Influenza Immunization

Editorial Influenza

Immunization

Autumn is the crucial time for protecting people in the high-risk groups against influenza. Because the occurrence and severity of influenza cannot be predicted accurately, the Surgeon General’s Advisory Committee on Influenza recommends routine annual immunization for these groups the aged, the chronically ill, and pregnant women. For maximum protection, these people should be fully immunized before winter sets in. Influenza viruses of one type or another are almost constantly present in a few people everywhere. The general population develops some degree of immunity against them. A “crash program” of immunization is indicated when a variant strain of virus crops up or when an established strain goes on a rampage, but certain groups of people are always vulnerable to a special degree and protection must be extended to them on a continuing annual basis. The definition of these high-risk groups is of significance to the chest physician. Many, perhaps most, of his patients fall into the high-risk category. Individuals in the following classifications require routine immunization: 1.

Persons A.

of all

Patients mitral

B. Patients sclerotic evidence C.

Patients asthma, pulmonary

D. Persons E.

Patients

2.

Pregnant

3.

All

The greater severe

persons

ages

with stenosis.

with

chronic

rheumatic

with other or hypertensive of frank or

debilitating heart

cardiovascular heart incipient

disease,

with

diabetes

particularly:

especially

those

diseases, such disease; especially cardiac insufficiency.

with chronic broncho-pulmonary chronic bronchitis, bronchiectasis, emphysema, and pulmonary with

disease,

as arteriothose with

disease: e. g., chronic pulmonary fibrosis, tuberculosis.

mellitus.

Addison’s

disease.

women. 65

years

of

age

and

older.

susceptibility of these people to influenza is not than that of the population at large, but influenza stress on these people and it is more likely to threaten

This showed waves of Asian was introduced the third wave by approximately pected for the

with

necessarily places a their lives.

up dramatically in connection with the three epidemic influenza that occurred in this country after the strain in 1957. The two initial waves in 1957 and 1958 and during the first three months of 1960 were accompanied 86,000 deaths in excess of the number normally experiods involved. Analysis of the mortality data shows 470

Oct.,

ROBERT

1%1

J.

ANDERSON

471

that almost 85 per cent of these deaths were attributed to pneumoniainfluenza (33 per cent) and cardiovascular-renal disease (51 per cent). With each successive wave, the proportion of victims over 65 increased. During the third wave, three-fourths of the total excess deaths occurred in this older group. Aqueous, polyvalent, killed-virus vaccines are available commercially. Recent vaccine evaluations indicate that they are from 60 to ‘75 per cent effective against influenza caused by virus Types A, A1, A2, and B. Their use is contraindicated only in persons with a history of allergy to eggs or chicken, or who have had a previous allergic reaction to an egg-produced vaccine. For initial immunization, the recommended adult dose of multivalent vaccine is 1.00 cc. (500 CCA units) given subcutaneously on two occasions, at intervals of at least two months. Members of the Advisory Committee have found that the booster response from the second dose is greater with this interval. Of course, if an epidemic threatens, it might become expedient to revert to the two-week interval between doses. Preferably, vaccination should be completed by November 1. Persons who have had the initial immunizing series should be given a 1.0 cc. booster dose of the vaccine subcutaneously by November 1 of each succeeding year. Routine ly lower physician

annual immunization of high-risk the unnecessary deaths associated is in a particularly strategic position

individuals could drasticalwith influenza. The chest to protect the vulnerable.

ROBERT

J. ANDERSON,

Chairman, American

*Assistant

Surgeon

Service,

General,

Deputy

U. S. Department

of

Chief,

Health,

Bureau

of

Education,

and

POSTPERICARDIOTOMY The open defects

postpericardlotomy

heart

surgery,

and

Although

the an

utilizing relief

cardium,

Engle,

M.

in

A.,

in and

all

reaction, 30

a Ito,

pericardial T.:

patients

“The

per

aortic

that

State

Services,

Public

Health

Welfare.

patIents

undergoing

This has

Postopericardiotomy

syndrome already

among

for

repair

stenosis. that

sometimes

cent. sac

30

machine,

pericarditis

pericardial

approximately blood

in

heart-lung and

F.C.C.P.,5

SYNDROME

occurred

pulmonic traumatic

delayed

in to

the

develops

a

reaction

of

immediate

electrocardiograms

develops

syndrome

M.D.,

Washington, D. C. Council on Public Health College of Chest Physicians

Four

can

be

100

consecutive

atrial

and

patients

and

incision pleural probably

undergone Syndrome,”

survivors ventricular

experienced

demonstrated

wide with

of

and

represents

J.

by of

pulmonary

traumatic Am.

recurrences. followed

exploration

and

the

involvement, a

hypersensitivity

pericarditis. Cardiol.,

of septal

7:73,

1961.

serial pen-