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Finland: THL Announces the Start Of H5 Vaccination For High Risk Groups (Aug 6th)

Michael Coston

Editor, Senior Moderator
Finland: MOH Announcement On Avian Flu Vaccine Availability For People At High Risk


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BSL-3 – Credit CDC PHIL
#18,131

The H5N1 avian flu threat has been with us for more than 2 decades, and over that time the virus has continually evolved. Nearly 4 dozen H5Nx candidate vaccine viruses (CVVs) have been selected by WHO for development, although many of these older CVVs are for viruses that no longer circulate in the wild, having been supplanted by newer versions.

Having a proven CVV already tested and approved can save months of valuable time if mass production and distribution of a pandemic vaccine are ever required, although an emerging pandemic virus might not be an exact match.​



Since H5 viruses have been such a rapidly moving target, early attempts to stockpile large quantities of vaccine have pretty much been abandoned. Most of those early stockpiles have long expired, or no longer match circulating strains.

Rather than pour expired vaccine down the drain, in 2008 Japan offered free H5 vaccines to high risk groups (see Japan Begins Pre-pandemic Inoculation Of Health Care Workers).



While it isn't certain exactly how protective current CVVs would be against the current (and highly diverse) crop of H5N1 viruses, last week the European Union announced the procurement of 665,000 doses of H5N1 vaccine from Seqirus, with the first shipment to go to Finland.

PRESS RELEASE 11 June 2024 Brussels
Commission secures access for Member States to 665,000 doses of zoonotic influenza vaccines to prevent avian flu

Today, the Commission's Health Emergency Preparedness and Response Authority (HERA) as part of its mandate on preparedness, has signed on behalf of participating Member States, a joint procurement framework contract for the supply of up to 665,000 pre-pandemic vaccine doses of the up-to-date Zoonotic Influenza Vaccine Seqirus, as well as an option for a further 40 million doses over the duration of the contract. Thanks to this contract the participating Member States will have access to medical countermeasures to prevent avian flu.

The vaccine is intended for those most exposed to potential transfers of avian influenza from birds or animals, such as poultry farm workers and veterinarians. It aims to prevent the spread or potential outbreaks of avian influenza in Europe, protecting citizens and livelihoods. The vaccine is the only preventive zoonotic avian influenza vaccine currently authorized in the EU.

Fifteen EU and EEA Member States are participating in this voluntary procurement with the company Seqirus UK Ltd. The contract allows each participating country to take into account their public health context and order vaccines depending on national need. The contract will run for a maximum of 4 years.

Shipments are currently being prepared to Finland for immediate vaccinations of the workers at risk of exposure, at the Member State's request. Shipments to other participating countries will follow.

Background

Seqirus UK Ltd has an EU wide modified marketing authorisation for this vaccine for use in adults, which protects against flu caused by H5 strains of the influenza A virus.

The EU's mechanism of joint procurement is laid down in the EU's Joint Procurement Agreement for Medical Countermeasures, which is signed by 36 countries, including all EU and EEA Member States. The mechanism allows the participating countries to jointly procure medical countermeasures on a voluntary and flexible basis. These countermeasures include vaccines, therapeutics, medical devices, and these can be used as an alternative or to complement to procurement at national level.

The Agreement secures a more equitable access to specific medical countermeasures and improves the security of supply, together with more balanced prices for the participating countries. The Agreement also contributes to the EU-level preparedness for public health crises or pandemics.




This initial order is enough to vaccinate 330,000 people, and the full order enough for 20 million. But the EU would need something in excess of 1 billion doses to cover their entire population.

Although it isn't expressly stated why Finland will receive he first shipment, Finnish fur farms have been hard hit over the past year with H5N1, with > 70 farms affected and more than 500,000 animals (mink, foxes, raccoon dogs) culled.


While reporting of new cases ended last December, the testing of hundreds of farms, and the culling and disposal of hundreds of thousands of animals, appears to have taken a heavy financial toll on their inspection agency.​



Last week we saw a disturbing announcement that Finland's Food Agency To Curb Services & Lay Off Animal Disease Investigators, where they reported:
. . . The Food Agency has to lay off personnel and . . . leave unfilled vacancies.

The cost-saving measures also affect the Food Agency's service ability in laboratories investigating animal diseases. We try to serve our customers as well as possible, but there may be a delay in the completion of studies during the rest of the year.



Given the absence of any follow-up reports on the inspection and culling of fur farms since late last fall, it is difficult to know how many of the Finland's 400+ fur farms were actually inspected, and how robust re-inspection and continued surveillance of Finland's fur farms will be going forward.

