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Flu Vaccine (cont.)

History and Development of Flu Vaccines

In 1933, researchers discovered that viruses (influenza virus types A, B, and rarely C) cause influenza (flu). Prior to 1933, a bacterium named Haemophilus was thought to cause the flu. In 1938, Jonas Salk and Thomas Francis developed the first vaccine against flu viruses. This first flu vaccine was used to protect the U.S. military forces against the flu during World War II. Dr. Salk used his experience with influenza vaccine to develop an effective polio vaccine in 1952. Vaccines produced from the 1940s to the 1960s were not as purified as more modern vaccines, and the impurities in vaccines were thought to contribute to side effects such as fever, aches, and fatigue. Since these symptoms were similar to those that accompanied the flu (flu symptoms usually were more severe and lasted longer), people mistakenly thought they got the flu from the vaccination. However, they did not get the flu from the vaccines since the vaccines used killed virus.

In a public vaccination program designed to prevent a pandemic swine flu outbreak in 1979, about 25% of people in the United States were vaccinated. Unfortunately, the 1979 vaccine was associated with a small increased risk of Guillain-Barré syndrome, a serious neurological condition, with the risk estimated to be one to nine excess cases per million doses of vaccine, but no cause for this increase in risk was ever discovered. Fortunately, no pandemic developed, and the vaccination program for that flu virus was cancelled. Since that time, vaccine purification has been improved, and millions of people have continued to be vaccinated every year. Currently, influenza viruses are inoculated into eggs, where they multiply; afterward, they are harvested and separated from most egg particles and egg antigens. Attenuated viruses (for nasal spray) are grown similarly, but strains are selected that only replicate under cool or cold temperatures so they can survive in the cool nasal passages long enough to stimulate an immune response but do not easily replicate and spread to warmer body regions like the lungs.

Because of the potential for widespread infection and deaths that the H1N1 pandemic virus strain seemed to possess, the H1N1 tests were accelerated so that vaccine could be provided before the usual six-month timeline. However, all of the steps (cultivation, safety, efficacy, approval, and distribution) were done in the same way as for seasonal vaccines but over a shorter time period with fewer people involved in the initial trials. Tested and approved H1N1 vaccine started to become available in late September 2009 (in Europe) and in October 2009 in the Americas and Asia. However, suppliers could not produce enough vaccine because of a low yield of virus from eggs, so there were worldwide shortages. Because of these shortages, the WHO, the CDC, and other organizations recommended first vaccinating the people known to be at high risk for complications or death (described below) if they became infected with H1N1. Changes in vaccine synthesis, testing, and distribution are being considered by the CDC to improve the vaccine response to pandemic flu in the future due to these problems.

In 2013, the first quadrivalent (4 antigen-containing) vaccine was used.

Another change in 2013 was the FDA approval of Flublok, a trivalent flu vaccine made from insect-cell cultures with insect-cell recombinant DNA modified to make viral hemagglutinin. The hemagglutinin from the three dominant flu strains are synthesized and purified for the vaccine. No live viruses, eggs, or mercury preservatives are used, so this vaccine is live virus-, mercury-, and egg-free.

A major change in terminology (naming conventions for influenza vaccines) occurred in the 2014-2015 vaccine year. The new terminology (presented in bold type) is as follows:

  • TIV (trivalent inactivated influenza vaccine) has been replaced with IIV (inactivated influenza vaccine) and has two subclasses; IIV3 which stands for egg-based and cell-culture-based trivalent inactivated influenza vaccines while IIV4 represents egg-based quadrivalent inactivated influenza vaccine.
  • RIV is recombinant hemagglutinin influenza vaccine available as a trivalent form (RIV3).
  • LAIV is live attenuated influenza vaccine, available as a quadrivalent formulation (LAIV4).
  • The prefix cc means vaccine is cell-culture based (for example, ccIIV3).
  • The older abbreviations LAIV, IIV, and RIV now indicate vaccine categories while the number at the end (suffix) represents the number of antigens in the vaccine (for example, IIV3 represents inactivated influenza vaccine with three antigens).
Medically Reviewed by a Doctor on 9/2/2014

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