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Standaert B, Van Vlaenderen I, Van Bellinghen LA, Talbird S, Hicks K, Carrico J, Buck PO. Constrained Optimization for the Selection of Influenza Vaccines to Maximize the Population Benefit: A Demonstration Project. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:519-531. [PMID: 31755016 PMCID: PMC7347519 DOI: 10.1007/s40258-019-00534-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Influenza is an infectious disease causing a high annual economic and public health burden. The most efficient management of the disease is through prevention with vaccination. Many influenza vaccines are available, with varying efficacy and cost, targeting different age groups. Therefore, strategic decision-making about which vaccine to deliver to whom is warranted to improve efficiency. OBJECTIVE We present the use of a constrained optimization (CO) model to evaluate targeted strategies for providing influenza vaccines in three adult age groups in the USA. METHODS CO was considered for identifying an influenza vaccine provision strategy that maximizes the benefits at constrained annual budgets, by prioritizing vaccines based on return on investment. The approach optimizes a set of predefined outcome measures over several years resulting from an increasing investment using the best combination of influenza vaccines. RESULTS Results indicate the importance of understanding the relative differences in benefits for each vaccine type within and across age groups. Scenario and threshold analyses demonstrate the impact of changing budget distribution over time, price setting per vaccine type, and selection of outcome measure to optimize. CONCLUSION Significant gains in cost efficiency can be realized for a decision maker using a CO model, especially for a disease like influenza with many vaccine options. Testing the model under different scenarios offers powerful insights into maximum achievable benefit overall and per age group within the predefined constraints of a vaccine budget.
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Wang W, Chen Q, Ford-Siltz LA, Katzelnick LC, Parra GI, Song HS, Vassell R, Weiss CD. Neutralizing Antibody Responses to Homologous and Heterologous H1 and H3 Influenza A Strains After Vaccination With Inactivated Trivalent Influenza Vaccine Vary With Age and Prior-year Vaccination. Clin Infect Dis 2020; 68:2067-2078. [PMID: 30256912 DOI: 10.1093/cid/ciy818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/21/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Prior influenza immunity influences the homologous neutralizing antibody responses elicited by inactivated influenza vaccines (IIV), but neutralizing antibody responses to heterologous strains have not been extensively characterized. METHODS We analyzed neutralizing antibody titers in individuals aged 1-88 who received the 2009-2010 season IIV before infection by or vaccination against the 2009 pandemic H1N1 virus. Neutralization titers to homologous and heterologous past, recent, and advanced H1 and H3 strains, as well as H2, H5, and H7 strains, were measured using influenza hemagglutinin pseudoviruses. We performed exploratory analyses based on age, prior-year IIV, and prevaccination titer, without controlling for Type I errors. RESULTS IIV elicited neutralizing antibodies to past and advanced H1 and H3 strains, as well as to an H2 strain in individuals who were likely infected early in life. The neutralization of avian subtype viruses was rare, and there was no imprinting of neutralization responses to novel avian subtype viruses based on the influenza group. Compared to adults, children had higher seroresponse rates to homologous and heterologous strains, and their sera generated larger antigenic distances among strains. Seroresponse rates to homologous and heterologous strains were lower in subjects vaccinated with prior-year IIV, though postimmunization titers were generally high. CONCLUSIONS IIV elicited neutralizing antibodies to heterologous H1 and H3 strains in all ages groups, but titers and seroresponse rates were usually higher in children. Prior-year vaccination with the same strains tended to blunt IIV neutralization responses to all strains in young and old age groups, yet postimmunization titers were high.
