If there is a flu pandemic, prevention, treatment and containment will be essential. This isn't something that can be done on a national or even a continental level. It has to be a worldwide effort.

The World Health Organization's Strategic Advisory Group of Experts (SAGE) on Immunization met in July to discuss issues around H1N1 influenza and make recommendations related to the vaccine for this flu. Right now, WHO categorizes the severity of the pandemic as "moderate" with most patients experiencing uncomplicated, self-limited illness. However, some groups, such as pregnant women and those with asthma, appear to be at increased risk for severe disease or death from infection.

Not knowing the numbers of cases of H1N1 the early fall will bring, SAGE identified three objectives as part of a country's pandemic vaccination strategy:

1.      protect the integrity of the healthcare system and the country's critical infrastructure;

2.      reduce morbidity and mortality; and

3.      reduce transmission of the pandemic virus within communities.

Has to Work for Each Country

SAGE acknowledges each country must address the situation as their capabilities allow, but any strategy should reflect the country's epidemiological situation, resources and ability to access vaccine. Since the spread of the pandemic virus is considered unstoppable, vaccine will be needed in all countries.

The following recommendations were provided to the WHO director general:

• All countries should immunize their healthcare workers as a first priority to protect the essential health infrastructure. As initial vaccine availability will not be sufficient, a step-wise approach to vaccinate particular groups may be considered. SAGE suggested this order, noting countries need to determine their order of priority based on country-specific conditions: pregnant women; those older than age 6 months with one of several chronic medical conditions; healthy young adults ages 15 to 49; healthy children; healthy adults ages 50 to 64; and healthy adults 65 years and above.

• Acknowledging new technologies are involved in the production of some pandemic vaccines, and these have not yet been extensively evaluated for their safety in certain groups, WHO believes it is important to implement stringent postmarketing surveillance. In addition, quickly sharing the results of immunogenicity and postmarketing safety and effectiveness studies among the international community is essential to allow countries to make necessary adjustments to vaccination policies.

• In view of the anticipated limited vaccine availability at the global level and the potential need to protect against "drifted" strains of virus, SAGE recommended production and use of vaccines formulated with oil-in-water adjuvants and live attenuated influenza vaccines. SAGE did not consider there was a need to recommend a "switch" from seasonal to pandemic vaccine production, in areas, such as the northern hemisphere were seasonal vaccine production for 2009-10 flu season is almost complete.

Who is SAGE?

The 15-member SAGE was established by the WHO director general in 1999 as the principal advisory group to WHO for vaccines and immunization. Members represent a broad range of disciplines from around the world in epidemiology, public health, vaccinology, pediatrics, internal medicine, infectious diseases, immunology, drug regulation, program management, immunization delivery and healthcare administration.

To read more about WHO's recommendations go to: http://www.who.int/csr/disease/swineflu/notes/h1n1_vaccine_20090713/en/index.html.