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Some factors affecting the decision on non-mandatory vaccination in an influenza pandemic: comparison of pandemic (H1N1) and seasonal influenza vaccination

Background: The 2009 influenza pandemic caused by the influenza A (H1N1) 2009 virus was accompanied by a debate about whether or not to be vaccinated. The percentage of people who decided to be vaccinated was lower than in the case of seasonal influenza vaccination. We therefore compared factors influencing the decision on pandemic and seasonal influenza vaccination.

Method: Slovene inhabitants aged 18 and over (N=1383) completed an internet based survey on socio-demographic and health behaviour-related characteristics, personality traits, and characteristics of decision-making. Two stepwise logistic regression analyses were performed, one with an uptake of the pandemic influenza vaccine and the other with an uptake of the seasonal influenza vaccine as a dependent variable.

Results: In addition to common predictors of a decision in favour of the two vaccinations (age, gender, chronic illnesses, working in healthcare, trust in media news and vaccination side-effects in someone close), deciding in favour of vaccination against the pandemic virus was related to living with children and thoroughness in decision-making. It was also related to being vaccinated against seasonal influenza, trust in pandemic vaccine safety and professional information in favour of vaccination, and the decision of someone close.

Conclusions: In the face of the pandemic threat and lack of information, people behaved as they had in previous similar situations and according to the behaviour of people close to them and information from trusted sources. Concern for children and decision-making characteristics also became important. These factors should be considered in future crisis interventions.

1 Introduction In Europe, influenza occurs in regular annual epidemics in the winter season. Seasonal influenza epidemics are associated with high morbidity and mortality. Severe illness and complications are more common in certain risk groups, which include those with chronic medical conditions and individuals 65 years of age and above ( 1 , 2 , 3 ). Vaccination is the main public health intervention for preventing influenza ( 3 ). To protect vulnerable individuals and reduce influenza virus transmission, vaccination is also recommended for healthcare workers

Quality Control of Seasonal Influenza Vaccines

The purpose of seasonal influenza vaccination is to prevent its spread. The vaccines contain strains of the influenza virus recommended and approved for a particular season. Just like any other medicinal product, all vaccines require marketing approval. Batches of approved vaccines are extensively tested by the manufacturers and additionally controlled by the approving authorities, which issue the quality control certificates. This article not only to describes the legal background of quality control, but also how control test results obtained by a Croatian official control laboratory are compared to manufacturer's results. We have found that testing results can slightly differ depending on methods/analytical procedures used in different laboratories. This investigation has also shown how important it is to test finished medicinal products, independently of testing at intermediate stages, and how retesting by control authorities ensures that marketed vaccines meet quality standards.

-MOVE: a European network to measure the effectiveness of influenza vaccines. Euro Surveill. 2012;17(39):11-21. 10. European Centre for Disease Prevention and Control (ECDC), Protocol for case-control studies to measure pandemic and seasonal influenza vaccine effectiveness in the European Union and European Economic Area Member States, Technical document. Available from: 11. European Commission. Commission Decision

bacterial and viral coinfection. Curr Opin Crit Care. 2017; 23(5): 385–390. 12. Martin-Loeches I, van Someren Gréve F, Schultz MJ. Bacterial pneumonia as an influenza complication. Curr Opin Infect Dis. 2017; 30(2): 201–207. 13. Reed C, Chaves SS, Perez A, D’Mello T, Daily Kirley P, Aragon D, Meek JI, Farley MM, Ryan P, Lynfield R, Morin CA, Hancock EB, Bennett NM, Zansky SM, Thomas A, Lindegren ML, Schaffner W, Finelli L. Complications among adults hospitalized with influenza: a comparison of seasonal influenza and the 2009 H1N1 pandemic. Clin Infect Dis. 2014; 59


Background: An outbreak of highly pathogenic avian influenza (HPAI) H5N1 virus in Thailand was first reported in 2004. To date, electron micrographs demonstrating the morphology of HPAI H5N1 virus particle are quite limited.

Objective: To demonstrate the morphology of HPAI H5N1 virus particles, avian influenza viruses with low pathogenicity, seasonal influenza viruses, and H5N1 structural components in infected cells. The M amino acid residues that might affect the viral morphology were also analyzed.

Methods: Electron micrographs of negatively-stained virus particles and positively-stained thin sections of the HPAI H5N1 virus infected cells were visualized under a transmission electron microscope. M amino acid sequences of the study viruses were retrieved from the GenBank database and aligned with those of reference strains with known morphology and residues that are unique for the morphological type of the virus particles.

