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The Lombardy Region has announced that it has reached an agreement with pediatricians to strengthen the vaccination campaign against influenza among children up to 6 years of age. The initiative will be launched in mid-November and will involve the use of aerosol vaccines, which are not generally used in Italy compared to more traditional vaccines that are administered by injection.
Several details of the program are still unclear and the start in November is considered late, given that the Ministry of Health has been advising for months to anticipate vaccination campaigns against influenza, given the concomitance with the ongoing coronavirus pandemic. At least in the initial phase, COVID-19 symptoms can be mistaken for flu symptoms, complicating diagnoses. The flu vaccine helps reduce cases of the flu, which can cause severe symptoms in people at risk, easing the workload of hospitals, which could be confronted again with the coronavirus as occurred in the first half of the year. year.
Classic vaccine and spray
Most flu vaccines are given by injection into a muscle. Inside, the vaccine contains an inactivated version of the virus (usually between two and four variants, estimated to be in circulation each flu season) capable of eliciting an immune response, but without running the risk of getting sick. This system teaches the immune system to recognize flu viruses, so it can deal with them and prevent them from starting an infection that could later lead to illness.
In some countries, a variant of the classic vaccine called LAIV has been available for some time (Live attenuated influenza vaccine). As its name suggests, it contains influenza viruses that are still live and active, but treated in such a way that they are less aggressive than the version circulating in the population. LAIV is given by nasal spray and then given by inhalation.
The influenza strains contained in the LAIV are treated in such a way that they resist the temperature of the nasal mucosa by replicating within them, without affecting the lower respiratory tract. This reduces the risk that the attenuated viruses could infiltrate too much and cause infections that could be dangerous.
Using the Laives
So far in Italy, experiences with LAIV have been extremely limited, and the Ministry of Health itself reported until recently that: “The vaccine is not currently available in Italy.” According to what was declared by the Lombardy Councilor for Welfare, Giulio Gallera, in mid-November the region will receive around half a million doses that will be used for the vaccination (voluntarily by parents) of children. According to the promoters of the initiative, the administration should be faster and more practical, less traumatic for children and, therefore, better seen by parents. However, several details are still unclear.
The use of LAIV is allowed in Europe and in recent times it has been the basis of some vaccination campaigns against influenza in the pediatric sector. Programs similar to the one Lombardy is working on have been implemented in the UK and Finland, where aerosol vaccines were offered to children in the age groups 2-11 and 2-3 years, respectively.
LAIV is not recommended for use in children under 2 years of age because it may cause temporary breathing problems. Gallera spoke of an “organizational plan for the flu vaccination of children between six months and six years old,” this implies that the vaccine to be injected will be used up to 2 years, leaving the other to older children.
Administration of LAIV usually requires two doses, one month apart, but in some countries the use of a single dose has been tested with satisfactory results. The Lombardy Regional Prevention Department will need to determine if a dose is sufficient or if a booster dose should also be administered.
Effectiveness
Beyond the uncertainties about Lombardy’s programs, questions have been raised in the past about the efficacy of LAIV compared to the traditional vaccine. The US health authorities (CDC) in 2016 advised against the use of LAIV in that year’s flu season due to its lower efficacy, which arose in the three previous flu seasons. Subsequently, an analysis conducted on the administration in children found that LAIV had led to below-expected results in some age groups.
To date, it is still not completely clear why LAIV has proven to be less reliable in some flu seasons. At the beginning of 2018, however, the health authorities again recommended the use of the spray vaccine, eliminating the indications that indicated the use of the traditional vaccine as preferable after new analyzes on its effectiveness.
Inquire about
Getting a flu shot is always important for people at risk, such as the elderly and people with other illnesses, and it could be even more so this year due to the pandemic. The Ministry of Health recommended to advance the vaccination campaign and offer the vaccine for free to broader sectors of the population. Following these guidelines, each Region, responsible for health management, has launched its own vaccination programs. For information, you can contact ASL or your doctor.
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