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Suzuki A, Mizumoto K, Akhmetzhanov AR, Nishiura H. Interaction Among Influenza Viruses A/H1N1, A/H3N2, and B in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214179. [PMID: 31671851 PMCID: PMC6862093 DOI: 10.3390/ijerph16214179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
Abstract
Seasonal influenza epidemics occur each winter season in temperate zones, involving up to 650,000 deaths each year globally. A published study demonstrated that the circulation of one influenza virus type during early influenza season in the United States interferes with the activity of other influenza virus types. However, this finding has yet to be validated in other settings. In the present work, we investigated the interaction among seasonal influenza viruses (A/H1N1, A/H3N2 and B) in Japan. Sentinel and virus surveillance data were used to estimate the type-specific incidence from 2010 to 2019, and statistical correlations among the type-specific incidence were investigated. We identified significant negative correlations between incidence of the dominant virus and the complementary incidence. When correlation was identified during the course of an epidemic, a linear regression model accurately predicted the epidemic size of a particular virus type before the epidemic peak. The peak of influenza type B took place later in the season than that of influenza A, although the epidemic peaks of influenza A/H1N1 and A/H3N2 nearly coincided. Given the interaction among different influenza viruses, underlying mechanisms including age and spatial dependence should be explored in future.
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Affiliation(s)
- Ayako Suzuki
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan.
- CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama 332-0012, Japan.
| | - Kenji Mizumoto
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University Yoshida-Nakaadachi-cho, Sakyo-ku, Kyoto 606-8306, Japan.
| | - Andrei R Akhmetzhanov
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan.
- CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama 332-0012, Japan.
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15-Jo Nishi 7-Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan.
- CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama 332-0012, Japan.
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52
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Zak AJ, Hill BD, Rizvi SM, Smith MR, Yang M, Wen F. Enhancing the Yield and Quality of Influenza Virus-like Particles (VLPs) Produced in Insect Cells by Inhibiting Cytopathic Effects of Matrix Protein M2. ACS Synth Biol 2019; 8:2303-2314. [PMID: 31487465 DOI: 10.1021/acssynbio.9b00111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To provide broader protection and eliminate the need for annual update of influenza vaccines, biomolecular engineering of influenza virus-like particles (VLPs) to display more conserved influenza proteins such as the matrix protein M2 has been explored. However, achieving high surface density of full-length M2 in influenza VLPs has been left unrealized. In this study, we show that the ion channel activity of M2 induces significant cytopathic effects in Spodoptera frugiperda (Sf9) insect cells when expressed using M2-encoding baculovirus. These effects include altered Sf9 cell morphology and reduced baculovirus replication, resulting in impaired influenza protein expression and thus VLP production. On the basis of the function of M2, we hypothesized that blocking its ion channel activity could potentially relieve these cytopathic effects, and thus restore influenza protein expression to improve VLP production. The use of the M2 inhibitor amantadine indeed improves Sf9 cellular expression not only of M2 (∼3-fold), but also of hemagglutinin (HA) (∼7-fold) and of matrix protein M1 (∼3-fold) when coexpressed to produce influenza VLPs. This increased cellular expression of all three influenza proteins further leads to ∼2-fold greater VLP yield. More importantly, the quality of the resulting influenza VLPs is significantly improved, as demonstrated by the ∼2-fold, ∼50-fold, and ∼2-fold increase in the antigen density to approximately 53 HA, 48 M1, and 156 M2 per influenza VLP, respectively. Taken together, this study represents a novel approach to enable the efficient incorporation of full-length M2 while enhancing both the yield and quality of influenza VLPs produced by Sf9 cells.
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Affiliation(s)
- Andrew J. Zak
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Brett D. Hill
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Syed M. Rizvi
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Mason R. Smith
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Madeleine Yang
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Fei Wen
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
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53
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Jang YH, Seong BL. The Quest for a Truly Universal Influenza Vaccine. Front Cell Infect Microbiol 2019; 9:344. [PMID: 31649895 PMCID: PMC6795694 DOI: 10.3389/fcimb.2019.00344] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022] Open
Abstract
There is an unmet public health need for a universal influenza vaccine (UIV) to provide broad and durable protection from influenza virus infections. The identification of broadly protective antibodies and cross-reactive T cells directed to influenza viral targets present a promising prospect for the development of a UIV. Multiple targets for cross-protection have been identified in the stalk and head of hemagglutinin (HA) to develop a UIV. Recently, neuraminidase (NA) has received significant attention as a critical component for increasing the breadth of protection. The HA stalk-based approaches have shown promising results of broader protection in animal studies, and their feasibility in humans are being evaluated in clinical trials. Mucosal immune responses and cross-reactive T cell immunity across influenza A and B viruses intrinsic to live attenuated influenza vaccine (LAIV) have emerged as essential features to be incorporated into a UIV. Complementing the weakness of the stand-alone approaches, prime-boost vaccination combining HA stalk, and LAIV is under clinical evaluation, with the aim to increase the efficacy and broaden the spectrum of protection. Preexisting immunity in humans established by prior exposure to influenza viruses may affect the hierarchy and magnitude of immune responses elicited by an influenza vaccine, limiting the interpretation of preclinical data based on naive animals, necessitating human challenge studies. A consensus is yet to be achieved on the spectrum of protection, efficacy, target population, and duration of protection to define a “universal” vaccine. This review discusses the recent advancements in the development of UIVs, rationales behind cross-protection and vaccine designs, and challenges faced in obtaining balanced protection potency, a wide spectrum of protection, and safety relevant to UIVs.
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Affiliation(s)
- Yo Han Jang
- Molecular Medicine Laboratory, Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, South Korea
| | - Baik Lin Seong
- Molecular Medicine Laboratory, Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, South Korea.,Vaccine Translational Research Center, Yonsei University, Seoul, South Korea
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54
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Sah P, Alfaro-Murillo JA, Fitzpatrick MC, Neuzil KM, Meyers LA, Singer BH, Galvani AP. Future epidemiological and economic impacts of universal influenza vaccines. Proc Natl Acad Sci U S A 2019; 116:20786-20792. [PMID: 31548402 PMCID: PMC6789917 DOI: 10.1073/pnas.1909613116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The efficacy of influenza vaccines, currently at 44%, is limited by the rapid antigenic evolution of the virus and a manufacturing process that can lead to vaccine mismatch. The National Institute of Allergy and Infectious Diseases (NIAID) recently identified the development of a universal influenza vaccine with an efficacy of at least 75% as a high scientific priority. The US Congress approved $130 million funding for the 2019 fiscal year to support the development of a universal vaccine, and another $1 billion over 5 y has been proposed in the Flu Vaccine Act. Using a model of influenza transmission, we evaluated the population-level impacts of universal influenza vaccines distributed according to empirical age-specific coverage at multiple scales in the United States. We estimate that replacing just 10% of typical seasonal vaccines with 75% efficacious universal vaccines would avert ∼5.3 million cases, 81,000 hospitalizations, and 6,300 influenza-related deaths per year. This would prevent over $1.1 billion in direct health care costs compared to a typical season, based on average data from the 2010-11 to 2018-19 seasons. A complete replacement of seasonal vaccines with universal vaccines is projected to prevent 17 million cases, 251,000 hospitalizations, 19,500 deaths, and $3.5 billion in direct health care costs. States with high per-hospitalization medical expenses along with a large proportion of elderly residents are expected to receive the maximum economic benefit. Replacing even a fraction of seasonal vaccines with universal vaccines justifies the substantial cost of vaccine development.
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Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Jorge A Alfaro-Murillo
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Lauren A Meyers
- Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
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Scott AN, Buchan SA, Kwong JC, Drews SJ, Simmonds KA, Svenson LW. Using population-wide administrative and laboratory data to estimate type- and subtype-specific influenza vaccine effectiveness: a surveillance protocol. BMJ Open 2019; 9:e029708. [PMID: 31575570 PMCID: PMC6773297 DOI: 10.1136/bmjopen-2019-029708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The appropriateness of using routinely collected laboratory data combined with administrative data for estimating influenza vaccine effectiveness (VE) is still being explored. This paper outlines a protocol to estimate influenza VE using linked laboratory and administrative data which could act as a companion to estimates derived from other methods. METHODS AND ANALYSIS We will use the test-negative design to estimate VE for each influenza type/subtype and season. Province-wide individual-level records of positive and negative influenza tests at the Provincial Laboratory for Public Health in Alberta will be linked, by unique personal health numbers, to administrative databases and vaccination records held at the Ministry of Health in Alberta to determine covariates and influenza vaccination status, respectively. Covariates of interests include age, sex, immunocompromising chronic conditions and healthcare setting. Cases will be defined based on an individual's first positive influenza test during the season, and potential controls will be defined based on an individual's first negative influenza test during the season. One control for each case will be randomly selected based on the week the specimen was collected. We will estimate VE using multivariable logistic regression. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Alberta's Health Research Ethics Board-Health Panel under study ID Pro00075997. Results will be disseminated by public health officials in Alberta.
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Affiliation(s)
- Allison Nicole Scott
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Public Health, Concordia University of Edmonton, Edmonton, Alberta, Canada
| | - Sarah A Buchan
- Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
- Public Health Sciences, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
- Public Health Sciences, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Kimberley A Simmonds
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence W Svenson
- Ministry of Health, Government of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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56
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Switzer C, Babiuk L, Loeb M. Determining optimal community protection strategies for the influenza vaccine. Expert Rev Vaccines 2019; 18:755-764. [PMID: 31288585 DOI: 10.1080/14760584.2019.1642110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Seasonal influenza poses a major risk to the health of the population. Optimal strategies for influenza vaccination can help to reduce this risk. Areas covered: Systematic evaluations of the burden of influenza are first reviewed. Key meta-analysis, randomized trials, and observational studies are critically reviewed to provide the best estimates of the efficacy of influenza vaccine. The concept of herd effect is first introduced and this is followed by the rationale and the evidence to support herd effect that can be provided with strategic use of influenza vaccination in populations. Challenges including the effect of repeated influenza vaccination and vaccine hesitancy are reviewed. The citations were selected by the authors based on PubMed searches of the literature. Expert opinion: Efforts to develop new vaccines, including a universal vaccine, offer the best prospects for improved herd effect. Increasing uptake in new populations can increase likelihood of a herd effect.
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Affiliation(s)
- Charlotte Switzer
- a Department of Health Research Evidence, and Impact, McMaster University , Hamilton , Ontario , Canada
| | - Lorne Babiuk
- b Department of Agricultural Life and Environmental Sciences, University of Alberta , Edmonton , Alberta , Canada
| | - Mark Loeb
- a Department of Health Research Evidence, and Impact, McMaster University , Hamilton , Ontario , Canada
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57
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Foppa IM, Ferdinands JM, Chung J, Flannery B, Fry AM. Vaccination history as a confounder of studies of influenza vaccine effectiveness. Vaccine X 2019; 1:100008. [PMID: 31384730 PMCID: PMC6668227 DOI: 10.1016/j.jvacx.2019.100008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vaccination history may confound estimates of influenza vaccine effectiveness (VE) when two conditions are present: (1) Influenza vaccination is associated with vaccination history and (2) vaccination modifies the risk of natural infection in the following seasons, either due to persisting vaccination immunity or due to lower previous risk of natural infection. METHODS Analytic arguments are used to define conditions for confounding of VE estimates by vaccination history. Simulation studies, both with accurate and inaccurate assessment of current and previous vaccination status, are used to explore the potential magnitude of these biases when using different statistical models to address confounding by vaccination history. RESULTS We found a potential for substantial bias of VE estimates by vaccination history if infection- and/or vaccination-derived immunity persisted from one season to the next and if vaccination uptake in individuals was seasonally correlated. Full adjustment by vaccination history, which is usually not feasible, resulted in unbiased VE estimates. Partial adjustment, i.e. only by prior season's vaccination status, significantly reduced confounding bias. Misclassification of vaccination status, which can also lead to substantial bias, interferes with the adjustment of VE estimates for vaccination history. CONCLUSIONS Confounding by vaccination history may bias VE estimates, but even partial adjustment by only the prior season's vaccination status substantially reduces confounding bias. Misclassification of vaccination status may compromise VE estimates and efforts to adjust for vaccination history.