Results: Morphologically, three forms of influenza virus particles, spherical, regular, and irregular rods, and long filamentous particles, were demonstrated. However, the spherical form was the most predominant morphological type and accounted for more than 80% of the virus populations examined. In addition, the viral entry and exit steps including incomplete particles in infected Madin-Darby canine kidney cells were visualized. Our analyses did not find any M amino acid residues that might influence the viral morphology.

Conclusion: Of all virus isolates studied, we demonstrated that the spherical particles were the major population observed regardless of virus subtype, host of origin, virus virulence, or passage history. Our study suggested that the morphology of influenza virus particles released, might not be strongly influenced by M gene polymorphism.


Background: The world is entering the post-outbreak period of the 2009 A H1N1 strain of the influenza virus. The strain is expected to continue spreading, as seasonal influenza viruses do each year. The majority of children have relatively low immunity and engage in activities at school where opportunities abound for exposure to and spreading of diseases.

Objectives: We compared the effectiveness of influenza prevention by using non-pharmaceutical measures in primary schools.

Methods: This study was conducted at two medium-sized primary schools in Nakhon Phanom province, Thailand. Multistage sampling was used to select students from Grades 4 to 6. The study group consisted of 230 students from the 2 schools and the control group 224 students from the 2 schools. The research included (a) 8 h of instruction on influenza-like illnesses and their prevention integrated into health promotion and physical education classes and (b) building understanding among parents and in the community. Data were analyzed for frequencies, percentages, and multiple logistic regression.

Results: Non-pharmaceutical influenza interventions reduced the rate of influenza-like illnesses by 77% (AOR = 0.23, 95% CI: 0.15"0.36). Students who did not receive the influenza-like prevention and control training had a morbidity of 54.9%; whereas those who received the training had a morbidity of 23.5%. Overall, the group receiving the educational model saw a 57% reduction in its morbidity compared with the control group. The students in the intervention group who washed their hands for 20 seconds three or more times per day had a morbidity of 38.9%, which resulted in an overall reduction in morbidity of 36.4%. The morbidity rate of students who missed school because they were ill was 39.5%. When comparing training methods, the hand-washing group saw morbidity reduced by 34.7%, while simply receiving news and information from public health officials resulted in only a 29.2% reduction in morbidity. Overall, the group receiving the disease prevention and control training was able to reduce morbidity by 58.7%.

Conclusion: Influenza prevention education among students was integrated into the health education curriculum. Children were taught hand-washing and respiratory etiquette (i.e., covering the nose and face when sneezing, coughing, and nose-blowing). Cartoon media were used as visual teaching aids. The results from this program helped to decrease the number of cases of influenza-like illness and morbidity among students and families.

professionals’ knowledge about and attitude towards influenza vaccination in Freetown Sierra Leone: A cross-sectional study. BMC Public Health , 17 , 692. Jorgensen, P., Mereckiene, J., Cotter, S., Johansen, K., Tsolova, S., Brown, C. (2018). How close are countries of the WHO European Region to achieving the goal of vaccinating 75% of key risk groups against influenza? Results from national surveys on seasonal influenza vaccination programmes, 2008/2009 to 2014/2015. Vaccine , 36 , 442–452. Maltezou, H. C., Poland, G. A. (2014). Vaccination policies for healthcare

-2003. Vaccine 2005; 23: 5133-43. 7. Blank PR, Schwenkglenks M, Szucs TD. Vaccination coverage rates in eleven European countries during two consecutive influenza seasons. J Infect. 2009; 58: 446-58. 8. Mereckiene J, Cotter S, Nicoll A, Lopalco P, Noori T, Weber J. et al. Seasonal influenza immunisation in Europe: overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11). Euro Surveill 2014; 19: 20780. 9. Telford R, Rogers A. What influences elderly peoples’ decisions about whether to accept

] The complications of influenza infection can be either mild or very severe. Sinusitis and otitis are examples of moderate complications of influenza. [ 39 ] Serious complications include viral pneumonitis, secondary bacterial pneumonia ( Staphylococcus aureus pneumonia or Streptococcus pneumoniae ), [ 39 , 40 ] myocarditis, encephalitis, myositis or rhabdomyolysis, GBS, and multiple organ failures. [ 41 , 42 , 43 ] INFLUENZA VACCINES AND ADVERSE EFFECTS Influenza vaccines are commonly available for seasonal influenza and new versions of the vaccines are