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Vaccine manufacture at the time of a pandemic influenza.

Chalumeau HP.

In the event of a major influenza epidemic, the availability of a potent and safe vaccine would be a major concern. The following presentation describes the main features of a flu vaccine manufacturing campaign: beginning with the supply of embryonated eggs, in which the flu viruses are cultivated, through the different steps of vaccine production - egg harvest, purification, inactivation, splitting - down to the final vaccine formulation and aseptic filling in the appropriate containers. In usual times, such a production cycle takes over 70 weeks. In an emergency situation, the manufacturers and the authorities would have to take innovative approaches to minimize such delays. This will inevitably translate into an enormous strain on all the players in such a project, from the egg suppliers to the organisers of the vaccine dispatching and administration. It will result in suboptimal yields and costs. However, facing a massive and urgent need of vaccine, both the authorities and the vaccine manufacturers must work together to supply the necessary doses in time.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7843364&dopt=Abstract flu, flu medicine, tamiflu



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Pandemic planning in Canada.

Tamblyn SE.

Perth District Health Unit, Stratford, Ontario, Canada.

A Canadian plan for pandemic influenza was completed by the National Advisory Committee on Immunization in 1988. Its development took several years and involved consultation with provincial public health and laboratory authorities, the licensing body, manufacturers of influenza vaccine and antiviral agents, and representatives in the USA and UK. Key decisions in creating the pandemic plan include: (1) aiming for federal-provincial consensus on use of vaccine and antiviral drugs, (2) a selective vaccination approach (high-risk persons plus essential workers), (3) bulk purchasing and distribution of vaccine through the public sector, (4) leaving antiviral drugs on the open market, (5) careful planning of the communications strategy, and (6) increasing inter-pandemic use of flu vaccine in target groups. The plan addresses recognition of a pandemic; activation of a Pandemic Influenza Committee whose membership and responsibilities are spelled out; the federal-provincial decision making process; influenza vaccine considerations; amantadine and other antiviral agents; estimates of target group size, vaccine uptake, manufacturing capabilities and time frames; and communication considerations. Since 1988, influenza vaccine use has increased considerably in Canada and experience has been gained with amantadine. Manufacturing capability within Canada for influenza vaccine has also been enhanced. It is now time to update the plan, especially the targets, and to make sure that everyone involved remains aware of the assigned roles.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7843368&dopt=Abstract flu, flu medicine, tamiflu



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Crisis communication in the event of a flu pandemic.

Saliou P.

GEIG, Paris, France.

When we talk about planning we cannot avoid discussing information, prevention and reaction, three notions that underlie communication in times of emergency. From a management point of view, emergency information in the event of an influenza pandemic comes under two headings: preventive information and reactive information. An example of preventive information provided by GEIG has aimed to sensitize public opinion about the phenomenon of influenza, correcting various preconceived ideas about the illness and reinforcing faith in the influenza vaccine. The strategy adopted by GEIG is founded on a few simple rules: (1) One message/one voice, GEIG unites its areas of competence by relying on a Scientific Council that guarantees the legitimacy of its influenza information, (2) the collection and coordination of information, (3) the identification and prioritisation of target groups, (4) an understanding of the media based on working relationships, making GEIG a reference when it comes to opinion, (5) the conception of information packs adapted to different categories of the public (press packs, documents for health professionals, leaflets for the general public, etc.), and (6) side-by-side with its role as broadcaster, the GEIG has set up a mechanism for listening and for evaluation (public opinion surveys, special enquiries, etc.). These are reliable monitoring tools allowing constant updating of our information policy. Emergency strategy: reactive information. An influenza pandemic is a special kind of crisis, since it is a crisis of collective responsibility, requiring a rapid deployment of adapted communication techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7843373&dopt=Abstract flu, flu medicine, tamiflu



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[The chemoprophylaxis of influenza in troop units]

[Article in Russian]

Efimov EI, Razgulin SA.

Materials concerning the existing and perspective drugs for chemoprophylaxis of flu and its application schemes are described in this article. From the point of view of modern epidemiological theory, and on the basis of mechanism of action, all described medications are subdivided according to their influence on the elements of "influenza virus--human organism" parasitic system. Application of these drugs is in conformity with the modern complex system of non-specific prophylaxis of flu and acute respiratory diseases. Basic conditions for its successful application in military contingency are also described.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7856138&dopt=Abstract flu, flu medicine, tamiflu



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Maternal flu, fever, and the risk of neural tube defects: a population-based case-control study.

Lynberg MC, Khoury MJ, Lu X, Cocian T.

Birth Defects and Genetic Diseases Branch, Division of Birth Defects and Developmental Disabilities, National Center for Disease Control and Prevention, Atlanta, GA 30341-3724.

Results of clinical and epidemiologic studies have shown an increased risk for neural tube defects (NTD) in infants whose mothers were exposed to heat during pregnancy. However, the risk for NTD in infants whose mothers had influenza during pregnancy has not been well studied. This population-based case-control study of infants born in metropolitan Atlanta, Georgia, from 1968 through 1980 included 385 infants with NTD, 3,647 infants with other birth defects, and 2,676 infants without birth defects. Of the 385 mothers of case infants, 31 reported having a 2-day or longer episode of flu with fever from 1 month before through 3 months after conception (odds ratio (OR) = 3.0; 95% confidence interval (CI) 1.9-4.7). Infants of mothers who took medications for their episodes of flu with fever had an even higher risk for NTD (OR = 4.3, 95% CI 2.6-7.1). When mothers of infants with birth defects other than NTD were used as controls, an increased risk of NTD remained for flu with fever (OR = 1.7, 95% CI 1.1-2.5). There was no increased risk for NTD among the infants of mothers who reported fever from causes other than flu. Because of the heterogeneity of maternal flu, the individual contributions of infection, fever, and medications remain difficult to disentangle.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8030627&dopt=Abstract flu, flu medicine, tamiflu



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Donor follow-up of influenza vaccine-related multiple viral enzyme immunoassay reactivity.

Arnold NL, Slade BA, Jones MM, Popovsky MA.

American Red Cross Blood Services, Northeast Region, Dedham, Mass. 02026.

False-positive enzyme immunoassay (EIA) tests in blood donors receiving influenza vaccine were first reported in 1991. We conducted follow-up testing for 6 months of those donors with multiply reactive, but unconfirmed EIA (at least 2 positives in anti-HCV-1.0, anti-HIV-1, and anti-HTLV-I assays) with a history of recent flu vaccine to determine the duration of false positivity. Of 133,000 donors tested, 16 met study criteria; all 16 were reactive for anti-HCV, 10 were reactive for anti-HIV-1, and 12 were reactive for anti-HTLV-I. Fifteen donors were available for follow-up testing (using the original screening and supplemental tests): 10 (67%) reverted to negative for the 3 tests and 5 remained false positive for various markers at last sampling (3-6 months after vaccination). The mean duration of false positivity for those reverting to negative EIA test status, was 4.2 months (range 2-7 months) indicating a transient phenomenon and supporting studies which suggest a role for IgM in the mechanism.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7801610&dopt=Abstract flu, flu medicine, tamiflu