Flu shot

from Wikipedia, the free encyclopedia

The flu vaccination is a vaccination against influenza ("real flu"). Influenza virus infections are very common, affecting around 18% of the population in England every year. Almost all children in the Netherlands were infected with at least one of the virus subtypes at the age of six . On average, only about a third of those infected develop a fever and most of those infected recover from the symptoms within a week without medical intervention . But the high frequency of infections leads to a significant number of dangerous complications, especially among the elderly and previously ill, and to a global burden on the health systems and economy. The first vaccinations of the general population have therefore been given since 1942 . The vaccination should take place before the start of the influenza season, i.e. in the northern hemisphere preferably in October and November. The effectiveness of the influenza vaccines approved to date is not optimal, because for decades it has been on average well below that of vaccines against other pathogens and fluctuates very strongly from season to season. But so far there is no better medical protection against influenza. The previous influenza vaccines have to be adapted every year to the currently circulating influenza viruses, so it is recommended that you vaccinate yourself every year. The vaccine is usually given by injection into a muscle ( intramuscularly ). Vaccines that are injected into the skin ( intradermal ), under the skin ( subcutaneous ), or sprayed into the nose are also recommended . Up to now, trivalent vaccines (triple vaccines) and quadrivalent vaccines (quadruple vaccines, tetravalent vaccines) have been used to provide protection against the most important three or four circulating virus strains. The influenza vaccination does not protect against "flu-like infections" (also: "colds" or "colds"), as they are caused by other pathogens.

Vaccination indications

Influenza vaccination for the US military: The vaccine is injected into the deltoid muscle .

WHO

Currently the World Health Organization (WHO) recommends influenza vaccinations for

  • Pregnant women at any point in pregnancy (even in the first trimester )
  • Children between 6 months and 5 years
  • People over 65 years of age
  • People with chronic illnesses
  • Health care workers.

In Germany

The the Robert Koch Institute is moved Standing Committee on Vaccination (STIKO) currently recommends vaccination for

  • all persons aged 60 and over (so-called standard indication, "S" for short)

as well as under certain conditions for other people (so-called indication vaccinations, short "I"):

  • All pregnant women, contrary to the WHO, usually only from the 2nd trimester, so that the vaccination is not responsible for the high number of miscarriages that occur in the first trimester . If there is an increased health risk as a result of an underlying condition, pregnant women should be vaccinated in the 1st trimester.
  • People with an increased health risk as a result of an underlying condition (such as chronic diseases of the respiratory organs, heart or circulatory diseases, liver or kidney diseases, diabetes or other metabolic diseases, chronic basic neurological diseases such as multiple sclerosis with attacks triggered by infections, congenital or acquired immunodeficiency or HIV)
  • Residents of retirement or nursing homes
  • People who, as a possible source of infection, could endanger high-risk people living in the same household or cared for by them. At risk are groups of people with underlying diseases for whom there are indications of a significantly reduced effectiveness of the influenza vaccination, such as B. People with dialysis-dependent kidney failure or people with congenital or acquired immunodeficiency or suppression.
  • People at increased risk (e.g. medical staff)
  • People in facilities with extensive public traffic
  • People who can act as a possible source of infection for those at risk they care for.
  • People with direct contact with poultry and wild birds (the vaccination does not protect against avian flu, but it prevents problematic double infections)

as well as a so-called travel indication ("R" for short) for

  • Travelers who do not belong to either the standard or the indication group, after risk assessment according to exposure and vaccine availability.

In these groups, the vaccination coverage should be increased to over 70%. In fact, only just under 35% of people aged 60 and over were vaccinated in the 2016/17 season. In the 2008/09 and 2009/10 seasons, almost half of all people in this age group in Germany were vaccinated against influenza. After that, the numbers went down. Since the 2012/13 season, the vaccination rates seem to have stagnated at a level - for a third of all people over 60.
The Federal Joint Committee (G-BA) as the highest body of joint self-administration in Germany's health system decides to assume the costs of the flu vaccination for all legally insured persons for whom it is recommended by the STIKO, as an annual vaccination in autumn with a vaccine with the current antigen combination recommended by the WHO. Similar regulations apply to those with private health insurance.

