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The Strategic Advisory Group of
Experts (SAGE) on Immunization, which advises the World
Health Organization (WHO) met recently for two days in
Geneva, Switzerland to discuss policies and strategies
for vaccines and immunization and against the H1N1
virus.
The experts reviewed the current
situation of the pandemic worldwide and considered
issues and options from a public health perspective.
Items on the
agenda included the status of vaccine availability,
results from clinical trials on vaccine immunogenicity,
and early results from safety monitoring in countries
where administration of the H1N1 pandemic vaccine is
currently under way.
The experts also advised the WHO on
the number of doses of the vaccine needed to confer
protection, also in different age groups, the
co-administration of seasonal and pandemic vaccines, and
vaccines for use in pregnant women. Recommendations on
the formulation of seasonal influenza vaccines for the
southern hemisphere in 2010 were also provided.
Current
situation
Globally, teenagers and young adults
continue to account for the majority of cases, with
rates of hospitalization highest in very young children.
Between 1% to 10% of patients with clinical illness
require hospitalization. Of hospitalized patients,
between 10% to 25% require admission to an intensive
care unit, and 2% to 9% have a fatal outcome. Overall,
7% to 10% of all hospitalized patients are pregnant
women in their second or third trimester of pregnancy.
Pregnant women are ten times more likely to need care in
an intensive care unit when compared with the general
population. Based on these and other current findings,
the experts made a number of recommendations.
Single dose
recommended
SAGE
recommended the use of a single dose of vaccine in
adults and adolescents, beginning at the age of 10
years, provided such use is consistent with indications
from regulatory authorities.
Data on immunogenicity in children
older than 6 months and younger than 10 years are
limited and more studies are needed. Where national
authorities have made children a priority for early
vaccination, SAGE recommended that priority be given to
the administration of one dose of vaccine to as many
children as possible. SAGE further stressed the need for
studies to determine dosage regimens effective in immunocompromised persons.
Co-administration of vaccines
Clinical
trials investigating the co-administration of seasonal
and pandemic vaccines are ongoing, but SAGE acknowledged
the recommendation, from the US Centers for Disease
Control and Prevention, that live attenuated seasonal
and live attenuated pandemic vaccines should not be
co-administered.
he experts recommended that seasonal
and pandemic vaccines can be administered
simultaneously, provided both vaccines are inactivated,
or one is inactivated and the other is live attenuated.
They found no evidence that co-administration of
vaccines, as recommended, would increase the risk of
adverse events.
Swisslatin /
2.11.2009
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