VIEWS & REVIEWS

Influenza - a thing of the past? Truly effective control of influenza may be a

'realistic goal for the early years of the next millennium', say Drs Gregory Poland from the Mayo Medical School and Foundation, Minnesota, and Robert Couch from the Baylor College of Medicine, Texas, US.!

Their comment is in response to the publication in JAMA of the results of a phase III trial of Aviron's intranasal influenza virus vaccine ['FluMist'] showing that the agent not only protects against influenza-like illness, but also reduces illness-related work absenteeism and healthcare resource use.2 Drs Poland and Couch comment that these results are important from an individual, medical and public health point of view.

However, they go on to say that although influenza virus causes significant morbidity and mortality, annual influenza immunisation rates remain below desired levels. Drs Poland and Couch explain that annual influenza vaccine programmes are difficult, inconvenient and expensive to implement, because of barriers including logistics, direct and indirect costs associated with the trained personnel needed to administer an injection, and patient and physician compliance.

Drs Poland and Couch therefore consider that the major advantage associated with an intranasal influenza vaccine is its ease of administration. They point out that such a vaccine has a number of potential advantages. For instance, being able to obtain the vaccine over-the-counter would eliminate the cost and inconvenience associated with mass influenza immunisation programmes. In addition, being able to self-administer the vaccine may lead to an improve­ment in the ability to prevent influenza transmission. Drs Poland and Couch add that such factors would be an advantage for the development of a vaccine-based programme for the prevention of epidemic influenza outbreaks. 1. Poland GAo et al. Intranasal influenza vaccine: adding to the armamentarium for influenza control1ournal of the American Medical Association 282: 182-184.

141ull999 2. Nichol KL. et al. Effectiveness of live. attenuated intranasal influenza virus vaccine in healthy, working adults: a randomized controlled trial. 10urnal oflbe American Medical Association 282: 137-144, 141ull999 ..,,6295'

>- Editorial comment: The study results were presented at the International Symposium on Influenza and Other Respiratory lilUSes, held in Kapalua, Hawaii, US, in December 1998 [see Inpharma 1167: 10,12 Dec 1998; 800726995].

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