Category: Flu Vaccine

Introduction

Avian influenzaoften referred to as avian flu or bird fluis a virus that has circulated among the worlds migratory birds for at least a century. However, in recent decades, new, highly pathogenic strains of the virus have wreaked havoc on certain bird populations, particularly poultry livestock, and become a growing threat to humans and other mammals.

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Since 2020, cases have been rising in other birds and in mammals that were not previously susceptible. The global surge in outbreaks has forced agriculture companies to cull millions of poultry, the most consumed meat in the world, and threatened some endangered species. Meanwhile, drawing on the harsh lessons of the COVID-19 pandemic, scientists and policymakers are raising concerns about the prospect of avian flu morphing into the next zoonotic pandemic.

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First discovered in 1878, avian influenza is a viral disease that primarily infects birds, although some strains can spread to and kill mammals, including humans. The H5N1 strain, one of the most common today, was first identified in domestic waterfowl in 1996.

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Birds. The flu mainly spreads asymptomatically among wild aquatic birds, but domestic poultry are also susceptible and can become extremely ill and die. Twenty-five known subtypes of avian flu have been identified in birds. There are two main categories: low pathogenicity, which often causes little-to-no signs of disease, and high pathogenicity, strains that cause severe disease and poultry mortality. Highly pathogenic strains of avian influenza have a 90 to 100 percent mortality rate among poultry. Most infected livestock die within forty-eight hours.

Humans. Human cases of bird flu are extremely rare, but often deadly. Most people who have been infected have usually been directly exposed to infected poultry or contaminated environments by them. Human-to-human transmission is believed to have only occurred in a few isolated instances, but sustained transmission between humans has not yet been identified. The two strains of avian flu that have killed the most people are H5N1 and H7N9. The first human cases of H5N1 were detected in China in 1997, but the bulk of cases came between 2003 and 2015, with Egypt as a hot spot. To date, there have been 882 human cases, with 461 deaths across nearly two dozen countries, according to World Health Organization (WHO) data.

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H7N9 was also first reported in China in 2013, and it has killed more than six hundred people to date. Some non-fatal cases are asymptomatic, but common effects can include flu-like symptoms, conjunctivitis (pink eye), pneumonia, multi-organ failure, seizures, and neurological damage. Newer strains that later evolved, such as H5N6 and H5N8, are also infecting humans.

Other mammals. Since 2020, avian flu has been found in close to fifty mammal species across more than two dozen countries, considerably more widespread than past waves. The disease can often be deadly for mammals. There have been notable outbreaks in mink in Spain, seals in Peru, and even domestic cats and dogs in several countries. Most recently, at the beginning of 2024, H5N1 was found in seals in Antarctica for the first time.And as of March, avian flu wasreportedly worsening in marine mammals at rates that have prompted scientists to become concerned about mammal-to-mammal transmission, which would represent a much more dangerous threat to the affected ecosystems. In April, the virus was detected in U.S. cattle for the first time, affecting herds in several states. At least one farm worker, in Texas, was also infected.

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H5N1began circulatingin parts of Africa, Asia, and Europe in late 2021, but its reach has exploded since then: the virus has been recorded in more than eighty countries since 2022. There have been recent cases in all continents except for Australia.

In the current wave, relentless outbreaks in poultry have wracked U.S. agriculture nationwide as well. Avian flu has been recorded in forty-eight states and affected more than eighty-two million poultry, as of March 2024. European countries witnessed a similar pattern of surging infections, affecting some fifty million poultry across thirty-seven countries, though France suffered the brunt of these. Other countries, such as Japan and South Africa, experienced their worst avian flu outbreaks among farmed birds.

Avian flu outbreaks can cost farmers and consumers billions of dollars in lost profits and higher prices, and they disrupt important international trade. The ongoing avian flu outbreak in the United States, the worlds largest poultry meat producer and second-largest egg producer, caused economic losses around $2.53 billion by the end of 2023, and experts expect this cost will only rise amid new surges of the disease in 2024. Avian flu has led to the deaths or culling of more than eighty million poultry livestock. Per U.S. regulations, producers must cull all the birds in an infected flock, even if some of them do not have the disease. Amid the outbreak, the cost of a dozen eggs more than doubled to nearly five dollars in January 2023 before producers were able to restore their flocks. In recently infected cattle, U.S. farmers have reported reduced milk production, although it has had a limited effect on supplies thus far.

The reduction of poultry has exacerbated food security in some parts of the world, particularly in lower-income countries where poultry products are a major source of protein. South Africas poultry industry underwent major supply shortages in 2023 as its worst avian flu outbreak added to its chronic power outages, which further hampered poultry production. Studies in Egypt have recorded stunted growth in youth coinciding with past avian flu outbreaks.

Avian flu and the perceptions around it can also harm the global trade of poultry products. Amid a 2004 outbreak in the United States, for example, U.S. poultry exports dipped more than 20 percent after several countries imposed embargoes on U.S. poultry products. These trade constrictions also reduce incomes for producers whose flocks never even contracted the virus, as well as for others involved in the poultry value chain. These economic concerns have rendered several countries wary of vaccinating poultry for avian flu, as they do not want to risk potential embargoes from their trading partners.

The global spread is due in part to bird migration patterns, allowing infected birds to carry the disease thousands of miles to sites along their flyways. At the same time, the virus is increasingly mutating as it encounters new host animals and new species.

Outbreaks in the past often subsided in the summer when bird migrations ceased, yet this was not the case in the recent H5N1 strain, which was some of the cause for scientists concern. The constant stream of outbreaks across the world in 2023 triggered concerns that avian flu could become a year-round threat. The reasoning for the viruss persistence is still not fully clear, although some research has indicated that climate change and human activities are contributing factors. Climate changerelated fluctuation in conditions such as temperature are altering the timing of some bird behaviors, including migration and breeding. Meanwhile, habitat destruction and urbanization are also affecting breeding site availability. The confluence of these factors drives birds from different parts of the world to come into contact with each other for the first time and interact with more habitats, both natural and urban. Such encounters expand the opportunities for the virus to spread and mutate.

