Fear of the unknown: Influenza vaccination

An inactivated virus vaccine has been available since the late 1940´s but it only began to be used extensively when the influenza virus antigenic variability was taken into account. Aside from such variability, influenza viruses are capable of infecting a wide variety of vertebrates, (4) including many avian species, both wild and domestic, thus it is essential to monitor the antigenic characteristics of influenza virus strains currently circulating, and so the vaccine formula has to be evaluated and modified accordingly every year.

Vaccine indications

The efficacy of influenza vaccine is relatively low (70%-90%) (5) and vaccinated persons could have insufficient protection even to homologous virus strains, not to mention those viruses that have undergone antigenic changes, either drift or shift. Furthermore, other respiratory viruses such as parainfluenza, adenoviruses or respiratory syncytial virus could cause a similar illness, frequent anecdotal comments of acute respiratory illness (ARI) coincident with vaccine application is therefore not too surprising.

The risk of complications during an influenza episode, leading to hospitalization and death is higher in older people (≥ 65 years) and in those patients undergoing any of a well-known list of chronic debilitating diseases, (6) yet the benefit of the influenza vaccine should be weighted in different situations. In Mexico, the Ministry of Health (Secretaría de Salud) recommends vaccine application to people belonging to certain groups (7) (Table 1).

Additional information to make better particular recommendations for influenza vaccine use is available from WHO, (8) as well as from the Advisory Committee on Immunization Practices9 in the United States of America:

• Healthy individuals: vaccination may be recommended from age 50 onwards.
• Adults and children with health conditions such as chronic pulmonary disease (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus).
• Persons who have immunosuppression, including compromised immune systems caused by medications or human immunodeficiency virus (HIV) infection.
• Women who are or will be pregnant during the influenza season.
• Children and adolescents (aged 6 months-18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s syndrome after influenza virus infection.
• Residents of nursing homes and other long-term care facilities.
• Persons who are morbidly obese, with a body mass index (BMI) over 39.

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Medline

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