October 1, 2007

Global Surveillance, Vaccine Use Key to Controlling Seasonal Influenza

Kathryn EdwardsPandemic influenza has garnered much attention in recent years, but the global burden of seasonal influenza is also significant. That was the key message from Kathryn M. Edwards, MD, FIDSA, professor of pediatrics at Vanderbilt University Medical School and keynote speaker for the Joseph E. Smadel Lecture on “Seasonal Influenza: Is It a Global Problem and What Can We Do About It?” 

Controlling the problem will take improved influenza surveillance and broader use of influenza vaccine across nations.

Scientists know surprising little about the global burden of influenza, Dr. Edwards said, although data from Hong Kong suggests that the burden may be greater in tropical and subtropical areas of the world, where influenza viruses circulate throughout the year. In 1999, the Hong Kong Government Virology Laboratory tested nearly 20,000 samples: From January to March, 35 percent of isolates were positive for influenza; from June to September, 15 percent were positive.

Compounding the problem, Dr. Edwards said, is the fact that viral respiratory infections have been shown to play a role in pneumonia and invasive pneumococcal disease (IPD). In lndia and large parts of Africa, 20 to 25 percent of childhood deaths are from pneumonia. (Williams BG. Lancet Infect Dis 2002; 2:25-32)  It’s not clear what portion of those deaths may be attributable to influenza—but Dr. Edwards believes that scientists need to know. 

Influenza vaccine is underutilized throughout the world, and some experts predict that the supply of vaccine will soon exceed demand. A study of influenza vaccination rates in 56 countries showed a correlation between a country’s gross national product and influenza immunization rates. Only Canada (with about 350 doses distributed per 1000 population) and the Republic of Korea (about 300 per 1000) have immunization rates surpassing the United States (under 300 per 1000), and all other countries are trailing far behind. Of the countries studied, 27 distribute fewer than 100 does per 1000. (Fedson, et al. Vaccine 2005; 23:5133-5143

According to a recent analysis, over 400 million doses of influenza vaccine were produced in 2006-2007, but the total capacity was 826 million doses. As new technologies are improved upon, the total capacity is projected to grow to 2 billion doses by 2013, including live vaccine and cell-based and egg-based inactivated vaccine. Some of the excess supply will be diverted to pandemic preparedness initiatives, but Dr. Edwards asserted that the excess supply should also be considered for seasonal vaccination in developing countries, who cannot afford to immunize their populations. 

Not only are the supplies adequate, Dr. Edwards said, but current influenza vaccines are effective, and newer adjuvanted vaccines offer even greater promise. 

For More Information: 

See IDSA’s principles for pandemic and seasonal influenza at http://www.idsociety.org/Content.aspx?id=5716

Slides from this session and many others from IDSA 2007 are available online.  

Audio files of individual sessions or a full-conference CD-ROM are available for purchase from Sound Images.   

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