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About the research on pandemic flu

This Highlight draws on the following NIHR funded research studies:

Influenza A/H1N1v in pregnancy:

Yates L, Pierce M, Stephens S, Mill AC, Spark P, Kurinczuk JJ, et al.Influenza A/H1N1v in pregnancy: An investigation of the characteristics and management of affected women and the relationship to pregnancy outcomes for mother and infant. Health Technol Assess 2010;14(34).

DOI: http://dx.doi.org/10.3310/hta14340-02

https://www.journalslibrary.nihr.ac.uk/programmes/hta/098447/#/ 

VIPER trial:

Simpson CR, Ritchie LD, Robertson C, Sheikh A, McMenamin J.Vaccine effectiveness in pandemic influenza - primary care reporting (VIPER): an observational study to assess the effectiveness of the pandemic influenza A (H1N1) v vaccine. Health Technol Assess 2010;14(34).

DOI: http://dx.doi.org/10.3310/hta14340-05

https://www.journalslibrary.nihr.ac.uk/hta/hta14340-05/#/abstract 

Comparing two H1N1 vaccines in children:

Waddington C, Andrews N, Hoschler K, Walker W, Oeser C, Reiner A, et al.Open Label, Randomized, Parallel-Group, Multi-Centre Study to Evaluate the Safety, Tolerability and Immunogenicity of an AS03B /oil-in-water emulsion-adjuvanted (AS03B) split-virion vs. non-adjuvanted whole virion H1N1 influenza vaccine in UK children 6 months to 12 years of age. Health Technol Assess 2010;14(46)

DOI: http://dx.doi.org/10.3310/hta14460-01

https://www.journalslibrary.nihr.ac.uk/hta/hta14460-01/#/abstract 

A follow-up study comparing two H1N1 vaccines in children:

de Whalley P, Walker W, Snape MD, Oeser C, Casey M, Moulsdale P, et al.A 1-year follow-on study from a randomised, head-to-head, multicentre, open-label study of two pandemic influenza vaccines in children. Health Technol Assess 2012;15(45)

DOI: http://dx.doi.org/10.3310/hta15450

https://www.journalslibrary.nihr.ac.uk/programmes/hta/1011101/#/ 

Comparison of two H1N1 vaccines in adults:

Nicholson KG, Abrams KR, Batham S, Clark TW, Hoschler K, Lim WS, et al.A randomised, partially observer-blind, multi-centre, head-to-head comparison of a two dose regimen of Baxter and GSK H1N1 pandemic vaccines, administered 21 days apart. Health Technol Assess 2011;14(55)

 DOI: http://dx.doi.org/10.3310/hta14550-04

https://www.journalslibrary.nihr.ac.uk/programmes/hta/099301/#/ 

Published outputs from these studies

Perinatal outcomes following maternal 2009/H1N1 infection: a national cohort study.

Pierce, M; Kurinczuk, J; Spark, P; Brocklehurst, P; Knight, M. BMJ 2011;342:d3214

Effectiveness of H1N1 vaccine for the prevention of pandemic influenza in Scotland, UK: a retrospective observational cohort study

Simpson CR, Ritchie LD, Robertson C, Sheikh A, McMenamin J. Lancet Infectious Diseases 2012;Volume 12, Issue 9, Pages 696 - 702, September 2012 doi:10.1016/S14

Predictors of immune response and reactogenicity to AS03B-adjuvanted split virion and non-adjuvanted whole virion H1N1 (2009) pandemic influenza vaccines

Andrews N J, Walker W T, Finn A, Heath P T, Collinson A, Pollard A J, Snape M, Faust S N, Waight P A, Hoschler K, Sheasby L, Waddington C, Kerridge S, Chalk J, John T, Fletcher M, Allen R, Fineman N, Wilkins S, Casey M, Michaelis L, Oeser C, Okiki I, Ladhani S, Miller E. Vaccine 2011;29(45):7913-9

Safety and immunogenicity of AS03B adjuvanted split virion versus non-adjuvanted whole virion H1N1 influenza vaccine in UK children aged 6 months-12 years: open label, randomised, parallel group, multicentre study

Waddington, C. S.; et al. BMJ 2010;340:c2649

T-cell responses in children to internal influenza antigens, 1 year after immunisation with pandemic H1N1 influenza vaccine, and response to revaccination with seasonal trivalent inactivated influenza vaccine

Lambe, T; Spencer, AJ; Mullarkey, CE; Antrobus, RD; Yu, L; de Whalley, P; Thompson, BAV; Jones, C; Chalk, J; Kerridge, S; Hill, AVS; Snape, MD; Pollard, AJ; Gilbert, SC. Pediatric Infectious Disease Journal 2012;31(6):e86-91

