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How Flu Strains are Selected for the Seasonal Flu Vaccine Each Year

March 14, 2018 6 comments
SereseMarotta_FamiliesFightingFlu-300x300by Serese Marotta, Chief Operating Officer of Families Fighting Flu 

 

The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 6 months and older, with rare exception, get an annual flu vaccine. But did you ever wonder how the flu strains are selected for the seasonal vaccine every year?

A lot more goes into the decision than you might think!

Seasonal flu vaccines contain three (trivalent) or four (quadrivalent) flu strains. Because flu is a complex, dynamic virus that is constantly changing, there are more than 100 monitoring centers in over 100 countries located across the globe that monitor flu activity on a year-round basis to identify which flu strains are circulating.

These centers receive and test thousands of influenza virus samples from patients. They then send representative virus samples to five World Health Organization (WHO) Collaborating Centers for Reference and Research on Influenza, located in Atlanta, GA (i.e., the CDC); London, United Kingdom; Melbourne, Australia; Tokyo, Japan; and Beijing, China. The surveillance data gathered from these samples, along with other information, are used to make a recommendation on which flu strains should be included in the upcoming year’s seasonal flu vaccine.

Contrary to popular belief, the flu vaccine is not just based on last year’s flu viruses. Three general sources of information are considered in the selection of flu strains for the seasonal flu vaccine:

 

  • Surveillance data represents information gathered from the influenza monitoring centers that collect virus samples from patients. Experts use this information to determine which flu strains are circulating and where.
  • Laboratory data refers to antigenic characterization of the flu viruses in a laboratory, which simply means the identification of specific molecular structures on the influenza virus that are recognized by our immune systems and elicit an immune response. The antigen is the “invader” (i.e., in this case, the flu virus) that causes our immune systems to launch an attack through the formation of specific antibodies. Antibodies are what our bodies produce following flu vaccination so that it’s properly “armed and ready” to recognize and fight that specific flu virus if and when we’re exposed.
  • Genetic characterization of flu viruses may also be considered in the selection of vaccine strains. This refers to “mapping” of the genetic codes that make up each flu strain, which allows the experts to monitor changes in circulating flu viruses.
  • Data from clinical studies on vaccine effectiveness are also considered.

With this robust amount of data in hand,  the WHO then meets twice per year to make a recommendation for flu vaccine strains for the upcoming season: once in February to recommend flu strains for the Northern Hemisphere seasonal flu vaccine, and again in September to recommend flu strains for the Southern Hemisphere seasonal flu vaccine. But it doesn’t stop there! Each country then considers the WHO recommendation, reviews the available information, and makes their own decision on which flu strains to include in their country’s seasonal flu vaccine.

In the U.S., once the WHO makes their recommendation for flu strains for the upcoming year’s seasonal flu vaccine, an advisory committee from the U.S. Food and Drug Administration (FDA) meets in February or March to review the WHO’s recommendation and supporting information and vote on the final selection of flu strains. The role of the FDA is an important one, because once the flu strains are selected, the FDA produces materials in their laboratories that are critical for actually producing the flu vaccines. For instance, the FDA provides vaccine manufacturers with the seed viruses and the potency reagents needed to ensure that flu vaccines made by one manufacturer are similar to those made by another. The FDA also conducts quality control measures by ensuring that batches (referred to as “lots”) of flu vaccines released by the manufacturers meet appropriate standards and reflect the correct genetic composition.

Following the selection of flu strains for the seasonal vaccine and receipt of the appropriate materials and information from the FDA, private sector manufacturers begin the process of making the vaccines. All flu vaccines in the U.S. contain the same flu strains, i.e., the flu vaccine available in New York contains the same three or four flu strains as the vaccine that’s available in California. And it’s important to remember that all flu strains (influenza A or B) can be potentially dangerous, regardless of an individual’s health status, and are capable of causing serious illness, hospitalization, or even death.

Influenza is a vaccine-preventable disease that has the ability to affect all of us around the world, which is why it remains such a pressing global public health issue. Seasonal flu vaccines may not be perfect, but given the complexity of flu viruses and their ability to change and mutate frequently, the U.S. does have a solid, scientifically-based approach for flu vaccine development. While much research and development is being done for a universal flu vaccine, the possibility of this technological advancement is still many years off.  In the meantime, let’s not forget all the hard work and research that goes into helping to protect us with the currently available seasonal flu vaccines. And if you’re wondering “why bother” with a flu vaccine that may be substantially less than 100% effective, let’s remember that something is better than nothing, especially when it comes to your life or the life of a loved one.