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Affiliation(s)
- Wei Wang
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Qiong Chen
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Lauren A Ford-Siltz
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley
| | - Gabriel I Parra
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Hyo Sook Song
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Russell Vassell
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Carol D Weiss
- Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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Skarlupka AL, Handel A, Ross TM. Influenza hemagglutinin antigenic distance measures capture trends in HAI differences and infection outcomes, but are not suitable predictive tools. Vaccine 2020; 38:5822-5830. [PMID: 32682618 DOI: 10.1016/j.vaccine.2020.06.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 01/24/2023]
Abstract
Vaccination is the most effective method to combat influenza. Vaccine effectiveness is influenced by the antigenic distance between the vaccine strain and the actual circulating virus. Amino acid sequence based methods of quantifying the antigenic distance were designed to predict influenza vaccine effectiveness in humans. The use of these antigenic distance measures has been proposed as an additive method for seasonal vaccine selection. In this report, several antigenic distance measures were evaluated as predictors of hemagglutination inhibition titer differences and clinical outcomes following influenza vaccination or infection in mice or ferrets. The antigenic distance measures described the increasing trend in the change of HAI titer, lung viral titer and percent weight loss in mice and ferrets. However, the variability of outcome variables produced wide prediction intervals for any given antigenic distance value. The amino acid substitution based antigenic distance measures were no better predictors of viral load and weight loss than HAI titer differences, the current predictive measure of immunological correlate of protection for clinical signs after challenge.
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Affiliation(s)
- Amanda L Skarlupka
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, USA
| | - Andreas Handel
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Ted M Ross
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, USA; Department of Infectious Diseases, University of Georgia, Athens, GA, USA.
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104
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Boravleva EY, Lunitsin AV, Kaplun AP, Bykova NV, Krasilnikov IV, Gambaryan AS. Immune Response and Protective Efficacy of Inactivated and Live Influenza Vaccines Against Homologous and Heterosubtypic Challenge. BIOCHEMISTRY (MOSCOW) 2020; 85:553-566. [PMID: 32571185 DOI: 10.1134/s0006297920050041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Inactivated (whole-virion, split, subunit, and adjuvanted) vaccines and live attenuated vaccine were tested in parallel to compare their immunogenicity and protective efficacy. Homologous and heterosubtypic protection against the challenge with influenza H5N1 and H1N1 viruses in a mouse model were studied. Single immunization with live or inactivated whole-virion H5N1 vaccine elicited a high level of serum antibodies and provided complete protection against the challenge with the lethal A/Chicken/Kurgan/3/05 (H5N1) virus, whereas application of a single dose of the split vaccine was much less effective. Adjuvants increased the antibody levels. Addition of the Iso-SANP adjuvant to the split vaccine led to a paradoxical outcome: it increased the antibody levels but reduced the protective effect of the vaccine. All tested adjuvants shifted the ratio between IgG1 and IgG2a antibodies. Immunization with any of the tested heterosubtypic live viruses provided partial protection against the H5N1 challenge and significantly reduced mouse mortality, while inactivated H1N1 vaccine offered no protection at all. More severe course of illness and earlier death were observed in mice after immunization with adjuvanted subunit vaccines followed by the challenge with the heterosubtypic virus compared to challenged unvaccinated animals.
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Affiliation(s)
- E Y Boravleva
- Chumakov Federal Scientific Center for Research and Development of Immune and Biological Products, Russian Academy of Sciences, Moscow, 108819, Russia
| | - A V Lunitsin
- FSBSI Federal Research Center for Virology and Microbiology, Volginsky, Vladimir Region, 601125, Russia
| | - A P Kaplun
- Lomonosov Moscow University of Fine Chemical Technology, Moscow, 119571, Russia
| | - N V Bykova
- Lomonosov Moscow University of Fine Chemical Technology, Moscow, 119571, Russia
| | - I V Krasilnikov
- Saint Petersburg Institute of Vaccines and Sera, FMBA, St.-Petersburg, 198320, Russia
| | - A S Gambaryan
- Chumakov Federal Scientific Center for Research and Development of Immune and Biological Products, Russian Academy of Sciences, Moscow, 108819, Russia.
