Delivery Of Influenza Vaccine Research Articles

Practice and Physician Characteristics Associated with Influenza Vaccination Delivery Rates Following a Patient Reminder Letter Intervention

As part of the "Provider and Patient Reminders in Ontario: Multi-strategy Prevention Tools" demonstration project, the purpose of this study was to explore the practice and physician characteristics associated with influenza vaccination rates following a reminder letter intervention for patients 65 years of age and older. Using a sample of 179 physicians, we estimated a multiple linear regression model to examine variables predictive of vaccination delivery rates. Several provider characteristics, including certification with the College of Family Physicians of Canada and practicing in an urban area, were predictive of the success of the reminder letter campaign. Examining other physician and practice factors associated with vaccination delivery following a reminder letter campaign may help improve such prevention efforts.

Intranasal delivery of whole influenza vaccine prevents subsequent allergen‐induced sensitization and airway hyper‐reactivity in mice

Infection with influenza virus has been associated with seemingly opposing effects on the development of asthma. However, there are no data about the effects of mucosal vaccination with inactivated influenza on the inception of allergic asthma. To assess the immunological effects of inhaled inactivated influenza vaccine, using two different types of flu vaccines, on the inception of allergic sensitization and allergen-mediated airway disease in a mouse model. BALB/c mice were intranasally or intratracheally vaccinated with whole or split influenza virus vaccine (days -1 or -1, 27) before systemic sensitization with ovalbumin (OVA) (days 1, 14) and repeated airway allergen challenges (days 28-30). Allergen sensitization (IgE serum levels), airway inflammation (differential cells in bronchoalveolar lavage fluid) and airway hyper-reactivity (AHR) (in vivo lung function) were analysed. The intranasal instillation of whole influenza vaccine before allergen sensitization significantly reduced the serum levels of total and OVA-specific IgE as well as allergen-induced AHR. Prevention was due to an allergen-specific shift from a predominant T helper (Th)2- towards a Th1-immune response. Application of split influenza vaccine did not show the same preventive effect. Intranasal administration of inactivated whole influenza vaccine reduced subsequent allergen sensitization and prevented allergen-induced AHR. Our results show that the composition of the influenza vaccine has a major influence on subsequent development of allergen-induced sensitization and AHR, and suggest that mucosal inactivated whole influenza vaccination may represent a step towards the development of a preventive strategy for atopic asthma.

Efficacy of Multiple Influenza Vaccine Delivery Systems in a Single Facility

We retrospectively investigated different inpatient influenza delivery strategies used during 3 consecutive years at a single institution. Vaccination rates were 3% for a physician reminder system, 21% for a manual standing order program, and 43% for a manual standing order program with a provider education program.

Preventing Influenza: Vaccine Systems and Practices in the Southeast

The purpose of this study was to determine from state and local health departments: (1) how they purchase, distribute, and fund influenza vaccine; (2) whether they experienced a shortage in 2003/04; (3) how the shortages were handled; and (4) how they prepared for distribution in 2004/05. A web-based survey was completed from June to August 2004 in eight Southeastern states. Data were obtained from each state and 222 local health departments. Major differences between and within states were found with regard to purchasing, distributing, and funding influenza vaccine. Although the majority of health departments experienced periods of shortages in 2003/2004, surpluses of vaccine remained at the end of the season. There was little evidence of interaction between the public and private sectors to share vaccine resources in response to shortages. Tracking systems for redistribution of vaccine or follow-up were often not in place. Entering the 2004/05 season, 25% of states and 11% of counties were not developing any special procedures to deal with shortages beyond what was in place earlier. Better systems and funding are needed, especially for adult influenza vaccine delivery and for redistribution of influenza vaccine in response to shortages.