The corporate consolidation of U.S. factory farms, where poultry livestock are typically held in close quarters, also contributes to the rapid spread of the virus and mass poultry deaths. The environmental nonprofit Food and Water Watch said in a 2020 study [PDF] that 96 percent of U.S. chickens are raised under a production contract by major corporations, such as Tyson Foods or Perdue Farms.

Human cases of avian flu are rare, and experts say the threat to public health is generally low. However, human cases have a high fatality rate, at more than 50 percent. (At its peak, for comparison, the global COVID-19 death rate was reported to be around 8 percent, though it is widely thought to be far higher.) Still, health experts are worried about the risks to farm workers who could be regularly exposed to infected animals.

For a virus to have pandemic potential, it needs to be able to pass easily from person-to-person. H5N1 does not have the ability to do so, but scientists fear it could develop this feature.

The bigger picture is that this virus is not cooling off, CFR Senior Fellow Jennifer Nuzzo toldPolitico. Weve been worrying about this virus for twenty years, more than twenty years. And in the last year, it has really been remarkable in how far across the globe it has been spreading, and how many species its been affecting.

The WHO warns that the recent surge in avian flu outbreaks among mammals could increase the viruss ability to circulate more easily among humans. As viruses quickly spread and evolve, they can more easily mutate and create new strains that are more effective at infecting people. In April 2024, the United States reported its second-ever case of H5N1, a human who became infectedvia sick dairy cattle in Texas, raising concerns of growing mammal-to-mammal transmission. Amid these latest outbreaks, the Centers for Disease Control and Prevention (CDC) is also recommending against the consumption of raw milk, which is sold legally in most states.

Countries such as Egypt and Indonesia experienced the brunt of human cases in the 2015 wave, and in the current wave, Cambodia and the United Kingdom have the highest numbers, which are much lower still than those seen in the prior outbreaks. Nonetheless, the ongoing bouts of avian flu in countries that have never experienced cases in mammals has evoked international attention.

The Food and Agriculture Organization (FAO), WHO, and World Organization for Animal Health (WOAH) are urging countries to work together across sectors to prevent both human and animal infections. Their recommendations include enhanced surveillance and information sharing; increased biosecurity measures, such as vaccinating livestock; restricted contact with other farms and equipment; and proper hygiene and disinfection of farm equipment and facilities.

There are avian flu vaccines for humans and birds, but there are a number of challenges and uncertainties with both. For instance, there is global hesitancy over the bird vaccine for trade reasons, and the existing human vaccines are derived from previous strains, so it could take a while to develop new ones and implement them on a mass scale. Some countries fear that importing vaccinated birds will make conducting surveillance more difficult, as it will be harder to determine if birds have been infected or vaccinated. To some degree, there are concerns that importing eggs or meat from birds that have been vaccinated could inadvertently spread the disease within the importing countrys borders, though there is no evidence to suggest this is possible.

Avian flu vaccines are mostly administered to birds in countries where the flu is endemic, and that have minimal poultry trade, such as Egypt, Indonesia, Mexico, and most recently, France. Commercial poultry in the United States receive other vaccinations, such as against fowlpox, but not yet for avian flu. The U.S. Department of Agriculture (USDA) is testing several bird vaccines but has not approved any, mostly over concerns that requiring a vaccine will harm trade. Despite this roadblock, experts have increasingly called for the U.S. government to launch a vaccination campaign for poultry, which they say would reduce the risk of spillover that could trigger a pandemic. Some poultry vaccines have proven to be as high as 94 percent effective.

There is also a lot of uncertainty around the prospects of an avian flu vaccine for humans. Several major companies that manufacture them have said they could expedite the production of millions of doses in the event of a pandemic. The United States has an emergency stockpile of H5N1 vaccines, but experts have said that they would be insufficient if this particular strain were to start infecting people at a larger scale. Further, the shots have only been administered in trials and were derived from strains that circulated in 2004 and 2005. Some companies are working on developing vaccines that better match the highly pathogenic subvariant that is causing havoc today, but experts say it is unclear whether a human vaccine could be manufactured at a global scale while staying ahead of the curve on the viruss rapid mutation.

We shouldnt be overconfident in our ability to make vaccines that are safe and effective for avian flu because weve encountered challenges in the past with that antigen, says CFR Fellow Luciana Borio. Clinical trials involving H5N1 in the past have yielded lackluster results.

And as with many diseases, there is a global equity issue: these vaccines, which are not even past the testing phase, are already slated to go to richer countries first, leaving lower-income countries at risk. We cant do a repeat of what happened with COVID, where countries that were vaccine-producing waited until there was no more interest in vaccines in their populations before they really worked to consider the needs of developing countries and non-vaccine-producing countries, Borio says.

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What Is Avian Flu? - Council on Foreign Relations

If you are living with someone vulnerable, you should consider vaccination, as this will prevent you from spreading the flu, and so protects your loved ones."

LIFESTYLE NEWS - With influenza season fast approaching, stock of this years flu vaccine is currently available in South Africa.

There are different forms of flu caused by various virus strains, and each year the influenza virus mutates. A new vaccine is developed and needed every year for us to remain protected, says Dr Cathelijn Zeijlemaker, a family physician and medical director of Netcares Primary Care division.

Worldwide, between three and four million people fall seriously ill with influenza each year, resulting in hundreds of thousands of deaths. The World Health Organization (WHO) and the Department of Healths National Institute of Communicable Diseases (NICD) recognise vaccination as the most effective way to prevent flu.

Most at risk are those with a chronic condition, the elderly, pregnant women, and small children.

If you are living with someone vulnerable, you should consider vaccination, as this will prevent you from spreading the flu, and so protects your loved ones. This is also why every year Netcare encourages their healthcare personnel to receive the influenza vaccination.

Each year in September, the WHOs technical consultants advise which strains of the influenza virus should be included in the next years flu vaccine for the Southern Hemisphere to ensure that the protection provided is up to date.

The influenza vaccine does not cover all the common colds that one is exposed to during the winter season. Though the symptoms are similar, these are milder and shorter in duration.

Symptoms of influenza commonly include body aches, fever, nasal congestion, tiredness and coughing and stop you from continuing with your normal daily activities. Children tend to have the highest rates of seasonal flu infection, which can lead to wider transmission within communities.