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Affiliation(s)
- Ivo M. Foppa
- Battelle Memorial Institute, Atlanta, GA, USA
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jill M. Ferdinands
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessie Chung
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan Flannery
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M. Fry
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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58
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van Erp EA, Luytjes W, Ferwerda G, van Kasteren PB. Fc-Mediated Antibody Effector Functions During Respiratory Syncytial Virus Infection and Disease. Front Immunol 2019; 10:548. [PMID: 30967872 PMCID: PMC6438959 DOI: 10.3389/fimmu.2019.00548] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/28/2019] [Indexed: 12/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of severe lower respiratory tract infections and hospitalization in infants under 1 year of age and there is currently no market-approved vaccine available. For protection against infection, young children mainly depend on their innate immune system and maternal antibodies. Traditionally, antibody-mediated protection against viral infections is thought to be mediated by direct binding of antibodies to viral particles, resulting in virus neutralization. However, in the case of RSV, virus neutralization titers do not provide an adequate correlate of protection. The current lack of understanding of the mechanisms by which antibodies can protect against RSV infection and disease or, alternatively, contribute to disease severity, hampers the design of safe and effective vaccines against this virus. Importantly, neutralization is only one of many mechanisms by which antibodies can interfere with viral infection. Antibodies consist of two structural regions: a variable fragment (Fab) that mediates antigen binding and a constant fragment (Fc) that mediates downstream effector functions via its interaction with Fc-receptors on (innate) immune cells or with C1q, the recognition molecule of the complement system. The interaction with Fc-receptors can lead to killing of virus-infected cells through a variety of immune effector mechanisms, including antibody-dependent cell-mediated cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP). Antibody-mediated complement activation may lead to complement-dependent cytotoxicity (CDC). In addition, both Fc-receptor interactions and complement activation can exert a broad range of immunomodulatory functions. Recent studies have emphasized the importance of Fc-mediated antibody effector functions in both protection and pathogenesis for various infectious agents. In this review article, we aim to provide a comprehensive overview of the current knowledge on Fc-mediated antibody effector functions in the context of RSV infection, discuss their potential role in establishing the balance between protection and pathogenesis, and point out important gaps in our understanding of these processes. Furthermore, we elaborate on the regulation of these effector functions on both the cellular and humoral side. Finally, we discuss the implications of Fc-mediated antibody effector functions for the rational design of safe and effective vaccines and monoclonal antibody therapies against RSV.
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Affiliation(s)
- Elisabeth A. van Erp
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Willem Luytjes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Gerben Ferwerda
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Puck B. van Kasteren
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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59
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Smatti MK, Al Thani AA, Yassine HM. Viral-Induced Enhanced Disease Illness. Front Microbiol 2018; 9:2991. [PMID: 30568643 PMCID: PMC6290032 DOI: 10.3389/fmicb.2018.02991] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/19/2018] [Indexed: 12/24/2022] Open
Abstract
Understanding immune responses to viral infections is crucial to progress in the quest for effective infection prevention and control. The host immunity involves various mechanisms to combat viral infections. Under certain circumstances, a viral infection or vaccination may result in a subverted immune system, which may lead to an exacerbated illness. Clinical evidence of enhanced illness by preexisting antibodies from vaccination, infection or maternal passive immunity is available for several viruses and is presumptively proposed for other viruses. Multiple mechanisms have been proposed to explain this phenomenon. It has been confirmed that certain infection- and/or vaccine-induced immunity could exacerbate viral infectivity in Fc receptor- or complement bearing cells- mediated mechanisms. Considering that antibody dependent enhancement (ADE) is a major obstacle in vaccine development, there are continues efforts to understand the underlying mechanisms through identification of the epitopes and antibodies responsible for disease enhancement or protection. This review discusses the recent findings on virally induced ADE, and highlights the potential mechanisms leading to this condition.
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Affiliation(s)
- Maria K Smatti
- Biomedical Research Center, Qatar University, Doha, Qatar
| | | | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha, Qatar
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60
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Chuah CXP, Lim RL, Chen MIC. Investigating the Legacy of the 1918 Influenza Pandemic in Age-Related Seroepidemiology and Immune Responses to Subsequent Influenza A(H1N1) Viruses Through a Structural Equation Model. Am J Epidemiol 2018; 187:2530-2540. [PMID: 30165573 PMCID: PMC6269251 DOI: 10.1093/aje/kwy192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/21/2018] [Indexed: 01/08/2023] Open
Abstract
A(H1N1) strains of Influenzavirus were responsible for 2 pandemics in the last 100 years. Because infections experienced early in life may have a long-lasting influence on future immune response against other influenza strains, we drew on previously collected seroincidence data from Singapore (n = 2,554; June-October 2009) to investigate whether the 1918 pandemic influenza virus and its early descendants produced an age-related signature in immune responses against the A/California/7/2009(H1N1)pdm09 virus of 2009. Hemagglutination inhibition assays revealed a J-shaped relationship; the oldest birth cohort (born in 1911-1926) had the highest titers, followed by the youngest (born in 1987-1992). Differential response by vaccination history was also observed, with seasonal influenza vaccine being associated with higher titers mainly in the oldest birth cohort. On the assumption that antibody titers are a correlate of protection, structural equation modeling predicted that a titer-mediated effect by the vaccine could, on its own, account for a negative association with seroconversion equivalent to a risk reduction of 23% (relative risk = 0.77, 95% confidence interval: 0.60, 0.99) in the oldest birth cohort. A subset of 503 samples tested against the A/Brisbane/59/2007(H1N1) and A/Puerto Rico/8/1934(H1N1) strains also revealed different age-related antibody profiles. The effectiveness of seasonal influenza vaccines against future pandemic strains could thus be age-dependent and related to early-life exposures.
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Affiliation(s)
- Cheryl X P Chuah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Rachel L Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Mark I C Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
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61
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Estimating Vaccine-Driven Selection in Seasonal Influenza. Viruses 2018; 10:v10090509. [PMID: 30231576 PMCID: PMC6165116 DOI: 10.3390/v10090509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 11/17/2022] Open
Abstract
Vaccination could be an evolutionary pressure on seasonal influenza if vaccines reduce the transmission rates of some ("targeted") strains more than others. In theory, more vaccinated populations should have a lower prevalence of targeted strains compared to less vaccinated populations. We tested for vaccine-induced selection in influenza by comparing strain frequencies between more and less vaccinated human populations. We defined strains in three ways: first as influenza types and subtypes, next as lineages of type B, and finally as clades of influenza A/H3N2. We detected spatial differences partially consistent with vaccine use in the frequencies of subtypes and types and between the lineages of influenza B, suggesting that vaccines do not select strongly among all these phylogenetic groups at regional scales. We did detect a significantly greater frequency of an H3N2 clade with known vaccine escape mutations in more vaccinated countries during the 2014⁻2015 season, which is consistent with vaccine-driven selection within the H3N2 subtype. Overall, we find more support for vaccine-driven selection when large differences in vaccine effectiveness suggest a strong effect size. Variation in surveillance practices across countries could obscure signals of selection, especially when strain-specific differences in vaccine effectiveness are small. Further examination of the influenza vaccine's evolutionary effects would benefit from improvements in epidemiological surveillance and reporting.
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62
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Crowe JE. Is It Possible to Develop a "Universal" Influenza Virus Vaccine? Potential for a Universal Influenza Vaccine. Cold Spring Harb Perspect Biol 2018; 10:cshperspect.a029496. [PMID: 28663208 DOI: 10.1101/cshperspect.a029496] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Development of optimal vaccines for influenza is challenging, in part as a result of the high antigenic variability in field strains associated with genetic shift from reassortment and genetic drift from point mutations. Discovery of conserved antigenic sites on the hemagglutinin (HA) protein for neutralizing antibodies suggested the possibility that influenza vaccines could be developed that induce focused antibody responses to the conserved neutralizing determinants, especially the HA stem region. Recent studies have focused on the antigenicity and immunogenicity of such domains, using monoclonal antibodies and candidate-engineered HA stem-based vaccines. Much progress has been made, but we still do not fully understand the biology of the immune response to this unique antigenic region.
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Affiliation(s)
- James E Crowe
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, Tennessee 37232-0417
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63
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Kimiya T, Shinjoh M, Anzo M, Takahashi H, Sekiguchi S, Sugaya N, Takahashi T. Effectiveness of inactivated quadrivalent influenza vaccine in the 2015/2016 season as assessed in both a test-negative case-control study design and a traditional case-control study design. Eur J Pediatr 2018; 177:1009-1017. [PMID: 29680993 DOI: 10.1007/s00431-018-3145-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/09/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Abstract
UNLABELLED Both traditional case-control studies (TCCSs) and test-negative case-control studies (TNCCSs) are commonly used to assess influenza vaccine effectiveness (VE). To compensate for the fact that observational studies are susceptible to bias, we combined both methods to assess VE in one geographical area during the 2015/2016 season, when influenza A (H1N1)pdm was dominant. Our TNCCS covered 331 children aged 6 months to 15 years who visited our hospital with fever, including 182 with influenza, and our TCCS covered 812 pediatric outpatients aged 6 months to 15 years, including 214 with influenza. Influenza infection and vaccination history were reviewed, and VE was calculated as (1 - odds ratio) × 100. In the TNCCS, VE against influenza A was 68% (95% CI 47-81) overall, and 70% (48-83) for those given two doses; against influenza B, VE was 37% (- 12-64) overall and 49% (2-74) for two doses. In the TCCS, VE against influenza A was 44% (15-63) overall and 44% (13-64) for two doses, and VE against influenza B was 24% (- 19-52) overall and 41% (3-64) for two doses. CONCLUSION Both studies confirmed significant VE against influenza A, significant two-dose VE against influenza B, and better two-dose VE than one-dose VE. What is Known: • Influenza vaccine effectiveness (VE) varies from year to year. • Observational studies are conventionally used for VE assessment. However, they are inherently susceptible to bias and confounding. What is New: • This is the first report of influenza VE assessment using more than one observational study and performed in a specific area during the same season. • VE estimates obtained in our traditional case-control study were lower than those in our test-negative case-control study, but both studies found significant VE against influenza.
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Affiliation(s)
- Takahisa Kimiya
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiohtsuka, Toshima-ku, Tokyo, 170-8476, Japan.
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Makoto Anzo
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiohtsuka, Toshima-ku, Tokyo, 170-8476, Japan
| | - Hiroki Takahashi
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minamiohtsuka, Toshima-ku, Tokyo, 170-8476, Japan
| | - Shinichiro Sekiguchi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Norio Sugaya
- Department of Pediatrics, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-shi, Kanagawa, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Zarnitsyna VI, Bulusheva I, Handel A, Longini IM, Halloran ME, Antia R. Intermediate levels of vaccination coverage may minimize seasonal influenza outbreaks. PLoS One 2018; 13:e0199674. [PMID: 29944709 PMCID: PMC6019388 DOI: 10.1371/journal.pone.0199674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
For most pathogens, vaccination reduces the spread of the infection and total number of cases; thus, public policy usually advocates maximizing vaccination coverage. We use simple mathematical models to explore how this may be different for pathogens, such as influenza, which exhibit strain variation. Our models predict that the total number of seasonal influenza infections is minimized at an intermediate (rather than maximal) level of vaccination, and, somewhat counter-intuitively, further increasing the level of the vaccination coverage may lead to higher number of influenza infections and be detrimental to the public interest. This arises due to the combined effects of: competition between multiple co-circulating strains; limited breadth of protection afforded by the vaccine; and short-term strain-transcending immunity following natural infection. The study highlights the need for better quantification of the components of vaccine efficacy and longevity of strain-transcending cross-immunity in order to generate nuanced recommendations for influenza vaccine coverage levels.
