Pathogen And Epidemiology
- Influenza virus undergoes frequent mutations causing antigenic drifts and shifts.
- Requires updated vaccine composition annually to match circulating strains.
- World Health Organization Global Influenza Surveillance and Response System monitors and updates composition twice yearly for northern and southern hemispheres.
Types Of Vaccines
Inactivated Influenza Vaccines
- Comprise split-product vaccines produced from detergent-treated purified virus, or surface antigen subunit vaccines containing purified hemagglutinin and neuraminidase.
- Quadrivalent vaccines contain two influenza A strains (H1N1 and H3N2) and two influenza B strains.
- Administered via intramuscular route.
- Demonstrate 63.2 percent efficacy against moderate-to-severe influenza in children 6 to 35 months of age.
- Efficacy wanes over time, offering clinical protection for approximately 6 to 8 months.
Live-Attenuated Influenza Vaccines
- Developed by repeated passage of viruses at low temperatures to form temperature-sensitive variants.
- Virus replicates efficiently at 25 degrees Celsius but fails to replicate at core body temperatures of 37 to 39 degrees Celsius.
- Administered intranasally using an accuspray device.
- Exhibit overall efficacy of 82 percent against laboratory-confirmed influenza in healthy children.
- Avoided in high-risk categories, immunocompromised individuals, and pregnant women.
Dosage And Administration Schedule
| Parameter | Inactivated Influenza Vaccine | Live-Attenuated Influenza Vaccine |
|---|---|---|
| Minimum Age | 6 months | 2 years |
| Dose And Route | 0.5 ml (15 µg); Intramuscular | 0.25 ml in each nostril; Intranasal |
| First Time Vaccination (<9 Years) | Two doses spaced 4 weeks apart | Two doses spaced 4 weeks apart |
| First Time Vaccination (>=9 Years) | Single dose | Single dose |
| Revaccination | Single annual dose | Single annual dose |
Indications And Target Groups
- Recommended universally for children aged 6 months to 5 years.
- Prioritized for high-risk children older than 5 years with chronic cardiac, pulmonary, renal, or liver diseases.
- Indicated in congenital or acquired immunodeficiency, including human immunodeficiency virus infection.
- Strongly recommended for pregnant women during any stage of pregnancy to protect mothers and young infants.
- Optimum administration time in India is the pre-monsoon period (April to May) using the most recent available strains.
Contraindications And Precautions
- Both vaccine types contraindicated in individuals with severe allergic reactions to previous doses or vaccine components.
- Precaution required for individuals developing Guillain-Barre syndrome within 6 weeks of prior influenza vaccination.
- Inactivated vaccines must be administered with extreme caution under medical supervision in patients with severe egg allergy.
- Live-attenuated vaccines contraindicated during concomitant aspirin therapy, in children with wheezing episodes in the past 12 months, and following receipt of antiviral medications within 48 hours.