Although most people start to feel better after a few days of rest, influenza can cause severe prolonged illness and complications. It is therefore very important to seek medical advice if you are not getting better, start to feel worse or experience chest pains or shortness of breath, she says.

To beat the seasonal flu, it is worthwhile having your annual influenza vaccine early, as it takes approximately two weeks for your body to develop full protection. Although the peak flu season usually coincides with the colder weather in winter, it is unpredictable when a flu outbreak will occur, she says.

Dr Zeijlemaker points out that it is not uncommon for the influenza vaccine to give mild side effects, like redness, mild swelling, and pain over the injection site, or a mild fever, mild rash, headache, or body aches. These begin soon after vaccination and are usually mild and short-lived. As with other medications, there is always a small chance of a severe allergic reaction.

Make sure you tell your doctor about your recent medical history before your vaccination, or if you are feeling unwell, as you may be advised to postpone the vaccination, she says.

Those who should consider vaccination include

In addition to having the flu shot, tips to help prevent the spread of flu include:

Prevention is always preferable to a bout of seasonal flu, and the doctors practising at Netcare Medicross facilities countrywide are here to take care of your familys every primary healthcare need all year round, Dr Zeijlemaker says.

Contact your local Netcare Medicross Medical and Dental Centre to book your familys influenza vaccinations or visit https://www.netcare.co.za/ to make an appointment with a general practitioner.

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Protect your family with the latest flu shot - George Herald

Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people.

Influenza virtually disappeared from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020.

Its difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season started earlier than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year.

Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Heres what to know about this years shots, available from this month.

Like other vaccines, influenza vaccines work by training the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus.

Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change much higher than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are reviewed twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next seasons predicted circulating strains.

All current influenza vaccines in Australia contain four different strains (known as quadrivalent vaccines). One of the strains appeared to disappear during the COVID pandemic, and the WHO has recently recommended dropping this strain from the vaccine. Its expected trivalent (three strain) vaccines will become available in the near future.

There are eight brands of flu vaccines available in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad).

Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the 1940s, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely.

However, there have been several enhancements to influenza vaccines in recent years.

Older peoples immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies suggest adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people.

An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad another option for older adults which contains the equivalent of four doses of a standard influenza vaccine. Studies suggest the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people.

Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are not yet available also use different technologies. In the past, manufacturing issues with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future.

Given indications this years flu season may be earlier than usual, its probably safest to get your vaccine early. This is particularly important for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life.

Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, four of the vaccines are subsidised by the Australian government through the National Immunisation Program.

In older people, a number of vaccines are now recommended: COVID and influenza, as well as one-off courses of pneumococcal and shingles vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need.

All influenza vaccines can cause a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in adjuvanted and high dose vaccines.

As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, studies suggest they can safely receive any (including egg-based) influenza vaccines.

Serious side effects from the influenza vaccine, such as Guillain-Barr syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are thought to be less common after influenza vaccination than after infection with influenza.

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There are new flu vaccines on offer for 2024. Should I get one? What do I need to know? - The Peter Doherty Institute for Infection and Immunity

Bird flu has spread to cattle on dairy farms, including one where a worker became infected, but it has never spread among people. (Getty Images)

The Centers for Disease Control and Prevention is asking states to prepare for more bird flu cases by gearing up to test at-risk people for the virus, but insists that the risk to the general public remains low, Reuters reports. It comes after one dairy worker in Texas contracted bird flu, also known as avian influenza, which has been spreading among cattle in the state, as well as in Idaho, Kansas, Michigan, New Mexico and Ohio. It hasnt spread to any other people, so far.

How concerned should you be about bird flu, and what might this mean for the food supply? Heres what you need to know.

Bird flu clinically known as influenza A (H5N1) is a variation of flu virus that spreads primarily among birds and poultry and can be highly contagious and even fatal among birds, according to the CDC. Occasionally, the virus will jump to other animals if they eat infected birds or drink water contaminated by the feces of infected birds, the CDC says. That has become more common in recent years. Viruses are constantly mutating, and the more they spread, the more they mutate. A recent family of variants may be particularly adept at infecting other animals, including cattle, according to the World Health Organization.

Its rare for the virus to infect humans, and when it does happen, its usually confined to one person who was in close contact with an infected animal and doesnt spread to others. Bird flu may cause mild to severe sickness in humans, and it has the potential to cause pneumonia and severe, sometimes fatal lung inflammation. Since 2020, there have been 26 cases in humans confirmed by the WHO, seven of which have been fatal.

The CDC continues to call for calm and considers the risk to the general public low, but on Monday the agency requested that state health departments begin gearing up in case additional people are infected.

So far the U.S. Department of Agriculture has confirmed nine cases of infected dairy cattle herds in Texas, three in Kansas, two in New Mexico and one each in Idaho, Michigan and Ohio.

The infected person was diagnosed after developing conjunctivitis, or pink eye. Its only the second-ever human case of bird flu in the U.S.; the first was a poultry farm worker who was infected in 2022 while culling infected birds and recovered after experiencing only mild fatigue. Eye inflammation is the only symptom of the person currently infected, and theyre receiving antiviral medication.

Other dairy and poultry farm workers are the CDC's main concern now. The agency asked state health officials to take steps like making sure they have bird flu tests available to confirm possible infections. It also said health officials should stay in close contact with veterinarians and agriculture department officials and asked to be notified of any "challenges" states encounter.

For the general public, the risk remains low, the CDC says. Bird flu has never been very good at spreading from person to person, so its unlikely to become widespread. The virus would have to mutate in some specific, key ways to make that possible.The good news is that it hasnt, according to preliminary testing of a sample of virus from the infected person, who has only mild symptoms.

Bird flu has been detected in egg-laying chickens and dairy cows at a handful of U.S. farms. It has also been found in unpasteurized milk. But the USDA says that there is no concern about the safety of the commercial milk supply because products are pasteurized before entering the market. Pasteurization is a partial sterilization process thatseffective at killing harmful viruses and bacteria, including bird flu. You shouldnt consume unpasteurized milk or cheese regardless, the CDC warns, because they carry risks of infections like listeria. The CDC also notes that the risk of being infected from eating eggs is low, and properly cooking them would kill any virus anyway.