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Affiliation(s)
- Veronika I. Zarnitsyna
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, 30322, United States of America
- * E-mail: (VZ); (RA)
| | - Irina Bulusheva
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, 141701, Russia
| | - Andreas Handel
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, 30602, United States of America
| | - Ira M. Longini
- Department of Biostatistics, University of Florida, Gainesville, FL, 32611, United States of America
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, United States of America
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Rustom Antia
- Department of Biology, Emory University, Atlanta, GA, 30322, United States of America
- * E-mail: (VZ); (RA)
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65
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Does consecutive influenza vaccination reduce protection against influenza: A systematic review and meta-analysis. Vaccine 2018; 36:3434-3444. [DOI: 10.1016/j.vaccine.2018.04.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 01/06/2023]
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66
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Chaisri U, Chaicumpa W. Evolution of Therapeutic Antibodies, Influenza Virus Biology, Influenza, and Influenza Immunotherapy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9747549. [PMID: 29998138 PMCID: PMC5994580 DOI: 10.1155/2018/9747549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/19/2018] [Accepted: 03/31/2018] [Indexed: 02/07/2023]
Abstract
This narrative review article summarizes past and current technologies for generating antibodies for passive immunization/immunotherapy. Contemporary DNA and protein technologies have facilitated the development of engineered therapeutic monoclonal antibodies in a variety of formats according to the required effector functions. Chimeric, humanized, and human monoclonal antibodies to antigenic/epitopic myriads with less immunogenicity than animal-derived antibodies in human recipients can be produced in vitro. Immunotherapy with ready-to-use antibodies has gained wide acceptance as a powerful treatment against both infectious and noninfectious diseases. Influenza, a highly contagious disease, precipitates annual epidemics and occasional pandemics, resulting in high health and economic burden worldwide. Currently available drugs are becoming less and less effective against this rapidly mutating virus. Alternative treatment strategies are needed, particularly for individuals at high risk for severe morbidity. In a setting where vaccines are not yet protective or available, human antibodies that are broadly effective against various influenza subtypes could be highly efficacious in lowering morbidity and mortality and controlling unprecedented epidemic/pandemic. Prototypes of human single-chain antibodies to several conserved proteins of influenza virus with no Fc portion (hence, no ADE effect in recipients) are available. These antibodies have high potential as a novel, safe, and effective anti-influenza agent.
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Affiliation(s)
- Urai Chaisri
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wanpen Chaicumpa
- Center of Research Excellence on Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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67
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Lewnard JA, Cobey S. Immune History and Influenza Vaccine Effectiveness. Vaccines (Basel) 2018; 6:E28. [PMID: 29883414 PMCID: PMC6027411 DOI: 10.3390/vaccines6020028] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022] Open
Abstract
The imperfect effectiveness of seasonal influenza vaccines is often blamed on antigenic mismatch, but even when the match appears good, effectiveness can be surprisingly low. Seasonal influenza vaccines also stand out for their variable effectiveness by age group from year to year and by recent vaccination status. These patterns suggest a role for immune history in influenza vaccine effectiveness, but inference is complicated by uncertainty about the contributions of bias to the estimates themselves. In this review, we describe unexpected patterns in the effectiveness of seasonal influenza vaccination and explain how these patterns might arise as consequences of study design, the dynamics of immune memory, or both. Resolving this uncertainty could lead to improvements in vaccination strategy, including the use of universal vaccines in experienced populations, and the evaluation of vaccine efficacy against influenza and other antigenically variable pathogens.
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Affiliation(s)
- Joseph A Lewnard
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| | - Sarah Cobey
- Department of Ecology and Evolution, University of Chicago, Chicago, IL 60637, USA.
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68
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Development and Regulation of Novel Influenza Virus Vaccines: A United States Young Scientist Perspective. Vaccines (Basel) 2018; 6:vaccines6020024. [PMID: 29702547 PMCID: PMC6027304 DOI: 10.3390/vaccines6020024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 01/28/2023] Open
Abstract
Vaccination against influenza is the most effective approach for reducing influenza morbidity and mortality. However, influenza vaccines are unique among all licensed vaccines as they are updated and administered annually to antigenically match the vaccine strains and currently circulating influenza strains. Vaccine efficacy of each selected influenza virus vaccine varies depending on the antigenic match between circulating strains and vaccine strains, as well as the age and health status of the vaccine recipient. Low vaccine effectiveness of seasonal influenza vaccines in recent years provides an impetus to improve current seasonal influenza vaccines, and for development of next-generation influenza vaccines that can provide broader, long-lasting protection against both matching and antigenically diverse influenza strains. This review discusses a perspective on some of the issues and formidable challenges facing the development and regulation of the next-generation influenza vaccines.
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69
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Lipsitch M, Jha A, Simonsen L. Observational studies and the difficult quest for causality: lessons from vaccine effectiveness and impact studies. Int J Epidemiol 2018; 45:2060-2074. [PMID: 27453361 DOI: 10.1093/ije/dyw124] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 11/13/2022] Open
Abstract
Although randomized placebo-controlled trials (RCT) are critical to establish efficacy of vaccines at the time of licensure, important remaining questions about vaccine effectiveness (VE)-used here to include individual-level measures and population-wide impact of vaccine programmes-can only be answered once the vaccine is in use, from observational studies. However, such studies are inherently at risk for bias. Using a causal framework and illustrating with examples, we review newer approaches to detecting and avoiding confounding and selection bias in three major classes of observational study design: cohort, case-control and ecological studies. Studies of influenza VE, especially in seniors, are an excellent demonstration of the challenges of detecting and reducing such bias, and so we use influenza VE as a running example. We take a fresh look at the time-trend studies often dismissed as 'ecological'. Such designs are the only observational study design that can measure the overall effect of a vaccination programme [indirect (herd) as well as direct effects], and are in fact already an important part of the evidence base for several vaccines currently in use. Despite the great strides towards more robust observational study designs, challenges lie ahead for evaluating best practices for achieving robust unbiased results from observational studies. This is critical for evaluation of national and global vaccine programme effectiveness.
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Affiliation(s)
- Marc Lipsitch
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ayan Jha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Health Education & Research Institute, Charleston Area Medical Center, Charleston, WV, USA
| | - Lone Simonsen
- Department of Global Health, George Washington University, Washington, DC, USA.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Foppa IM, Ferdinands JM, Chaves SS, Haber MJ, Reynolds SB, Flannery B, Fry AM. The case test-negative design for studies of the effectiveness of influenza vaccine in inpatient settings. Int J Epidemiol 2018; 45:2052-2059. [PMID: 26979985 PMCID: PMC5025336 DOI: 10.1093/ije/dyw022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 01/11/2023] Open
Abstract
Background: The test-negative design (TND) to evaluate influenza vaccine effectiveness is based on patients seeking care for acute respiratory infection, with those who test positive for influenza as cases and the test-negatives serving as controls. This design has not been validated for the inpatient setting where selection bias might be different from an outpatient setting. Methods: We derived mathematical expressions for vaccine effectiveness (VE) against laboratory-confirmed influenza hospitalizations and used numerical simulations to verify theoretical results exploring expected biases under various scenarios. We explored meaningful interpretations of VE estimates from inpatient TND studies. Results: VE estimates from inpatient TND studies capture the vaccine-mediated protection of the source population against laboratory-confirmed influenza hospitalizations. If vaccination does not modify disease severity, these estimates are equivalent to VE against influenza virus infection. If chronic cardiopulmonary individuals are enrolled because of non-infectious exacerbation, biased VE estimates (too high) will result. If chronic cardiopulmonary disease status is adjusted for accurately, the VE estimates will be unbiased. If chronic cardiopulmonary illness cannot be adequately be characterized, excluding these individuals may provide unbiased VE estimates. Conclusions: The inpatient TND offers logistic advantages and can provide valid estimates of influenza VE. If highly vaccinated patients with respiratory exacerbation of chronic cardiopulmonary conditions are eligible for study inclusion, biased VE estimates will result unless this group is well characterized and the analysis can adequately adjust for it. Otherwise, such groups of subjects should be excluded from the analysis.
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Affiliation(s)
- Ivo M Foppa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Sandra S Chaves
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael J Haber
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sue B Reynolds
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Memorial Institute, Atlanta, GA, USA and
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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71
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Temime L, Cohen N, Ait-Bouziad K, Denormandie P, Dab W, Hocine MN. Impact of a multicomponent hand hygiene-related intervention on the infectious risk in nursing homes: A cluster randomized trial. Am J Infect Control 2018; 46:173-179. [PMID: 28987524 DOI: 10.1016/j.ajic.2017.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to assess the impact of a multifaceted hand hygiene (HH) program on the infectious risk in nursing homes (NHs). METHODS This was a 2-arm cluster randomized trial; French NHs were allocated randomly to the intervention (13 NHs) or control (13 NHs) groups. The intervention consisted of implementing a bundle of HH-related measures over 1 year, including increased availability of alcohol-based handrub, HH promotion, staff education, and local work groups. The primary end point was the incidence rate of acute respiratory infections and gastroenteritis reported in the context of clustered cases episodes. Secondary end points were mortality, hospitalization, and antibiotic prescription rates. RESULTS Baseline characteristics did not differ between groups. The overall handrub consumption was higher in the intervention group over the 1-year intervention period. Because of underreporting, data on the primary end points were of insufficient quality for analysis. Hospitalizations did not differ between the 2 groups. However, the intervention group showed significantly lower mortality (2.10 vs 2.65 per 100 residents per month, respectively; P = .003) and antibiotic prescriptions (5.0 vs 5.8 defined daily doses per 100 resident days, respectively; P < .001). These results were confirmed by the longitudinal multivariate analysis adjusted for NH and resident characteristics and for seasonality (mortality rate ratio, 0.76). CONCLUSIONS A multifaceted HH intervention may have a short-term impact on mortality in NHs. Nevertheless, other strategies may remain necessary to reduce morbidity.
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72
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Opatowski L, Baguelin M, Eggo RM. Influenza interaction with cocirculating pathogens and its impact on surveillance, pathogenesis, and epidemic profile: A key role for mathematical modelling. PLoS Pathog 2018; 14:e1006770. [PMID: 29447284 PMCID: PMC5814058 DOI: 10.1371/journal.ppat.1006770] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Evidence is mounting that influenza virus interacts with other pathogens colonising or infecting the human respiratory tract. Taking into account interactions with other pathogens may be critical to determining the real influenza burden and the full impact of public health policies targeting influenza. This is particularly true for mathematical modelling studies, which have become critical in public health decision-making. Yet models usually focus on influenza virus acquisition and infection alone, thereby making broad oversimplifications of pathogen ecology. Herein, we report evidence of influenza virus interactions with bacteria and viruses and systematically review the modelling studies that have incorporated interactions. Despite the many studies examining possible associations between influenza and Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Neisseria meningitidis, respiratory syncytial virus (RSV), human rhinoviruses, human parainfluenza viruses, etc., very few mathematical models have integrated other pathogens alongside influenza. The notable exception is the pneumococcus-influenza interaction, for which several recent modelling studies demonstrate the power of dynamic modelling as an approach to test biological hypotheses on interaction mechanisms and estimate the strength of those interactions. We explore how different interference mechanisms may lead to unexpected incidence trends and possible misinterpretation, and we illustrate the impact of interactions on public health surveillance using simple transmission models. We demonstrate that the development of multipathogen models is essential to assessing the true public health burden of influenza and that it is needed to help improve planning and evaluation of control measures. Finally, we identify the public health, surveillance, modelling, and biological challenges and propose avenues of research for the coming years.
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Affiliation(s)
- Lulla Opatowski
- Université de Versailles Saint Quentin, Institut Pasteur, Inserm, Paris, France
| | - Marc Baguelin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Public Health England, London, United Kingdom
| | - Rosalind M. Eggo
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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73
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Shim E, Smith KJ, Nowalk MP, Raviotta JM, Brown ST, DePasse J, Zimmerman RK. Impact of seasonal influenza vaccination in the presence of vaccine interference. Vaccine 2018; 36:853-858. [PMID: 29329684 DOI: 10.1016/j.vaccine.2017.12.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/22/2017] [Accepted: 12/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Annual influenza vaccination is a key to preventing widespread influenza infections. Recent reports of influenza vaccine effectiveness (VE) indicate that vaccination in prior years may reduce VE in the current season, suggesting vaccine interference. The purpose of this study is to evaluate the potential effect of repeat influenza vaccinations in the presence of vaccine interference. METHODS Using literature-based parameters, an age-structured influenza equation-based transmission model was used to determine the optimal vaccination strategy, while considering the effect of varying levels of interference. RESULTS The model shows that, even in the presence of vaccine interference, revaccination reduces the influenza attack rate and provides individual benefits. Specifically, annual vaccination is a favored strategy over vaccination in alternate years, as long as the level of residual protection is less than 58% or vaccine interference effect is minimal. Furthermore, the negative impact of vaccine interference may be offset by increased vaccine coverage levels. CONCLUSIONS Even in the presence of potential vaccine interference, our work provides a population-level perspective on the potential merits of repeated influenza vaccination. This is because repeat vaccination groups had lower attack rates than groups that omitted the second vaccination unless vaccine interference was at very high, perhaps implausible, levels.
