the health care workers should be first in line when vaccinations against the swine flu virus are ready and approved, a expert group of the World Health Organization concluded in a meeting last week. The Strategic Advisory Group of Experts on Immunization (SAGE) also said that countries should consider vaccinating other groups such as those most at risk of death and illness, but said each country must chart its own strategy depending on what he hopes to achieve and the amount of vaccine available to it.
SAGE held a special meeting July 7 to discuss the pandemic and the development of vaccines in development. A summary of its recommendations approved by the Director-General Margaret Chan, July 11, was released in a statement today and discussed at a press conference (audio file) by Marie-Paule Kieny, head of 'WHO Initiative for vaccine research.
protect doctors, nurses and other medical staff is the key to maintaining health care systems running, SAGE concluded. If countries have enough vaccine, they can reduce disease and death in high-risk groups such as pregnant women, people with chronic health problems, or even all young adults in good health aged between 15 and 49, the age group that is most vulnerable vaccinated. They can also choose to try to slow transmission of the virus, in which case the vaccination of healthy children is an option, Kieny said, because they are a "transmission amplifier."
Meanwhile, the amount of vaccine available in the world could be much lower than expected because of a problem in the production process. Kieny said that, for reasons that are not entirely understood, vaccine manufacturers that use eggs to grow vaccine virus yields of only 25% to 50% of those obtained during the production of seasonal vaccine. WHO influenza laboratory network is currently producing a new series of seed virus which Kieny hope will result in higher yields. If successful, the delivery of the vaccine should not be delayed, Kieny said, because regulators are likely to accept clinical trials should soon be * with low-yield strains, although the high-yield strains used to produce the vaccine. But if yields remain low, it would take many more months to produce billions of doses of vaccine WHO hoped, according to Kieny presentation to SAGE meeting.
total vaccine supply will depend on several other unknown, especially if 15 micrograms of antigen is sufficient, as is the case with the vaccine and seasonal whether one or two shots are necessary. A key factor is how many companies will use so-called adjuvants that stimulate the immune response and thus reduce the amount of antigen needed per shot. A recent survey of 36 vaccine producers, also presented by Kieny, showed that only 12 of the 33 proposed vaccine formulations will contain an adjuvant. Many companies have never used adjuvants and now adding them would raise additional security issues, Kieny said. "It is very difficult to mix the antigen of a company with an adjuvant of another company when they have never been tested together."
* The tests are currently underway as stated above.
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