Whilst rates of influenza, particularly the new H1N1 strain ('swine flu'), increase in intensity and geographical spread across Europe, the roll out of the vaccination campaigns is receiving mixed levels of uptake and opposition from anti-vaccine campaigners that puts at risk public health and lives, says the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).
Influenza is reported by the World Health Organization as 'widespread' in 10 European countries (Belgium, Iceland, Ireland, Italy, Netherlands, Norway, Russia, Spain, Sweden and the UK) with cases of respiratory illness requiring medical intervention increasing in 17 countries - in Italy, for example, the number of cases per week doubled recently. Not only are levels of influenza unusually high for this time of year, the H1N1virus accounts for 99 percent of cases.
But as major H1N1 vaccine campaigns get underway, ESCMID joins others concerned about the lack of uptake due to both public scepticism and deliberate misinformation being raised by a growing anti-vaccination movement in a number of countries. It is feared a low uptake of the vaccine could greatly hamper efforts to control the pandemic and increase pressure on health systems across Europe.
"No one can afford to be complacent or sceptical about the benefits of the H1N1 vaccine. The serious consequences of skipping the flu jab must be considered by patients, and physicians must make clear the safety and vital protection role the vaccine has to play," said the President of ESCMID, Professor Javier Garau. "Physicians should do their best to advertise vaccination among their patients, with special reference to the most vulnerable ones. No one should reject a safe and effective vaccine when we are dealing with an unpredictable virus capable of killing children and young adults in their prime."
ESCMID emphasizes the central role this vaccine has in protecting people against pandemic flu by providing specific, prolonged individual protection, in contrast to antiviral drugs which must be taken daily and do not prevent future infection. The risk-benefit balance is clearly in favour of the vaccine, without which people are at risk of a serious viral infection, with a minority of patients developing severe illness, including pneumonia and heart and lung problems.
"Failure of the vaccine campaign across Europe would entail wider spread of the pandemic, an increased possibility of adverse complications, and increased possibility of the virus mutating into more aggressive and/or drug-resistant forms", warned Professor Giuseppe Cornaglia, Past President of ESCMID. "This is something that the public and the health community cannot afford to risk."
An anti-vaccination lobby is actively contesting both the need and the safety of the pandemic flu vaccine across Europe. Although anti-vaccine movements have long existed, specific criticisms have been raised to the current H1N1 vaccine. But these criticisms are, stresses ESCMID, scientifically unfounded. Some have argued that since the seasonal influenza vaccine was intended for elderly, most of the data available are from adults rather than children. However, data have been acquired from more than 3000 children showing both safety and strong immunogenicity of influenza vaccines.
Others make the case that the H1N1 vaccine has not had sufficient time for adequate testing. However, the fast track development of the pandemic (H1N1) 2009 vaccines has not been at the expense of safety or efficacy. The vaccine has been made in exactly the same way as the seasonal flu vaccine, by the same manufacturers using the same materials, except for one new piece - the specific virus particle. The safety and immunogenicity of pandemic vaccines has been tested in large randomised trial, without which the European Medicines Agency (EMEA )would not have approved the vaccine.
"Rather than developing an unsafe and untested vaccine, the 'fast track' process allowing this vaccine to be promptly released should be considered a success, showing that a strictly controlled and proactive collaboration between national and international authorities and the pharmaceutical industry can accelerate the preparation of influenza vaccines under critical situations" said Professor Garau.
WHO have just reported on the safety of the current H1N1 vaccine campaigns which are rigorously monitored - to date an estimated 80 million doses have been distributed and around 65 million people have been vaccinated. They have found that the pandemic vaccine matches the excellent safety profile of seasonal influenza vaccines which have been used successfully for more than 60 years. [i]
"Those who are trying to undermine vaccines in general, and the H1N1 vaccine specifically, are acting irresponsibly and without scientific foundation. We are calling for a concerted and coordinated effort by national and European authorities to counter anti-vaccine propaganda," explained Garau.
ESCMID also stresses the impact H1N1 influenza is having on health systems in Europe. Ukraine was the first country to report a severe impact on hospital and intensive care services, but similar impacts are also reported in Ireland and Scandinavia, highlighting the need to be prepared to cope with a surge of patients with respiratory disease and potentially severe complications. Recent research in the UK also showed that with the resurge of pandemic flu there may not be enough intensive care beds for one of the most seriously affected groups - children[ii].
"Continued preparedness and careful monitoring are essential because influenza viruses are unpredictable and this pandemic could last a long time. Health systems will come under strain, especially if vaccine uptake is limited and patient numbers increase, putting added pressure on hospitals capacity to cope," said Professor Cornaglia.
[i] WHO Safety of pandemic vaccines Pandemic (H1N1) 2009 briefing note 16
[ii] Modelling the impact of pandemic influenza A(H1N1) on UK paediatric intensive care demand, Cambridge University Department of Anaesthesia, Addenbrooke's Hospital, Cambridge published in Archives of Disease in Childhood, November 2009 Volume 94 Number 11
Source
The European Society of Clinical Microbiology and Infectious Diseases
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