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Affiliation(s)
- Eunha Shim
- Department of Mathematics, Soongsil University, Sangdo-ro 369, Dongjak-gu, Seoul 156-743 Republic of Korea.
| | - Kenneth J Smith
- University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 200, Pittsburgh, PA 15213, USA
| | - Mary Patricia Nowalk
- Department of Family Medicine, University of Pittsburgh School of Medicine, Suite 520 Schenley Place, 4420 Bayard Street, Pittsburgh, PA 15260, USA
| | - Jonathan M Raviotta
- Department of Family Medicine, University of Pittsburgh School of Medicine, Suite 520 Schenley Place, 4420 Bayard Street, Pittsburgh, PA 15260, USA
| | - Shawn T Brown
- Pittsburgh Supercomputing Center, Carnegie Mellon University, 300 S. Craig Street, Pittsburgh, PA 15213, USA
| | - Jay DePasse
- Pittsburgh Supercomputing Center, Carnegie Mellon University, 300 S. Craig Street, Pittsburgh, PA 15213, USA
| | - Richard K Zimmerman
- Department of Family Medicine, University of Pittsburgh School of Medicine, Suite 520 Schenley Place, 4420 Bayard Street, Pittsburgh, PA 15260, USA
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Dong W, Bhide Y, Sicca F, Meijerhof T, Guilfoyle K, Engelhardt OG, Boon L, de Haan CAM, Carnell G, Temperton N, de Vries-Idema J, Kelvin D, Huckriede A. Cross-Protective Immune Responses Induced by Sequential Influenza Virus Infection and by Sequential Vaccination With Inactivated Influenza Vaccines. Front Immunol 2018; 9:2312. [PMID: 30356772 PMCID: PMC6189474 DOI: 10.3389/fimmu.2018.02312] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/17/2018] [Indexed: 02/05/2023] Open
Abstract
Sequential infection with antigenically distinct influenza viruses induces cross-protective immune responses against heterologous virus strains in animal models. Here we investigated whether sequential immunization with antigenically distinct influenza vaccines can also provide cross-protection. To this end, we compared immune responses and protective potential against challenge with A(H1N1)pdm09 in mice infected sequentially with seasonal A(H1N1) virus followed by A(H3N2) virus or immunized sequentially with whole inactivated virus (WIV) or subunit (SU) vaccine derived from these viruses. Sequential infection provided solid cross-protection against A(H1N1)pdm09 infection while sequential vaccination with WIV, though not capable of preventing weight loss upon infection completely, protected the mice from reaching the humane endpoint. In contrast, sequential SU vaccination did not prevent rapid and extensive weight loss. Protection correlated with levels of cross-reactive but non-neutralizing antibodies of the IgG2a subclass, general increase of memory T cells and induction of influenza-specific CD4+ and CD8+ T cells. Adoptive serum transfer experiments revealed that despite lacking neutralizing activity, serum antibodies induced by sequential infection protected mice from weight loss and vigorous virus growth in the lungs upon A(H1N1)pdm09 virus challenge. Antibodies induced by WIV vaccination alleviated symptoms but could not control virus growth in the lung. Depletion of T cells prior to challenge revealed that CD8+ T cells, but not CD4+ T cells, contributed to cross-protection. These results imply that sequential immunization with WIV but not SU derived from antigenically distinct viruses could alleviate the severity of infection caused by a pandemic and may improve protection to unpredictable seasonal infection.
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Affiliation(s)
- Wei Dong
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, Shantou, China
| | - Yoshita Bhide
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Federica Sicca
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Tjarko Meijerhof
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kate Guilfoyle
- National Institute for Biological Standards and Controls, Medicines and Healthcare Products Regulatory Agency, Potters Bar, United Kingdom
| | - Othmar G. Engelhardt
- National Institute for Biological Standards and Controls, Medicines and Healthcare Products Regulatory Agency, Potters Bar, United Kingdom
| | | | - Cornelis A. M. de Haan
- Virology Division, Department of Infectious Diseases & Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - George Carnell
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham Maritime, Kent, United Kingdom
| | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent, Chatham Maritime, Kent, United Kingdom
| | - Jacqueline de Vries-Idema
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - David Kelvin
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, Shantou, China
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | - Anke Huckriede
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- *Correspondence: Anke Huckriede
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Morales KF, Paget J, Spreeuwenberg P. Possible explanations for why some countries were harder hit by the pandemic influenza virus in 2009 - a global mortality impact modeling study. BMC Infect Dis 2017; 17:642. [PMID: 28946870 PMCID: PMC5613504 DOI: 10.1186/s12879-017-2730-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A global pandemic mortality study found prominent regional mortality variations in 2009 for Influenza A(H1N1)pdm09. Our study attempts to identify factors that explain why the pandemic mortality burden was high in some countries and low in others. METHODS As a starting point, we identified possible risk factors worth investigating for Influenza A(H1N1)pdm09 mortality through a targeted literature search. We then used a modeling procedure (data simulations and regression models) to identify factors that could explain differences in respiratory mortality due to Influenza A(H1N1)pdm09. We ran sixteen models to produce robust results and draw conclusions. In order to assess the role of each factor in explaining differences in excess pandemic mortality, we calculated the reduction in between country variance, which can be viewed as an effect-size for each factor. RESULTS The literature search identified 124 publications and 48 possible risk factors, of which we were able to identify 27 factors with appropriate global datasets. The modelling procedure indicated that age structure (explaining 40% of the mean between country variance), latitude (8%), influenza A and B viruses circulating during the pandemic (3-8%), influenza A and B viruses circulating during the preceding influenza season (2-6%), air pollution (pm10; 4%) and the prevalence of other infections (HIV and TB) (4-6%) were factors that explained differences in mortality around the world. Healthcare expenditure, levels of obesity, the distribution of antivirals, and air travel did not explain global pandemic mortality differences. CONCLUSIONS Our study found that countries with a large proportion of young persons had higher pandemic mortality rates in 2009. The co-circulation of influenza viruses during the pandemic and the circulation of influenza viruses during the preceding season were also associated with pandemic mortality rates. We found that real time assessments of 2009 pandemic mortality risk factors (e.g. obesity) probably led to a number of false positive findings.
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Affiliation(s)
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Monto AS, Malosh RE, Petrie JG, Martin ET. The Doctrine of Original Antigenic Sin: Separating Good From Evil. J Infect Dis 2017; 215:1782-1788. [PMID: 28398521 PMCID: PMC5853211 DOI: 10.1093/infdis/jix173] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022] Open
Abstract
The term “original antigenic sin” was coined approximately 60 years ago to describe the imprinting by the initial first influenza A virus infection on the antibody response to subsequent vaccination. These studies did not suggest a reduction in the response to current antigens but instead suggested anamnestic recall of antibody to earlier influenza virus strains. Then, approximately 40 years ago, it was observed that sequential influenza vaccination might lead to reduced vaccine effectiveness (VE). This conclusion was largely dismissed after an experimental study involving sequential administration of then-standard influenza vaccines. Recent observations have provided convincing evidence that reduced VE after sequential influenza vaccination is a real phenomenon. We propose that such reduction in VE be termed “negative antigenic interaction,” given that there is no age cohort effect. In contrast, the potentially positive protective effect of early influenza virus infection later in life continues to be observed. It is essential that we understand better the immunologic factors underlying both original antigenic sin and negative antigenic interaction, to support development of improved influenza vaccines and vaccination strategies.
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Affiliation(s)
- Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Ryan E Malosh
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
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Abstract
The incidence of complex chronic health conditions is rising. Some of these conditions might have their roots in gut disturbances, which in Chinese Medicine would be categorized as Spleen and Stomach Qi Disharmonies. In this article, the author explores these issues from an integrative perspective and suggests areas where acupuncture techniques could be helpful. Five cases are described briefly to illustrate the use of acupuncture.
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Wang B, Russell ML, Fonseca K, Earn DJD, Horsman G, Van Caeseele P, Chokani K, Vooght M, Babiuk L, Walter SD, Loeb M. Predictors of influenza a molecular viral shedding in Hutterite communities. Influenza Other Respir Viruses 2017; 11:254-262. [PMID: 28207989 PMCID: PMC5410723 DOI: 10.1111/irv.12448] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patterns of influenza molecular viral shedding following influenza infection have been well established; predictors of viral shedding however remain uncertain. OBJECTIVES We sought to determine factors associated with peak molecular viral load, duration of shedding, and viral area under the curve (AUC) in children and adult Hutterite colony members with laboratory-confirmed influenza. METHODS A cohort study was conducted in Hutterite colonies in Alberta, Canada. Flocked nasal swabs were collected during three influenza seasons (2007-2008 to 2009-2010) from both symptomatic and asymptomatic individuals infected with influenza. Samples were tested by real-time reverse-transcription polymerase chain reaction for influenza A and influenza B, and the viral load was determined for influenza A-positive samples. RESULTS For seasonal H1N1, younger age was associated with a larger AUC, female sex was associated with decreased peak viral load and reduced viral shedding duration, while the presence of comorbidity was associated with increased peak viral load. For H3N2, younger age was associated with increased peak viral load and increased AUC. For pandemic H1N1, younger age was associated with increased peak viral load and increased viral AUC, female sex was associated with reduced peak viral load, while inapparent infection was associated with reduced peak viral load, reduced viral shedding duration, and reduced viral AUC. CONCLUSIONS Patterns of molecular viral shedding vary by age, sex, comorbidity, and the presence of symptoms. Predictor variables vary by influenza A subtype.
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Affiliation(s)
- Biao Wang
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonONCanada
| | - Margaret L. Russell
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Kevin Fonseca
- Department of Microbiology and Infectious Diseases and Provincial Laboratory for Public HealthUniversity of CalgaryCalgaryABCanada
| | - David J. D. Earn
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
- Michael G. De‐ Groote Institute for Infectious Disease ResearchMcMaster UniversityHamiltonONCanada
- Department of Mathematics and StatisticsMcMaster UniversityHamiltonONCanada
| | | | | | - Khami Chokani
- Saskatchewan HealthPrince Albert Parkland Health RegionPrince AlbertSKCanada
| | - Mark Vooght
- Saskatchewan HealthFive Hills Health RegionMoose JawSKCanada
| | | | - Stephen D. Walter
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
| | - Mark Loeb
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonONCanada
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
- Michael G. De‐ Groote Institute for Infectious Disease ResearchMcMaster UniversityHamiltonONCanada
- Department of MedicineMcMaster UniversityHamiltonONCanada
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79
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Skowronski DM, Chambers C, De Serres G, Sabaiduc S, Winter AL, Dickinson JA, Gubbay JB, Fonseca K, Drews SJ, Charest H, Martineau C, Krajden M, Petric M, Bastien N, Li Y, Smith DJ. Serial Vaccination and the Antigenic Distance Hypothesis: Effects on Influenza Vaccine Effectiveness During A(H3N2) Epidemics in Canada, 2010-2011 to 2014-2015. J Infect Dis 2017; 215:1059-1099. [PMID: 28180277 PMCID: PMC5853783 DOI: 10.1093/infdis/jix074] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/02/2017] [Indexed: 11/14/2022] Open
Abstract
Background The antigenic distance hypothesis (ADH) predicts that negative interference from prior season's influenza vaccine (v1) on the current season's vaccine (v2) protection may occur when the antigenic distance is small between v1 and v2 (v1 ≈ v2) but large between v1 and the current epidemic (e) strain (v1 ≠ e). Methods Vaccine effectiveness (VE) against medically attended, laboratory-confirmed influenza A(H3N2) illness was estimated by test-negative design during 3 A(H3N2) epidemics (2010-2011, 2012-2013, 2014-2015) in Canada. Vaccine effectiveness was derived with covariate adjustment across v2 and/or v1 categories relative to no vaccine receipt among outpatients aged ≥9 years. Prior vaccination effects were interpreted within the ADH framework. Results Prior vaccination effects varied significantly by season, consistent with the ADH. There was no interference by v1 in 2010-2011 when v1 ≠ v2 and v1 ≠ e, with comparable VE for v2 alone or v2 + v1: 34% (95% confidence interval [CI] = -51% to 71%) versus 34% (95% CI = -5% to 58%). Negative interference by v1 was suggested in 2012-2013 with nonsignificant reduction in VE when v1 ≈ v2 and v1 ≠ e: 49% (95% CI = -47% to 83%) versus 28% (95% CI = -12% to 54%). Negative effects of prior vaccination were pronounced and statistically significant in 2014-2015 when v1 ≡ v2 and v1 ≠ e: 65% (95% CI = 25% to 83%) versus -33% (95% CI = -78% to 1%). Conclusions Effects of repeat influenza vaccination were consistent with the ADH and may have contributed to findings of low VE across recent A(H3N2) epidemics since 2010 in Canada.