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105
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Ho BS, Chao KM. On the influenza vaccination policy through mathematical modeling. Int J Infect Dis 2020; 98:71-79. [PMID: 32561427 DOI: 10.1016/j.ijid.2020.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Aimed at mitigating influenza transmission, this study assessed the timing of the vaccination program and took vaccine capacity, strain mismatch and priority group into consideration. METHODS An age-structured dynamic transmission model was fitted to the laboratory data of the national influenza surveillance system to reconstruct a baseline scenario with which the vaccination scenarios of interest could be compared. Outcome measures were defined as the impacts on the seasonal epidemic: decompression of the epidemic peak, reduction of the epidemic burden and change of the epidemic peak time. RESULTS It was found that vaccine capacity building, although indispensable, could not guarantee substantial impact on the seasonal influenza epidemic. Vaccine mismatch might greatly offset vaccine capacity building. Notably, advance vaccine distribution could compensate for some vaccine underperformance. In the case of a well-matched vaccine, advance vaccine distribution could even exploit its utility. CONCLUSIONS This study indicated that timely vaccine distribution should be put high on the agenda of seasonal influenza control policies. It provided a tangible platform for the policymakers to evaluate health policy impacts and to enhance risk communication with the public through mathematical modeling.
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Affiliation(s)
- Bin-Shenq Ho
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan, ROC; Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Kun-Mao Chao
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan, ROC; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC.
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106
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Choi EJ, Park JH, Chun BC. Cost effectiveness of trivalent and quadrivalent influenza vaccines in 50- to 64-year-old adults in Korea. Vaccine 2020; 38:5002-5008. [PMID: 32532543 DOI: 10.1016/j.vaccine.2020.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/04/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Influenza causes severe complications in at-risk populations, resulting in significant morbidity and mortality. Vaccination is the most effective measure to prevent infection and complications caused by seasonal influenza. However, no study has analyzed the cost-effectiveness of influenza vaccines in 50- to 64-year-olds in South Korea. OBJECTIVE We examined the application of the National Immunization Program (NIP) in 50- to 64-year-olds and compared the cost-effectiveness of quadrivalent influenza vaccine (QIV) with that of trivalent influenza vaccine (TIV) in South Korea. METHODS One-year static model was assumed by constructing separate decision trees for age subgroups: 50-54, 55-59, and 60-64. Each subgroup was divided into at-risk and not-at-risk groups. Using circulation data from previous studies and Korea Centers for Disease Control and Prevention, we estimated the probabilities of influenza infection, outpatient treatment, hospitalization, and deaths. Medical cost was estimated from 2015 to 2017 National Health Insurance Sharing Service claim data, while productivity losses from work absenteeism or death were estimated from labor and economic surveys of Korean government. Disutility was estimated based on previous studies. RESULTS Compared with non-vaccination, incremental cost-effectiveness ratios (ICERs) for the 50-54, 55-59, and 60-64 age groups for TIV were US$2010.90, US$2004.58, and US$1865.55, respectively, while for QIV were US$2187.17, US$2190.89, and US$2074.52, respectively. Compared with TIV, ICERs for QIV were US$4445.66, US$4578.06, and US$4751.93, respectively. All the aforementioned ICER values were lower than the 2017 Korean GDP per capita of US$29,742.839. CONCLUSION Implementing the NIP in the 50- to 64-year-old age group was found to be cost effective. Since both TIV and QIV were cost effective, we recommend QIV as the preferred option, based on its greater protection against Influenza B.
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Affiliation(s)
- Eun Joung Choi
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Joo Hee Park
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea; Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, Republic of Korea.
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107
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Kubo M, Miyauchi K. Breadth of Antibody Responses during Influenza Virus Infection and Vaccination. Trends Immunol 2020; 41:394-405. [PMID: 32265127 DOI: 10.1016/j.it.2020.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 12/21/2022]
Abstract
Influenza viruses are a major public health problem, causing severe respiratory diseases. Vaccines offer the effective protective strategy against influenza virus infection. However, the systemic and adaptive immune responses to infection and vaccination are quite different. Inactivated vaccines are the best available countermeasure to induce effective antibodies against the emerged virus, but the response is narrow compared with potential breadth of virus infection. There is solid evidence to indicate that antibody responses to natural infection are relatively broad and exhibit quite different immunodominance patterns. Furthermore, T follicular helper cells (TFH) and germinal center (GC) responses play a central role in generating broad protective antibodies. In this review, we discuss recent advances on the contribution of TFH and GC responses to the breadth of antibody responses.
