TIMELINE January may be too late for vaccination

If the influenza A (H1N1) epidemic in Montenegro reaches its peak at the end of November and in December, as predicted, then it will be too late for the vaccination planned in January - believes Dr. Nikola Petrosilo, one of the leading European experts on the new flu, director of the Department of infectious diseases of the Italian National Institute "Lazzaro Spallanzani" in Rome.

Petrosilo says that vaccination should be done as soon as possible, since, according to experts' expectations, a significant number of clinical cases are expected during the fall, as a result of infection with the A(H1N1) virus, which will "significantly affect the mortality rate."

- The best time for vaccination depends on the prediction of its peak. I'm afraid that in January it will be too late for priority categories to receive the vaccine - health workers, public servants, police and social services - points out Dr. Petrosilo.

He thinks that 100.000 doses of the vaccine against the new flu, as much as the Ministry of Health plans to procure, is enough for Montenegro.

- The vaccine against the H1N1 flu is the most effective means of controlling the epidemic, in terms of the number of cases and deaths, as well as the spread of the infection. The expected maximum number of patients at the peak of the epidemic is around 20 to 30 percent of the population. Therefore, 100 to 150 thousand infected with the H1N1 virus is a correct prediction for Montenegro - says Petrosilo.

In order to mitigate such consequences in the field of public health and social interest, he advises that all countries should prepare their plan in time in case of an epidemic in terms of clinical management, infection control and hospital capacity readiness.

- In order to achieve satisfactory results, national health organizations should provide recommendations for doctors, patients and apply vaccination programs, with clearly marked priorities - health workers and employees in public services. Other risk groups are pregnant women, people between the ages of 25 and 64, especially those who are asthmatic, diabetic, obese, those who care for children under six months, and children and young people from 6 months to 24 years. They should be vaccinated immediately after medical and public workers, as soon as possible - warns Dr. Petrosilo.

The World Health Organization announced on Friday that detailed laboratory tests as part of the WHO's monitoring of the new flu show that it has not been observed that the H1N1 virus has mutated into a stronger form. WHO considers currently approved vaccines to be appropriate for circulating viruses and are expected to provide good protection. The World Health Organization's Strategic Advisory Expert Group on Vaccination recommends a single dose of the Mexican flu vaccine for adults, including pregnant women, starting with children ten years of age. According to the WHO, additional evidence is needed to determine whether a single dose is sufficient for younger children. The experts are also familiar with the earlier results of observing people who received vaccines and did not notice any signs of unusual back reactions.

- Some reactions were observed, but within the scope of those that also occur during seasonal flu vaccination with preparations that have an excellent safety profile. Although the results so far are convincing, observation due to possible back reactions should be continued - according to the WHO.

Globally, teenagers and young adults still make up the majority of patients, and the percentage of young children admitted to hospital treatment is still the highest. Between one and ten percent of patients with a clinical picture require hospitalization. From ten to 25 percent of those hospitalized must be placed in intensive care units, and in two to nine percent of cases the outcome is fatal. According to WHO data, from seven to ten percent of hospitalized pregnant women are in the second or third trimester of pregnancy. Pregnant women need ten times more intensive care treatment than the rest of the population.

Producers and buyer countries have so far respected the position of the European Medicines Agency, which recommended two doses as the optimum. Given that vaccine production capacity is limited, this is good news for poorer countries, as they are likely to get the needed amount of vaccine sooner.

Many countries have already carried out vaccination or are in the process of doing so. In Sweden, for example, it started at the end of September, Spain, as assessed, was late - they start next week, in Russia 2500 people have been infected, but 20 million have already been vaccinated. During the summer, Slovenia set aside 12 million euros and ordered 1,3 million doses of vaccine, thus enabling citizens to be vaccinated already at the beginning of November.

In Sweden, 700 people who had side effects after vaccination were reported, reopening the story of vaccine safety. Part of the British and Germans, whose governments have already procured vaccines and started vaccination, are not sure of their correctness, especially in Germany, where there is a debate whether those prepared for the state bureaucracy and protected categories and those for the "ordinary world" are of the same quality.

At the beginning of the pandemic, the predicted death rate was 0,4 percent. According to WHO data from November 1, 6153 people died from infection with the new flu worldwide, and more than 440.000 fell ill, which means that the mortality rate is about 1,29 percent. The obligation to report the number of patients in WHO member countries has ended, so the latest official data are far from the real situation.