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Affiliation(s)
- Danuta M Skowronski
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver
- School of Population and Public Health, University of British Columbia, Vancouver
| | - Catharine Chambers
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver
| | - Gaston De Serres
- Direction of Biological and Occupational Risks, Institut national de santé publique du Québec
- Department of Social and Preventive Medicine, Laval University, Québec
- Infection and Immunity, Centre Hospitalier Universitaire de Québec Research Centre
| | - Suzana Sabaiduc
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver
| | - Anne-Luise Winter
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto
| | - James A Dickinson
- Departments of Family Medicine and Community Health Sciences, University of Calgary
| | - Jonathan B Gubbay
- Public Health Ontario Laboratory, Public Health Ontario, Toronto
- Departments of Laboratory Medicine and Pathobiology and Paediatrics, University of Toronto
| | - Kevin Fonseca
- Diagnostic Virology, Alberta Provincial Laboratory, Calgary
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary
| | - Steven J Drews
- Diagnostic Virology, Alberta Provincial Laboratory, Edmonton
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton
| | - Hugues Charest
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec
- Département de microbiologie, d'infectiologie et d'immunologie, l'Université de Montréal
| | - Christine Martineau
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec
| | - Mel Krajden
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver
| | - Martin Petric
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver
| | - Nathalie Bastien
- Infectious Disease Prevention and Control Branch, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada; and
| | - Yan Li
- Infectious Disease Prevention and Control Branch, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada; and
| | - Derek J Smith
- Department of Zoology, University of Cambridge, England
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Treanor J. Flu Vaccine-Too Much of a Good Thing? J Infect Dis 2017; 215:1017-1019. [PMID: 28180278 PMCID: PMC5853256 DOI: 10.1093/infdis/jix075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- John Treanor
- Infectious Diseases Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY
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Gil Cuesta J, Aavitsland P, Englund H, Gudlaugsson Ó, Hauge SH, Lyytikäinen O, Sigmundsdóttir G, Tegnell A, Virtanen M, Krause TG. Pandemic vaccination strategies and influenza severe outcomes during the influenza A(H1N1)pdm09 pandemic and the post-pandemic influenza season: the Nordic experience. ACTA ACUST UNITED AC 2017; 21:30208. [PMID: 27123691 DOI: 10.2807/1560-7917.es.2016.21.16.30208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 12/03/2015] [Indexed: 11/20/2022]
Abstract
During the 2009/10 influenza A(H1N1)pdm09 pandemic, the five Nordic countries adopted different approaches to pandemic vaccination. We compared pandemic vaccination strategies and severe influenza outcomes, in seasons 2009/10 and 2010/11 in these countries with similar influenza surveillance systems. We calculated the cumulative pandemic vaccination coverage in 2009/10 and cumulative incidence rates of laboratory confirmed A(H1N1)pdm09 infections, intensive care unit (ICU) admissions and deaths in 2009/10 and 2010/11. We estimated incidence risk ratios (IRR) in a Poisson regression model to compare those indicators between Denmark and the other countries. The vaccination coverage was lower in Denmark (6.1%) compared with Finland (48.2%), Iceland (44.1%), Norway (41.3%) and Sweden (60.0%). In 2009/10 Denmark had a similar cumulative incidence of A(H1N1)pdm09 ICU admissions and deaths compared with the other countries. In 2010/11 Denmark had a significantly higher cumulative incidence of A(H1N1)pdm09 ICU admissions (IRR: 2.4; 95% confidence interval (CI): 1.9-3.0) and deaths (IRR: 8.3; 95% CI: 5.1-13.5). Compared with Denmark, the other countries had higher pandemic vaccination coverage and experienced less A(H1N1)pdm09-related severe outcomes in 2010/11. Pandemic vaccination may have had an impact on severe influenza outcomes in the post-pandemic season. Surveillance of severe outcomes may be used to compare the impact of influenza between seasons and support different vaccination strategies.
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82
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De Serres G, Skowronski DM, Ward BJ, Gardam M, Lemieux C, Yassi A, Patrick DM, Krajden M, Loeb M, Collignon P, Carrat F. Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement. PLoS One 2017; 12:e0163586. [PMID: 28129360 PMCID: PMC5271324 DOI: 10.1371/journal.pone.0163586] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 08/27/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Four cluster randomized controlled trials (cRCTs) conducted in long-term care facilities (LTCFs) have reported reductions in patient risk through increased healthcare worker (HCW) influenza vaccination. This evidence has led to expansive policies of enforcement that include all staff of acute care hospitals and other healthcare settings beyond LTCFs. We critique and quantify the cRCT evidence for indirect patient benefit underpinning policies of mandatory HCW influenza vaccination. METHODS Plausibility of the four cRCT findings attributing indirect patient benefits to HCW influenza vaccination was assessed by comparing percentage reductions in patient risk reported by the cRCTs to predicted values. Plausibly predicted values were derived according to the basic mathematical principle of dilution, taking into account HCW influenza vaccine coverage and the specificity of patient outcomes for influenza. Accordingly, predicted values were calculated as a function of relevant compound probabilities including vaccine efficacy (ranging 40-60% in HCWs and favourably assuming the same indirect protection conferred through them to patients) × change in proportionate HCW influenza vaccine coverage (as reported by each cRCT) × percentage of a given patient outcome (e.g. influenza-like illness (ILI) or all-cause mortality) plausibly due to influenza virus. The number needed to vaccinate (NNV) for HCWs to indirectly prevent patient death was recalibrated based on real patient data of hospital-acquired influenza, with adjustment for potential under-detection (5.2-fold), and using favourable assumptions of HCW-attributable risk (ranging 60-80%). RESULTS In attributing patient benefit to increased HCW influenza vaccine coverage, each cRCT was found to violate the basic mathematical principle of dilution by reporting greater percentage reductions with less influenza-specific patient outcomes (i.e., all-cause mortality > ILI > laboratory-confirmed influenza) and/or patient mortality reductions exceeding even favourably-derived predicted values by at least 6- to 15-fold. If extrapolated to all LTCF and hospital staff in the United States, the prior cRCT-claimed NNV of 8 would implausibly mean >200,000 and >675,000 patient deaths, respectively, could be prevented annually by HCW influenza vaccination, inconceivably exceeding total US population mortality estimates due to seasonal influenza each year, or during the 1918 pandemic, respectively. More realistic recalibration based on actual patient data instead shows that at least 6000 to 32,000 hospital workers would need to be vaccinated before a single patient death could potentially be averted. CONCLUSIONS The four cRCTs underpinning policies of enforced HCW influenza vaccination attribute implausibly large reductions in patient risk to HCW vaccination, casting serious doubts on their validity. The impression that unvaccinated HCWs place their patients at great influenza peril is exaggerated. Instead, the HCW-attributable risk and vaccine-preventable fraction both remain unknown and the NNV to achieve patient benefit still requires better understanding. Although current scientific data are inadequate to support the ethical implementation of enforced HCW influenza vaccination, they do not refute approaches to support voluntary vaccination or other more broadly protective practices, such as staying home or masking when acutely ill.
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Affiliation(s)
- Gaston De Serres
- Institut national de santé publique du Québec, Quebec City, Quebec, Canada
- Laval University, Quebec City, Quebec, Canada
| | - Danuta M. Skowronski
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian J. Ward
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Gardam
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Camille Lemieux
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Annalee Yassi
- University of British Columbia, Vancouver, British Columbia, Canada
| | - David M. Patrick
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Loeb
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Peter Collignon
- Australian National University, Acton, Australia
- Canberra Hospital, Garran, ACT, Australia
| | - Fabrice Carrat
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Sorbonne Universités, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France
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83
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Cobey S, Hensley SE. Immune history and influenza virus susceptibility. Curr Opin Virol 2017; 22:105-111. [PMID: 28088686 DOI: 10.1016/j.coviro.2016.12.004] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 12/25/2022]
Abstract
Antibody responses to influenza viruses are critical for protection, but the ways in which repeated viral exposures shape antibody evolution and effectiveness over time remain controversial. Early observations demonstrated that viral exposure history has a profound effect on the specificity and magnitude of antibody responses to a new viral strain, a phenomenon called 'original antigenic sin.' Although 'sin' might suppress some aspects of the immune response, so far there is little indication that hosts with pre-existing immunity are more susceptible to viral infections compared to naïve hosts. However, the tendency of the immune response to focus on previously recognized conserved epitopes when encountering new viral strains can create an opportunity cost when mutations arise in these conserved epitopes. Hosts with different exposure histories may continue to experience distinct patterns of infection over time, which may influence influenza viruses' continued antigenic evolution. Understanding the dynamics of B cell competition that underlie the development of antibody responses might help explain the low effectiveness of current influenza vaccines and lead to better vaccination strategies.
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Affiliation(s)
- Sarah Cobey
- Department of Ecology & Evolution, The University of Chicago, Chicago, IL 19104, USA.
| | - Scott E Hensley
- Department of Microbiology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104, USA.
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84
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Saito N, Komori K, Suzuki M, Morimoto K, Kishikawa T, Yasaka T, Ariyoshi K. Negative impact of prior influenza vaccination on current influenza vaccination among people infected and not infected in prior season: A test-negative case-control study in Japan. Vaccine 2016; 35:687-693. [PMID: 28043738 DOI: 10.1016/j.vaccine.2016.11.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Accumulating evidences indicate that repeated influenza vaccination has negative impact on the vaccine effectiveness (VE). However no published studies considered past influenza infection when assessing the VE of repeated vaccination. METHODS Prospective surveillance was conducted from 2009 to 2012 at a community hospital on a small island in Japan. The study included all outpatients with an influenza-like illness (ILI) who attended the hospital, and a rapid diagnostic test (RDT) was used to diagnose influenza A/B infection. The VE of trivalent inactivated influenza vaccine (TIV) against medically attended influenza A (MA-fluA) was estimated using a test-negative case-control study design. The influence of TIV in the prior season on VE in the current season was investigated in the context of MA-fluA during the prior season. RESULTS During the three influenza seasons, 5838 ILI episodes (4127 subjects) were analysed. Subjects who had an episode of MA-fluA in the prior season were at a significantly lower risk of MA-fluA in the current season (adjusted odds ratio: 0.38, 95% CI: 0.30-0.50). The overall adjusted VE was 28% (95% CI, 14-40). VE was substantially lower in subjects vaccinated in the prior season compared to those who had not been vaccinated in prior season (19%; 95% CI: 0-35 vs 46%; 95% CI: 26-60, test for interaction, P value <0.05). In subjects who did not have MA-fluA in the prior season showed the attenuation of VE due to repeated vaccination (13%; 95% CI: -7 to 30 vs 44%; 95% CI: 24-59, test for interaction, P<0.05). However this effect was not detected in subjects who had contracted MA-fluA in the prior season. CONCLUSIONS Negative effects of repeated vaccination were significant among those without history of MA-fluA in the prior season.