Fur farms are undoubtedly high risk venues for zoonotic transmission of novel flu viruses (see PNAS: Mink Farming Poses Risks for Future Viral Pandemics), making those workers an obvious choice for early vaccination.​



Against this backdrop, we have the following statement issued by Finland's MOH on plans to offer the H5N1 vaccine to vulnerable groups, including farmers and veterinarians.
Avian influenza vaccine to be offered to people at risk of infection
Ministry of Social Affairs and Health

Publication date13.6.2024 15.07
PRESS RELEASE

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Avian influenza vaccines will be offered to people who may be exposed to avian influenza. Vaccinations are scheduled to start as soon as possible.

Finland will receive vaccines as part of the EU’s joint procurement, in which 15 countries are taking part. The framework contract was signed by the EU’s Health Emergency Preparedness and Response Authority (HERA) on behalf of the participating Member States.

The avian influenza vaccine was developed by the pharmaceutical company Seqirus UK Ltd, and the contract for the supply of this vaccine will run for four years. The countries participating in the joint procurement will order vaccines depending on their national need.

Vaccine helps to protect fur and poultry farm workers and official veterinarians

The vaccine is intended for poultry and fur farm workers, veterinarians and other people who are at high risk of being infected with avian influenza. Based on a risk assessment, the Finnish Institute for Health and Welfare will determine the groups of people for whom the vaccine is recommended. The vaccine aims to prevent avian influenza infections and the severe forms of the disease.

The Finnish Institute for Health and Welfare will provide more information on avian influenza vaccinations soon. The wellbeing services counties are responsible for organising the vaccinations and providing information at the local level, whereas the Finnish Medicines Agency and the Finnish Institute for Health and Welfare are responsible for monitoring the safety of vaccines.

Avian influenza is poorly transmitted to humans

Avian influenza A(H5N1) circulated extensively among wild birds throughout Europe in 2020–2023. In Finland, the A(H5N1) virus caused exceptionally large mass deaths of wild birds and infections among farmed fur animals in summer 2023.

So far, no avian influenza infections have been detected in humans in Finland. Avian influenza can be transmitted to humans by infected or dead animals or their secretions or faeces. However, the avian influenza virus is poorly transmitted to humans, and in general, very few cases of infection occur.

The Finnish Food Authority monitors the occurrence of avian influenza in wild birds in Finland and works to prevent the spread of the disease on farms.

Inquiries:

Taneli Puumalainen, Director General, Ministry of Social Affairs and Health, tel. +358 295 163 280, taneli.puumalainen(at)gov.fi

Anniina Virkku, Medical Specialist, Finnish Institute for Health and Welfare, tel. +358 29 524 8231, anniina.virkku(at)thl.fi






It remains to be seen, of course, how effective that vaccine will be against current and future strains of H5N1, and how much uptake it will see from farm workers.

But it is - at the very least - a proactive step against the burgeoning H5N1 threat.​



And those have been in relatively short supply of late.


https://afludiary.blogspot.com/2024/06/finland-moh-announcement-on-avian-flu.html
 
Last edited:
Finland MOH: Target Groups For H5N1 Vaccination

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#18,147

Finland, whose fur industry has been hit particularly hard by H5N1 over the past year - with > 70 farms infected and > 500,000 animals (mink, fox, raccoon, etc.) culled - announced earlier this month that the financial drain has forced them to Curb Services & Lay Off Animal Disease Investigators.

A few days later, Finland's MOH announced they would offer the H5N1 vaccine to `high risk' individuals `as soon as possible.


Today, Finland's Institute for Health and Welfare (THL) released details on their plan to vaccinate high risk individuals over the summer against H5N1, with express goal of preventing dual infection next fall with H5N1 and seasonal flu.




As we discussed in The `Other Mixing Vessel' For Pandemic Influenza, while a pandemic reassortment might emerge from birds, pigs, or some other mammalian host - the most obvious path would be through a dual seasonal influenza-novel flu infection in a human host.

Both the 1957 H2N2 pandemic and the 1968 H3N2 pandemic emerged after an avian virus reassorted with the then-current seasonal flu. While the exact circumstances are unknown, human co-infection is considered a distinct possibility.​


First today's statement, after which I'll have a bit more.

Avian flu vaccinations begin - the vaccine is offered to those at increased risk of infection

Release date 25.6.2024

THL, in cooperation with the Food Agency, has drawn up a recommendation on target groups for bird flu vaccination. The vaccine is offered to those over 18 years of age who, due to their work or other circumstances, have an increased risk of contracting bird flu.