Alternative routes of influenza vaccine delivery

The global emergence of virulent avian influenza and the concomitant raised threat of an influenza pandemic has increased interest in the development of improved influenza vaccines. Whereas conventional influenza vaccines are delivered by parenteral injection, an intranasal influenza vaccine has been marketed since 2003. Many other technologies are in development for intranasal, oral, epidermal and topical influenza vaccines. This editorial summarises the advances in clinical development of technologies for needle-free influenza vaccine delivery.

Influenza vaccination coverage among children with high-risk medical conditions

We evaluated influenza vaccination coverage in children with chronic disease at high risk of influenza complications, and the need for methods to increase parents’ and pediatricians’ knowledge of influenza and its prevention. The 5286 children aged less than 14 years attending our Emergency Department on Wednesdays and Sundays between 1 January and 30 April 2003 included 274 (5.2%) high-risk patients. The use of influenza vaccine during the previous three seasons had been very low, but significantly increased in the last season (2000–2001, 5.1%; 2001–2002, 12.9%; 2002–2003, 26.3%; p<0.001). The children with asthma or cardiac disease showed the lowest vaccination rates; their parents and primary care pediatricians had only a marginal knowledge of influenza and the benefits of its prevention. In conclusion, the delivery of influenza vaccine to children with chronic disease at high risk of influenza complications is completely inadequate, and major efforts are urgently needed to increase parents’ and pediatricians’ knowledge of its importance.

Local immune responses following nasal delivery of an adjuvanted influenza vaccine

A key barrier to producing effective nasal immunisations is the low efficiency of uptake of vaccines across the nasal mucosa. Using a recently developed cannulation system, we examined the antibody response induced by nasal immunisation with an ISCOMATRIX ® influenza vaccine. This showed for the first time, that following nasal vaccination, specific antibodies enter the circulation of primed animals via the draining lymphatics as a wave that peaks approximately 5–6 days after vaccination. These antibodies included some of the IgA isotype and possessed functional haemagglutination inhibition activity. These responses, though small, were induced using a very simple delivery system, emphasising the applicability of this cannulation model for evaluation of excipients and adjuvants aimed at improving intranasal vaccine efficacy.

Delivery of Influenza Vaccine to Nonelderly Persons with Cardiovascular Disease, with Varying National Supply of Vaccine: A Decision Analysis

Influenza immunization rates among nonelderly persons at high risk for influenza are far below target levels in the United States. Provision of influenza vaccine at subspecialty practices can target high-risk patients, particularly during influenza vaccine shortages. We conducted a decision analysis to explore the potential effects on nonelderly cardiac patients’ immunization rates of improving vaccine availability, standing orders rates, and physicians’ vaccine recommendation rates in cardiology, primary care, and other medical subspecialty outpatient practices. We considered 2 supply circumstances (sufficient versus 50% of needed supply), and also incorporated community and hospital-based vaccine delivery as well as patient acceptance in the model. With sufficient vaccine supply, optimized performance of cardiology practices (maximum vaccine availability, strong physician recommendations, and standing orders) yielded greater improvement in vaccine coverage rate than with separately optimized performance in primary care, pulmonology, or endocrinology practices. With only 50% of needed vaccine supply, reallocation of doses from community sites to primary care and cardiology, pulmonology, and endocrine offices yielded higher estimated immunization rates in the target population than strategies without reallocation. Only with simultaneous interventions across primary care, subspecialty care, inpatient, and community domains did immunization rates exceed 60%. Targeted interventions to optimize delivery of influenza vaccine in cardiology practices may be the most effective means of raising vaccine coverage levels among nonelderly cardiovascular patients, in times of varying national vaccine supply.