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Affiliation(s)
- Nobuo Saito
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan
| | - Kounosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan
| | | | | | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki, Japan; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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85
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Kim JH, Reber AJ, Kumar A, Ramos P, Sica G, Music N, Guo Z, Mishina M, Stevens J, York IA, Jacob J, Sambhara S. Non-neutralizing antibodies induced by seasonal influenza vaccine prevent, not exacerbate A(H1N1)pdm09 disease. Sci Rep 2016; 6:37341. [PMID: 27849030 PMCID: PMC5110975 DOI: 10.1038/srep37341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/25/2016] [Indexed: 11/12/2022] Open
Abstract
The association of seasonal trivalent influenza vaccine (TIV) with increased infection by 2009 pandemic H1N1 (A(H1N1)pdm09) virus, initially observed in Canada, has elicited numerous investigations on the possibility of vaccine-associated enhanced disease, but the potential mechanisms remain largely unresolved. Here, we investigated if prior immunization with TIV enhanced disease upon A(H1N1)pdm09 infection in mice. We found that A(H1N1)pdm09 infection in TIV-immunized mice did not enhance the disease, as measured by morbidity and mortality. Instead, TIV-immunized mice cleared A(H1N1)pdm09 virus and recovered at an accelerated rate compared to control mice. Prior TIV immunization was associated with potent inflammatory mediators and virus-specific CD8 T cell activation, but efficient immune regulation, partially mediated by IL-10R-signaling, prevented enhanced disease. Furthermore, in contrast to suggested pathological roles, pre-existing non-neutralizing antibodies (NNAbs) were not associated with enhanced virus replication, but rather with promoted antigen presentation through FcR-bearing cells that led to potent activation of virus-specific CD8 T cells. These findings provide new insights into interactions between pre-existing immunity and pandemic viruses.
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Affiliation(s)
- Jin Hyang Kim
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Adrian J Reber
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Amrita Kumar
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Patricia Ramos
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Gabriel Sica
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, 1364 Clifton Rd, N.E. Atlanta, GA 30322, USA
| | - Nedzad Music
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Zhu Guo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Margarita Mishina
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.,Batelle Memorial Institute, Atlanta, GA 30322, USA
| | - James Stevens
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Ian A York
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Joshy Jacob
- Department of Microbiology and Immunology, Emory Vaccine Center, Yerkes National Primate Center, Emory University, 954 Gatewood Rd, Atlanta, GA, USA
| | - Suryaprakash Sambhara
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
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Ramakrishnan B, Viswanathan K, Tharakaraman K, Dančík V, Raman R, Babcock GJ, Shriver Z, Sasisekharan R. A Structural and Mathematical Modeling Analysis of the Likelihood of Antibody-Dependent Enhancement in Influenza. Trends Microbiol 2016; 24:933-943. [PMID: 27751627 DOI: 10.1016/j.tim.2016.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/15/2016] [Accepted: 09/12/2016] [Indexed: 12/26/2022]
Abstract
Broadly neutralizing monoclonal antibodies (bNAbs) for viral infections, such as HIV, respiratory syncytial virus (RSV), and influenza, are increasingly entering clinical development. For influenza, most neutralizing antibodies target influenza virus hemagglutinin. These bNAbs represent an emerging, promising modality for treatment and prophylaxis of influenza due to their multiple mechanisms of antiviral action and generally safe profile. Preclinical work in other viral diseases, such as dengue, has demonstrated the potential for antibody-based therapies to enhance viral uptake, leading to enhanced viremia and worsening of disease. This phenomenon is referred to as antibody-dependent enhancement (ADE). In the context of influenza, ADE has been used to explain several preclinical and clinical phenomena. Using structural and viral kinetics modeling, we assess the role of ADE in the treatment of influenza with a bNAb.
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Affiliation(s)
| | | | - Kannan Tharakaraman
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 01890, USA
| | - Vlado Dančík
- Center for the Science of Therapeutics, Broad Institute, Cambridge, MA 02142, USA
| | - Rahul Raman
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 01890, USA
| | - Gregory J Babcock
- Visterra, Inc. One Kendall Square, Suite B3301, Cambridge, MA 02139, USA
| | - Zachary Shriver
- Visterra, Inc. One Kendall Square, Suite B3301, Cambridge, MA 02139, USA
| | - Ram Sasisekharan
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 01890, USA.
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Mcbride WJH, Abhayaratna WP, Barr I, Booy R, Carapetis J, Carson S, De Looze F, Ellis-Pegler R, Heron L, Karrasch J, Marshall H, Mcvernon J, Nolan T, Rawlinson W, Reid J, Richmond P, Shakib S, Basser RL, Hartel GF, Lai MH, Rockman S, Greenberg ME. Efficacy of a trivalent influenza vaccine against seasonal strains and against 2009 pandemic H1N1: A randomized, placebo-controlled trial. Vaccine 2016; 34:4991-4997. [PMID: 27595443 DOI: 10.1016/j.vaccine.2016.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/31/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Before pandemic H1N1 vaccines were available, the potential benefit of existing seasonal trivalent inactivated influenza vaccines (IIV3s) against influenza due to the 2009 pandemic H1N1 influenza strain was investigated, with conflicting results. This study assessed the efficacy of seasonal IIV3s against influenza due to 2008 and 2009 seasonal influenza strains and against the 2009 pandemic H1N1 strain. METHODS This observer-blind, randomized, placebo-controlled study enrolled adults aged 18-64years during 2008 and 2009 in Australia and New Zealand. Participants were randomized 2:1 to receive IIV3 or placebo. The primary objective was to demonstrate the efficacy of IIV3 against laboratory-confirmed influenza. Participants reporting an influenza-like illness during the period from 14days after vaccination until 30 November of each study year were tested for influenza by real-time reverse transcription polymerase chain reaction. RESULTS Over a study period of 2years, 15,044 participants were enrolled (mean age±standard deviation: 35.5±14.7years; 54.4% female). Vaccine efficacy of the 2008 and 2009 IIV3s against influenza due to any strain was 42% (95% confidence interval [CI]: 30%, 52%), whereas vaccine efficacy against influenza due to the vaccine-matched strains was 60% (95% CI: 44%, 72%). Vaccine efficacy of the 2009 IIV3 against influenza due to the 2009 pandemic H1N1 strain was 38% (95% CI: 19%, 53%). No vaccine-related deaths or serious adverse events were reported. Solicited local and systemic adverse events were more frequent in IIV3 recipients than placebo recipients (local: IIV3 74.6% vs placebo 20.4%, p<0.001; systemic: IIV3 46.6% vs placebo 39.1%, p<0.001). CONCLUSIONS The 2008 and 2009 IIV3s were efficacious against influenza due to seasonal influenza strains and the 2009 IIV3 demonstrated moderate efficacy against influenza due to the 2009 pandemic H1N1 strain. Funded by CSL Limited, ClinicalTrials.gov identifier NCT00562484.
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Affiliation(s)
- William J H Mcbride
- James Cook University, Cairns Hospital Clinical School, Cairns, Queensland 4870, Australia.
| | - Walter P Abhayaratna
- Academic Unit of Internal Medicine, Canberra Hospital, Woden, Australian Capital Territory 2606, Australia; ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory 0200, Australia.
| | - Ian Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria 3051, Australia.
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The University of Sydney and The Children's Hospital at Westmead, Westmead, New South Wales 2145, Australia.
| | - Jonathan Carapetis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810, Australia.
| | - Simon Carson
- Southern Clinical Trials Ltd, Christchurch 8013, New Zealand.
| | - Ferdinandus De Looze
- Trialworks Clinical Research Pty Ltd and Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Queensland 4067, Australia.
| | | | - Leon Heron
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The University of Sydney and The Children's Hospital at Westmead, Westmead, New South Wales 2145, Australia.
| | - Jeff Karrasch
- Redcliffe Hospital, Redcliffe, Queensland 4020, Australia.
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, Robinson Research Institute and School of Medicine, University of Adelaide, Adelaide, South Australia 5006, Australia.
| | - Jodie Mcvernon
- Vaccine and Immunization Research Group, Melbourne School of Population and Global Health, University of Melbourne, and Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
| | - Terry Nolan
- Vaccine and Immunization Research Group, Melbourne School of Population and Global Health, University of Melbourne, and Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
| | - William Rawlinson
- South Eastern Sydney and Illawarra Area Health Service and University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Jim Reid
- Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - Peter Richmond
- University of Western Australia, School of Paediatrics and Child Health, Princess Margaret Hospital for Children, Perth, Western Australia 6872, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, South Australia 5001, Australia.
| | - Russell L Basser
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Gunter F Hartel
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Michael H Lai
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Steven Rockman
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Michael E Greenberg
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
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Taylor A, Foo SS, Bruzzone R, Dinh LV, King NJC, Mahalingam S. Fc receptors in antibody-dependent enhancement of viral infections. Immunol Rev 2016; 268:340-64. [PMID: 26497532 PMCID: PMC7165974 DOI: 10.1111/imr.12367] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sensitization of the humoral immune response to invading viruses and production of antiviral antibodies forms part of the host antiviral repertoire. Paradoxically, for a number of viral pathogens, under certain conditions, antibodies provide an attractive means of enhanced virus entry and replication in a number of cell types. Known as antibody‐dependent enhancement (ADE) of infection, the phenomenon occurs when virus‐antibody immunocomplexes interact with cells bearing complement or Fc receptors, promoting internalization of the virus and increasing infection. Frequently associated with exacerbation of viral disease, ADE of infection presents a major obstacle to the prevention of viral disease by vaccination and is thought to be partly responsible for the adverse effects of novel antiviral therapeutics such as intravenous immunoglobulins. There is a growing body of work examining the intracellular signaling pathways and epitopes responsible for mediating ADE, with a view to aiding rational design of antiviral strategies. With in vitro studies also confirming ADE as a feature of infection for a growing number of viruses, challenges remain in understanding the multilayered molecular mechanisms of ADE and its effect on viral pathogenesis.
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Affiliation(s)
- Adam Taylor
- Emerging Viruses and Inflammation Research Group, Institute for Glycomics, Griffith University, Gold Coast, Qld, Australia
| | - Suan-Sin Foo
- Emerging Viruses and Inflammation Research Group, Institute for Glycomics, Griffith University, Gold Coast, Qld, Australia
| | - Roberto Bruzzone
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong SAR, Hong Kong.,Department of Cell Biology and Infection, Institut Pasteur, Paris, France
| | - Luan Vu Dinh
- Discipline of Pathology, Bosch Institute, School of Medical Sciences, Sydney Medical School, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Nicholas J C King
- Discipline of Pathology, Bosch Institute, School of Medical Sciences, Sydney Medical School, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Suresh Mahalingam
- Emerging Viruses and Inflammation Research Group, Institute for Glycomics, Griffith University, Gold Coast, Qld, Australia
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Fell DB, Wilson K, Ducharme R, Hawken S, Sprague AE, Kwong JC, Smith G, Wen SW, Walker MC. Infant Respiratory Outcomes Associated with Prenatal Exposure to Maternal 2009 A/H1N1 Influenza Vaccination. PLoS One 2016; 11:e0160342. [PMID: 27486858 PMCID: PMC4972313 DOI: 10.1371/journal.pone.0160342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/18/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Infants are at high risk for influenza illness, but are ineligible for vaccination before 6 months. Transfer of maternal antibodies to the fetus has been demonstrated for 2009 A/H1N1 pandemic vaccines; however, clinical effectiveness is unknown. Our objective was to evaluate the association between 2009 A/H1N1 pandemic vaccination during pregnancy and rates of infant influenza and pneumonia. METHODS We linked a population-based birth cohort to administrative databases to measure rates of influenza and pneumonia diagnosed during ambulatory physician visits, hospitalizations and emergency department visits during one year of follow-up. We estimated incidence rate ratios and 95% confidence intervals (95% CI) using Poisson regression, comparing infants born to A/H1N1-vaccinated women (vaccine-exposed infants) with unexposed infants, adjusted for confounding using high-dimensional propensity scores. RESULTS Among 117,335 infants in the study, 36,033 (31%) were born to A/H1N1-vaccinated women. Crude rates of influenza during the pandemic (per 100,000 infant-days) for vaccine-exposed and unexposed infants were similar (2.19, 95% CI: 1.27-3.76 and 3.60, 95% CI: 2.51-5.14, respectively), as were crude rates of influenza and pneumonia combined. We did not observe any significant differences in rates of study outcomes between study groups during the second wave of the 2009 A/H1N1 pandemic, nor during any post-pandemic time period. CONCLUSION We observed no difference in rates of study outcomes among infants born to A/H1N1-vaccinated mothers relative to unexposed infants born during the second A/H1N1 pandemic wave; however, due to late availability of the pandemic vaccine, the available follow-up time during the pandemic time period was very limited.