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Affiliation(s)
- Masato Kubo
- Laboratory for Cytokine Regulation, Center for Integrative Medical Science (IMS), RIKEN Yokohama Institute, 1-7-22 Suehiro-cho, Tsurumi, Yokohama, Kanagawa 230-0045, Japan; Division of Molecular Pathology, Research Institute for Biomedical Science, Tokyo University of Science, 2669 Yamazaki, Noda-shi, Chiba 278-0022, Japan.
| | - Kosuke Miyauchi
- Laboratory for Cytokine Regulation, Center for Integrative Medical Science (IMS), RIKEN Yokohama Institute, 1-7-22 Suehiro-cho, Tsurumi, Yokohama, Kanagawa 230-0045, Japan
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108
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Ito T, Kumagai T, Yamaji Y, Sawada A, Nakayama T. Recombinant Measles AIK-C Vaccine Strain Expressing Influenza HA Protein. Vaccines (Basel) 2020; 8:vaccines8020149. [PMID: 32230902 PMCID: PMC7349030 DOI: 10.3390/vaccines8020149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022] Open
Abstract
Recombinant measles AIK-C vaccine expressing the hemagglutinin (HA) protein of influenza A/Sapporo/107/2013(H1N1pdm) (MVAIK/PdmHA) was constructed. Measles particle agglutination (PA) and influenza hemagglutinin inhibition (HI) antibodies were induced in cotton rats immunized with MVAIK/PdmHA. Cotton rats immunized with two doses of the HA split vaccine were used as positive controls, and higher HI antibodies were detected 3 weeks after the first dose. Following the challenge of A/California/07/2009(H1N1pdm), higher viral loads (107 TCID50/g) were detected in the lung homogenates of cotton rats immunized with the empty vector (MVAIK) or control groups than those immunized with MVAIK/Pdm HA (103 TCID50/g) or the group immunized with HA split vaccine (105 TCID50/g). Histopathologically, destruction of the alveolar structure, swelling of broncho-epithelial cells, and thickening of the alveolar wall with infiltration of inflammatory cells and HA antigens were detected in lung tissues obtained from non-immunized rats and those immunized with the empty vector after the challenge, but not in those immunized with the HA spilt or MVAIK/PdmHA vaccine. Lower levels of IFN-α, IL-1β, and TNF-α mRNA, and higher levels of IFN-γ mRNA were found in the lung homogenates of the MVAIK/PdmHA group. Higher levels of IFN-γ mRNA were detected in spleen cell culture from the MVAIK/PdmHA group stimulated with UV-inactivated A/California/07/2009(H1N1pdm). In conclusion, the recombinant MVAIK vaccine expressing influenza HA protein induced protective immune responses in cotton rats.
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Affiliation(s)
- Takashi Ito
- Laboratory of Viral Infection II, Kitasato Institute for Life Sciences, Tokyo 108-8641, Japan; (T.I.); (Y.Y.); (A.S.)
| | | | - Yoshiaki Yamaji
- Laboratory of Viral Infection II, Kitasato Institute for Life Sciences, Tokyo 108-8641, Japan; (T.I.); (Y.Y.); (A.S.)
| | - Akihito Sawada
- Laboratory of Viral Infection II, Kitasato Institute for Life Sciences, Tokyo 108-8641, Japan; (T.I.); (Y.Y.); (A.S.)
| | - Tetsuo Nakayama
- Laboratory of Viral Infection II, Kitasato Institute for Life Sciences, Tokyo 108-8641, Japan; (T.I.); (Y.Y.); (A.S.)