Farms are prohibited from selling products including milk and eggs from sick animals, so its unlikely that contaminated food would wind up on grocery store shelves. The most likely impact of the bird flu outbreak in animals on the food supply is rising prices. Egg prices have shot up as chickens have been culled or died, limiting the supply of eggs. Milk prices could see increases but are stable so far.

Two candidate vaccines drafts of what would become the shots seem to be good matches for the current strain of bird flu, the Washington Post reports. The CDC maintains a stockpile of vaccines, including vaccines against A(H5N1) the strain the poultry farmer contracted and A(H7N9) bird flu viruses, the agencys website also states. Antiviral drugs can also be used to treat bird flu, although the CDC says that some variations of bird flu first found in Asia arent as responsive to these treatments.

Dr. Arnold Monto, a professor emeritus of epidemiology at the University of Michigan and member of the FDAs vaccine committee, tells Yahoo Life that the U.S.s bird flu vaccines require adjuvants, ingredients that improve humans immune responses. An official with the Department of Health and Human Services also told the Washington Post that components for the vaccines are being tested, and it would likely take weeks to months for them to be ready for widespread distribution. Monto adds that the vaccine would also likely be given to only those at high risk poultry and dairy farm workers since theres no evidence that bird flu spreads among humans.

Avoid close or prolonged contact with wild birds, cattle or any other animal suspected of being infected. The CDC also recommends steering clear of surfaces that may be contaminated with raw milk, animal feces, litter or anything else that might have crossed paths with an infected animal.

Cooking poultry and eggs to an internal temperature of 165F will kill off any virus. It's also recommended for milk drinkers to consume only pasteurized milk to prevent contracting bird flu or other viruses or bacteria from raw foods, and to avoid raw or undercooked foods sourced from animals that may be infected with bird flu.

This article was originally published on Apr. 4, 2024. It has since been updated.

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Should you be worried about bird flu? Here are the latest updates on cases. - Yahoo Life

(Precision Vaccinations News)

As influenza vaccine producers prepare for the 2024 - 2025 flu season, innovative vaccine candidates are progressing in clinical research, focused on enhancing efficacy and safety.

CureVacN.V. today announced interim data from an ongoing Phase 2 study, which is part of the combined Phase 1/2 study of its seasonal influenza vaccine candidate.

The purpose of this clinical trial (NCT05823974)is to find and confirm the dose and asses the reactogenicity, safety, and immune response of GlaxoSmithKline's (GSK) messenger RNA (mRNA)-based multivalent seasonal influenza vaccine (GSK4382276A) candidates administered in healthy younger and older adults.

Results from the planned interim analysis showed that the multivalent vaccine candidate using CureVac's proprietary second-generation mRNA backbone boosted antibody titers against all encoded flu strains and across all age groups and tested dose levels, including the lowest tested dose.

"The Phase 2 interim data show that CureVac's highly effective and flexible mRNA technology platform puts us on the right track to advance our joint seasonal influenza vaccine program," said Dr. Myriam Mendila, Chief Development Officer of CureVac, in a press release on April 4, 2024.

"Results regarding influenza A strains were strong. Immunogenicity for B strains was also in line with our expectations in view of other initial mRNA-based clinical flu development programs."

"We are confident that planned optimizations will improve performance against these historically challenging influenza strains."

The multivalent candidate was selected from a comprehensive Phase 1 part, which tested vaccine candidates with up to eight separate mRNA constructs per candidate.

It was designed for broad antigen coverage, encoding antigens that matched all World Health Organization (WHO) recommended flu strains.

The WHO says flu shot campaigns should be timed according to local conditions.

Countries are encouraged to analyze local surveillance information to assess their seasonality pattern at both national and subnational levels, as appropriate, to make evidence-based decisions on the timing of vaccination campaigns.

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mRNA-Based Flu Shot Focuses on Improving Performance in Phase 2 Study - Precision Vaccinations

When youre pregnant, you know that youre in for a host of prenatal visits to make sure youre healthy and the fetus is developing appropriately.

And during those appointments, you can expect to have urine tests, blood tests, ultrasounds and other tests that will make sure your pregnancy is progressing healthily.

Your prenatal care may also include getting some vaccinations during your pregnancy.

Some vaccines are encouraged during pregnancy. Others should wait until after your baby is born.

"Most vaccines that contain live viruses shouldnt be administered during pregnancy because they might be harmful to the fetus. But others are very safe during pregnancy. Theyre important to your health and help to encourage healthy fetal development, says Ob/Gyn Oluwatosin Goje, MD.

Confused as to which vaccines you should get and which you should avoid during pregnancy? Dr. Goje walks us through it.

Vaccines strengthen your immune system so your body can fight off serious infectious diseases that can pose a risk to you and the fetus. They also benefit society by preventing the spread of communicable diseases.

If youre not up-to-date on certain vaccines, you may be more susceptible to diseases that can harm you or the developing fetus.

Not sure if youve had the proper vaccines? Youre not alone.

A lot of people dont have immediate access to their vaccination records, particularly from their childhood vaccinations, Dr. Goje states. If youve moved a lot or visited multiple healthcare systems throughout your life, piecing that information together can be tough.

Fortunately, your healthcare provider, such as a primary care physician, midwife or Ob/Gyn, can run a simple antibody test to check your blood for signs of immunity against diseases that can be harmful during pregnancy. From there, you and your provider can discuss what vaccines would be beneficial to you during pregnancy and which they would encourage you to wait to get after giving birth.

Some vaccines should be avoided during pregnancy because they can be harmful to the fetus. But others are safe during pregnancy and theyre important for keeping you both safe.

All vaccines are tested for safety under the supervision of the U.S. Food and Drug Administration (FDA). The vaccines are checked for purity, potency and safety. And the FDA and the U.S. Centers for Disease Control and Prevention (CDC) monitor the safety of each vaccine for as long as its in use.

The CDC also has guidelines regarding which vaccines should be given during pregnancy. Those are based on research studies about the potential benefits and risks of vaccines to both the pregnant person and the fetus.

If youre allergic to an ingredient in a vaccine, such as eggs in the influenza vaccine, talk with your healthcare provider before getting vaccinated.