More in-depth information on how flu strains are selected for the seasonal flu vaccine every year are available from the CDC and FDA


FFF logo_R copyAbout Families Fighting Flu:  Families Fighting Flu (FFF) is a national, nonprofit, 501(c)(3) volunteer-based advocacy organization dedicated to protecting the lives of children and families by helping to increase annual influenza vaccination rates, especially among children 6 months and older and their families.  Our members include families whose children have suffered serious medical complications or died from influenza, as well as healthcare practitioners and advocates committed to flu prevention.  In honor of our children, we work to increase awareness about the seriousness of influenza and to reduce the number of hospitalizations and deaths caused by the flu each year.

Bracelets Empower Moms and Ensure Kids Get Timely Vaccines

August 24, 2015 1 comment

Never underestimate the determination, creativity and problem solving capacity of an aspiring global health student.  

This month we’ve been featuring guest posts by several of our summer interns who have specific interests in global health and immunizations.  Today we share a story of another global health student, Lauren Braun, who spent the summer of 2009 as an intern in Peru following her sophomore year at Cornell University.  The challenges she observed in getting children timely immunizations inspired her to design a low-cost and innovative product that she hopes will one day be used by moms all over the world.

The idea came after Lauren spent the summer working at a Ministry of Health Clinic in Cusco, Peru.  Part of her day was spent going out and looking for moms who had children that were due for their immunizations.  Despite the fact that the health clinic offered free vaccines, and mothers clearly acknowledged the importance of vaccines for their children’s health, many of the moms were forgetting to bring their children in for their vaccines when they were due.  So Lauren came up with a creative idea to help that was eagerly embraced by the nurses.

In the video below, Lauren explains how she designed a simple silicone bracelet that moms could use to remind themselves of their children’s vaccination dates.  The way it works is that there are different numbers that represent the age that the child should be brought in to the clinic (2 months, 4 months, etc.) and also different symbols that represent the different vaccines.  When a child is brought to the clinic, a nurse would hole-punch the bracelet to indicate which vaccines have been administered, leaving the symbols for those vaccines that were still needed in the future.  Not only are the bracelets highly customizable to the needs of a local culture, they are also waterproof, durable, comfortable, baby-safe and can be designed to be worn up to four years of age.  Beyond the physical reminders that these bracelets represent, they are also a great way to increase general awareness about the vaccines that are recommended throughout childhood.

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In order to expand on her idea, Lauren created a non-profit company, Alma Sana, Inc., that received a grant from the Bill & Melinda Gates Foundation.  The funds helped Alma Sana produce the bracelets and complete an initial research study with 150 moms that were followed for six months.  But she’s not stopping there.

The organization is now ready for a Phase II study that will roll the program out to 5,000 moms that they will follow for a full year.  They’ve already lined up partners in Nigeria, Pakistan and Colombia, in hopes of gathering the evidence they need to determine how effective the bracelets are, and with what populations the bracelets work best with.

This is a pretty big undertaking, and the reason why Alma Sana is currently looking to raise $100,000.

When parents skip or delay vaccines, whether it is intentional or not, they leave their child vulnerable to disease for a longer period of time. Learn more about this initiative to ensure kids get timely immunizations all across the globe and contribute to their fundraising campaign here.

To help Alma Sana, Inc. fulfill their objective of getting children timely vaccines, please tell your friends, family, and colleagues about the campaign and encourage them to make a contribution.  You can even follow their progress by liking Alma Sana, Inc. on Facebook and following them on Twitter.

Please share other innovative immunization campaigns in the comments below so that we can continue to highlight programs that are in need of support here on our Shot of Prevention blog.

Help Stop Pneumonia, the Leading Infectious Killer of Children

November 12, 2014 5 comments

Every 20 seconds a child dies from pneumonia.