In Austria

The Agency for Health and Food Safety (AGES) monitors the influenza situation in Austria via an influenza surveillance system. This records data from a clinical and a virological sentinel surveillance system as well as reports of influenza virus detection from five virological laboratories. The Federal Ministry of Labor, Social Affairs, Health and Consumer Protection publishes the opinions of the National Vaccination Committee also with regard to influenza. For the season 2018/2019, the influenza vaccination according to the "Vaccination Plan Austria 2019" is recommended

  • “In principle” for all persons over the age of 6 months

"Particularly urgent" for

  • People at increased risk as a result of a chronic illness (chronic lung, heart and circulatory diseases except hypertension), kidney diseases, neurological diseases, metabolic diseases (including diabetes mellitus) and immune defects
  • hospitalized people at increased risk for influenza complications
  • Children / adolescents from 7 months of age up to 18 years of age under long-term ASA therapy (to prevent Reye's syndrome in the context of febrile influenza; it should be noted that live vaccination is contraindicated under this therapy regardless of age)
  • very overweight people ( body mass index (BMI) ≥ 40)
  • People with HIV infection or other immunosuppressive diseases or therapies
  • In the case of severe T-cell or B-cell suppression by immunosuppressants / biologics (e.g. antibodies against CD20-positive B cells): Vaccination one month before the start of therapy
  • Pregnant women and women trying to get pregnant during the influenza season
  • People around newborn babies
  • Persons from the age of 50
  • Caregivers (e.g. in hospitals, retirement homes and in the household) and household contacts in the aforementioned risk groups
  • Health professionals
  • People with frequent public contact
  • All travelers: Vaccination no later than 2 weeks before departure for protection during the trip (e.g. at the airport, on the plane) and at the travel destination

In Switzerland

In 2014 the Federal Office of Public Health (FOPH) of the Federal Department of the Interior (FDHA) launched the “National Strategy for Flu Prevention” (GRIPS) project after analyzing previous weaknesses in influenza prevention. The aim is to reduce the number of serious illnesses caused by seasonal flu, especially in people who are at increased risk of complications.

In addition, the Federal Office of Public Health, advised by the Federal Commission for Vaccination Issues (EKIF), issues the respective “Swiss Vaccination Plan” as part of its guidelines and recommendations . It only states (as of 2019) about the influenza vaccination: "The flu vaccination is recommended for all people aged 65 and over".

The recommendations of the same office are clearly broader elsewhere: There, the flu vaccination is currently recommended for "people with an increased risk of complications":

  • People over 65
  • pregnant women
  • premature babies up to two years
  • People with chronic illnesses

In addition, the vaccination recommendation currently applies to

  • everyone who is in regular, close contact with the aforementioned persons, u. a. close relatives, infant carers and health professionals

The FOPH admits that the flu vaccination does not always protect: "In healthy younger adults it lowers the risk of the disease by 70–90%, in senior citizens by 30–50%". But it adds that after the vaccination the symptoms are "often weakened" and "serious complications are less common".

Furthermore, for example, “InfoVac”, a non-official platform for vaccination issues, provides information and recommendations on influenza as well. According to this, the influenza vaccination is recommended “for everyone” and for “people with an increased risk of complications”, a group that is defined here more broadly than, for example, by the Federal Office of Public Health.

Pregnant women

Influenza infection with clinical symptoms during pregnancy nearly doubles the risk of miscarriage or stillbirth. Vaccinating pregnant women with influenza does not increase the risk of miscarriages. However, whether an influenza vaccination reduces the incidence of clinically symptomatic influenza in pregnant women and / or is beneficial for the unborn child and the infant is contradicting the opinion of meta-analyzes and large studies.

A vaccine approved in Germany since 2019 is approved by vaccinating pregnant women for passive immunization of infants under six months of age. The antibodies formed in the pregnant woman are transferred to the unborn child via the placenta, so that the newborn child has passive protection ( nest protection ) up to an age of less than six months .

