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Flu and Pneumo
(Vaxigrip and Pneumo23)
Dennis S. Quiambao, MD
Medical and Government Affairs Manager
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Influenza
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Influenza
"An unvarying disease
caused by a varying
virus"
Kilbourne, 1980
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Influenza
● Worldwide: 10% of the population gets the flu
● USA: more than 200,000 people are
hospitalized from flu complications; and about
36,000 people die from flu.
● Philippines:
● 5th leading cause of morbidity
● Rate per 100,000 population: 414.6
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Different Types of Influenza Virus
● Type A
● most serious type
● most common form, usually breaking out
every two or three years
● Type B
● Type C
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Why be concerned about
influenza?
● Absenteeism, income and learning
opportunities lost
● Presenteeism
● Cause complications, hospitalization and death
among the high-risk groups
● The looming threat of a pandemic due to
a
novel virus
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Who should be vaccinated?
●
Asthmatics
●
Chronic bronchitis patients
●
Diabetics
●
Kidney and liver disease
patients
●
>50 years old
●
Children 6months – 5 years old
●
●
●
Immunocompromised
Health care workers
Anyone who wishes to be
vaccinated
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Annual Flu Vaccination in Adults,
Current Local Recommendations:
Recommended by:
● Philippine College of Chest Physicians
● Philippine Society for Microbiology and
Infectious Diseases
● Philippine Foundation for Vaccination
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Contraindication
True allergy to chicken
eggs
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Possible adverse events
●Soreness, redness or swelling at the
injection site
●Low grade fever
●Muscle aches
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Preventing Influenza
● Each year a new vaccine is prepared which when given
can prevent influenza
● WHO recommends which viral strains will be included
in the vaccine
● Vaccine is about 89% effective in preventing disease,
and for the 11% not covered by the vaccine, the illness
caused by the virus is milder because of partial
protection from the viral strains in the vaccine (cross
protection)
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Southern Hemisphere
Recommendation 2012
● an A/California/7/2009 (H1N1)-like virus;
● an A/Perth/16/2009 (H3N2)-like virus;
● a B/Brisbane/60/2008-like virus
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Seasonal Occurrence of Influenza
Southern hemisphere
J
F M A M J
J
A S
O
Tropical
Northern hemisphere
N D
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Vaccine Manufacturing Time
Lines
INTERNATIONAL SURVEILLANCE NETWORK
VACCINE MANUFACTURER
WHO
PRODUCTION
(Northern hemisphere)
F
M
A
M
J
J
MELBOURNE
A
S
O
N
D
J
F
M
PRODUCTION
(Southern hemisphere)
Choice of strains
Vaccine on time
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Timing of Influenza Vaccination
• Vaccination should be given once a year
preferably from February to June
• The Southern Hemisphere vaccine which
is made available starting February of
each year is recommended to cover the
expected increase in influenza activity
from June to November.
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Influenza: Frequently
Asked Questions
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Can the flu shot give me the flu?
● No, the flu shot cannot cause flu illness.
● The three influenza viruses contained in
the flu vaccine are each inactivated
(killed), which means they cannot cause
infection.
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Why do I need to get vaccinated against
the flu every year?
●
Vaccine against influenza viruses change from year to year, which
means two things.
● First, you can get the flu more than once. The immunity that
is built up from having the flu caused by one virus strain
doesn't always provide protection when a new strain is
circulating.
● Second, a vaccine made against flu viruses circulating last
year may not protect against the newer viruses. That is why
the influenza vaccine is updated to include current viruses
every year.
●
Another reason to get flu vaccine every year is that after you get
vaccinated your immunity declines over time and may be too low
to provide protection after a year.
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Does the flu vaccine work right
away?
● No. It takes about two weeks after vaccination
for antibodies to develop in the body and
provide protection against influenza virus
infection. In the meantime, you are still at risk
for getting the flu.
● That's why it's better to get vaccinated early
before the flu season really gets under way.
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Pneumococcal Disease
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High Burden of Disease
● Serious pneumococcal
infections are a major global
health problem
● A leading cause of death and morbidity in all ages,
in both developed and developing world
● WHO estimates 11 to 20 M hospitalizations from
pneumonia occur each year in developing countries
● At least 1M children die every year from
pneumococcal infections – primarily pneumonia and
meningitis- including >800,000 children under
5 years old
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Steptococcus Pneumoniae: The
bacterium
●
●
Also called « pneumococcus »
It’s polysaccharide capsule protects the
bacterium against attack from the immune
system
There are at least 90 different serotypes of S. pneumoniae
[1]
The 10 most common serotypes are estimated to account for
about 62% of invasive diseases worldwide [2]
[1] Fedson and Musher. In: Vaccines, 4th ed., 2004
[2] PINK BOOK. 10th edition February 2007
S. Pneumoniae: Transmission and
colonization
●
Colonization: S. Pneumoniae is common inhabitant of the respiratory tract and may be
isolated from the nasopharynx of 5% to 70% of healthy adults [1a]
●
●
Humans may carry the bacteria without being infected but may still pass on
the bacteria to others
Transmission: Person-to-person via respiratory droplets/secretions OR Autoinoculation in
asymptomatic carriers [1b]
Nasal cavity
Asymptomatic
carrier
Nasopharynx:
site of
colonization
Aerosol
Trachea
Inhalation
Patient with
pneumococca
l disease
Dissemination
[1] PINK BOOK. 10th edition February 2007
[2] Adapted from Musher DM. Streptococcus pneumoniae 1995
S. Pneumoniae: Pathogenesis
Breach
of blood-brain
barrier
Meningitis
CSF leakage
Sinusitis
Breach of
mucociliary
defenses
Otitis media
Nasopharyngeal
colonization
Bacteraemia
Peritonitis
Arthritis arc
Breach
of phagocytic
defenses
Pneumonia
Adapted from [1] Salyers & Whitt. In: Bacterial Pathogenesis: A Molecular Approach. 1994
Factors predisposing to
pneumococcal disease
●
Age
[1]
- Age-related impairment of the immune
system and other defense mechanisms
- Decreased physical activity
- Chronic diseases
- Poor nutrition
INCREASED RISK OF SEVERE PNEUMOCOCCAL DISEASE
[1] Musher DM. In Mandell G, Bennett JE, Dolin R editors. Principles and practice of infectious disease.4th ed.