This is the tragic reality we face, despite the fact that pneumonia is one of the most solvable problems in global health today.  As we mark World Pneumonia Day each year on November 12th, we commit ourselves to raising awareness about pneumonia’s toll and promoting interventions that can protect against, treat, and prevent the disease.  Today I ask you to support the Global Coalition Against Child Pneumonia in their fight against the world’s leading killer of children under age five.   Please help share key facts about pneumonia and ask others to take simple actions that can help combat pneumonia worldwide.

WPD_Logo_BannerKey Facts

Pneumonia is the leading infectious killer of children under five years old.

In 2013 alone, more than 900,000 children died from pneumonia, accounting for 15% of mortality worldwide in those under five years of age, and children in poor and rural communities are most affected.

Pneumonia creates an economic burden for families, communities, and governments.

Preventing pneumonia not only saves money that is spent on treatment, but it also allows children to become healthy, productive adults. The fact is that scaling up coverage of vaccines against Hib and pneumococcus in the world’s 73 poorest countries (2011-2020) would avert $51 billion dollars in treatment costs and productivity losses. This increase in vaccine coverage would also save 2.9 million lives and prevent 52 million cases of illness.

Ways We Can Protect Against, Prevent and Treat Pneumonia

To advance progress, we must continue to scale up interventions that we know will save children’s lives, including continued access to vaccines, proper antibiotic treatment, improved sanitation, as well as the promotion of practices such as breastfeeding, frequent hand washing, care seeking, and the use of clean cookstoves to reduce indoor air pollution.

Vaccines against pneumococcus, Hib, pertussis, and measles can prevent a significant portion of pneumonia cases from ever occurring.  Meanwhile, other preventative strategies include zinc supplementation for children with diarrhea, prevention of HIV infection in children & antibiotic prophylaxis for HIV-infected children.  Additionally, we need to improve access to services and ensure effective and integrated case management strategies that provide children with proper and timely treatment.  For instance, antibiotics, such as amoxicillin, can prevent the majority of pneumonia deaths, and cost only about $US 0.21-0.42 per treatment course. Read more…

Three Rubella Cases Remind Us of Continued Risk

April 1, 2013 1 comment

Every day a child is born with birth defects.  While most parents are not able to determine the cause of these defects with much certainty, there are cases in which disease and maternal infection are known to contribute to the presence of birth defects in children.

RubellaTake for instance the last major rubella epidemic in the United States in 1964-1965.  An estimated 12.5 million rubella virus infections among pregnant women resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with Congenital Rubella Syndrome (CRS) which can cause such serious birth defects as deafness, cataracts, cardiac complications and mental retardation.

Thanks to a successful vaccination program in the United States, birth defects caused by rubella infection are almost non-existent.  And in 2004, it was declared that rubella was eliminated in the United States.  So, why is it that a CDC published report, released late last week, included details about three infants born with CRS this past year? Read more…

Baby Steps Lead to Big Milestones

July 23, 2012 3 comments

We’ve all heard it before.

You have to walk before you can run. 

This phrase conjures up numerous images in my mind.  Images of my own five children, each learning in their own way, and in their own time, how to walk and how to run.  But ultimately it serves as a constant reminder that we must master the basic skills before we can achieve more complex things.  Often this takes time.  It takes perseverance.  And it takes patience.

Admittedly, patience is not my best virtue.  I want results and I want them fast.  Perhaps that is why, when I consider the many global issues that face our society today, I get a bit disillusioned.

How is it that I can live in a nice home, where my children and I are relatively healthy, safe from harm and free from disease, when half way around the world, woman and children are dying needlessly from things we can easily prevent?

There was a time when I felt powerless over these tragedies – when I believed that there was nothing that I, personally, could do to make a difference.  Looking back, I believe I was trying to detach myself from the awful realities.  In essence, I was giving myself permission not to become emotionally consumed by these social injustices.

However, these words have recently brought me some perspective.

The first step towards getting somewhere is to decide that you are not going to stay where you are.  – John Pierpont Morgan.

Several months ago, I took my first step by becoming a Champion for the UN Foundation’s Shot@Life campaign.  I was inspired further when I learned how the UN Foundation has been taking their own steps towards making the world a safer, healthier, and better place for women and children.  The UN Foundation’s work in global health – including vaccines, reproductive health, clean cookstoves, malaria and mobile technology have all contributed to slashing preventable deaths – by 70 percent – within one generation.  It was then that I realized that each tiny step I can take in support of the UN Foundation could lead to significant milestones.