- Correspondence: ; Tel.: +81-3-5791-6269; Fax: +81-3-5791-6130
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109
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Redlberger-Fritz M, Kundi M, Popow-Kraupp T. Heterogeneity of Circulating Influenza Viruses and Their Impact on Influenza Virus Vaccine Effectiveness During the Influenza Seasons 2016/17 to 2018/19 in Austria. Front Immunol 2020; 11:434. [PMID: 32256493 PMCID: PMC7092378 DOI: 10.3389/fimmu.2020.00434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/25/2020] [Indexed: 11/13/2022] Open
Abstract
The constantly changing pattern in the dominance of viral strains and their evolving subclades during the seasons substantially influences influenza vaccine effectiveness (IVE). In order to further substantiate the importance of detailed data of genetic virus characterization for IVE estimates during the seasons, we performed influenza virus type and subtype specific IVE estimates. IVE estimates were assessed using a test-negative case-control design, in the context of the intraseasonal changes of the heterogeneous mix of circulating influenza virus strains for three influenza seasons (2016/17 to 2018/19) in Austria. Adjusted overall IVE over the three seasons 2016/17, 2017/18, and 2018/19 were -26, 39, and 63%, respectively. In accordance with the changing pattern of the circulating strains a broad range of overall and subtype specific IVEs was obtained: A(H3N2) specific IVE ranged between -26% for season 2016/17 to 58% in season 2018/19, A(H1N1)pdm09 specific IVE was 25% for the season 2017/18 and 65% for the season 2018/19 and Influenza B specific IVE for season 2017/18 was 45%. The results obtained in our study over the three seasons demonstrate the increasingly complex dynamic of the ever changing genetic pattern of the circulating influenza viruses and their influence on IVE estimates. This emphasizes the importance of detailed genetic virus surveillance for reliable IVE estimates.
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Affiliation(s)
| | - Michael Kundi
- Department of Environmental Health, Medical University Vienna, Vienna, Austria
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110
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Mouratidou E, Lambrou A, Andreopoulou A, Gioula G, Exindari M, Kossyvakis A, Pogka V, Mentis A, Georgakopoulou T, Lytras T. Influenza vaccine effectiveness against hospitalization with laboratory-confirmed influenza in Greece: A pooled analysis across six seasons, 2013-2014 to 2018-2019. Vaccine 2020; 38:2715-2724. [PMID: 32033848 DOI: 10.1016/j.vaccine.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Monitoring seasonal influenza Vaccine Effectiveness (VE) is key to inform vaccination strategies and sustain uptake. Pooling data across multiple seasons increases precision and allows for subgroup analyses, providing more conclusive evidence. Our aim was to assess VE against hospitalization with laboratory-confirmed influenza in Greece over six seasons, from 2013 to 2014 to 2018-2019, using routinely collected surveillance data. METHODS Swab samples from hospitalized patients across the country were tested for influenza by RT-PCR. We used the test-negative design, with patients testing positive for influenza serving as cases and those testing negative serving as controls. VE was calculated as one minus the Odds Ratio (OR) for influenza vaccination, estimated by mixed-effects logistic regression and adjusted for age, sex, hospitalization type (being in intensive care or not), time from symptom onset to swabbing, and calendar time. Stratified estimates by age and hospitalization type were obtained, and also subgroup estimates by influenza type/subtype and season. Antigenic and genetic characterization of a subset of circulating influenza strains was performed. RESULTS A total of 3,882 test-positive cases and 5,895 test-negative controls were analyzed. Across all seasons, adjusted VE was 45.5% (95% CI: 31.6-56.6) against all influenza, 62.8% against A(H1N1)pdm09 (95% CI: 40.7-76.7), 28.2% against A(H3N2) (95% CI: 12.0-41.3) and 45.5% against influenza B (95% CI: 29.1-58.1). VE was slightly lower for patients aged 60 years and over, and similar between patients hospitalized inside or outside intensive care. Circulating A(H1N1)pdm09 and B strains were antigenically similar to the vaccine strains, whereas A(H3N2) were not. CONCLUSION Our results confirm the public health benefits from seasonal influenza vaccination, despite the suboptimal effectiveness against A(H3N2) strains. Continued monitoring of VE is essential, and routinely collected surveillance data can be valuable in this regard.