Tiered Use of Inactivated Influenza Vaccine in the Event of a Vaccine Shortage

The United States has experienced disruptions in the manufacture or distribution of inactivated influenza vaccine during three of the last five influenza seasons. Delays in delivery of influenza vaccine or vaccine shortages remain possible, in part, because of inherent time constraints in manufacturing the vaccine, given the annual updating of influenza vaccine strains and uncertainties regarding vaccine supply (including licensure of new vaccine preparations). Although total vaccine supply for the 2005-06 influenza season is not yet known, the minimum anticipated supply is approximately 58-60 million doses of inactivated vaccine and 3 million doses of live, attenuated vaccine. This estimated supply is similar to that available during the 2004-05 season and would be adequate to satisfy historical demand for influenza vaccine among persons considered by the Advisory Committee on Immunization Practices (ACIP) to be at high risk for serious complications associated with influenza virus infection, health-care workers, and household contacts of children aged <6 months. These groups were prioritized for influenza vaccination in 2004-05. Additional doses of inactivated influenza vaccine might be available for the U.S. market in 2005-06, but this cannot yet be confirmed. Availability of additional vaccine would allow for expansion of the priority groups and, preferably, vaccination of all persons who desire it.

Standing Orders in an Ambulatory Setting Increases Influenza Vaccine Usage in Older People

To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients. Retrospective analysis of influenza vaccine usage over 4 years (1999-2002). University ambulatory setting. Overall, 912 elderly patients of two physicians who issued standing orders and 884 elderly patients of two physicians who did not do so constituted the study group. Physicians were categorized as to whether they issued a verbal or written standing order to their nurses to administer the influenza vaccine to patients aged 65 and older. Rates of influenza vaccination of patients whose physicians used standing orders were compared with those of physicians who did not use standing orders. Five hundred seventy-six (63%) patients of physicians who used standing orders received influenza vaccine, compared with 332 (38%) patients of physicians who did not use them (P<.001). Standing orders accounted for a significantly higher rate of influenza vaccination in each study year. Moreover, in 2001, when influenza vaccine delivery was delayed, physicians who used standing orders maintained their same rate of usage, but physicians who did not had rates of about one-half their usage of the other 3 years. More Medicare recipients received influenza vaccine when their physicians used standing orders for its administration than when their physicians did not. Influenza vaccine represents an important prevention modality that demands widespread implementation, and standing orders can increase its usage.

Influenza Vaccination: A Collaborative Effort to Improve the Health of the Community

The need to improve influenza vaccination delivery in our community became painfully clear during the winter of 1997-1998 when high rates of respiratory illness led to congestion in the emergency department and a critical shortage of hospital beds. In response, the local hospital and the Department of Health launched a collaborative program to increase influenza vaccine coverage in the community. The partnership was designed to increase the number of citizens receiving influenza vaccine and to moderate the severity of lower respiratory tract illness during the winter season. A variety of methods were used to increase public awareness, enhance vaccine delivery, and create a relatively seamless service for the community. During three seasons, influenza vaccination rates increased by a relative 150%. This represented immunization of 16% of the entire community and more than 75% of residents older than 65 years. Hospital employee vaccination rates also rose from 34% to 58%. When compared with other hospitals in the county, the campaign reduced the average number of annual visits to the emergency department for all respiratory diagnoses by 34% and exacerbations of chronic obstructive pulmonary disease by 46%. This influenza vaccination program illustrates the potential for synergy that exists between local departments of health and community hospitals in successfully increasing vaccine delivery to the community. Furthermore, it also suggests that such efforts can be successful in reducing use of the emergency department, resulting in a positive impact on the health of the community.

A novel dry powder influenza vaccine and intranasal delivery technology: induction of systemic and mucosal immune responses in rats

Intranasal (IN) vaccination represents an attractive non-invasive alternative to needle-based injection and provides superior protection at mucosal surfaces. However, new formulations are needed to improve efficacy and reduce the refrigerated storage and distribution requirements associated with standard liquid vaccines. Here, we describe a powder formulation of whole inactivated influenza virus and a novel IN delivery platform. The powder-formulated vaccine elicited a significant serum antibody response in rats that was at least as strong as that provided by the liquid vaccine administered IN or via intramuscular (IM) injection. Significant nasal IgA responses were also observed solely after IN delivery. This study demonstrates for the first time the generation of potent nasal mucosal and systemic immune responses using an IN delivered influenza vaccine powder and suggests an alternative approach to vaccination against influenza and other infectious diseases.

