Vaccination: Another Perspective – Ineffective and Unsafe

Effectiveness of influenza vaccine during pregnancy in preventing hospitalizations and outpatient visits for respiratory illness in pregnant women and their infants.

Kaiser Permanente Vaccine Study Center, Oakland, CA 94612, USA.

The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommends influenza vaccination for women who will be in the second or third trimester of pregnancy during the influenza season. We analyzed hospital admissions with principal diagnoses of influenza or pneumonia and influenza-like illness (ILI) outpatient visits to study the effectiveness of influenza vaccine during pregnancy in protecting women and infants from influenza-related morbidity. Estimates of influenza vaccine effectiveness across five flu seasons (Fall 1997 to Spring 2002) were calculated using Cox proportional hazards models for women and infant study populations in Kaiser Permanente Northern California. Outpatient utilization outcomes included physician visits with a diagnosis of upper respiratory infection, pharyngitis, otitis media, asthma, bronchial asthma, viral infection, pneumonia, fever, cough, or wheezing associated with respiratory illness. Inpatient outcomes included hospitalizations with principal diagnoses of influenza or pneumonia. Women who received influenza vaccine during pregnancy had the same risk for ILI visits compared with unvaccinated women, adjusting for women’s age and week of delivery. When asthma visits were excluded from the outcome measure, we also found no difference in the risk of outpatient visits for vaccinated and unvaccinated women. Hospital admissions for influenza or pneumonia for women in the study population were quite rare and no women died of respiratory illness during pregnancy. Infants born to women who received influenza vaccination had the same risks for influenza or pneumonia admissions compared with infants born to unvaccinated women, adjusting for infant’s gender, gestational age, week of birth, and birth facility. Maternal influenza vaccination was also not a significant determinant of risk of ILI (excluding otitis media) outpatient visits for infants, nor did it significantly affect the risk of otitis media visits. Influenza vaccination during pregnancy did not significantly affect the risk of cesarean section, adjusting for the woman’s age. It also did not affect the risk of preterm delivery. Although the immunogenicity of influenza vaccination in pregnancy in mother and infant has been well documented, in this study, we were unable to demonstrate the effectiveness of influenza vaccination with data for hospital admissions and physician visits. One possible interpretation of these findings is that typical influenza surveillance measures based on utilization data are not reliable in distinguishing influenza from other respiratory illness. Hospitalizations for respiratory illness were uncommon in both vaccinees and nonvaccinees.

PMID: 15311370 [PubMed – indexed for MEDLINE

Is routine influenza immunization warranted in early pregnancy?

Skowronski DM, De Serres G.

BC Centre for Disease Control, Vancouver, BC, Canada. danuta.skowronski@bccdc.ca

Routine influenza immunization is recommended for select groups because of their higher risk of serious influenza outcomes. Based on that benefit-risk framework, we assessed whether routine administration of trivalent inactivated influenza vaccine (TIV) is warranted in pregnancy, beginning in 1st trimester. Higher maternal mortality due to influenza was extensively described during the 1918 and 1957 pandemics, but epidemiologic evidence thereafter is limited to case reports and a single ecologic analysis during a single season. Significantly elevated rates of hospitalization have been reported with seasonal influenza beginning in 1st trimester among women with select comorbidities and during the 2nd half of normal pregnancy. TIV protection against serious outcomes in pregnant women has not yet been shown. Although harm has also not been shown, sample size to date is insufficient to assert TIV safety in 1st trimester. Benefit-risk analysis suggests influenza immunization may be warranted at any stage of pregnancy during certain pandemics and annually among women with select comorbidities. TIV may also be warranted to protect women against influenza-related hospitalization during the 2nd half of normal pregnancy. Evidence is otherwise insufficient to recommend routine TIV as the standard of practice for all healthy women beginning in early pregnancy.

PMID: 19515466 [PubMed – in process

Determination of genotoxicity of classical swine fever vaccine in vitro by cytogenetic and comet tests.

GENETICA, Facultad de Agronomía y Veterinaria, Universidad Nacional de Río Cuarto Argentina.

Chromosome damage in lymphocyte cultures induced by live virus vaccine against classical swine fever (CSF) has been observed in previous studies. In vivo cytogenetic tests were made with several doses of vaccines used in Argentina to control the disease. These studies have shown that genotoxic effects increased with dose. In the present study, two different in vitro assays were performed by recording the frequency of cells with chromosome alterations and by assessing the ability of the vaccine to damage DNA, using the single cell gel microelectrophoretic assay (comet test). Frequencies of cells with chromosomal alterations increased significantly when compared with controls and were dose (microl/ml) dependent: 0 = 1.23, 5 = 2.29, 10 = 5.42 and 20 = 11.71%. In the comet assay the variables measured, tail length (TL) and tail moment (TM), also increased. For control cultures TL was 2.32 microm, whereas with concentrations of 20 and 100 microl/ml TL were 12.47 and 42.3 microm, respectively. TM of control cultures was 0.18, whereas with vaccine concentrations of 20 and 100 microl/ml TM were 5.52 and 24.52, respectively. Comet frequency distributions differed significantly among treatments. These results agree with previous in vivo observations. Regarding CSF pathogeny, our results support a direct effect of CSF vaccinal virus on lymphocyte DNA. Genotoxicity of CSF vaccine was corroborated in vitro at the cytogenetic and molecular levels.

PMID: 16571637 [PubMed – indexed for MEDLIN