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Affiliation(s)
- Elisavet Mouratidou
- National Public Health Organization, Athens, Greece; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | | | | | - Georgia Gioula
- National Influenza Centre for Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Exindari
- National Influenza Centre for Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Kossyvakis
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Vasiliki Pogka
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Andreas Mentis
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
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111
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Hsu PS, Lian IB, Chao DY. A Population-Based Propensity Score-Matched Study to Assess the Impact of Repeated Vaccination on Vaccine Effectiveness for Influenza-Associated Hospitalization Among the Elderly. Clin Interv Aging 2020; 15:301-312. [PMID: 32184579 PMCID: PMC7060795 DOI: 10.2147/cia.s238786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background Influenza is a major cause of morbidity and mortality in the elderly worldwide. Influenza vaccination can prevent morbidity/mortality from influenza infection. A gap of 1–2 years, before an epidemic strain is recommended by the World Health Organization (WHO) to be the vaccine strain in Southeast Asia, has been reported; this results in a high rate of vaccine mismatch and excess influenza-associated morbidity. The aim of the current study was to evaluate the effect of repeated vaccination on vaccine effectiveness (VE) among the elderly in Taiwan, during years with and without early appearance of antigenically drifted strains. Methods A historical cohort study was conducted to evaluate the impact of repeated vaccination on the reduction of influenza-associated hospitalization among persons older than 64 years over two influenza seasons: 2007–08, with all circulating virus strains mismatched, and 2008–09, with all virus strains matched with the vaccine strains, considering four exposure effects, namely current vaccine effect, sequential vaccination effect, residual protection effect and no vaccination effect. Propensity score matching on vaccination status was performed to ensure similar baseline characteristics between the groups that received and did not receive vaccination. Results Only current-year vaccination in combination with prior history of annual revaccination significantly reduced the risk of hospitalization, with adjusted hazard ratios of 0.68 (95% CI: 0.54, 0.85) and 0.74 (95% CI: 0.57, 0.95) during the 2007–08 and 2008–09 influenza seasons, respectively. Further stratification showed that even during the 2007–08 influenza season, when all vaccinations were mismatched with the circulating strains, sequential vaccinations still significantly reduced influenza-associated hospitalization in the female population aged 68–74 and 75–84 years, with adjusted VE of 25.2% (95% CI: −9.6, 49.0%) and 36.9% (95% CI: 17.1, 52.0%), respectively. Conclusion Our study supports the recommendation of annual revaccination against influenza in the elderly, even though the circulating strain of influenza virus was antigenically mismatched with the vaccine strains.
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Affiliation(s)
- Pi-Shan Hsu
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.,Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Ie-Bin Lian
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan.,Department of Applied Math, National Chung-Hsing University, Taichung, Taiwan
| | - Day-Yu Chao
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung, Taiwan
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112
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Chen Q, Wang L, Xie M, Li X. Recommendations for influenza and Streptococcus pneumoniae vaccination in elderly people in China. Aging Med (Milton) 2020; 3:1-11. [PMID: 32232186 PMCID: PMC7099755 DOI: 10.1002/agm2.12102] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/06/2023] Open
Abstract
Influenza and pneumonia can be prevented by vaccination, but they remain major causes of morbidity and mortality in age-related diseases. In most areas of China, the rates of influenza and pneumococcal vaccination are relatively low and public awareness of vaccination remains insufficient. Thus, it is essential to recommend influenza and Streptococcus pneumoniae vaccination to elderly people in clinical practice. Based on recently published studies and related documents issued by several vaccination authorities, such as the World Health Organization, the National Health and Wellness Committee, the Chinese Center for Disease Control and Prevention, the US Centers for Disease Control and Prevention, and the US Advisory Committee on Immunization Practices, we propose official recommendations for influenza and S pneumoniae vaccination in elderly people in China.