Breastfeeding

Women who are breastfeeding and vaccinated against influenza pass on antibodies against influenza to the child in their breast milk . This gives children who are too young to be vaccinated themselves some protection against influenza.

Toddlers and teenagers

The risk of healthy infants and young children being admitted to hospital due to respiratory tract disease during the flu season is similar to that of high-risk adult patients or the elderly. Influenza vaccinations of healthy children under 2 years of age can only slightly reduce their risk of developing influenza. The vaccination protection between the ages of 2 and 17 years is similarly modest.

Healthy adults

Healthy adults under the age of 60 are unlikely to develop significant symptoms after being infected with the influenza virus. Nevertheless, because of the good tolerability of the vaccine, it is usually medically acceptable to vaccinate such people against influenza. In the hope of reducing sick leave during a flu season, many companies are offering their employees a free flu shot during working hours.

Intense epidemic and pandemic

In the event of an impending “intense epidemic” and pandemic , the WHO and the health authorities recommend vaccinations against influenza on a larger scale and with a possibly adapted vaccine. With a view to the future, after the H1N1 2009/10 pandemic ("swine flu") , the WHO determined that the current vaccinations, treatment methods and controls are only "limited" and, with the aim of improving the project, the "Global influenza strategy 2019– 2030 "started.

Supplement with pneumococcal vaccination

One of the most dangerous complications of influenza disease is the colonization of the airways previously damaged by the virus with bacteria, especially pneumococci . The pneumococcal pneumonia that then develops can be life-threatening, especially in patients with chronic diseases and in the elderly. Pneumococcal vaccination combined with influenza vaccination lower the risk of pneumococcal pneumonia and fatal outcome compared to pneumococcal vaccination alone, influenza vaccine alone, and placebo .

Contraindications

The flu vaccine has so far mostly been produced using incubated chicken eggs and therefore contains traces of chicken protein. But around 1.3% of all children and 0.2% of all adults have an allergy to egg white. After about 1 in 1.3 million vaccinations with the leading influenza vaccines to date, severe allergic reactions such as anaphylaxis occur. Individuals who are known to have mild symptoms of reaction to the consumption of egg white can be vaccinated with any approved influenza vaccine without any special precautions. People with a known severe allergy to egg white should only be vaccinated with hen's egg-based influenza vaccines if clinical monitoring after vaccination and treatment of any anaphylactic reaction that may occur are ensured. An alternative is influenza vaccine, which is produced on cell cultures and is therefore free from egg white.

The vaccination is also contraindicated in the case of known severe hypersensitivity reactions to other vaccine components, such as preservatives and adjuvants . Oseltamivir or zanamivir is available during epidemic times for these patients or immunosuppressed patients in whom an adequate antibody response is not expected , which reduces the frequency of infection somewhat.

effectiveness

The number of publications on the effectiveness of influenza vaccination is large. Most of the studies are retrospective observational studies, especially in the form of “test-negative case-control studies” (“test negative design” for short). This involves evaluating data from patients who have sought medical treatment for “flu symptoms” within a certain period of time. It is determined whether or not they can be detected with influenza viruses. From the number of people vaccinated with influenza viruses ("cases") and those vaccinated without influenza viruses ("controls") it can be deduced how effective the vaccination is, even if only roughly.
The overwhelming majority of studies on the effectiveness of influenza vaccination therefore do not meet recognized requirements for high quality (see Jadad scale ). The authors of a meta-analysis carried out at the University of Minnesota in 2012 found almost a thousand publications on the effects of the infection and the vaccination. But only 31 of them were really evaluable due to their quality (“eligible”). In particular, publications on the question of the extent to which the influenza vaccination reduces the mortality of at least 65-year-olds led to false assumptions (“mired”) due to the design of the study. In many of these studies, the alleged reduction in mortality was simulated by distortions in the selection of test subjects in the sense of a “healthy vaccine recipient effect” (also: “healthy vaccinee effect”, analogous to the healthy worker effect ). The authors point out that the overestimation of the vaccine effect on the one hand damages public confidence in vaccinations in general, and on the other hand hinders the development of actually better effective vaccines, which are “urgent”.

