Vaccination policies in case of an influenza pandemic
10 April 2000
An influenza pandemic could cause substantial social disruption, insofar as it would involve a large proportion of the population contracting a serious or less serious form of the illness. The level of infection would be high in all age groups. A large number of premature deaths could be expected, partly as a result of secondary bacterial infections. The development of an influenza vaccine potent against a particular pandemic virus strain is time-consuming, so it is almost inevitable that there would be a major vaccine shortage in the early stages of a pandemic. The formulation of vaccination priorities is therefore essential.
In this report, a Health Council Committee defines the four groups of people that, on medical grounds, are most in need of vaccination. The Committee makes no attempt to suggest which sections of the population, if any, should be prioritized for social or political reasons.
The four groups are defined below in descending order of priority. The subgroups within each group have equal priority.
* Patients with serious abnormalities or functional disorders affecting the airways or lungs, who, despite receiving medication, would be at increased risk of lung function decompensation if they were to be infected by the pandemic influenza virus. This subgroup includes patients with very serious bronchial asthma, very serious emphysema, COPD (chronic obstructive pulmonary disease), anthracosilicosis, lung fibrosis, mucoviscidosis and kyphoscoliosis, and people who have undergone lung resection.
* Patients with serious, acute or chronic functional heart disorders, who, despite receiving medication, would be at increased risk of heart function decompensation if they were to be infected by the pandemic influenza virus.
* Patients with furunculosis, members of their immediate family and comparable contacts.
* Patients with an insulin dependent form of diabetes mellitus (diabetes mellitus type I).
* Pregnant women in the third trimester of the pregnancy during the pandemic.
* Patients with abnormalities or functional disorders affecting the airways or lungs, who, in contrast to the patients in group 1, would be afforded relatively stable lung-function compensation by their medication.
* Patients with chronic functional heart disorders, who, in contrast to the patients in group 1, would be afforded relatively stable heart-function compensation by their medication. This subgroup includes patients with disorders of the left ventrical, patients with congenital heart abnormalities and patients with valve abnormalities, insofar as their medication affords compensation.
* Patients with chronic renal insufficiency. This subgroup includes patients receiving haemodialysis or chronic ambulant peritoneal dialysis (CAPD) and people who have undergone kidney transplants
* Children and adolescents aged between six months and eighteen years, who are long-term salicylate users.
* Patients undergoing immunosuppressive therapy following a recent bone marrow or organ transplant operation.
* Patients with a non-insulin dependent form of diabetes mellitus (diabetes mellitus type II).
* People with mental disabilities in intramural care and nursing home residents whose medical condition predisposes them to airway infections (as in the case of people with Down’s syndrome).
* People aged sixty-five or older not included in classes 1 to 3.
* People aged less than sixty-five with reduced resistance to infection, such as people who are HIV-positive.
If insufficient influenza vaccine were available for people in the four groups, the Committee believes that pneumococcal vaccines should be made available. By offering protection against (secondary) pneumococcal infections, which often accompany pandemic influenza, such vaccines could improve the recipients’ survival chances.
Health Council of the Netherlands: Vaccination policies in case of an influenza pandemic. The Hague: Health council of the Netherlands, 2000; publication no. 2000/01. ISBN 90-5549-303-1