Such are:

  • persons in contact with fur animals in fur farms
  • those working with poultry who are in contact with poultry, excluding slaughterhouse workers
  • persons involved in the handling and disposal of sick or dead birds or other animals or in the cleaning of premises, such as those working in animal by-product processing facilities
  • bird ringers
  • those who work in aviaries caring for wild birds
  • workers in petting zoos and aviaries
  • official veterinarians
  • laboratory workers who handle avian influenza virus or samples that may contain it
  • close contacts of a suspected or confirmed bird flu case, should human cases occur.
For those at risk of infection, 20,000 doses of bird flu vaccine have been procured in Finland through EU joint procurement. The amount is enough to vaccinate 10,000 people with two doses.

Bird flu vaccinations aim to protect those at risk of contracting bird flu from serious disease caused by the virus.

In addition, the goal is to prevent a situation where the bird flu virus infects humans at the same time as the seasonal flu virus, which could enable the emergence of a new type of virus.
So far, there are no human bird flu infections in Finland

So far, no human infection with bird flu has been detected in Finland.

You can get infected from sick or dead animals or their secretions. However, the bird flu virus is weakly contagious to humans, and cases of infection are generally very rare.

The H5N1 subtype bird flu virus, which has also caused disease in wild and farmed animals in Finland in recent years, has also been linked to serious or fatal disease cases in humans.
Vaccinations will be started in welfare areas as soon as possible

The H5N8 bird flu vaccine, developed to combat the H5 subtype bird flu virus, received marketing authorization in the EU in April 2024.

The vaccination series includes two doses. The second dose is given no earlier than 3 weeks after the first dose. However, the vaccination interval can be clearly longer.

"The goal is to start vaccinations in the welfare areas as soon as possible, so that the two-dose vaccination series can be offered to the vaccinated before the start of the autumn flu season," says THL's expert doctor Anniina Virkku .

The welfare areas are responsible for organizing vaccinations and tell you where and when you can get the vaccination.

Fimea and THL are responsible for safety monitoring of vaccines.
The bird flu situation in Finland is calm

In 2023, there were large mass deaths of wild birds in Finland, which were caused by avian influenza virus infection. The virus also spread widely to fur farms, causing high morbidity and mortality in animals.

This year, bird flu has occurred in wild birds significantly less than last year. So far, the Food Agency has confirmed only one disease case.

The Food Agency monitors the occurrence of bird flu in wild birds in Finland and prevents the spread of the disease on animal farms.

(Continue . . . )



Two weeks ago, the EU Commission secured access for Member States to 665,000 doses of zoonotic influenza vaccines to prevent avian flu, and announced the first shipment would go to Finland. The Seqirus vaccine is based on an older strain of the H5 virus, but is expected to provide some degree of protection against currently circulating strains.

But exactly how much real-world protection they will provide is unknown. Even in a good year, our seasonal flu vaccines are only 50%-60% protective.​

While vaccines and antivirals will be important tools during our next pandemic, they will be in limited supply - will likely be only partially effective - and will only help blunt the impact.

Although the numbers remain small, we've seen some worrisome signs that H5N1 (and more recently, seasonal flu) may be picking up varying degrees of antiviral resistance.
Despite their limitations, I'd still rather go into a pandemic with these tools than without them. But avoiding a pandemic - if at all possible - remains a far preferable scenario.

https://afludiary.blogspot.com/2024/06/finland-moh-target-groups-for-h5n1.html
 
Finland: THL Announces the Start Of H5 Vaccination For High Risk Groups


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#18,227

Finland has been hit unusually hard by HPAI H5N1, with more than 70 fur farms infected, and > 500,000 animals culled since last summer. Reporting on this crisis dropped off abruptly last December, and follow-up reports have been rare.

The economic toll of this outbreak has been enormous, with compensation to affected farmers often delayed. Two months ago, we saw a disturbing announcement that Finland's Food Agency To Curb Services & Lay Off Animal Disease Investigators, where they reported:

. . . The Food Agency has to lay off personnel and . . . leave unfilled vacancies.

The cost-saving measures also affect the Food Agency's service ability in laboratories investigating animal diseases. We try to serve our customers as well as possible, but there may be a delay in the completion of studies during the rest of the year.

This could explain why we've heard so little about HPAI H5N1 out of Finland since late last year. It may boil down to a lack of resources. But few details are being shared.
Shortly after this statement, Finland's MOH announced their acquisition of a limited quantity of an older HPAI H5 vaccine for high risk individuals, including farm workers and veterinarians.​

Today, Finland's Institute for Health and Welfare (THL) announced that vaccinations could finally begin - but that the vaccine they received will expire at the end of September - and recipients will need to get their first shot in August and their second shot before the end of next month.