New York, USA: Churchill Livingstone, Inc.; 1995. p. 1811-26
Factors predisposing to
pneumococcal disease
●
Chronic illness [1a]
Cardiovascular
disease
Pulmonary
disease
Diabetes
Liver cirrhosis
RISK OF DECOMPENSATION OF THE UNDERLYING DISEASE
AND INCREASED RISK OF SEVERE PNEUMOCOCCAL
DISEASE
[1] CDC. Prevention of pneumococcal disease. Recommendations of the ACIP. MMWR 1997; 46 (N° RR-8): 1-24
Factors predisposing to
pneumococcal disease
●
Immunodeficiency [1]
- HIV Infection
- Immunosuppressive therapies
- Sickle cell anaemia
- Organ transplantation
- Haematological neoplasms
- Cancers (e.g. lymphomas, myelomas)
INCREASED RISK OF SEVERE PNEUMOCOCCAL
DISEASE
[1] Musher DM. In Mandell G, Bennett JE, Dolin R editors. Principles and practice of infectious disease. 4th ed.
New York, USA: Churchill Livingstone, Inc.; 1995. p. 1811-26
Factors predisposing to
pneumococcal infection
● Environmental factors
Very close
contact
Nursing homes/
hospitals for
elderly persons
Prisons
Shelters for
homeless persons
PREDISPOSITION TO PNEUMOCOCCAL INFECTION
[1] Musher DM. In Mandell G, Bennett JE, Dolin R editors. Principles and practice of infectious disease. 4th ed. New York,
USA: Churchill Livingstone, Inc.; 1995. p. 1811-26
10 Leading Causes of Morbidity
2007, FHSIS Data, Philippines
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Pneumococcus: Diversity of
Serotypes
● There are at 1,2
least 90 different serotypes of S.
pneumoniae
●
Each has a capsule of a different chemical
composition
●
Each stimulates the production of a different
antibody
● Only a minority of serotypes cause most cases
of human disease
●
8-10 cause two-thirds of serious pneumococcal
infections in adults3
1 Fedson, Musher, in Vaccines, 1994
2 Henrichsen, J Clin Microbiol, 1995
3 UK DoH, Immunisation Against Infectious Disease,
1996
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Pneumococcal Vaccines: Antigen
Composition
●
23-valent pneumococcal vaccine contains purified capsular
polysaccharides derived from 23 S. pneumoniae serotypes1
●
1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A,11A, 12F, 14, 15B, 17F, 18C, 19A, 19F,
20, 22F, 23F, 33F
●
Serotype coverage2,3
●
85-90% of serotypes responsible for all cases of invasive pneumococcal
disease
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Vaccine includes major serotypes that have developed antimicrobial
resistance
●
Cross protection within some serotypes1
●
For example, antibody response to serotype 6B protects against serotype
6A, which is not in the vaccine
1 CDC, MMWR, 1989
2 Fedson, Musher, in Vaccines, 1994
3 Geslin et al., Méd Mal Infect, 1992
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Pneumococcal Disease Prevention:
Vaccination Recommendations
●
WHO view (Technical Advisory Group convened by WHO
Regional Office for Europe, 1988)1
●
●
Pneumococcal vaccination should be recommended for all
elderly persons (aged 60-65 years) and for persons of any
age at high risk of acquiring pneumococcal infection
National recommendations
●
Many countries recommend vaccination for specific at-risk
groups or conditions
●
Some countries recommend vaccination for elderly persons
aged:
• 60 years: Belgium, Germany, Iceland
• 65 years: Denmark, Finland, Norway, Sweden, USA,
Canada, New Zealand
1 Fedson et al., Infection 1989
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Local associations that recommend
pneumococcal vaccination
● Philippine Foundation for Vaccination (PFV)
● Philippine Society for Microbiology and
Infectious Diseases (PSMID)
● Philippine College of Chest Physicians (PCCP)
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Pneumococcal Vaccination
Recommendation
● Age > 60 yrs (routinely): once
● If < 60 yrs but with the following conditions:
● Chronic illnesses (Cardio,COPD, Chronic
Tuberculosis*, Bronchiectasis, diabetics,
cirrhosis, CSF leaks)
● Immunocompromised (lymphoma, leukemia)
● Chronic renal failure, nephrotic syndrome
● Transplant patients
● Patients on chemo/ radio therapy
● HIV/ AIDS functional or anatomic asplenia
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