The aforementioned meta-analysis of 31 studies showed that the trivalent influenza vaccines (TIV) only offered moderate ("moderate") protection on average, which in some seasons is further reduced or completely absent ("absent"). The effectiveness both in the particularly vulnerable age group of at least 65 years and in children between 2 and 17 years has not been adequately proven.

A 2014 Cochrane meta-analysis examined the benefit of flu vaccination for adults, including pregnant women, and found very little effect on influenza symptoms and the number of sick days.

A meta-analysis by the Cochrane Collaboration also from 2012 confirmed that there are no sufficiently meaningful studies on the effectiveness of influenza vaccination for children under 2 years of age.

In 2006, a meta-analysis by the Cochrane Collaboration examined the benefits of vaccination for caregivers of elderly patients. The poor quality of the study design of many studies was criticized . The main statement that was summarized was that the vaccinations did not lead to any reduction in influenza or infections of the lower respiratory tract. On the other hand, mortality was lower among the vaccinated compared to the unvaccinated, both overall and from other pneumonia (influenza-like illness).

A 2014 meta-analysis showed that people over 60 had fewer respiratory illnesses, pneumonia, hospital admissions and deaths after vaccination against seasonal influenza. This effect was independent of whether the vaccine used corresponded to the circulating flu viruses or not.

A Cochrane meta-analysis from 2018 with data from Europe and the USA between 1965 and 2000 showed: In the age group of at least 65-year-olds who are particularly at risk from influenza infection, vaccination lowers the frequency of infection by around 6% in one season 2.4%, ie by 60%.

The US agency Centers for Disease Control and Prevention (CDC) has published data on the effectiveness of influenza vaccinations there every year since 2005 on the basis of test-negative case-control studies. The effectiveness averaged below 41% between 2004/2005 and 2017/2018.

For Germany, the Working Group Influenza (AGI), a network of several hundred medical practices, vaccine providers and the lead Robert Koch Institute , has been publishing a “report on the epidemiology of influenza in Germany” for years. According to the report for the 2017/2018 season, the effectiveness of the influenza vaccination against subtype A (H3N2), which was frequently circulating in the 2013/2014 season, was minus 66% (-187 to 17%), so vaccinated people were not less rare, but significantly more frequent infected with this virus as unvaccinated. In the 2017/2018 season, triple vaccines were used in accordance with the WHO recommendation, in which the B / Phuket / 3073/2013-like strain (Yamagata line) of the influenza virus, which was still contained in the triple vaccine of the 2015/16 season, was replaced by B / Brisbane / 60/2008. In fact, the Yamagata line made up 59% of circulating influenza viruses. Therefore, the protective effect averaged only 15% in the 2017/2018 season. Overall, in the seasons 2012/13 to 2017/18, the effectiveness of influenza vaccinations in Germany was below 50% on average. The RKI summarized that the protective effect of the flu vaccination was "basically not as high as with other vaccinations". In older people, it has “an effectiveness of 40 to 60 percent. There are also years in which the protective effect is even lower. ”The AGI therefore recommends that people who have been vaccinated also think of influenza during seasonal influenza waves if symptoms of acute respiratory illness are present.