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Affiliation(s)
- Qiong Chen
- Department of GeriatricsDepartment of Respiratory MedicineXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
| | - Lijing Wang
- Department of GeriatricsDepartment of Respiratory MedicineXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
| | - Mingxuan Xie
- Department of GeriatricsDepartment of Respiratory MedicineXiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya HospitalCentral South UniversityChangshaChina
| | - Xiaoying Li
- Department of Cardiovascular MedicineChinese PLA General HospitalBeijingChina
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113
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Destexhe É, Grosdidier É, Bouhraoua A, Thirion-Delalande C, Bouzya B, Rouxel RN, Mallett CP, Baumeister J. Chimeric hemagglutinin supra-seasonal universal influenza vaccine candidates administered sequentially by the intramuscular route are locally and systemically well-tolerated in rabbits. Regul Toxicol Pharmacol 2020; 113:104625. [PMID: 32119974 DOI: 10.1016/j.yrtph.2020.104625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/24/2020] [Accepted: 02/25/2020] [Indexed: 11/28/2022]
Abstract
Sequential intramuscular immunization with chimeric hemagglutinins (cHA) composed of the same conserved HA stalk domain and distinct HA heads is a proposed strategy to produce a supra-seasonal universal influenza vaccine. To evaluate the local tolerance and the local and systemic effects of this strategy, two studies were performed in rabbits. In the first study, two different split virion monovalent cHA vaccines, containing cH5/1N1 and cH8/1N1, with or without AS01 or AS03, were injected at a two-week interval. In the second study, animals were given these vaccines and two weeks later an additional dose of split virion monovalent cHA vaccine containing cH11/1N1, with or without AS01 or AS03. General health status, rectal temperature, local tolerance, ophthalmology, hematology, coagulation, and blood chemistry parameters were monitored. Macroscopic and microscopic evaluations were performed three days after the last dose and after a treatment-free recovery period. The treatment-related changes included body weight loss and food consumption decrease, increases in neutrophil count, C-reactive protein and fibrinogen levels. Microscopic signs of inflammation at the injection sites and immune stimulation of the draining lymph nodes and spleen were also noticed. Most post-injection findings could be linked to the transient inflammation due to the establishment of the desired vaccine-elicited immune response, and were mainly observed in the adjuvanted groups. In conclusion, the sequential administration of different cHA vaccines was locally and systemically well-tolerated in rabbits.
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Influenza vaccine effectiveness against influenza-associated hospitalization in children: A systematic review and meta-analysis. Vaccine 2020; 38:2893-2903. [PMID: 32113808 DOI: 10.1016/j.vaccine.2020.02.049] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/12/2020] [Accepted: 02/15/2020] [Indexed: 01/20/2023]
Abstract
Vaccination remains the most effective way to prevent influenza infection, albeit vaccine effectiveness (VE) varies by year. Compared to other age groups, children and elderly adults have the highest risk of developing influenza-related complications and requiring hospitalization. During the last years, "test negative design" (TND) studies have been implemented in order to estimate influenza VE. The aim of this systematic review and meta-analysis was to summarize the findings of TND studies reporting influenza VE against laboratory-confirmed influenza-related hospitalization in children aged 6 months to 17 years. We searched the PubMed and Embase databases and identified 2615 non-duplicate studies that required detailed review. Among them, 28 met our inclusion criteria and we performed a random-effects meta-analysis using adjusted VE estimates. In our primary analysis, influenza vaccine offered significant protection against any type influenza-related hospitalization (57.48%; 95% CI 49.46-65.49). When we examined influenza VE per type and strain, VE was higher against H1N1 (74.07%; 95% CI: 54.85-93.30) and influenza B (50.87%; 95% CI: 41.75-59.98), and moderate against H3N2 (40.77%; 95% CI: 25.65-55.89). Notably, influenza vaccination offered higher protection in children who were fully vaccinated (61.79%; 95% CI: 54.45-69.13), compared to those who were partially vaccinated (33.91%; 95% CI: 21.12 - 46.69). Also, influenza VE was high in children less than 5 years old (61.71%; 95% CI: 49.29-74.12) as well as in children 6-17 years old (54.37%; 95% CI: 35.14-73.60). In conclusion, in the pediatric population, influenza vaccination offered significant protection against influenza-related hospitalization and complete annual vaccination should be encouraged.