The (translated) announcement follows. I'll have a bit more after the break.
Release date 6.8.2024

According to the recommendation of the Institute of Health and Welfare (THL), bird flu vaccination is offered to those over 18 years of age who, due to their work or other circumstances, have an increased risk of contracting bird flu. The vaccination series includes two doses. The batch of vaccine received in Finland expires at the end of September, so those at risk of infection should take the first vaccine dose during August.

Bird flu vaccinations aim to protect those at risk of contracting bird flu from serious disease caused by the virus.

Taking the vaccine is voluntary. THL has drawn up a recommendation in cooperation with the Food Agency, according to which bird flu vaccination is recommended:

  • for those in contact with fur animals in fur farms
  • for those working with poultry who are in contact with poultry, excluding slaughterhouse workers
  • for those involved in the handling and disposal of sick or dead birds or other animals or in the cleaning of facilities, such as those working in animal by-product processing facilities
  • for bird ringers
  • for those working in aviaries caring for wild birds
  • for workers in animal farms and aviaries
  • for official veterinarians
  • for laboratory workers handling avian influenza virus or samples that may contain it
  • for close contacts of a suspected or confirmed bird flu case, should human cases occur.
For the vaccination of these groups, Finland has received 20,000 doses of H5N8 bird flu vaccine through EU joint procurement. The amount is enough to vaccinate 10,000 people with two doses.

The batch of vaccine received in Finland must be used by the end of September, so those at risk of bird flu infection should take the first vaccine during August. The second vaccine dose is given at least three weeks after the first vaccination. Those who were vaccinated in August or earlier must take the second vaccine dose by the end of September.

Welfare areas responsible for organizing vaccinations. You can inquire at health stations about where you can get the vaccination.

The bird flu vaccine is expected to provide both immediate protection against infection and long-term protection against severe forms of the disease. When the vaccines are administered before the autumn flu season, a situation is prevented where the bird flu virus would infect a person at the same time as the seasonal flu virus, which could enable the emergence of a new type of virus.

"Since vaccines also offer long-term protection, it is important that those at risk of infection take the vaccine now. Although there is no certainty about the effectiveness of the vaccine against the viruses that occur during the spring migration of next year's birds, the vaccine is still an important means of protection against a serious disease," says THL's leading expert Mia Kontio .

So far, there are no human bird flu infections in Finland

Although the bird flu epidemic continues around the world, bird flu has occurred in wild birds in Finland this year significantly less than last year. There have been no cases of bird flu in fur farms in Finland this year.

The bird flu virus is weakly contagious to humans, and cases of infection are very rare. So far, no human infection with bird flu has been detected in Finland.

You can get infected from sick or dead animals or their secretions. Around the world, bird flu has been linked to serious and even fatal disease cases in humans.

The Food Agency monitors the occurrence of bird flu in wild birds in Finland and prevents the spread of the disease on animal farms. Fimea and THL are responsible for safety monitoring of vaccines.


The concern, as we've discussed previously, is the potential for a farm worker to be infected with both H5N1 and seasonal flu simultaneously, providing the H5 virus with an opportunity to reassort with a more humanized virus.




Vaccinating high-risk individuals against H5N1 sounds good in theory, but these vaccines were formulated against an older H5 strain, and no one really knows how effective they will be in preventing infection against the current H5N1 virus (or the one that emerges tomorrow).

Normally, influenza vaccines do best reducing the severity of infection, rather than preventing it. And previous studies on H5N1 vaccines have suggested they may be less immunogenic than seasonal flu vaccines.​

There is an argument to be made that having these 20,000 doses of about-to-expire H5N1 vaccines in the arms of farm workers is preferable to pouring it down the drain, a strategy we've seen employed previously in Japan and Taiwan (see Japan Begins Pre-Pandemic Inoculation Of Health Care Workers and Taiwan Offers Public Bird Flu Vaccinations.)

Here in the United States, the calculation has been made to promote the seasonal flu vaccine among farm workers (see CDC: $5 Million Initiative to Improve Uptake of Seasonal Flu Shots For Livestock Workers), rather than roll out an experimental (and potentially divisive) H5N1 shot.

Last May the CDC contracted with CSL Seqirus to prepare 4.8 million doses of two different H5N1 vaccines, but so far they see little value in releasing it.​

That could change over time, of course. But it is likely we'd need to create, manufacture, and deploy a an updated strain-specific vaccine - a process that could take months, possibly years - to effectively deal with a severe H5 pandemic.​
 
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