Theres good reason your healthcare provider will recommend certain vaccines during your pregnancy: Theyre proven to be safe and to protect you and the fetus from serious complications.

Getting vaccines during pregnancy can protect you from certain illnesses, and that immunity can transfer to the fetus, Dr. Goje explains. That can help keep the baby protected during the first few months of their life until they can get vaccinated themselves.

But remember, even when you get vaccinated during your pregnancy, its important to keep up with babys own vaccination schedule, too. Thats because immunity from vaccines will decrease over time. So2, your baby will still need to be vaccinated on schedule to keep them safe from disease.

Heres a look at some common vaccines and whether they should be given during pregnancy:

The COVID-19 vaccine is recommended for everyone over the age of 6 months. The CDC says that during pregnancy, you may be at a higher risk for becoming severely ill if youre infected with COVID-19. That means a higher likelihood that if you catch COVID-19, you could need to be hospitalized and have complications that can severely affect fetal development.

The COVID-19 vaccine provides the best protection against developing severe cases of COVID-19 infection.

What weve found in a growing number of research studies is that the benefits of COVID-19 vaccination during pregnancy far outweigh any potential risks, Dr. Goje reassures.

Recommendations regarding how often you need a COVID-19 vaccine to be fully protected depend on several factors. Like when your last COVID-19 vaccine was given, which vaccine you got and if youre living with a condition that compromises your immune system. Talk with your pregnancy provider or a primary care provider about whether youre due for a COVID-19 vaccination.

The flu shot is safe and effective for every trimester of pregnancy. And an annual flu vaccine is the best way to protect yourself from the flu. Avoiding the flu is especially important when youre pregnant. Because research suggests that getting the flu during pregnancy can be associated with serious complications.

Pregnancy can make you more susceptible to becoming more seriously ill if you get the flu, Dr. Goje notes. And flu infection in a pregnant person is associated with increased risks, like preterm birth, low birth weight and even pregnancy loss.

The flu vaccine comes in a few different forms, including a live virus thats given as a nasal spray and an inactivated injection (flu shot). If youre pregnant during flu season, you should plan to get the inactive flu shot. The live vaccine should be avoided during pregnancy.

The RSV vaccine is a relative newcomer. And its a game-changer.

RSV (respiratory syncytial virus) is a respiratory illness that usually doesnt have severe effects on healthy adults. But it can be dangerous even life-threatening for older adults and babies under 6 months old.

Babies can be immunized for RSV as they enter their first respiratory illness season (typically, around September in the Northern Hemisphere).

But if you get the RSV vaccine during pregnancy, your baby will be protected from RSV from the get-go. And they wont need to get immunized later.

The RSV vaccine is administered during the third trimester (between 32 and 36 weeks of pregnancy) during the RSV season.

Pregnant people should plan to get the Tdap vaccine starting in the 27th week of pregnancy.

Tdap protects you and your baby from tetanus, diphtheria and pertussis (whooping cough).

The best advice is to get a Tdap vaccine during every pregnancy, regardless of whether youve had one in the past, Dr. Goje advises. Protection from these infections wanes over time. Getting the vaccine will make sure you pass along antibodies to help protect the baby from the day theyre born.

And early protection matters. Babies cant get their first dose of the Tdap vaccine until their two-month visit. That leaves a critical window of time where they can be infected with whooping cough during their first weeks of life. Whooping cough is highly contagious and can be life-threatening to infants.

For that reason, Tdap vaccines are recommended not just for pregnant people, but also for any adults wholl care for the baby. Talk with your provider if you have older children in the home who may also be candidates for Tdap boosters to help protect your new baby.

Vaccines typically are created in one of two ways.

Some use tiny amounts of live viruses that introduce germs to your immune system. Because theyre introduced at a very low dose, they typically wont make you sick. But they train your immune system to defend you against that virus. That means that the next time youre exposed to the virus, your body has the tools it needs to fight it off.

Other vaccines use deactivated viruses. Thats to say, viruses that arent alive and cant replicate in your body. But theyre still recognized by your immune system as invaders. Your body fights off deactivated viruses like theyre the real thing, so if youre infected later, your immune system is ready to mount a defense.

Deactivated vaccines like vaccines for COVID-19, RSV, whooping cough and flu shots have been proven to be safe and effective for pregnancy.

Live vaccines arent recommended for pregnancy. Thats because scientists believe theres a chance that live viruses in those vaccines could (at least in theory) cross the placenta and infect the fetus.

Live vaccines that arent recommended during pregnancy include MMR (which protects you from measles, mumps and rubella) and the varicella (chickenpox) vaccine. Babies typically get their first chickenpox and MMR vaccines around their first birthday.

The HPV vaccine is also not recommended during pregnancy. But unlike the MMR and chickenpox vaccines, HPV isnt a live vaccine. Its not given during pregnancy, though, because it hasnt yet been thoroughly tested to be proven safe during pregnancy.

If youre concerned about your vaccination status and its effect on fetal development, talk with your healthcare provider. They can help you understand the benefits of vaccines during pregnancy and advise you on which vaccines are best for you during pregnancy.

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Opinion

With the flu season starting and peaking earlier, there have been several enhancements to influenza vaccines. What are they? And which one should you get?

Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people.

Influenza virtually disappeared from Australia during the first years of the Covid-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020.

Its difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season started earlier than usual for the third year running (peaking in early January rather than late February or March), with a similar number of reported cases and hospitalisations to the previous year.

Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Heres what to know about this years shots, available from this month.

Like other vaccines, influenza vaccines work by training the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus.

Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change much higher than for Sars-CoV-2 (the virus that causes Covid). The strains that go into the vaccine are reviewed twice each year by the World Health Organization, which selects vaccine strains to match the next seasons predicted circulating strains.

All current influenza vaccines in Australia contain four different strains (known as quadrivalent vaccines). One of the strains appeared to disappear during the Covid pandemic, and the WHO has recently recommended dropping this strain from the vaccine. Its expected trivalent (three strain) vaccines will become available in the near future.

There are eight brands of flu vaccines available in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad).

Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the 1940s, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely.

However, there have been several enhancements to influenza vaccines in recent years.

Older peoples immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies suggest adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people.