There is no one giant step that does it.  It’s lots of little steps. – Peter A. Cohen

In support of Shot@Life, I’m now connected with hundreds if not thousands of other global health advocates.  I’m advocating for change in every way that I can – by hosting Shot@Life events, signing petitions, sending emails to Congress, donating money and educating others about the need for change.  Now I realize that my baby steps, in union with those of many others, can provide the support for organizations, such as the UN Foundation, who are constantly pushing us towards the finish line of this great marathon.

Now, although I’m realistic about the stumbling blocks that continue to challenge our society, I can still envision the end of the marathon and the fact that we are running to the rescue of millions of people around the world.

One of the secrets of life is to make stepping stones out of stumbling blocks. – Jack Penn

This journey towards better global health is not going to be accomplished in one, giant step, but will certainly be achieved with perseverance, determination and patience – one step at a time.  Hopefully, today will be the day you join us in taking your first step towards change.  To find out how you can help us “make stepping stones out of stumbling blocks,” and achieve big milestones in the fight for better global health, consider becoming a Champion and visit the Shot@Life website today.

Help Give A Child A Healthy Shot At Life

February 1, 2012 18 comments

As I was preparing to leave for a brief business trip on Sunday evening I heard these words:

“God comes to us disguised as our life.”

Little did I know that over the next two days I would come to a fuller understanding of what these words mean to me in regards to my life at this moment.

In my faith, I believe that the choices we make and the actions we take should be guided by our love for our neighbor who encompasses all of humanity.  With that vision, it’s my personal opinion that there’s nothing more compassionate than saving the life of a child.

While parents in the United States often have the luxury of waiting for hours in line for that magical Dumbo ride at Disney, the reality remains that in many other countries mothers walk for miles and wait for hours for a simple vaccine in hopes that their own princes and princesses will have the hope of a healthier life.  While many of us readily acknowledge that such disparity exists, children all over the globe continue to suffer and die from vaccine preventable diseases.  As individuals we often feel powerless to do anything about it.   However, by supporting global vaccination programs we can save the life of a child every 20 seconds and stop the nearly 2 million unnecessary deaths that happen every year.

One way in which I personally plan to evoke change is through supporting a new campaign called Shot@Life.  By helping to educate, connect and empower people, Shot@Life is launching a powerful initiative that promotes vaccines as one of the most cost-effective ways to save the lives of children in developing countries.  This new UN Foundation project focuses on ways in which every day people can help give children around the world the shot at life they deserve, no matter where they live.  As you can see in the video below, some children may never experience the milestones that many of us take for granted; like saying their first words, losing their first tooth, or even getting their first vaccine.

After attending a special Shot@Life volunteer summit earlier this week, it became quite clear to me – as well as to each of the other volunteer champions in attendance – that there are as many ways to help, as there are people who want to be a part of the solution. Read more…

Diseases Are Often Just a Plane Ride Away

Like it or not, global health impacts us all.

For all the complaining we do as Americans, it’s easy to see that, by comparison to other nations, we have it pretty good. 

Sure, we still have a lot of national health issues that could be improved upon, but generally speaking, we have an abundance of choices that provide us with good nutrition, plenty of opportunity to exercise and advanced medical care.  We have options that the majority of people in this world will never have.   And while socio-economic status and regional location may limit our individual choices, our overall public health is still far better than most other places around the globe. 

I guess that’s why it is not surprising to hear some parents question the need for vaccines.  They often wonder why we need to immunize against diseases which are rarely seen.  Some go so far as to argue that a healthy diet, adequate exercise and access to clean water and proper sanitation will provide their children with a healthy immune system that will naturally protect them from disease without the need for immunizations.  While being healthy can help prevent disease, the concern here is that many diseases we currently immunize for are highly contagious.  They don’t discriminate based on income, sanitation or diet.  Otherwise healthy individuals can, and do, fall victim to these diseases.  Sometimes these diseases even result in death.  Though these diseases are somewhat rare in the US, they still threaten the lives of millions of people throughout the world.  The concern is that many other countries continue to experience outbreaks of vaccine preventable diseases.  Today, more than ever, it’s evident that these diseases are often just a plane ride away.   Read more…