Vaccines in practice - 2009

Exposing the hidden impact of influenza
David Cliff
pp 1-4
The emergence of the highly pathogenic avian influenza A (H5N1) in the late 1990s, and the more recent pandemic of influenza A (H1N1) in 2009, have stimulated governments and health authorities globally to prepare and plan for one of the most challenging health crises of our generation. Healthcare services are often well adjusted to coping with ‘seasonal flu’, but, periodically, a novel subtype of influenza virus can occur, with the potential to cause a pandemic and, consequentially, considerable morbidity and mortality worldwide. One recent estimate suggested that, if a pandemic such as the ‘Spanish flu’ pandemic of 1918 occurred today, around 62 million deaths would occur worldwide.
Comment: Desperately seeking evidence
Peter M English
pp 3-3
You may be familiar with one of the slides I use in my lectures to prove the value of vaccination; it’s on page 314 of The Green Book and shows the notification rate for poliomyelitis in the years before and after the introduction of the vaccine. I often ask the audience why they think the rate was trundling along at about 1,000 until the mid-1940s, before shooting up to 7,000 or so. The answer is that it wasn’t until there was a realistic prospect of controlling the disease that the notification process was improved.
Local implementation of H1N1 vaccination priorities
Sarah Lang and Noel McCarthy
pp 4-5
In October 2009, the H1N1v swine flu vaccination programme began in the UK, based on national guidance that had identified priority groups to be immunised. For many general practices, the initial supply of 500 vaccines per practice did not allow coverage of all those in these nationally identified priority groups. Clinicians and practices therefore needed to decide who should be vaccinated first. This led practices and primary care trusts (PCTs) to seek advice from local pandemic influenza leads and immunisation advisers.
Assessing vaccine efficacy
Alasdair RJ Bamford and Beate Kampmann
pp 6-8
Proof of efficacy is an essential part of a vaccine’s development and licensing. Efficacy is a measure of how well a vaccine works. True vaccine efficacy is calculated from the results of randomised, placebo controlled clinical trials and is defined as the percentage reduction in the incidence of a disease in the vaccinated compared to the incidence of the disease in the unvaccinated (see Box 1).
Practical aspects of vaccination: part 2
Linda E Diggle
pp 9-9
Immunisers should reflect on their practice and carry out practices that are evidence based. This is the second part of an article around the practical aspects of vaccination (see Vaccines in practice 2.3 for part 1).
Examining immunisation in New Zealand
Helen Petousis-Harris and Nikki Turner
pp 10-11
In New Zealand, the first formal schedule for universal immunisation was drawn up in November 1960; this was for the delivery of the diphtheria, tetanus and pertussis vaccine (DTP), which was provided to practitioners free of charge. Since September 2008, the schedule includes universal free vaccination against diphtheria, tetanus, pertussis, polio, hepatitis B, Haemophilus influenzae type b, pneumococcal disease, measles, mumps, rubella and human papillomavirus (HPV). Special groups also receive the influenza, hepatitis B immunoglobulin and Bacillus Calmette-Guérin (BCG) vaccines free.