An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad another option for older adults which contains the equivalent of four doses of a standard influenza vaccine. Studies suggest the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people.

Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are not yet available also use different technologies. In the past, manufacturing issues with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future.

Given indications this years flu season may be earlier than usual, its probably safest to get your vaccine early. This is particularly important for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life.

Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, four of the vaccines are subsidised by the Australian government through the National Immunisation Program.

In older people, a number of vaccines are now recommended: Covid and influenza, as well as one-off courses of pneumococcal and shingles vaccines. In general, most vaccines can be given in the same visit but talk to your doctor about which ones you need.

All influenza vaccines can cause a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in adjuvanted and high dose vaccines.

As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor but in general, studies suggest they can safely receive any (including egg-based) influenza vaccines.

Serious side effects from the influenza vaccine, such as Guillain-Barr syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are thought to be less common after influenza vaccination than after infection with influenza.

Allen Cheng is professor of infectious diseases at Monash University. This article was originally published in the Conversation

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There are new flu vaccines on offer in Australia in 2024. Heres what to know about them - The Guardian

Federal officials are preparing for the possibility of additional human cases of bird flu, testing components to create a vaccine after a Texas dairy worker was infected with the highly virulent virus, even as they stress the United States remains far from needing to activate a full-blown emergency response

Two candidate vaccine viruses essentially the building blocks manufacturers use to produce a vaccine appear well matched to protect against the H5N1 strain circulating among dairy cattle and birds, according to federal health officials. Itd probably be weeks to months before those shots could first be made available if needed, according to a Health and Human Services official who spoke on the condition of anonymity to describe an ongoing investigation.

Top officials at the Centers for Disease Control and Prevention said the agency is well poised to detect if a person has H5N1 through the agencys regular surveillance for seasonal flu at more than 100 public health labs in all states as well as enhanced monitoring put in place in 2022 for anyone who has been exposed to birds infected with that strain.

CDC and the whole U.S. government is taking this situation very seriously, CDC Director Mandy Cohen said in an interview. We had not seen avian flu in cattle prior to last week. That is new. Its a reservoir for virus to circulate and potentially, change.

The development underscores critical questions about whether the country is equipped to handle an influenza outbreak after the coronavirus pandemic, the worst global health crisis in a century, exposed the weaknesses in the nations public health infrastructure and decimated the publics trust in key federal agencies.

More than half a dozen federal officials say their job is to prepare for the worst but said risk to the general public remains low. H5N1 was first identified in geese in China in 1996, but outbreaks in the past havent led to an explosion of cases in humans.

The heightened attention on bird flu comes after the virulent H5N1 strain was recently identified in U.S. dairy cattle for the first time. Federal and state officials announced Monday that a dairy worker in Texas is being treated for bird flu, marking the second-ever human case of this bird flu strain in the United States. The patient who experienced eye inflammation as the only symptom was exposed to cattle presumed to be infected with the virus. Disease trackers are monitoring for additional cases, particularly whether the virus can jump from human to human, which has happened infrequently and would be cause for more alarm.

Why I feel we can say the risk of avian flu remains low to the public is because the virus we are seeing in the cattle and in this one human case is the same genetic virus that we were seeing in poultry, Cohen said, meaning the virus has not yet evolved to spread easily in humans.

Since bird flu isnt a novel virus, some experts believe the country is better prepared to tackle such an outbreak than covid, but cautioned against overconfidence.

Others pointed to the drastic cut in funding for pandemic preparedness.

Federal funding for pandemic influenza has not kept up with the threat, even by the governments own assessments, Tom Daschle, former Senate majority leader and head of the Coalition To Stop Flu, which includes public health organizations and vaccine manufacturers, said in a statement Tuesday.

The government group responsible for defining requirements for medical countermeasures called for $1.15 billion in funding for pandemic influenza for 2025, Daschle said. But the $335 million in Bidens 2025 budget request fell far short. (Congress appropriated $335 million for pandemic influenza preparedness in the most recent appropriations bill.)

Significant cuts to preparedness funding were also made two weeks ago in a bipartisan appropriations package, Daschle said. That funding could have been used to speed vaccine development and manufacturing, improve diagnostics and early warning capabilities, and ensure the public health workforce on the front lines is adequately resourced, he said.

Detecting changes in the viruss pattern starts with surveillance.

When there is a presumptive positive test, state health departments begin an investigation and send specimens to the CDC for confirmatory testing, said Vivien Dugan, who heads the agencys influenza division. The CDC conducts extensive lab testing and analysis to determine the risk to public health; it expects to finish sequencing the sample from the infected dairy worker this week.

Since bird flu outbreaks have become widespread globally in recent years, the CDC and the Agriculture Department have enhanced surveillance closely monitoring anyone who has been exposed to infected birds or poultry infected with H5N1 for 10 days. More than 8,000 people have been monitored in all the 50 states, D.C., New York City, Puerto Rico, Virgin Islands and the Northern Marianas. Until this week, the only positive case was in Colorado in 2022.

If an outbreak in humans occurs, quickly scaling up vaccination would be paramount. The nations 10-year playbook to modernize flu vaccination sets a goal of delivering first doses of a vaccine within 12 weeks of the declaration of an influenza pandemic.

Federal officials point to some good news: Manufacturing a vaccine to match this specific strain of the virus and then mass producing it is vastly easier than the effort to develop a coronavirus vaccine. Thats because there are already vaccines to combat the bird flu. They can be altered, experts say, to better protect against this specific strain.

This scenario would probably only happen if theres fairly widespread human-to-human transmission. But there would be trade-offs. Manufacturers have limited capacity to produce flu vaccine. Manufacturers are now in the midst of producing the estimated 156 million to 170 million doses of the annual seasonal flu vaccine to be given in the fall.

It would be a risky political decision to disrupt that production and switch to making millions of doses of a new shot, public health officials and experts have said.

We have a n of 1, said CDCs Dugan, referring to the single human case.

Its a good news story that we have bulk vaccine in [a government stockpile] but I dont think we should assume that all Americans will get jabs, said another federal health official who spoke on the condition of anonymity because of an ongoing investigation.

