SWINE INFLUENZA VACCINE USAGE
General Recommendations

High-Risk Groups: Bivalent influenza A vaccine is recommended for persons of all ages who have such chronic health problems as 1) heart disease of any etiology, particularly with mitral stenosis or cardiac failure, 2) chronic bronchopulmonary diseases, such as asthma, chronic bronchitis, cystic fibrosis, bronchiectasis, tuberculosis, and emphysema, 3) chronic renal failure, and 4) diabetes mellitus and other chronic metabolic disorders.

Bivalent influenza A vaccine is also recommended for older persons, particularly those over age 65 years. This is because excess mortality in influenza outbreaks is seen among those in the older age groups as well as among patients with chronic illnesses.

General Population: Monovalent A/New Jersey/76 (swine influenza virus) vaccine is recommended for all persons not in the high-risk groups who can safely and effectively be vaccinated. Age criteria for vaccine recipients will be derived from the field trials being conducted at the present time and will be included in the final ACIP influenza statement to be published in July 1976.

Information for Vaccinees: Influenza vaccination should be preceded by informing all potential recipients or the parents of children to be vaccinated of the general characteristics of the vaccine, what its benefits are, and what side effects it has. Comparable procedures for providing this information should be used. There should be ample opportunity for recipients to have their questions answered, and there should be documentation that information was received and vaccination desired. Documentation could be by the signature of potential recipients or of parents or guardians or by other systems of records judged sufficient to identify those who, after being informed, choose to be vaccinated.

Dosage and Schedule

Only one dose of the bivalent vaccine or the monovalent influenza A vaccine should be needed. Age criteria, proper dosages, and routes of administration will be derived from field study results. Influenza vaccination programs should begin as vaccines become available and should continue through the fall so that the target population can be vaccinated before winter, the season when influenza characteristically occurs.

Side Effects

Influenza vaccines currently produced by manufacturers in the United States are purified by zonal centrifugation and should produce few severe side effects. Before these new purification techniques came into general use in the late 1960s, influenza vaccines fairly commonly caused local and systemic reactions considered objectionable by many recipients. With current influenza vaccines, however, only mild local reactions, such as erythema and tenderness at the injection site, will be relatively common. Systemic reactions, including low-grade fever, chills, malaise, or headache, should occur only infrequently. These conclusions are based on experience with influenza vaccines similar to the ones that will be used this year. Data from field trials with the actual 1976-1977 vaccines will help delineate side effects. Precautions

Persons with known hypersensitivity to egg protein should not be given influenza vaccine except under the close supervision of a physician.

Concurrent Administration of Influenza and Other
Vaccines

It would seem prudent not to administer influenza vaccine along with vaccine containing diphtheria, pertussis, or tetanus antigens since fever is often associated with these antigens, and their simultaneous administration might increase the chance of febrile responses. Furthermore, influenza vaccine should probably not be administered within 14 days after vaccination with the live, attenuated measles virus vaccine since measles vaccine is known to induce fever in 15 percent or more of vaccinees beginning about 6 days after vaccination and lasting several days.

If, in the context of the National Influenza Immunization Program, health agencies plan to provide vaccines other than those against influenza, they should take into account such matters as the risk of coincidental vaccine reactions, the need for informing recipients about all antigens to be given and for documenting vaccine acceptance, and the record-keeping commitments that giving multiple antigens entail.

Every effort should be made during the period of the National Influenza Immunization Program to maintain routine vaccination activ ties and to conduct whatever programs are needed to prevent and control outbreaks of vaccine-preventable illnesses.

Epidemiologic Notes and Reports

In October 1975 a family camping in Trinity County (California) shot a bear which was menacing them at their campsite. Some bear meat was eaten after cooking, some was made into jerky, and a large amount was frozen or given to friends. Ten days after eating some of the cooked meat and jerky which had been smoked for 4 days, a 77year-old man developed diarrhea, abdominal distress, and muscle aches. He recovered without treatment. His serum,

obtained 3 weeks after onset, showed a bentonite flocculation titer of 1:320, which is diagnostic for trichinosis.

The Humboldt-Del Norte Health Department immediately began investigation of this episode to prevent further exposures. Laboratory examination of freezer-stored bear meat showed numerous encysted trichinae. All 34 other individuals who had consumed the bear meat or jerky were interviewed for a history of illness; serum specimens for