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Appendix K
PROSPECTS FOR IMMUNIZING AGAINST INFLUENZA VIRUSES A AND B

Influenza infection is a widespread problem in the United states, yet existing influenza vaccines are among the most poorly utilized vaccines available. The need for annual revaccination, misconceptions about the capabilities of the vaccines (some recipients expect them to prevent all respiratory infections during winter months), and unanswered questions about their efficacy in high-risk populations have led many providers to conclude that vaccination against influenza is not worth the effort. Attempts to alter this picture have focused principally on the development of attenuated live virus vaccines to replace the current inactivated virus products. Improvement of subunit vaccines is possible, and other potential approaches (not considered here) include synthetic viral peptides and viral neuraminidase vaccines. It is hoped that vaccines that provide longer lasting immunity will lead to improved utilization; however, antigenic drift and antigenic shift of the viruses, described below, may still necessitate periodic revaccination.

Disease Description

Influenza viruses cause both upper and lower respiratory tract symptoms, including nasal congestion, sore throat, hoarseness, and cough. Systemic symptoms such as fever, muscle aches and pains, and malaise may be the primary symptoms initially, but the respiratory symptoms usually predominate as the disease progresses (Davenport, 1982). Patients often develop a hacking cough with coryza, sore throat, and hoarseness; but some individuals may be asymptomatic or exhibit only mild symptoms. The disease typically runs its course in about a week, but the cough and weakness might last for several weeks, and pneumonia and death can occur.

The advice and assistance of W.P.Glezen, A.Kendal, E.Kilbourne, and A.Monto in the preparation of this appendix are gratefully acknowledged. The committee takes full responsibility for any judgments or assumptions.



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