Those who do become infected with bird flu could be treated with antiviral drugs the Food and Drug Administration has approved for the flu. Experts and officials said there havent been any signs that the current strain would be resistant to those therapeutics. The nations Strategic National Stockpile has an emergency supply of antivirals that are also available on the commercial market.

In the wake of our experiences with covid-19, it has become increasingly clear that some individuals show a preference for therapeutic interventions post-infection over preventative vaccination, Taylor Sexton, the executive director of the Medical Countermeasures Coalition, wrote in an email. Vaccines and therapeutics are two sides of the same coin when we are fighting a pathogen, and both remain critical.

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How prepared the U.S. is for a bird flu pandemic - The Washington Post

Those who are considering getting an influenza vaccine may now save on costs as the World Health Organization (WHO) and influenza experts have agreed that the B/Yamagata lineage virus may no longer be necessary to be included in the flu shot.

This opens doors for the return of the trivalent influenza vaccine, which could be less expensive, and have more takers.

Why is the B/Yamagata lineage virus being excluded?

The vaccine is manufactured with a live virus, which is then inactivated or attenuated. However, the B/Yamagata lineage virus has not been seen for the past four years, according to experts.

The virus is currently only found in the vaccine labs around globe, and any lapses in handling and containment, could bring it back into circulation, Professor Parvaiz A. Koul, who is former director of Sher-e-Kashmir Institute of Medical Sciences, J&K, told The Wire.

An avid influenza researcher, Koul, further said, It defies logic as to why you should vaccinate for an infection that has not been seen for the past four years.

He strongly advocated for the reintroduction and re-adoption of trivalent flu shots.

Separately, the WHO, in a four-day consultative meeting on Composition of Influenza Virus Vaccines, on 23 February, decided to omit the B/Yamagata lineage virus from the vaccines.

In September, WHO had declared the need to exclude the B/Yamagata strain from the vaccine because it is no longer warranted. Its influenza vaccine composition advisory committee said, [The] inclusion of a B/Yamagata lineage antigen in quadrivalent influenza vaccines is no longer warranted, and every effort should be made to exclude this component as soon as possible.

Influenza vaccines are updated biannually so that they align with circulating strains to match evolving flu viruses. This process ensures effective protection from the virus.

The Yamagata lineage virus

Influenza B/Yamagata is one of the two main lineages of Influenza B viruses that commonly circulate and cause illness in humans, alongside Influenza B/Victoria. Influenza A and Influenza B are two types of viruses that cause the flu. Influenza A, in comparison to Influenza B, is usually responsible for more severe flu outbreaks due to its ability to undergo significant changes, called antigenic shift.

The fresh recommendations mandate the the egg-based flu vaccines must contain an A/Victoria/4897/2022 (H1N1)pdm09-like virus, an A/Thailand/8/2022 (H3N2)-like virus, and a B/Austria/1359417/2021 (B/Victoria lineage)-like virus. Similarly, the cell culture or recombinant-based flu vaccines may contain an A/Wisconsin/67/2022 (H1N1)pdm09-like virus, an A/Massachusetts/18/2022 (H3N2)-like virus, and a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.

These names represent specific strains of flu viruses. The first part refers to the type of flu virus (either influenza A or B), followed by the location where the virus was isolated (such as Victoria, Thailand, or Austria), and then a number and year indicating when the virus was identified or isolated. The egg-based flu vaccines are manufactured by growing the vaccine inside chicken eggs, while cell-culture based ones are grown inside animal eggs.

Days before WHOs consultative meetings, the Lung India,a peer-reviewed medical journal, published a paper titled Influenza vaccination: A case for removal of B/Yamagata from the quadrivalent vaccine. The paper was written by professor Parvaiz A. Koul. The article advocated for the B Yamagata virus to be dropped from the vaccines.

It read: After the onset of the COVID-19 pandemic, there was a virtual elimination of the influenza circulation from the globe (Influenza virus detections reported to FluNet for all viruses), which, however, reappeared in 2021 (mid-year). However, the recent global influenza surveillance has been notable in the virtual absence of the circulation of B/Yamagata lineage.

Given the virtual absence of B/Yamagata from the global circulation, after the onset of the COVID-19 pandemic in 2020, it would be apt to drop B/Yamagata totally from the vaccine and recommend only the trivalent vaccine with B/Victoria lineage, it added.

The two Influenza A lineages are determined by WHO twice every year, based on circulating strains data, Koul said.

Kim Sampson, executive director Asia Pacific Alliance for the Control of Influenza (APACI), and advisor to the Australian Immunisation Coalition, while endorsing the case for exclusion of B/Yamagata, told The Wire that the case was clear. Inclusion of a non-existent virus in a vaccine is unreasonable, to say the least, he said.

He further said, The Lung India recommendations are very succinct and put forward a case for the removal of B/Yamagata from the forthcoming vaccine composition. Soon after the Lung India article publication, the WHO reached the same conclusion, he said.

Kouls article in Lung India said, This (exclusion of B Yamagata) would also prevent inadvertent reintroduction of the vaccine-contained B/Yamagata strain into the community circulation.

Last year, WHO and the UKs Medicines and Healthcare products Regulatory Agency noted in a meeting in London that there was no global circulation of B/Yamagata viruses since 2020, except for those derived from live attenuated vaccines, he said in his article.

On February 28, the New England Journal of Medicine (NEJM) published a paper titled Ending B Yamagata Flu Transmission Shifting from Quadrivalent Vaccines. The paper suggested that discussions may lead to an immediate return to trivalent vaccine formulation, analysing advisory group recommendations, manufacturer practices, regulatory requirements, and virus circulation patterns.

Earlier last week, the US Food and Drug Administration (FDA) issued a statement that called for the revamping of influenza vaccines, and switching to trivalent ones.

In the interest of public health, FDA strongly recommended to influenza vaccine manufacturers the removal of the B/Yamagata lineage virus from seasonal influenza vaccines in the US for the 2024-2025 influenza season. FDA and the manufacturers have been working together so that the move from quadrivalent to trivalent seasonal influenza vaccines occurs for the upcoming influenza season, read the statement.

The seasonal flu is a bi-annual incidence in India. As per estimates, between 2,91,000 and 6,46,000 people die each year from seasonal influenza-associated respiratory illnesses, of which 36% occur in low and middle income countries (LMICs) like India.