The WHO had recommended tri- and quadrivalent (tetravalent) influenza vaccines for 2018/2019, stating that they did not prefer either variant. However, the STIKO deviated from this and on January 11, 2018 recommended only tetravalent vaccines for 2018/2019. On January 16, 2018, the RKI publicly hoped that “a better vaccine” would be available in the future in the form of the quadruple vaccine. The joint federal committee followed the recommendation of the STIKO on April 5, 2018 and included in the SI-RL that for all vaccines of the 2018/2019 season, only quadrivalent vaccines are bindingly reimbursable at the expense of the statutory health insurance. As with the WHO recommendation in the previous season, the G-BA's decision, which deviated from the WHO, turned out to be medically unsuitable. Among the viruses in the 2018/2019 season that were circulating six months later, the B-type only made up about 1%. Almost 99% were of type A, predominantly A (H1N1) pdm09. Therefore, the additional type B component, which is mandatory in Germany, had no corresponding medical benefit despite the increased costs for the vaccine. In fact, the effectiveness of the influenza vaccines in the 2018/2019 season was just as unsatisfactory as in the previous season: In the USA, it was only 47% on average for all influenza virus types and age groups in patients, and only 24% in patients of at least 50 years of age % and in some subgroups it was even found that among the patients treated for respiratory problems there were significantly more vaccinated than unvaccinated. In eleven EU countries (including Germany), the effectiveness against the almost exclusively circulating type A virus was only between 32% and 43% in outpatients and (without data from Germany) only 38% in inpatients. This low level of vaccination protection for all vaccinated persons is based on the fact that the vaccine against influenza A / H1N1 (the most common subtype this season) was ineffective in some subgroups, especially in older people, although the antigens of the vaccines worked well with the circulating wild viruses of type A H1N1 matched. The vaccines against the (less frequently circulating) subtype A (H3N2) also proved to be mostly ineffective in all age groups. As in the 2013/2014 and 2017/2018 seasons, in the 2018/2019 season the frequency of influenza infections was significantly higher in parts of the vaccinated population than in the unvaccinated population, i.e. statistically one for them The vaccination increased the risk of influenza.

In 2019, the European Center for Disease Prevention and Control , an EU agency , published a meta-analysis and came to a conclusion similar to that of the US CDC: The effectiveness of the vaccines used in the 2008/2009 to 2016/2017 seasons against the circulating ones Virus was only between about 30 and 60%. In the 2018/2019 season, protection against the most frequently detected sub-type A / H1N1pdm09 was only between 0% and 37% for vaccinated people over 64 years of age who are particularly at risk from influenza, depending on the state. Compared to the less common sub-type A (H3N2), the vaccine even offered no protection in all age groups.

The German Institute for Quality and Efficiency in Health Care (IQWiG), whose official mandate is to help the general public with health information to understand the advantages and disadvantages of important treatment options and health care offers, summarizes: In seasons with medium spread of the flu virus 5 out of 100 people fall ill without influenza vaccination, and 2 out of 100 people after influenza vaccination.

In 2019, the German Network for Evidence-Based Medicine pointed out that the Patient Rights Act guarantees citizens the right to information and informed decision-making. In order to be able to make an informed decision, the possible advantages and disadvantages as well as the uncertainties of a medical measure must be presented comprehensively and in an understandable form. From the current data, the network for evidence-based medicine concludes that there are vaccinations whose benefits are undisputed, such as those against polio and smallpox . In addition, there are vaccinations with previously unclear benefits, including those against influenza. It should not be asserted in the medical consultation that "the vaccination prevents the disease very effectively and very safely." With regard to the flu vaccination, such a statement would be wrong.

Data from Denmark with over 600,000 high blood pressure patients suggest that vaccination can lower mortality in the vaccinated control group. This is explained by the fact that acute inflammation from influenza can reduce the stability of vascular plaques.

Building effectiveness

It usually takes 10 to 14 days for the protection to be fully established.

Dependence of effectiveness on previous antigen exposure

Meta-analyzes of both influenza waves and influenza vaccinations suggest that the human immune system is influenced favorably or unfavorably with regard to the reaction to later influenza antigens, depending on the circumstances, by influenza antigens administered for the first time. In contrast to genomic imprinting , this so-called imprinting is acquired. It was previously known that in the H1N1 pandemic of 2009, elderly people who had been infected by H1N1 viruses between 1918 and 1957 and / or since 1977 rarely fell ill. Younger people, on the other hand, who had previously only been affected by the H3N2 virus, fell ill with the H1N1 virus particularly frequently and severely, despite their younger age. One case of unfavorable imprinting was probably reflected in the poor effectiveness of the A (H1N1) component of the vaccine that was used in 2017/2018: people who were immunized between 1977 and 1985 by the then version of the wild virus A (H1N1) built antibodies against the slightly changed antigens of the same subtype in the vaccine are barely protective.