Plan office flu vaccine strategy to improve immunization rate

With influenza season approaching, pediatricians should fine-tune office procedures to prepare for the delivery of influenza vaccine to all healthy children 6 to 23 months of age, based on the new, expanded recommendations taking effect this fall. ![Figure][1] For the 2004-'05 season, the

음이온성 유화제로 수식된 폴리락티드/글리코리드 공중합체 나노 입자와 백신의 결합성

Recently, studies on intranasal mucosa delivery of influenza vaccine have been actively developed because of lack of pain and ease of administration. We studied on preparation of nanoparticle delivery system using biodegradable polymer as a poly(DL-lactide-co-glycolide) (PLGA) and their binding characteristics with vaccine. Three kinds of PLGA nanoparticles were prepared by spontaneous emulsification solvent diffusion (SESD) method using sodium dodecyl sulfate and sodium laurate as an anionic surfactant and Lutrol F68 (polyethylene glycol-block-polypropylene glycol copolymer) as a nonionic surfactant. The 5-aminofluorescein labeled vaccine was coated on the surface of nanoparticles by ionic complex. The complexes between vaccine and nanoparticles were confirmed by change of the size. After vaccine coating on the surface of anionic nanoparticles, particle size was increased from 174 to 1,040 nm. However the size of nonionic nanoparticles was not more increased than size of anionic nanoparticles. The amount of coated vaccine on the surface of PLGA nanoparticles was with sodium dodecyl sulfate, with sodium laurate, and with Lutrol F68, respectively. In conclusion, prepared nanoparticles in this study is possible to use as a virus-like nanoparticles and it could be accept in the field of influenza vaccine delivery system.

Intranasal cold-adapted influenza virus vaccine combined with inactivated influenza virus vaccines: an extra boost for the elderly?

Although influenza vaccine delivery strategies have improved coverage rates to unprecedented levels nationally among persons aged 65 years and older, influenza remains one of the greatest vaccine-preventable threats to public health among elderly in the US. A new, intranasal live attenuated influenza vaccine (LAIV) was recently approved by the US FDA for use in persons aged 5-49 years, which excludes the elderly population. Limitations of immune response to inactivated influenza vaccine (IAIV) and effectiveness of current influenza vaccination strategies among the elderly suggest that a combined approach using LAIV and/or the IAIV in various permutations might benefit this group. We explore characteristics of the LAIV, data regarding its utility in protecting against influenza in the elderly, and challenges and opportunities regarding potential combined inactivated/live attenuated vaccination strategies for the elderly. Although LAIV appears to hold promise either alone or in combination with IAIV, large well conducted randomised trials are necessary to define further the role of LAIV in preventing influenza morbidity and mortality among the elderly. We also suggest that innovative vaccine coverage strategies designed to optimise prevention and control of influenza and minimise viral transmission in the community must accompany, in parallel, the acquisition of clinical trials data to best combat morbidity and mortality from influenza.

Reducing barriers to influenza vaccination: ‘Flu clinics’, local partnerships

![Figure][1] Solo practitioner Anders Nelson, M.D., FAAP, maximizes delivery of influenza vaccine through “flu clinics” and during regular visits. Last year, 2,165 patients were vaccinated in his office. (Photo courtesy of National Foundation for Infectious Diseases) About eight years

