It was recommended that all Health Care Professional should be vaccinated and that this includes Medical Professionals as well as other workers who are in the hospital and outpatient settings, medical emergency-response workers as well as everybody training. And so if you're a work-clerk working in a hospital, if you're a secretary working in a hospital, if you're in a healthcare setting, you're going to transmit and share virus. You should be vaccinated. And as you have heard New York state is taking one step further and it has how mandated vaccination across the hospitals.
And it's because of this, when we take a look at the pediatric population which should be the easiest population of vaccinating because they are used to coming in for vaccines. We are very, very poor, less than 50% of the population who should be vaccinated, ever get vaccinated in any given year. This was '06, this has been mirrored year after year, year, we are not very good in getting kids back in to get vaccinated. It's a narrow window, vaccine is only available for a period of October through February or March. Kids come in the summer for their preschool camp physicals, they don't remember to come back in, we are busy, they come in and they are seeking, don't give it to them and they don't come back.
All the reasons and excuses but ultimately, we only vaccinate half of the kids and even more worrisome is of the children who get one vaccine. If they're less than anything, they need a booster four weeks later. You see, less than 25% of them ever get their second booster. So they are not protected in that first year. And the rule is if you get in your first year, if your eights years in age and under, you need two vaccines, four weeks apart.
If you don't get two vaccines in the first year than in your second year, you should get two vaccines four weeks apart. If you don't get in your second year, the third year you are down to just one vaccine because you had two years leaving up to, so you don't need that second vaccine in the third year performance. But you try to get that second vaccine in -- or before the second year at the end of the day.
What vaccines we have available? Well, there are really two forms, we have this standard trivalent and you have the live attenuated influenza vaccine, FDA approved these in the years that you see with our trivalent since the 60s, the live attenuated since 2003.
The relative administration is different, the route administration is into muscular versus intranasal, and the difference relates to the humoral response. You get only humoral response, IGG response, with the standard chilled trivalent vaccine where we get a mucosal cellular response, T-cell response as well as that, immunoglobulin response with that. I'll show you why in just a moment.
But it really comes down to what you are giving. Ultimately, you are giving subunits that are in affidavit, that are standardized leukemia gluten, whereas with the live attenuated you are giving an adapted whole virus particle. So you are giving the entire virus which is stimulating full immunologic response as opposed to just immunoglobulin response.
Their growth medium is same, they are both growing chickened. If you're neutralizing antibody to the hemoglobin, but with a fly virus since it has the potential to replicate, it has other epitopes, you get a more complete immunologic response stimulating your cellular immune system, the T-cell and mucosal portion of the response, not just the B-cell.
You are also going to have active antibody to neuraminidase as well as the other internal proteins which will not be present in the enactment. And really the reason is supported because cytokine involves and as I alluded to earlier cytokine storm is an important part of what makes us sick, and in some cases of mortality. Influenza or the localize will cause the release of a number of cytokines and it looks like IL-6 and TNF-alpha are two of the most important which are responsible for the signals, the symptoms that we have as in the disease.
Well, we also note that TNF-alpha, and this is natural killer T-cell activity and that's your first line of defense, when it comes to fighting off influenza viral infection. So the ability to have -- whereas the live attenuated is haemagglutinin and neuraminidase combined with the core protein and the way that occurs is that there is a master donor virus which has been attenuated, so that it cannot replicate at body temperature.
So, once you –- when you mix this master donor virus to the wild type haemagglutinin and neuraminidase genes are transmitted or are attached to your core and so you now have the haemagglutinin and neuraminidase that you expect in the present season combined with the core from the master donor which is attenuated so it will not replicate in body temperature. So for called cold adapted.
And so it's able to replicate at 25 degree centigrade but it is unable to replicate above 37 degree centigrade. But since you are giving it in a nasal mucosa, you get activation of immunity beginning here which includes that T-cell response of this would be end of the death. The studies I think are very interesting, they are all published in major journals, this was published in the New England Journal back in 2007, study over 84,000 children, these were 6-59 months of age in 2004 bio-flu season. The exclusion criteria or as you see here, they wanted just the pure group of healthy children, so they excluded all these other morbidities at the end of the day.
And they wanted to make sure there was an equal spread across every age sub-groups so there is equal number of patients who were 6-23 months, 24 and 35, and 36-59, there is also an equal number who had previous infection, equal number who had the presence or absence in the history of these as well as the country residence. So they are trying to make it as equal across the board as they could so that the groups were comparable at the end of the day.
The primary end point was culture confirmed CDC to find influenza like illness against the antigenically matched strainer virus. So they look to see what virus was in that specific community and it was matched to the vaccine, firstly that was infection by mismatch virus to the vaccine over the course of this study period. They both are able to keep attack rate of matched virus and the attack rate of the mismatched virus and virus that had a different antigen then what the vaccine was supposedly protecting us from.
They also looked at the safety end points that are accordance specifically medically significant reasoning, that’s we are using in required medical care and treatment. What they found and this is in the two years old to five year old, was that compared to inactivated flu vaccine or standard flu vaccine, there was 52% reduction in attack rate or in cases against the matched virus, a 54% reduction against mismatched virus.
So, it was clear that it afforded at least since the pediatric population take greater degree of protection even when the vaccine was not matched to the virus that circulated in the community. With an overall drop of 54% in total cases for the end of that flu season period.
Another study that had been done a number of years earlier, and this was a study that actually led them to think that this might occur. This was a two year study, it was a planned two year study to see the continued protection of patients given flu vaccine in two consecutive years. And it turned out that in the first year of the study, 1996, the vaccine was well-matched to what was in the community. But in the second year, the vaccine strain was not matched to what was in the community.
So we had strictly by accident, a mismatched year in the second year of the study and of the 1600 children who were vaccinated during the first year they were able to get back 1358, the same children in the second year for their second vaccine. Comparing it this case, the placebo, they found as you would expect a huge drop off in attack rate in the first year against matched virus compared to the placebo but they also found a very nice drop off in protection or in attack rate even in the second year, which turned out to be a mismatched virus, two year vaccine.
So I think it gives us a nice feeling for what the benefit is. When you take a look at the last 12 years, six of them have been mismatched year, that is six of the last 12 years, the vaccine that we give has not been a match to the influenza that’s circulated in the community. And so it tells us just how imprecise we are on a year by year basis and that's what leads many people to think influenza by vaccine doesn't work all that well. And it's really our ability to predict what's going to circulate that.
The safety end points that were looked, went through 180 days of hospitalization, and they looked at medically significant reasoning, up to six weeks after the dose, and they found that in this population of 2-6 year olds, hospitalization rate was no different, in fact, it was a little bit less in the patients who were given the live attenuated. And the reasoning rate was actually a little bit less who were given live attenuated. It was in the 12-24 month old group that they saw an increase in reasoning, and they also saw an increase in old caused hospitalization where they analysed that data, turned out that the reason for hospitalization was more from GI, diarrhea, or dehydration, not from respiratory disease.
So they are still not sure what that means but it was only in the youngest, 12-24 month group that they saw that. But because of that signal, they have been very cautious in expanding into a younger group and they have also been very cautious in expanding into group of children who are veasors, who are resonetics. And that's why you see the present precaution, not because you saw the data in the two year old group but because of data in the younger group, that are at uncertainty as to what it means yet across the larger population. And on going studies are going to be done to take a look at that.
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