Decrease in effectiveness due to mutation of the seed viruses

During the preparation of the seed viruses for the later commercial mass reproduction in hen's eggs, mutations apparently occur, as is the case with circulating wild viruses. As a result, the antigenicity of the vaccines that will eventually come onto the market can differ so greatly from that of the original seed and circulating wild viruses that the protective effect of the vaccine is reduced, as studies for subtype A (H3N2) have shown.

Decrease in effectiveness during a season

Studies from 2010 to 2017 showed that the risk of being infected by the virus despite being vaccinated is lowest around three to five weeks after vaccination, i.e. the protective effect is highest. After reaching the maximum, the vaccination protection decreases by 16% every four weeks, i.e. already during the current influenza season.

Decrease in effectiveness after repeated vaccination

The vaccine must be given in a new composition every year. However, it is known from studies on health care workers that repeated vaccinations can lead to a decrease in the effectiveness of the vaccine. A meta-analysis of further studies confirmed that vaccinations in an annual repetition primarily impair the protection against infections with the virus subtype H3N2, which is particularly dangerous for the elderly. The cause is probably antibodies against the vaccine. Multiple vaccinations can also cause a chicken protein allergy.

Decrease in effectiveness with age

Older people who have been vaccinated against influenza viruses usually develop significantly less protection than younger people. One of the reasons discussed for this is a general decline in the ability of the immune system to build up a specific humoral and / or cellular reaction after contact with antigens, the so-called immunosenescence . At the same time, there are other reasons for older people, such as the decrease in effectiveness after repeated vaccination and / or imprinting.

unwanted effects

Side effects occur in around 13% of those vaccinated. However, as has been found in randomized, controlled and double-blind studies, these are limited to mild general complaints such as fever, body aches and fatigue, as well as local complaints such as redness, swelling or pain at the injection site, which last for about 1 to 3 days. A tendency to allergic reactions to components of the vaccine can lead to reactions - see contra-indications .

Most of the vaccines approved to date consist of non-replicable virus components and therefore cannot cause influenza. The vaccine for spraying into the nose, on the other hand, consists of weakened influenza viruses (LAIV). Here there is a risk of virus transmission to severely immunocompromised people within a period of one to two weeks after vaccination. Therefore, the vaccinated person should avoid close contact with people who are e.g. B. are still in isolation after a bone marrow transplant.

In connection with vaccinations, including the flu shot, Guillain-Barré syndrome (GBS), a disease of the nervous system with symptoms of paralysis, is sometimes referred to . Some studies suggest that there are one to two cases per million influenza vaccinations each year. However, GBS occurs with a similar frequency even without influenza vaccination.

Vaccines

See influenza vaccine for more details

WHO: Recent recommendations on the seasonal composition of vaccines

For previous years data, see influenza vaccine

Unlike the hoped-for “universal vaccine ” , the vaccines available up to now have to be adapted every season to the circulating influenza viruses. Reference laboratories all over the world - in Germany the National Reference Center for Influenza at the Robert Koch Institute - continuously examine the circulating influenza viruses and transmit their results to the WHO. The WHO then usually recommends certain antigen combinations for the northern hemisphere in February / March and for the southern hemisphere in September of each year on the basis of these reports.

WHO recommendations for the composition of influenza vaccines
Northern hemisphere of the earth Southern hemisphere of the earth
season composition season composition
2020/2021


Chicken-based or live-attenuated influenza vaccines:

  • A / Guangdong-Maonan / SWL1536 / 2019 (H1N1) pdm09-like strain
  • A / Hong Kong / 2671/2019 (H3N2) -like strain
  • B / Washington / 02/2019-like trunk (B / Victoria line)

in the quadruple vaccine as a second B antigen:

  • B / Phuket / 3073/2013 (B / Yamagata lineage) -like strain


cell-based influenza vaccines:

  • A / Hawaii / 70/2019 (H1N1) pdm09-like strain
  • A / Hong Kong / 45/2019 (H3N2) -like strain
  • B / Washington / 02/2019-like trunk (B / Victoria line)

in the quadruple vaccine as a second B antigen:

  • B / Phuket / 3073/2013-like strain (B / Yamagata lineage)
 2020 A / Brisbane / 02/2018 (H1N1) pdm09-like strain
A / South Australia / 34/2019 (H3N2) -like strain
B / Washington / 02/2019-like strain (B / Victoria / 2/87 line)

in the quadruple vaccine as the second B antigen
B / Phuket / 3073/2013-like strain (B / Yamagata / 16/88 line)

2019/2020 A / Brisbane / 02/2018 (H1N1) pdm09-like strain
A / Kansas / 14/2017 (H3N2) -like strain
B / Colorado / 06/2017-like strain (B / Victoria / 2/87 line)

in the quadruple vaccine as the second B antigen
B / Phuket / 3073/2013-like strain (B / Yamagata / 16/88 line)

2019 A / Michigan / 45/2015 (H1N1) pdm09-like strain
A / Switzerland / 8060/2017 (H3N2) -like strain
B / Colorado / 06/2017-like strain (B / Victoria / 2/87 line)

in the quadruple vaccine as the second B antigen
B / Phuket / 3073/2013-like strain (B / Yamagata / 16/88 line)

2018/2019 A / Michigan /
45/2015 (H1N1) pdm09-like strain A / Singapore / INFIMH-16-0019 / 2016 (H3N2) -like strain
B / Colorado / 06/2017-like strain (B / Victoria / 2 / 87- Line)

in the quadruple vaccine also B / Phuket / 3073/2013-like strain (B / Yamagata / 16/88 line)

2018 A / Michigan /
45/2015 (H1N1) pdm09-like strain A / Singapore / INFIMH-16-0019 / 2016 (H3N2) -like strain
B / Phuket / 3073/2013-like strain

in the quadruple vaccine also B / Brisbane / 60/2008-like strain

In line with this recommendation, the industry is developing influenza vaccines, which are initially scientifically assessed by the Committee for Medicinal Products for Human Use (CHMP) at the European Medicines Agency (EMA) . The European Commission then decides on approval for the area of ​​the European Union. Finally, the national authorities approve certain vaccines for the domestic market. For years it was mostly combinations of the three subtypes A / H1N1 , A / H3N2 and B (trivalent influenza vaccine, English: TIV). At the beginning of the northern hemisphere's 2018/2019 season, the US CDC stated with reference to the Advisory Committee on Immunization Practices (ACIP) that none of the different types of influenza vaccine was preferable to another. However, when the very low effectiveness of the vaccine produced for the 2017/2018 season became apparent, in January 2018 the STIKO recommended for Germany to switch to the quadrivalent vaccine (English: QIV) made from two A and two B strains. Quadrivalent influenza vaccines have since been the standard for those insured in Germany's statutory health insurance until further notice. The WHO, on the other hand, stuck to the CDC's assessment in February 2018 that TIV is just as suitable as QIV for the northern hemisphere.

Even if the expected subtype of a season (for example A / California / 7/2009 of type H1N1 ) is the same as that of the previous year, the vaccine offered for this season usually has a slightly different antigen composition, as the viruses usually have meanwhile changed by antigen drift . Occasionally a new subtype arises as a result of antigen shift, which can replace or supplement the previous subtype.

Vaccines currently approved in Germany

For previous years data, see influenza vaccine

For the 2019/2020 season, the Paul Ehrlich Institute approved the following influenza vaccines in accordance with the recommendations of the WHO and the assessment by the CHMP:

Trade name Vaccine type Application type Application age
Afluria Split virus, inactivated intramuscular from 5 years
Gruipal Subunit, inactivated intramuscular from 6 months
Fluad Subunit, inactivated intramuscular from 65 years
Fluarix Split virus, inactivated intramuscular from 6 months
Flucelvax Tetra Subunit, inactivated, tetravalent, from cell cultures intramuscular from 9 years
Fluenz Tetra live-attenuated, tetravalent nasal from 2 to 17 years inclusive
Influs split Tetra Split virus, inactivated, tetravalent intramuscular from 6 months
Influvac Subunit, inactivated intramuscularly or deep subcutaneously from 6 months
Influvac Tetra Subunit, inactivated, tetravalent intramuscular from 18 years
Vaxigrip Tetra Split virus, inactivated, tetravalent intramuscular, subcutaneous from 6 months
Xanaflu Subunit, inactivated intramuscular from 6 months
Xanaflu Tetra Subunit, inactivated, tetravalent intramuscularly or deep subcutaneously from 18 years

