The first doses of pandemic influenza A(H1N1) vaccine will soon arrive in U.S. physician’s offices and clinics in the form of the live attenuated, nasal-spray vaccine, with supplies of inactivated, injectable vaccine scheduled to be available in mid-October.

Because the first wave of the vaccine supply will be nasal spray, physicians won’t be able to administer it to two groups of people who the U.S. Centers for Disease Control and Prevention targeted as high-risk individuals who need early vaccine protection: pregnant women and patients with asthma. In guidance released by the CDC late on Oct. 2, the agency reiterated its position that people in both of these groups should receive the injectable H1N1 vaccine formulation only. Nasal-spray vaccine is not licensed for use in pregnant women, and it should not be used in patients with asthma because the spray can trigger wheezing. As always, the injectable vaccine shouldn’t be given to anyone with a life-threatening allergy to eggs or any other substance in the vaccine.

Pregnant women were designated a high-priority vaccination group because about 6% of confirmed H1N1 flu deaths this year have been in pregnant women, even though only about 1% of the general population is pregnant at any time. A secondary advantage to vaccinating pregnant women is that the protection they receive is also important once their children are born. Flu vaccine is not recommended for infants younger than 6 months; instead vaccine is aimed at household contacts and caregivers of these very young children. Flu vaccines are recommended for all pregnant women at any time during pregnancy.

“One of the most important actions providers of obstetrical care can take is to strongly recommend to their patients that they receive [H1N1] vaccine,” the CDC said in its information for health care providers. The agency suggested vaccinating women during a prenatal visit, offering separate vaccination days or clinics, or referring patients to nearby vaccination sites.

The CDC information guide also highlighted that flu vaccines have not been shown to harm pregnant women or infants, that vaccine formulations with thimerosal preservative are safe during pregnancy, and that pregnant women can safely receive a seasonal flu and H1N1 vaccine on the same day, although different injection sites should be used. Pregnant women are not known to have an increased risk for side effects from the H1N1 vaccine.

Prevention of H1N1 infection by vaccination or early treatment of infection with oseltamivir is important for patients with asthma because they have an increased risk for influenza-related complications, the CDC said in a second information guide for clinicians. “Persons with asthma [who are] aged 6 months through 64 years are listed in the priority groups to receive initial doses of the injectable, inactivated, 2009 H1N1 influenza A monovalent vaccine when it becomes available in their community,” the guide said.

Another anti-influenza drug often used for early treatment of flu, zanamivir was not recommended for patients with asthma because zanamivir is administered by inhalation, which can trigger such adverse events as bronchospasm in people with asthma.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

在供应10月中旬批次灭活、注射型疫苗的同时，首批活性减毒、鼻喷剂型大流行性甲型流感(H1N1)疫苗即将送达医师的办公室和门诊。

 

因该疫苗将以鼻喷剂形式供应，所以医师无法将其用于美国疾病预防控制中心(CDC)指定的需疫苗早期保护的两类高危人群：孕妇和哮喘病人。在10月2日CDC颁布的指南中，当局重申，上述两类人群只能接受注射型疫苗。鼻喷剂型不得在孕妇中使用，且因其可引起喘鸣，也不得用于哮喘病人。一如既往，注射剂型也不得用于对蛋或对疫苗中任何成分有致命性过敏的人群。

 

孕妇被指定为高危人群，因为尽管孕妇只占人群的1%，但今年大约6%的H1N1流感死亡病例是孕妇。给孕妇注射疫苗的另一个好处是，她们受到的保护对其娩出的婴儿同样重要。流感疫苗不得用于小于6个月的婴儿，对他们的保护是通过给家庭成员或看护人员注射疫苗得以实现。流感疫苗适用于任何孕周的妇女。

 

“产科人员可以采取的最重要的措施，是强烈建议婴儿的父母接受H1N1疫苗。”CDC在给医护人员的指南中说。当局建议给孕妇留出单独的时间或诊室，或转诊至附近的免疫地点，在产前随诊时进行免疫。

 

CDC的指南还强调，尚无证据表明流感疫苗对孕妇或婴儿有害，含有硫柳汞防腐剂的疫苗在孕期使用是安全的，孕妇可在同一天接受季节性流感疫苗和H1N1流感疫苗(注射部位应不同)。另外，尚不清楚孕妇接受H1N1流感疫苗后发生副作用的风险是否增加。

 

CDC在另一份指南中说，注射疫苗防范H1N1感染或早期用奥司他韦治疗对哮喘病人非常重要，因为他们更容易患上流感相关的并发症。“当社区得到第一批2009 H1N1流感注射型灭活单价疫苗时，6个月到64岁之间的哮喘病人是最先接种的重点人群之一。”

 

另一种早期应用的药物，扎那米韦，因采取吸入方式给药，可能诱发哮喘病人出现支气管痉挛，所以不推荐用于该人群的治疗。

 

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