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MESH Headings
- Adult
- Cohort Studies
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza Vaccines/adverse effects
- Influenza Vaccines/therapeutic use
- Influenza, Human/congenital
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Male
- Middle Aged
- Pneumonia/congenital
- Pneumonia/epidemiology
- Pneumonia/etiology
- Pregnancy
- Prenatal Exposure Delayed Effects/epidemiology
- Prenatal Exposure Delayed Effects/etiology
- Prenatal Exposure Delayed Effects/immunology
- Respiratory Distress Syndrome, Newborn/epidemiology
- Respiratory Distress Syndrome, Newborn/etiology
- Retrospective Studies
- Treatment Outcome
- Vaccination/adverse effects
- Vaccination/statistics & numerical data
- Young Adult
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Affiliation(s)
- Deshayne B. Fell
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Ducharme
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven Hawken
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann E. Sprague
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Jeffrey C. Kwong
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Graeme Smith
- Department of Obstetrics & Gynaecology, Queen’s University, Kingston, Ontario, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark C. Walker
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
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Rajão DS, Chen H, Perez DR, Sandbulte MR, Gauger PC, Loving CL, Shanks GD, Vincent A. Vaccine-associated enhanced respiratory disease is influenced by haemagglutinin and neuraminidase in whole inactivated influenza virus vaccines. J Gen Virol 2016; 97:1489-1499. [DOI: 10.1099/jgv.0.000468] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Daniela S. Rajão
- Virus and Prion Diseases of Livestock Research Unit, National Animal Disease Center, USDA, Agricultural Research Service, Ames, IA, USA
| | - Hongjun Chen
- Department of Veterinary Medicine, University of Maryland, College Park, and Virginia-Maryland Regional College of Veterinary Medicine, College Park, MD, USA
| | - Daniel R. Perez
- Department of Veterinary Medicine, University of Maryland, College Park, and Virginia-Maryland Regional College of Veterinary Medicine, College Park, MD, USA
| | - Matthew R. Sandbulte
- Department of Veterinary Microbiology and Preventive Medicine, Iowa State University, Ames, IA, USA
| | - Phillip C. Gauger
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, IA, USA
| | - Crystal L. Loving
- Virus and Prion Diseases of Livestock Research Unit, National Animal Disease Center, USDA, Agricultural Research Service, Ames, IA, USA
| | | | - Amy Vincent
- Virus and Prion Diseases of Livestock Research Unit, National Animal Disease Center, USDA, Agricultural Research Service, Ames, IA, USA
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91
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Skowronski DM, Chambers C, Sabaiduc S, De Serres G, Winter AL, Dickinson JA, Krajden M, Gubbay JB, Drews SJ, Martineau C, Eshaghi A, Kwindt TL, Bastien N, Li Y. A Perfect Storm: Impact of Genomic Variation and Serial Vaccination on Low Influenza Vaccine Effectiveness During the 2014-2015 Season. Clin Infect Dis 2016; 63:21-32. [PMID: 27025838 PMCID: PMC4901864 DOI: 10.1093/cid/ciw176] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 2014-2015 influenza season was distinguished by an epidemic of antigenically-drifted A(H3N2) viruses and vaccine components identical to 2013-2014. We report 2014-2015 vaccine effectiveness (VE) from Canada and explore contributing agent-host factors. METHODS VE against laboratory-confirmed influenza was derived using a test-negative design among outpatients with influenza-like illness. Sequencing identified amino acid mutations at key antigenic sites of the viral hemagglutinin protein. RESULTS Overall, 815/1930 (42%) patients tested influenza-positive: 590 (72%) influenza A and 226 (28%) influenza B. Most influenza A viruses with known subtype were A(H3N2) (570/577; 99%); 409/460 (89%) sequenced viruses belonged to genetic clade 3C.2a and 39/460 (8%) to clade 3C.3b. Dominant clade 3C.2a viruses bore the pivotal mutations F159Y (a cluster-transition position) and K160T (a predicted gain of glycosylation) compared to the mismatched clade 3C.1 vaccine. VE against A(H3N2) was -17% (95% confidence interval [CI], -50% to 9%) overall with clade-specific VE of -13% (95% CI, -51% to 15%) for clade 3C.2a but 52% (95% CI, -17% to 80%) for clade 3C.3b. VE against A(H3N2) was 53% (95% CI, 10% to 75%) for patients vaccinated in 2014-2015 only, significantly lower at -32% (95% CI, -75% to 0%) if also vaccinated in 2013-2014 and -54% (95% CI, -108% to -14%) if vaccinated each year since 2012-2013. VE against clade-mismatched B(Yamagata) viruses was 42% (95% CI, 10% to 62%) with less-pronounced reduction from prior vaccination compared to A(H3N2). CONCLUSIONS Variation in the viral genome and negative effects of serial vaccination likely contributed to poor influenza vaccine performance in 2014-2015.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control
- University of British Columbia, Vancouver
| | | | | | - Gaston De Serres
- Institut National de Santé Publique du Québec
- Laval University
- Centre Hospitalier Universitaire de Québec
| | | | | | - Mel Krajden
- British Columbia Centre for Disease Control
- University of British Columbia, Vancouver
| | | | - Steven J Drews
- University of Alberta
- Alberta Provincial Laboratory, Edmonton
| | | | | | | | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg
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92
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Ricklin ME, Vielle NJ, Python S, Brechbühl D, Zumkehr B, Posthaus H, Zimmer G, Summerfield A. Partial Protection against Porcine Influenza A Virus by a Hemagglutinin-Expressing Virus Replicon Particle Vaccine in the Absence of Neutralizing Antibodies. Front Immunol 2016; 7:253. [PMID: 27446083 PMCID: PMC4928594 DOI: 10.3389/fimmu.2016.00253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/13/2016] [Indexed: 11/13/2022] Open
Abstract
This work was initiated by previous reports demonstrating that mismatched influenza A virus (IAV) vaccines can induce enhanced disease, probably mediated by antibodies. Our aim was, therefore, to investigate if a vaccine inducing opsonizing but not neutralizing antibodies against the hemagglutinin (HA) of a selected heterologous challenge virus would enhance disease or induce protective immune responses in the pig model. To this end, we immunized pigs with either whole inactivated virus (WIV)-vaccine or HA-expressing virus replicon particles (VRP) vaccine based on recombinant vesicular stomatitis virus (VSV). Both types of vaccines induced virus neutralizing and opsonizing antibodies against homologous virus as shown by a highly sensitive plasmacytoid dendritic cell-based opsonization assay. Opsonizing antibodies showed a broader reactivity against heterologous IAV compared with neutralizing antibodies. Pigs immunized with HA-recombinant VRP vaccine were partially protected from infection with a mismatched IAV, which was not neutralized but opsonized by the immune sera. The VRP vaccine reduced lung lesions, lung inflammatory cytokine responses, serum IFN-α responses, and viral loads in the airways. Only the VRP vaccine was able to prime IAV-specific IFNγ/TNFα dual secreting CD4(+) T cells detectable in the peripheral blood. In summary, this work demonstrates that with the virus pair selected, a WIV vaccine inducing opsonizing antibodies against HA which lack neutralizing activity, is neither protective nor does it induce enhanced disease in pigs. In contrast, VRP-expressing HA is efficacious vaccines in swine as they induced both potent antibodies and T-cell immunity resulting in a broader protective value.
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Affiliation(s)
- Meret E Ricklin
- Institute of Virology and Immunology , Mittelhäusern , Switzerland
| | | | - Sylvie Python
- Institute of Virology and Immunology , Mittelhäusern , Switzerland
| | - Daniel Brechbühl
- Institute of Virology and Immunology , Mittelhäusern , Switzerland
| | - Beatrice Zumkehr
- Institute of Virology and Immunology , Mittelhäusern , Switzerland
| | - Horst Posthaus
- Vetsuisse Faculty, Institute for Animal Pathology, University of Bern , Bern , Switzerland
| | - Gert Zimmer
- Institute of Virology and Immunology , Mittelhäusern , Switzerland
| | - Artur Summerfield
- Institute of Virology and Immunology, Mittelhäusern, Switzerland; Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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93
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Enhanced risk of illness during the 1918 influenza pandemic after previous influenza-like illnesses in three military populations. Epidemiol Infect 2016; 144:2043-8. [PMID: 26957052 DOI: 10.1017/s0950268816000479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The reasons for the unprecedented mortality during the 1918 influenza pandemic remain poorly understood. We examined morbidity records from three military cohorts from years prior to and during the 1918 pandemic period to assess the effects of previous respiratory illnesses on experiences during the pandemic. Clinical registers and morbidity lists were examined to identify all medical encounters for acute respiratory illnesses in students at two U.S. military officer training academies and Australian soldiers deployed in Europe. Influenza-like illness prior to the major pandemic wave of 1918 predisposed Australian soldiers [relative risk (RR) 1·37, 95% confidence interval (CI) 1·18-1·60, P < 0·0001] and US officer trainees at West Point (RR 3·10, 95% CI 2·13-4·52, P < 0·0001) and Annapolis (RR 2·03, 95% CI 1·65-2·50, P < 0·0001) to increased risks of medically treated illnesses in late 1918. The findings suggest that susceptibility to and/or clinical expressions of the 1918 pandemic influenza virus depended on previous experiences with respiratory infectious agents. The findings are consistent with observations during the 2009 pandemic in Canada and may reflect antibody-dependent enhancement of influenza infection.
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94
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McKimm-Breschkin JL, Fry AM. Meeting report: 4th ISIRV antiviral group conference: Novel antiviral therapies for influenza and other respiratory viruses. Antiviral Res 2016; 129:21-38. [PMID: 26872862 PMCID: PMC7132401 DOI: 10.1016/j.antiviral.2016.01.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 01/08/2023]
Abstract
The International Society for Influenza and other Respiratory Virus Diseases (isirv) held its 4th Antiviral Group Conference at the University of Texas on 2–4 June, 2015. With emerging resistance to the drugs currently licensed for treatment and prophylaxis of influenza viruses, primarily the neuraminidase inhibitor oseltamivir phosphate (Tamiflu) and the M2 inhibitors amantadine and rimantadine, and the lack of effective interventions against other respiratory viruses, the 3-day programme focused on the discovery and development of inhibitors of several virus targets and key host cell factors involved in virus replication or mediating the inflammatory response. Virus targets included the influenza haemagglutinin, neuraminidase and M2 proteins, and both the respiratory syncytial virus and influenza polymerases and nucleoproteins. Therapies for rhinoviruses and MERS and SARS coronaviruses were also discussed. With the emerging development of monoclonal antibodies as therapeutics, the potential implications of antibody-dependent enhancement of disease were also addressed. Topics covered all aspects from structural and molecular biology to preclinical and clinical studies. The importance of suitable clinical trial endpoints and regulatory issues were also discussed from the perspectives of both industry and government. This meeting summary provides an overview, not only for the conference participants, but also for those interested in the current status of antivirals for respiratory viruses. The International Society for Influenza and other Respiratory Viruses held an Antiviral Group conference in June, 2015. This report covers oral presentations, including therapies against influenza and respiratory syncytial virus infections. Therapies for rhinovirus, MERS and SARS coronavirus infections were also topics at the conference. Some speakers focused on monoclonal antibodies as therapeutics and antibody-dependent enhancement of disease. The importance of suitable clinical trial endpoints and regulatory issues were also discussed.