Manufacture of the vaccine

See influenza vaccine for more details

Examination of an embryonated chicken egg before infection

Influenza vaccines are produced in infected embryonated chicken eggs or in cell cultures of Vero cells with subsequent virus isolation . Inactivated viruses are fixed with formaldehyde or β- propiolactone , split vaccines are also split with a surfactant . A vaccine dose usually contains around 15 μg of hemagglutinin in each of the vaccine strains for the respective year of production.

Vaccination mode

Vaccinations against influenza have to be carried out every year, because the vaccines from the previous year are usually hardly effective against the viruses that have changed under the selection pressure of herd immunity (see genetic drift ). The great variability of the influenza virus (especially its surface proteins - see under influenza in the section: Epidemics / Pandemics and the immune system ) places great demands on the development and distribution of vaccines.

history

In 1936, neutralizing antibodies were first detected in the blood of people infected with the influenza virus. In the two years that followed, attempts to protect soldiers from influenza by injecting inactivated influenza viruses of type A / H1N1 began. Clinical trials with attenuated influenza viruses ( English live attenuated influenza vaccines, LAIV ) in the period from 1935 to 1941, however, initially did not lead to the general use of such vaccines. The vaccine was first mass-produced by propagation in chicken eggs developed in 1944, while the propagation in cell cultures developed five years later was not yet used. In 1942, the first bivalent vaccine made from inactivated viruses of type A and type B was licensed in the USA, used in the general population, and its effectiveness was demonstrated in larger studies. The elucidation of cases, lack of efficacy, the WHO in 1952, a first system for monitoring teaching (English: surveillance ) the vaccination effect one. Since then, the recommendations for the composition of the influenza vaccines for the coming season have taken into account the extent to which there was a mismatch between the circulating wild virus and the vaccine virus in the current season . When the virus type A / H3N2 ("Hong Kong flu") began to circulate in 1968 and caused a worldwide pandemic with high mortality, the first trivalent influenza vaccines with antigens from two type A and one type B viruses were developed have been standard for a long time. Influenza vaccines have now been approved in Europe and used in the general population. In addition, the first split-type vaccines (split vaccines) came into use at this time. In 1976 the first use of subunit vaccines (subunit vaccines) against influenza followed. As a reaction to the global pandemic of 1977/1978 caused by the A / H1N1 strain , vaccine production was accelerated using “recombinant DNA technology” . A vaccine with attenuated influenza viruses, which is used as a nasal spray, has been approved since 2003, and since 2011 another one that is injected intradermally rather than intramuscularly. Because of the still unsatisfactory effectiveness and complex production of these vaccines, research is being carried out on a "universal vaccine " against influenza with the support of international organizations .

literature

Web links

Wiktionary: Flu vaccination  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ Andrew C. Hayward et al. a .: Comparative community burden and severity of seasonal and pandemic influenza: results of the Flu Watch cohort study . In: The Lancet , Volume 2, Issue 6, P445-454, June 1, 2014, doi: 10.1016 / S2213-2600 (14) 70034-7 .
  2. ↑ R. Bodewes, G. de Mutsert, FR van der Klis, M. Ventresca, S. Wilks, DJ Smith, M. Koopmans, RA Fouchier, AD Osterhaus, GF Rimmelzwaan: Prevalence of antibodies against seasonal influenza A and B viruses in children in Netherlands. In: Clinical and vaccine immunology: CVI. Volume 18, number 3, March 2011, pp. 469-476, doi: 10.1128 / CVI.00396-10 , PMID 21209157 , PMC 3067385 (free full text).
  3. ↑ Clinical symptoms after influenza infection . Robert Koch Institute , January 19, 2018; accessed on June 17, 2019
  4. ↑ a b WHO: Most people recover from fever and other symptoms within a week without requiring medical attention
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