Different Approaches to Influenza Vaccination (New Eng Journ Med, Editorial)

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Volume 355:2586-2587 December 14, 2006 Number 24

Different Approaches to Influenza Vaccination
Keiji Fukuda, M.D., M.P.H., and Marie Paule Kieny, Ph.D.

In this issue of the Journal, two important and timely studies address basic questions related to the use and performance of influenza vaccines.1,2 The findings are also informative because both studies were conducted in the 2004–2005 influenza season when the influenza A (H3N2) components in both the inactivated and the live attenuated influenza vaccines were not optimally matched to the circulating strains.

<snip, study details included here>

The annual development of influenza vaccines is an exemplary model of public–private cooperation. The World Health Organization (WHO) coordinates global influenza-virus surveillance so that appropriate vaccine candidates can be identified by the WHO and national authorities and vaccines can be reformulated each year. Vaccine viruses must be selected every year, since genetic mutations arise continuously in influenza viruses — a process termed "drift" that results in the emergence of immunologically distinct variant viruses. Several regulatory and production steps to ensure safe, effective, and adequate vaccine supplies must then be completed before the vaccine is administered in time for each influenza season. The process is repeated each year, which imposes severe time restrictions on all groups involved.

Some have questioned whether the substantial effort to produce and deliver influenza vaccine is justified.4 The answer is, unambiguously, yes. Indeed, the critical public health question is not whether influenza vaccines should be used, but how they can be used to advantage. Although year-to-year variations in efficacy and effectiveness are expected because of differences among viruses, target age groups, antigenic matches, and study methods, such variations do not fundamentally undermine the value of vaccination against influenza in responding to seasonal epidemics as well as potential influenza pandemics.

In line with these conclusions, the WHO recently convened international experts to help address issues related to preparedness for pandemic influenza and to develop a "global pandemic influenza action plan to increase vaccine supply."5 This plan is timely because of rising concerns about pandemic influenza. It emphasizes the fact that the increased use of influenza vaccine, the increased and more broadly distributed capacity to produce influenza vaccine, and accelerated research to develop better influenza vaccines are needed to address all forms of influenza.

Source Information

From the Global Influenza Programme, Department of Epidemic and Pandemic Response (K.F.), and the Initiative for Vaccine Research, Department of Immunization, Vaccines, and Biologicals (M.P.K.), World Health Organization, Geneva.

References

King JC, Jr, Stoddard JJ, Gaglani MJ, et al. Effectiveness of school-based influenza vaccination. N Engl J Med 2006;355:2523-2532.

Ohmit SE, Victor JC, Rotthof JR, et al. Prevention of antigenically drifted influenza by inactivated and live attenuated vaccines. N Engl J Med 2006;355:2513-2522.

Edwards KM, Dupont WD, Westrich MK, Plummer WD, Palmer PS, Wright PF. A randomized controlled trial of cold-adapted and inactivated vaccines for the prevention of influenza A disease. J Infect Dis 1994;169:68-76.

Jefferson T. Influenza vaccination: policy versus evidence. BMJ 2006;333: 912-915.

Global pandemic influenza action plan to increase vaccine supply. Geneva: World Health Organization, 2006. (Code no. WHO/IVB/06.13.) (Accessed November 22, 2006, at http://www.who.int/vaccines-documents/DocsPDF06/863.pdf.)

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