The presence of a vaginal fistula has a profound effect on the quality of life since there is little control over the passage of urine and feces through the vagina.Urogenital fistulas are often classified according to their cause: obstetric fistula, congenital fistula and iatrogenic fistula. Urogenital fistulas can be classified by size and more specific anatomical location such as upper vagina or posterior vaginal wall. Causes
In developed countries, the causes of fistulas are iatrogenic (caused by surgical accidents). Physician error and lack of training contribute to the unsuccessful treatment of obstetric fistulas in developing countries. Injuries to pelvic organs are a cause of fistulas. Most of those not caused by obstructed labor develop from injuries. An example of this would be the improper placement of an instrument during a hysterectomy. Fistulas can form after long-term pessary use, hysterectomies, malignant disease and pelvic irradiation, pelvic surgery, cancer or a pelvic fracture. Fistulas are sometimes found after a cesarean section. Providers can also inadvertently cause a fistula when performing obstetric or gynecological surgery. The more training the physician has had, the less likely a uro-vaginal fistula will occur. Some women develop more than one fistula. Treatment
Surgery is often needed to correct a fistula leading to the vagina. Conservative treatment with an in-dwelling catheter can be effective for small and recently formed urinary fistulas. It has a success rate of 93%. Collagen plugs are used but have been found not to be successful. The surgical treatment to correct can be approached in different ways.
European UnionThe composition of virus vaccines for use in the European Union for the 2020–2021 Northern Hemisphere influenza season recommended by the European Medicines Agency on April 1, 2020, was:Egg-based or live attenuated trivalent vaccines should contain:
an A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus;
an A/Hong Kong/2671/2019 (H3N2)-like virus;
a B/Washington/02/2019 (B/Victoria lineage)-like virus.Cell-based trivalent vaccines should contain:
an A/Hawaii/70/2019 (H1N1)pdm09-like virus;
an A/Hong Kong/45/2019 (H3N2)-like virus;
a B/Washington/02/2019 (B/Victoria lineage)-like virus.A B/Phuket/3073/2013-like virus is recommended in addition to the strains mentioned above for the quadrivalent vaccines. 2021 southern hemisphere
The composition of vaccines for use in the 2021 Southern Hemisphere influenza season influenza season recommended by the World Health Organization in September 2020:For egg-based (trivalent):

an A/Victoria/2570/2019 (H1N1)pdm09-like virus;
an A/Hong Kong/2671/2019 (H3N2)-like virus; and
a B/Washington/02/2019 (B/Victoria lineage)-like virus.For cell- or recombinant-based (trivalent):

an A/Wisconsin/588/2019 (H1N1)pdm09-like virus;
an A/Hong Kong/45/2019 (H3N2)-like virus; and
a B/Washington/02/2019 (B/Victoria lineage)-like virus.The quadrivalent version should contain, in addition to the above:

a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.In Australia, the standard vaccine under the National Immunisation Program for 2021 is the quadrivalent one. 2021–2022 northern hemisphere
The composition of virus vaccines for use in the 2021–2022 Northern Hemisphere influenza season is

European UnionThe composition of virus vaccines for use in the European Union for the 2021–2022 Northern Hemisphere influenza season recommended by the European Medicines Agency on March 30, 2021, is:Egg-based or live attenuated trivalent vaccines should contain:
an A/Victoria/2570/2019 (H1N1)pdm09-like virus;
an A/Cambodia/e0826360/2020 (H3N2)-like virus;
a B/Washington/02/2019 (B/Victoria lineage)-like virus.Cell-based trivalent vaccines should contain:
an A/Wisconsin/588/2019 (H1N1)pdm09-like virus;
an A/Cambodia/e0826360/2020 (H3N2)-like virus;
a B/Washington/02/2019 (B/Victoria lineage)-like virus.A B/Phuket/3073/2013-like virus is recommended in addition to the strains mentioned above for the quadrivalent vaccines.