According to the Permanent Commission on Vaccination (STIKO) at the Robert Koch Institute, there is a new communication on vaccination against New Influenza A (H1N1), from which the following facts emerge:The WHO criteria for a pandemic have been met for the “new flu“, as the virus has spread rapidly on all continents.There is no protective immunity.However, to date, the extent of infections is still below the observations from previous pandemics. Since the virus did not appear until the spring of the current year, it was not possible to adapt the vaccines for the 2009/2010 influenza season.For this reason, a vaccine had to be developed that induces basic immunity and thus leads to a reduction in cases of illness and death. This vaccine will be available as early as November due to the ever-advancing technical and scientific research. The STIKO is already recommending vaccination for the “swine flu vaccination” in order to counteract severe and possibly fatal courses of the disease in the fall/winter of 2009/2010.Starting vaccination once high infection rates are present is hardly possible for logistical reasons alone. The following factors deviate from the basis of a general vaccination recommendation:
- Infection and morbidity rates can not yet be predicted for the new flu.
- Pathogenicity mutants of the new influenza also cannot yet be predicted.
- The vaccine against the new influenza has not yet been tested on large collectives; however, the data available to date do not suggest any particular side effects.
Therefore, the STIKO comes to the benefit-risk balance and pronounces a vaccination recommendation for the following groups of people:
- Employees in health care and welfare.
- Patients with health hazards such as chronic diseases.
- Pregnant women and women who have recently given birth (pregnant women should be vaccinated, preferably from the second trimester onwards, with a non-adjuvanted split-cell vaccine)
The following populations may be vaccinated in a second phase (circa four weeks after the above groups of people):
- Household contact persons of persons with health risks, pregnant women / women in childbed and infants under six months.
- All other persons
Indications (areas of application)
In principle, all groups of the population can benefit from vaccination against the new influenza.Each vaccination should be carried out after individual risk-benefit assessment. Regarding the situation in the United States, most H1N1 swine flu cases have affected children and young adults. So far, it is not clear why this is so, and it is equally unknown whether this will change. But some groups are at particularly high risk of becoming severely ill or having a particularly poor prognosis if they do become ill:
- Pregnant women have six times the risk of severe disease compared with women of the same age
- Young children under 2 years of age
- Patients with
- Bronchial asthma
- Chronic obstructive pulmonary disease (COPD) or other chronic lung diseases.
- Diabetes mellitus
- Immune disorders (including HIV) and patients under immunosuppressive therapy (chemotherapy, etc.).
- Cardiovascular diseases (except hypertension – high blood pressure).
- Chronic kidney disease (especially with renal insufficiency/kidney weakness).
- Epilepsy
- Liver disease
- Blood diseases (incl. sickle cell anemia; med.: drepanocytosis; also sickle cell anemia, Engl.)
- Neurological diseases including neuromuscular diseases.
- Nurses and caregivers
- Patients over the age of 65 who get swine flu (very rare) – however, if they do get sick, they are at particularly high risk of becoming severely ill
- Overweight people who fall ill with swine flu have a particularly high risk of complications (with underlying diseases such as pulmonary disease in particular and / or diabetes mellitus)
Implementation
- In children aged six months to nine years – two half adult doses (because of possible mild reactions to the vaccine).
- People aged 10 to 60 years – a full adult dose.
- Over 60-year-olds – two doses – but between the two vaccinations should be at least three weeks.
For pregnant women, a special vaccine should be available according to the Paul Ehrlich Institute possibly by the end of November. A risk-benefit assessment is carried out regularly by the STIKO and the vaccination recommendations adapted if necessary.
Possible complications
- Vaccination against H1N1 influenza during pregnancy does not increase the risk of malformation
- The vaccine is suspected of causing narcolepsy (sleeping sickness) in rare cases in children, adolescents and young adults.
In addition, the STIKO issues a vaccination recommendation against pneumococcus for certain indications.
