attributed to influenza (2). Vaccination is still the best means of prevention against influenza (Table 2). Younger children (six months to eight years of age) may require two doses of inactivated split virus vaccine to develop effective immunity. Based on the safety and immunogenicity of influenza vaccine and its potential benefits, the National Advisory Committee on Immunization recommends influenza immunization for children older than six months of age with medical conditions that will likely place them at increased risk of influenza complications (3). Despite these recommendations, however, the uptake of publicly funded influenza vaccine by persons younger than 65 years of age with chronic medical conditions is disappointingly low. Because physician recommendation is the most common reason that people get a vaccine, paediatricians are in a position to improve vaccine coverage in their high risk patients, and to encourage vaccination of family members and other close contacts of these children. Coverage among health care workers is also poor, and is estimated to be between 20% to 40%. Paediatricians and clinic staff should consider getting influenza vaccine for personal protection, for the protection of their high risk patients (especially those in hospital and long term care settings), and to reduce the chances of staff shortages during the busy influenza season. Influenza vaccine: Who needs it? Individuals with cardiac or pulmonary disorders severe enough to require regular medical follow-up or hospital care Residents of nursing homes and other chronic care facilities Individuals with chronic conditions Children and adolescents with conditions treated for a long period with acetylsalicylic acid (aspirin) Individuals at high risk of influenza complications embarking on travel to destinations where influenza is likely to be circulating Health care workers and other personnel who have significant contact with people in the high risk groups Household contacts (including children) of people at high risk who either cannot be vaccinated or may respond inadequately to vaccination Individuals with cardiac or pulmonary disorders severe enough to require regular medical follow-up or hospital care Residents of nursing homes and other chronic care facilities Individuals with chronic conditions Children and adolescents with conditions treated for a long period with acetylsalicylic acid (aspirin) Individuals at high risk of influenza complications embarking on travel to destinations where influenza is likely to be circulating Health care workers and other personnel who have significant contact with people in the high risk groups Household contacts (including children) of people at high risk who either cannot be vaccinated or may respond inadequately to vaccination Influenza vaccine: Who needs it? Individuals with cardiac or pulmonary disorders severe enough to require regular medical follow-up or hospital care Residents of nursing homes and other chronic care facilities Individuals with chronic conditions Children and adolescents with conditions treated for a long period with acetylsalicylic acid (aspirin) Individuals at high risk of influenza complications embarking on travel to destinations where influenza is likely to be circulating Health care workers and other personnel who have significant contact with people in the high risk groups Household contacts (including children) of people at high risk who either cannot be vaccinated or may respond inadequately to vaccination Individuals with cardiac or pulmonary disorders severe enough to require regular medical follow-up or hospital care Residents of nursing homes and other chronic care facilities Individuals with chronic conditions Children and adolescents with conditions treated for a long period with acetylsalicylic acid (aspirin) Individuals at high risk of influenza complications embarking on travel to destinations where influenza is likely to be circulating Health care workers and other personnel who have significant contact with people in the high risk groups Household contacts (including children) of people at high risk who either cannot be vaccinated or may respond inadequately to vaccination The influenza virus undergoes genetic changes constantly and, as a result, vaccine has to be given to patients every year. Table 3 outlines the influenza vaccine composition for this year. Annual influenza injections that are given to children in addition to routine immunizations may be unacceptable to many parents. Future influenza vaccine programs may avoid injections altogether if the new cold-adapted, live attenuated influenza vaccines, which are given intranasally, become available. Such vaccines are administered easily, safe and immunogenic in young children, and there is interest in their effectiveness in reducing the incidence of otitis media, antibiotic use, and the less common but more severe complications of influenza. Before greater routine use of influenza vaccine in infants and toddlers can be considered, large multicentre studies that demonstrate vaccine safety, effectiveness, acceptability and positive economic effects are required. What is the composition of the 2000–2001 influenza vaccine? An A/Moscow/10/99 (H3N2)-like virus* An A/New Caledonia/20/99 (H1N1)-like virus A B/Beijing/184/93-like virus† An A/Moscow/10/99 (H3N2)-like virus* An A/New Caledonia/20/99 (H1N1)-like virus A B/Beijing/184/93-like virus† A/Panama/2007/99 is an A/Moscow/10/99 (H3N2)-like virus; B/Yamanashi/166/98 is the most widely used B/Beijing/184/93-like vaccine strain virus What is the composition of the 2000–2001 influenza vaccine? An A/Moscow/10/99 (H3N2)-like virus* An A/New Caledonia/20/99 (H1N1)-like virus A B/Beijing/184/93-like virus† An A/Moscow/10/99 (H3N2)-like virus* An A/New Caledonia/20/99 (H1N1)-like virus A B/Beijing/184/93-like virus† A/Panama/2007/99 is an A/Moscow/10/99 (H3N2)-like virus; B/Yamanashi/166/98 is the most widely used B/Beijing/184/93-like vaccine strain virus

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