According to the WHO, children aged between six months and five years, pregnant women, adults aged 65 years and above, people with chronic medical conditions and healthcare workers constitute the high risk group for influenza.

Despite this, the vaccination coverage in India is poor.

A 2022 study assessing the vaccination coverage in older adults in India found that a miniscule 0.6% had taken the flu shot. Among healthcare workers, a study found that over 71% had been vaccinated at least once. The wide disparity, Koul said, could be due to a variety of reasons. Many hospitals have influenza vaccines at subsidised prices for healthcare workers; healthcare workers have a better education about influenza and vaccines; the threat perception is more, he said.

The cost

In India, the annual influenza vaccine shot costs around Rs 1,500 to Rs 2,000. Many believe that the switch to trivalent would reduce the cost and increase the uptake, especially in countries like India where the vaccine is not covered under any support or insurance system.

Sampson said having a lower price will certainly make people consider an annual flu shot, especially those in the community that have been introduced to the significance of vaccination against influenza. He said that while there certainly was a correlation between price and uptake, it is not the only factor to be considered when thinking about influenza vaccination at a global level.

Government funded programmes will have the most significant impact, but such programmes are limited to countries that can afford them, he said.

Koul said influenza vaccines saved lives. Influenza is a serious threat for many people and has been responsible for so many deaths. These deaths are preventable, he said. Switching to trivalent flu shots could help bring the costs down and probably help in making vaccines more affordable for people, he said.

CSL Seqirus, one of the largest vaccine companies, has announced that the transition from quadrivalent to trivalent influenza vaccines for the US will take place in time for the 2024-25 season. For other countries, we are continuing to consult on the most optimal timing, the company said.

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WHO Recommendation on Influenza Vaccines Paves Way for Affordable Shots - The Wire

A few simple interventions boosted flu vaccine uptake for patients waiting at the emergency department [ED], according to the cluster-randomized, controlled PROFLUVAXED trial.

People in ED waiting areas who consented to view a 3-minute video with a scripted message, read a one-page flyer, and have a short discussion with an ED clinician about the flu vaccine had a 30-day follow-up vaccination rate of 41% versus 15% among patients that received no messaging about the vaccine.

Even just asking people in the ED "Would you accept the influenza vaccine in the emergency department today if your doctor asked you to get it?" resulted in a 30-day vaccination rate of 32%, Robert Rodriguez, MD, of the University of California San Francisco, and colleagues reported in NEJM Evidence.

"We fully expected the interventions to improve vaccine uptake but were surprised by how effective they were," Rodriguez told MedPage Today. "The simple question intervention doubled vaccine uptake and the messaging intervention nearly tripled vaccine uptake."

"There is a distinctly underserved population whose primary (and often only) healthcare access occurs in emergency departments," Rodriquez noted. "To decrease disparities, public health interventions, especially vaccine messaging and vaccine administration, can and should be delivered in emergency departments."

To ensure the messages in the video and flyer reached medically underserved populations, researchers created five different versions with the same wording that featured African American, Latinx (English and Spanish versions), multiracial, or white physicians.

The consequences of poor influenza vaccine uptake are particularly stark for members of racial and ethnic minority groups, Zanthia Wiley, MD, and Annelys Roque Gardner, MD, both of Emory University School of Medicine in Atlanta, wrote in an accompanying editorial. Black, Hispanic, and American Indian or Alaska Native adults have age-adjusted influenza hospitalization rates of 1.2 to 1.8 times the rate of non-Hispanic white adults, they noted. Moreover, it is common for people who lack health insurance and access to primary care to visit EDs for non-emergency care, they pointed out.

"Exploring alternative methods of promoting vaccinations in racial and ethnic minority communities and for those individuals who have limited access to routine healthcare is essential for vaccine equity," Wiley and Gardner wrote.

The PROFLUVAXED trial enrolled 767 participants from six emergency departments in San Francisco, Houston, Philadelphia, Seattle, and Durham, North Carolina from October 2022 to February 2023. No participant was critically ill and the majority of ED visits were for conditions that would not preclude offering and administering vaccines. Forty-six percent of participants were female, 36% African American, and 21% Latinx. Sixteen percent had no health insurance, approximately one-third did not have a primary care physician, and 9% were unhoused or marginally housed.

All participants filled out a consent and intake survey and were then randomized to one of three groups. Participants in the first group (Intervention M, n=210) were asked to view the video and flyer and have a discussion with an ED clinician about the flu vaccine. Participants in the second group (Intervention Q, n=244) were asked if they would accept a flu vaccine if offered. The control group (n=313) received no intervention. Researchers used data from electronic health records for a period of 30 days post-intervention to determine if participants received the flu vaccine, or were contacted with a follow-up phone call.

Similar percentages of participants in the intervention groups said they would accept the flu vaccine in the ED (49% in M vs 45% in Q) and similar percentages also received the flu vaccine during their index ED visit (27% and 24%, respectively). However, nearly one-half of participants who said they were willing to receive the vaccine in the ED did not receive it at the index visit. The main reason for participants not receiving the vaccine at the index ED visit were clinicians not ordering or administering the vaccine.

One limitation of the study was that research coordinators delivered the vaccine messages in the intervention groups. These staff are unlikely to be available in most EDs, especially ones with limited resources, the authors pointed out. Also, all the sites participating in the study were urban academic EDs, so the study results may not be generalizable to rural or community EDs, they concluded.

Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.

Disclosures

The study was funded by the National Institute of Allergy and Infectious Diseases.

Rodriguez reported a relationship with the Pfizer Foundation; other study authors reported ties to industry.

Wiley and Gardner reported no ties to industry.

Primary Source

NEJM Evidence

Source Reference: Rodriguez RM, et al "Promotion of influenza vaccination in the emergency department" NEJM Evid 2024; DOI:10.1056/EVIDoa2300197.

Secondary Source

NEJM Evidence

Source Reference: Wiley Z and Gardner AR "Adult influenza vaccination -- seizing every opportunity" NEJM Evid 2024; DOI: 10.1056/EVIDe2400032.

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Flu Vaccine Uptake Tripled With Simple Promotion - Medpage Today