H1N1 antibody persistence one year after immunisation with an adjuvanted or whole virion pandemic vaccine and immunogenicity and reactogenicity of subsequent seasonal influenza vaccine: a multi-centre follow-on study

Walker, WT; de Whalley, P; Andrews, N; Oeser, C; Casey, M; Michaelis, L; Hoschler, K; Harrill, C; Moulsdale, P; Thompson, B; Jones, C; Chalk, J; Kerridge, S; John, T; Okike, I; Ladhani, S; Tomlinson, R; Heath, PT; Miller, E; Faust, SN; Snape, MD; Finn, A; Pollard, AJ. Clinical Infectious Diseases 2012;10.1093/cid/cir905

Research funding in a pandemic

Walley, T;Davidson, P. Lancet 2010; 375.972

Current Guidance

Guidance on immunisation is based on the available evidence and best practice.

Public Health England recommend that certain groups who are at increased risk should have a free flu vaccination.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/543624/PHE_9901_Flu_Vaccination_A5_booklet_Winter2016_17.pdf 

The groups include:

  • long-term conditions - heart problems, chest complaints or breathing difficulties, kidney disease, lowered immunity due to disease or treatment, liver disease, had a stroke or a transient ischaemic attack, diabetes, neurological conditions
  • aged 65 years or over
  • living in a residential or nursing home
  • the main carer of an older or disabled person
  • a household contact of an immunocompromised person
  • a frontline health or social care worker
  • pregnant
  • all two-, three- and four-year-old children, all children in school years 1, 2 and 3 and all primary school-aged children in some parts of the country, children over the age of six months with a long-term health condition

The Joint Committee on Vaccination and Immunisation (JCVI) advises UK health departments on immunisation programmes. https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

They produce their recommendations for public health professionals in the “Green Book” https://www.gov.uk/government/publications/immunisation-procedures-the-green-book-chapter-4

Guidance on influenza immunisation from the JCVI includes:

The use of nasal spray flu vaccine for the UK childhood influenza immunisation programme (2016):

https://www.gov.uk/government/publications/jcvi-statement-on-the-nasal-spray-flu-vaccine

“Given the strong evidence that the NHS childhood flu immunisation programme continues to protect the health of both children and the wider population, JCVI agreed to continue to recommend the use of the children's nasal spray flu vaccine for preventing flu in children, and more widely in our communities.”

The number of doses of flu vaccine that should be offered to children (2013):

https://www.gov.uk/government/publications/jcvi-summary-on-the-number-of-doses-of-flu-vaccine-for-children

“From 2013, a single dose of live attenuated influenza vaccine (LAIV) should be offered to children irrespective of whether influenza vaccine had been received before or not. However, influenza vaccine naïve children who are aged six months to less than nine years in clinical risk groups, or who are offered inactivated influenza vaccine as LAIV is unsuitable for them, may have greater benefit from the direct protection provided by a second dose of vaccine”.

Routine annual influence vaccine programme:

https://www.gov.uk/government/publications/jcvi-statement-on-the-routine-annual-influenza-vaccination-programme

NICE Guidance

The National Institute for Health and Care Excellence (NICE) have provided guidance on individual influenza vaccines.

Amantadine, oseltamivir and zanamivir (2009) https://www.nice.org.uk/guidance/ta168

Oseltamivir and zanamivir are recommended as possible treatments for people with flu if they meet certain criteria such as being in an at-risk group and the flu virus is going around. Amantadine is not recommended to treat people with flu.

Oseltamivir, amantadine (review) and zanamivir for the prophylaxis of influenza (2008) https://www.nice.org.uk/guidance/ta158 

NICE are also developing guidance on how to increase the uptake of flu vaccinations, which will be released in January 2018. https://www.nice.org.uk/guidance/indevelopment/gid-phg96

Further NIHR studies on Pandemic Flu

The NIHR has funded a range of studies from systematic reviews to large clinical trials on pandemic flu. The HTA journal series has 3 special themed editions that showcase such research:

Health Technology Assessment Journal, Volume 14, 2011 http://www.journalslibrary.nihr.ac.uk/hta/volume-14

Editions 34 (6 articles), 46 (5 articles), and 55 (6 articles).

NIHR also funded studies on Heath Preparedness for Emergencies:

A scoping study of emergency planning and management in health care: What further research is needed?

Boyd A, Chambers N, French S, King RA, Shaw D, Whitehead A. NIHR Health Services and Delivery Research programme, 2012.

http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_09-1005-01_V01.pdf 

Emergency planning in health: Scoping study of the international literature, local information resources and key stakeholders.

Lee ACK, Challen K, Gardois P, Mackway-Jones K, Carley SD, Phillips W, Booth A, Walter D, Goodacre S. NIHR Service Delivery and Organisation programme, 2012.

http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_09-1005-03_V01.pdf 

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