Influenza vaccine delivery and effectiveness in end-stage renal disease

Influenza vaccination rates in the general population have been associated with improved outcomes, yet high-risk populations, such as end-stage renal disease (ESRD) patients, have received little attention in determining the potential benefits. This report assessed the frequency and effectiveness of influenza vaccination, while also assessing disparities in vaccination rates in the ESRD population. Using the United States Renal Data System research files containing claims for all Medicare ESRD patients, vaccination rates and outcomes among vaccinated and unvaccinated persons for the 1997 to 1998 and 1998 to 1999 influenza seasons were compared after adjustment for baseline demographic factors and health characteristics. Vaccination rates in the ESRD population were less than 50% for each season. Influenza vaccination rates were lower in non-whites, women, younger patients, and peritoneal dialysis patients. Influenza vaccination was associated with a lower risk for hospitalization and death. Despite universal coverage of free influenza vaccination, the ESRD population had a less than 50% vaccination rate for the years 1997 to 1998 and 1998 to 1999 as demonstrated by Medicare billing data. Substantial differences were found in vaccination rates among non-whites and peritoneal dialysis patients. This study confirms that the ESRD populations benefit from influenza vaccination, suggesting that dialysis providers should take advantage of all opportunities to immunize this high-risk group.

Intranasal vaccination with ISCOMATRIX ® adjuvanted influenza vaccine

Mucosal delivery of inactivated vaccines that are able to elicit protective immune responses against respiratory diseases has been a long time goal of vaccinologists. Such vaccines would enable a more appropriate means of vaccination against respiratory diseases than those currently delivered by a parenteral route. The intranasal delivery of inactivated influenza vaccine plus the ISCOMATRIX ® (IMX) adjuvant, simply mixed together, was able to induce serum haemagglutination inhibition (HAI) titres in mice far superior to those obtained with unadjuvanted vaccine delivered subcutaneously. Furthermore, the IMX adjuvanted vaccine delivered intranasally induced mucosal IgA responses in the lung, nasal passages and large intestine, together with high levels of serum IgA. Intranasal delivery of IMX adjuvanted influenza vaccine in sheep gave antibody responses in both serum and nasal secretions that surpassed the levels obtained with unadjuvanted vaccine administered subcutaneously. These observations suggest that it may be possible to induce effective immunity to influenza in humans by intranasal vaccination with an IMX adjuvanted inactivated vaccine.

A survey of the delivery and uptake of influenza vaccine among health care workers.

During the 1990s, policies for immunizing fit health care workers against influenza varied between National Health Service (NHS) employers and the uptake of influenza vaccine by NHS staff was poor. In light of recent Department of Health recommendations to immunize key health care staff against influenza, we explored the possible reasons for poor uptake and assessed the impact of an intensive promotion campaign on vaccine acceptance. Among 290 doctors and nurses, the main perceived barriers to influenza immunization were difficulty with practical access to vaccine and lack of time to attend. Following intensive promotion and improved local access to influenza vaccine, the uptake among health care workers was approximately doubled. However, the overall proportion of staff immunized was low (5%) and the immunization rate among medical staff was particularly poor (2%). The practical implications for influenza immunization campaigns aimed at health care workers are discussed.

Influenza vaccine in children with asthma: Why no progress?

In an average year, 20% to 30% of chil- dren will be infected with influenza; this attack rate may be substantially higher during epidemic years and among certain populations, such as children in day care. Although most regard influenza as a self-limited ill- ness in children, it may cause substan- tial morbidity in children with and fluenza-associated excess hospitaliza- tion rates of 3 per 1000 high-risk chil- dren younger than 4 years. 2 For the vast majority of these children, the high-risk condition was asthma. Simi- larly, we conducted a study of children with asthma enrolled in Tennessee Medicaid and demonstrated excess hospitalization rates of 5.6 per 1000 children with asthma aged 1 to 3 years. 3 The hospitalization rates in both of these studies are comparable to rates in adult high-risk populations for whom influenza vaccine is recom- mended. In addition, in the Tennessee Medicaid study, an estimated 10% to 20% of children with asthma younger than 15 years had an additional outpa- tient visit during an average influenza season, and approximately 14% of such children received an additional antibiotic prescription. 3