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Affiliation(s)
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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95
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Laurie KL, Guarnaccia TA, Carolan LA, Yan AWC, Aban M, Petrie S, Cao P, Heffernan JM, McVernon J, Mosse J, Kelso A, McCaw JM, Barr IG. Interval Between Infections and Viral Hierarchy Are Determinants of Viral Interference Following Influenza Virus Infection in a Ferret Model. J Infect Dis 2015; 212:1701-10. [PMID: 25943206 PMCID: PMC4633756 DOI: 10.1093/infdis/jiv260] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/23/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Epidemiological studies suggest that, following infection with influenza virus, there is a short period during which a host experiences a lower susceptibility to infection with other influenza viruses. This viral interference appears to be independent of any antigenic similarities between the viruses. We used the ferret model of human influenza to systematically investigate viral interference. METHODS Ferrets were first infected then challenged 1-14 days later with pairs of influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses circulating in 2009 and 2010. RESULTS Viral interference was observed when the interval between initiation of primary infection and subsequent challenge was <1 week. This effect was virus specific and occurred between antigenically related and unrelated viruses. Coinfections occurred when 1 or 3 days separated infections. Ongoing shedding from the primary virus infection was associated with viral interference after the secondary challenge. CONCLUSIONS The interval between infections and the sequential combination of viruses were important determinants of viral interference. The influenza viruses in this study appear to have an ordered hierarchy according to their ability to block or delay infection, which may contribute to the dominance of different viruses often seen in an influenza season.
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Affiliation(s)
- Karen L. Laurie
- WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity
- School of Applied and Biomedical Sciences, Federation University, Churchill, Australia
| | - Teagan A. Guarnaccia
- WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity
- School of Applied and Biomedical Sciences, Federation University, Churchill, Australia
| | - Louise A. Carolan
- WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity
| | - Ada W. C. Yan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne
| | - Malet Aban
- WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity
| | - Stephen Petrie
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne
| | - Pengxing Cao
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne
| | - Jane M. Heffernan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne
- Modelling Infection and Immunity Laboratory, Centre for Disease Modelling, York Institute for Health Research
- Program in Mathematics and Statistics, York University, Toronto, Canada
| | - Jodie McVernon
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne
- Modelling and Simulation Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne
| | - Jennifer Mosse
- School of Applied and Biomedical Sciences, Federation University, Churchill, Australia
| | - Anne Kelso
- WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity
| | - James M. McCaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne
- Modelling and Simulation Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne
| | - Ian G. Barr
- WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity
- School of Applied and Biomedical Sciences, Federation University, Churchill, Australia
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96
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Zhang XS. Strain Interactions as a Mechanism for Dominant Strain Alternation and Incidence Oscillation in Infectious Diseases: Seasonal Influenza as a Case Study. PLoS One 2015; 10:e0142170. [PMID: 26562668 PMCID: PMC4642928 DOI: 10.1371/journal.pone.0142170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/19/2015] [Indexed: 12/17/2022] Open
Abstract
Background Many human infectious diseases are caused by pathogens that have multiple strains and show oscillation in infection incidence and alternation of dominant strains which together are referred to as epidemic cycling. Understanding the underlying mechanisms of epidemic cycling is essential for forecasting outbreaks of epidemics and therefore important for public health planning. Current theoretical effort is mainly focused on the factors that are extrinsic to the pathogens themselves (“extrinsic factors”) such as environmental variation and seasonal change in human behaviours and susceptibility. Nevertheless, co-circulation of different strains of a pathogen was usually observed and thus strains interact with one another within concurrent infection and during sequential infection. The existence of these intrinsic factors is common and may be involved in the generation of epidemic cycling of multi-strain pathogens. Methods and Findings To explore the mechanisms that are intrinsic to the pathogens themselves (“intrinsic factors”) for epidemic cycling, we consider a multi-strain SIRS model including cross-immunity and infectivity enhancement and use seasonal influenza as an example to parameterize the model. The Kullback-Leibler information distance was calculated to measure the match between the model outputs and the typical features of seasonal flu (an outbreak duration of 11 weeks and an annual attack rate of 15%). Results show that interactions among strains can generate seasonal influenza with these characteristic features, provided that: the infectivity of a single strain within concurrent infection is enhanced 2−7 times that within a single infection; cross-immunity as a result of past infection is 0.5–0.8 and lasts 2–9 years; while other parameters are within their widely accepted ranges (such as a 2–3 day infectious period and the basic reproductive number of 1.8–3.0). Moreover, the observed alternation of the dominant strain among epidemics emerges naturally from the best fit model. Alternative modelling that also includes seasonal forcing in transmissibility shows that both external mechanisms (i.e. seasonal forcing) and the intrinsic mechanisms (i.e., strain interactions) are equally able to generate the observed time-series in seasonal flu. Conclusions The intrinsic mechanism of strain interactions alone can generate the observed patterns of seasonal flu epidemics, but according to Kullback-Leibler information distance the importance of extrinsic mechanisms cannot be excluded. The intrinsic mechanism illustrated here to explain seasonal flu may also apply to other infectious diseases caused by polymorphic pathogens.
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Affiliation(s)
- Xu-Sheng Zhang
- Modelling and Economics Unit, Department of Statistics, Modelling and Economics, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
- * E-mail:
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97
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Abstract
Seasonal influenza is a significant public health concern globally. While influenza vaccines are the single most effective intervention to reduce influenza morbidity and mortality, there is considerable debate surrounding the merits and consequences of repeated seasonal vaccination. Here, we describe a two-season influenza epidemic contact network model and use it to demonstrate that increasing the level of continuity in vaccination across seasons reduces the burden on public health. We show that revaccination reduces the influenza attack rate not only because it reduces the overall number of susceptible individuals, but also because it better protects highly connected individuals, who would otherwise make a disproportionately large contribution to influenza transmission. We also demonstrate that our results hold on an empirical contact network, in the presence of assortativity in vaccination status, and are robust for a range of vaccine coverage and efficacy levels. Our work contributes a population-level perspective to debates about the merits of repeated influenza vaccination and advocates for public health policy to incorporate individual vaccine histories.
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98
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Hawken S, Kwong JC, Deeks SL, Crowcroft NS, McGeer AJ, Ducharme R, Campitelli MA, Coyle D, Wilson K. Simulation study of the effect of influenza and influenza vaccination on risk of acquiring Guillain-Barré syndrome. Emerg Infect Dis 2015; 21:224-31. [PMID: 25625590 PMCID: PMC4313628 DOI: 10.3201/eid2102.131879] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Under typical conditions, such as influenza incidence rates of >5% and vaccine effectiveness >60%, vaccination reduced risk. It is unclear whether seasonal influenza vaccination results in a net increase or decrease in the risk for Guillain-Barré syndrome (GBS). To assess the effect of seasonal influenza vaccination on the absolute risk of acquiring GBS, we used simulation models and published estimates of age- and sex-specific risks for GBS, influenza incidence, and vaccine effectiveness. For a hypothetical 45-year-old woman and 75-year-old man, excess GBS risk for influenza vaccination versus no vaccination was −0.36/1 million vaccinations (95% credible interval −1.22 to 0.28) and −0.42/1 million vaccinations (95% credible interval, –3.68 to 2.44), respectively. These numbers represent a small absolute reduction in GBS risk with vaccination. Under typical conditions (e.g. influenza incidence rates >5% and vaccine effectiveness >60%), vaccination reduced GBS risk. These findings should strengthen confidence in the safety of influenza vaccine and allow health professionals to better put GBS risk in context when discussing influenza vaccination with patients.
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99
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Blümel B, Schweiger B, Dehnert M, Buda S, Reuss A, Czogiel I, Kamtsiuris P, Schlaud M, Poethko-Müller C, Thamm M, Haas W. Age-related prevalence of cross-reactive antibodies against influenza A(H3N2) variant virus, Germany, 2003 to 2010. Euro Surveill 2015. [DOI: 10.2807/1560-7917.es2015.20.32.21206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- B Blümel
- Robert Koch Institute, Berlin, Germany
- Current affiliation: Institute of Medical Microbiology and Hygiene, University Medical Center Freiburg, Freiburg, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Postgraduate Training for Applied Epidemiology (PAE, German FETP), Robert Koch-Institute, Berlin, Germany
| | | | - M Dehnert
- Current affiliation: Department of Biotechnology and Bioinformatics, Weihenstephan-Triesdorf University of Applied Sciences, Freising, Germany
- Robert Koch Institute, Berlin, Germany
| | - S Buda
- Robert Koch Institute, Berlin, Germany
| | - A Reuss
- Robert Koch Institute, Berlin, Germany
| | - I Czogiel
- Robert Koch Institute, Berlin, Germany
| | | | - M Schlaud
- Robert Koch Institute, Berlin, Germany
| | | | - M Thamm
- Robert Koch Institute, Berlin, Germany
| | - W Haas
- Robert Koch Institute, Berlin, Germany
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100
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Gilca R, Skowronski DM, Douville-Fradet M, Amini R, Boulianne N, Rouleau I, Martineau C, Charest H, De Serres G. Mid-Season Estimates of Influenza Vaccine Effectiveness against Influenza A(H3N2) Hospitalization in the Elderly in Quebec, Canada, January 2015. PLoS One 2015; 10:e0132195. [PMID: 26200655 PMCID: PMC4511737 DOI: 10.1371/journal.pone.0132195] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/10/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The 2014/15 influenza season in Canada was characterized by an early epidemic due to vaccine-mismatched influenza A(H3N2) viruses, disproportionately affecting elderly individuals ≥65-years-old. We assessed vaccine effectiveness (VE) against A(H3N2) hospitalization among elderly individuals during the peak weeks of the 2014/15 epidemic in Quebec, Canada. METHODS Nasal specimens and clinical/epidemiological data were collected within 7 days of illness onset from elderly patients admitted with respiratory symptoms to one of four participating hospitals between November 30, 2014 and January 13, 2015. Cases tested RT-PCR positive for influenza A(H3N2) and controls tested negative for any influenza. VE was assessed by test-negative case-control design. RESULTS There were 314 participants including 186 cases (62% vaccinated) and 128 controls (59% vaccinated) included in primary VE analysis. Median age was 81.5 years, two-thirds were admitted from the community and 91% had underlying comorbidity. Crude VE against A(H3N2) hospitalization was -17% (95%CI: -86% to 26%), decreasing to -23% (95%CI: -99 to 23%) with adjustment for age and comorbidity, and to -39% (95%CI: -142 to 20%) with additional adjustment for specimen collection interval, calendar time, type of residence and hospital. In sensitivity analyses, VE estimates were improved toward the null with restriction to participants admitted from the community (-2%; 95%CI: -105 to 49%) or with specimen collection ≤4 days since illness onset (- 8%; 95%CI: -104 to 43%) but further from the null with restriction to participants with comorbidity (-51%; 95%CI: -169 to 15%). CONCLUSION The 2014/15 mismatched influenza vaccine provided elderly patients with no cross-protection against hospitalization with the A(H3N2) epidemic strain, reinforcing the need for adjunct protective measures among high-risk individuals and improved vaccine options.
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Affiliation(s)
- Rodica Gilca
- Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada
- CHU de Quebec, Quebec, QC, Canada
- Laval University, Quebec, QC, Canada
| | - Danuta M. Skowronski
- Influenza & Emerging Respiratory Pathogens, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Monique Douville-Fradet
- Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Rachid Amini
- Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Nicole Boulianne
- Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada
- CHU de Quebec, Quebec, QC, Canada
| | - Isabelle Rouleau
- Bureau de surveillance et de vigie, Ministère de la Santé et des Services sociaux du Québec, Quebec, QC, Canada
| | - Christine Martineau
- Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal, Canada
| | - Hugues Charest
- Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Montreal, Canada
| | - Gaston De Serres
- Biological, Environmental and Occupational Risks, Institut National de Santé Publique du Québec, Quebec, QC, Canada
- CHU de Quebec, Quebec, QC, Canada
- Laval University, Quebec, QC, Canada
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