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Comparison of the immunogenicity and safety of quadrivalent and tetravalent influenza vaccines in children and adolescents. Vaccine 2020; 38:1332-1344. [PMID: 31948819 DOI: 10.1016/j.vaccine.2019.11.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/31/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Children and adolescents are susceptible to influenza. Vaccination is the most important strategy for preventing influenza, yet there are few studies on the immunogenicity and safety of quadrivalent inactivated influenza vaccine (QIV) containing two A strains (H1N1 and H3N2) and two B lineages (Victoria and Yamagata). Therefore, to further clarify the immunogenicity and safety of QIV in children and adolescents, a meta-analysis was performed to provide a reference for the development of influenza prevention strategies. METHODS PubMed, EMBASE and Cochrane Library were searched for articles published as of February 12, 2019. Random clinical trials comparing the immunogenicity and safety of QIV and TIV among children and adolescents were selected. The main outcomes were comparisons of immunogenicity (seroprotection rate [SPR] and seroconversion rate [SCR] and adverse events using risk ratios (RRs). The meta-analysis was performed using random-effects models. RESULTS Among the 6 months up to 3 years group, QIV showed a higher SPR for B lineages than for TIV-B/Yamagata, with pooled RRs of 3.07 (95% CI: 2.58-3.66) and 1.06 (95% CI: 1.01-1.11), respectively. For the 3 years through 18 years, QIV had a higher SCR and SPR for the Yamagata lineage than for TIV-B/Victoria, with pooled RRs of 2.30 (95% CI: 1.83-2.88) and 1.16 (95% CI: 1.03-1.30), respectively. Compared to TIV-B/Yamagata, a higher SCR and SPR for the Victoria lineage was found for QIV, with RRs of 3.09 (95% CI: 1.99-4.78) and 1.72 (95% CI: 1.22-2.41), respectively. Regarding adverse events, only pain was more frequently reported for QIV than TIV ; the RR was 1.09 (95% CI: 1.02-1.17). CONCLUSIONS The immunogenicity of QIV for common ingredients was similar to that of TIV, but the former exhibited significantly higher immunogenicity for the unique lineage. QIV also had the same reliable safety as TIV.
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Choi A, Bouzya B, Cortés Franco KD, Stadlbauer D, Rajabhathor A, Rouxel RN, Mainil R, Van der Wielen M, Palese P, García-Sastre A, Innis BL, Krammer F, Schotsaert M, Mallett CP, Nachbagauer R. Chimeric Hemagglutinin-Based Influenza Virus Vaccines Induce Protective Stalk-Specific Humoral Immunity and Cellular Responses in Mice. Immunohorizons 2020; 3:133-148. [PMID: 31032479 DOI: 10.4049/immunohorizons.1900022] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The high variation of the influenza virus hemagglutinin (HA), particularly of its immunodominant head epitopes, makes it necessary to reformulate seasonal influenza virus vaccines every year. Novel influenza virus vaccines that redirect the immune response toward conserved epitopes of the HA stalk domain should afford broad and durable protection. Sequential immunization with chimeric HAs (cHAs) that express the same conserved HA stalk and distinct exotic HA heads has been shown to elicit high levels of broadly cross-reactive Abs. In the current mouse immunization studies, we tested this strategy using inactivated split virion cHA influenza virus vaccines (IIV) without adjuvant or adjuvanted with AS01 or AS03 to measure the impact of adjuvant on the Ab response. The vaccines elicited high levels of cross-reactive Abs that showed activity in an Ab-dependent, cell-mediated cytotoxicity reporter assay and were protective in a mouse viral challenge model after serum transfer. In addition, T cell responses to adjuvanted IIV were compared with responses to a cHA-expressing live attenuated influenza virus vaccine (LAIV). A strong but transient induction of Ag-specific T cells was observed in the spleens of mice vaccinated with LAIV. Interestingly, IIV also induced T cells, which were successfully recalled upon viral challenge. Groups that received AS01-adjuvanted IIV or LAIV 4 wk before the challenge showed the lowest level of viral replication (i.e., the highest level of protection). These studies provide evidence that broadly cross-reactive Abs elicited by cHA vaccination demonstrate Fc-mediated activity. In addition, cHA vaccination induced Ag-specific cellular responses that can contribute to protection upon infection.
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Affiliation(s)
- Angela Choi
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | | | | | - Daniel Stadlbauer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Arvind Rajabhathor
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | | | | | | | - Peter Palese
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029; and
| | | | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Michael Schotsaert
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | | | - Raffael Nachbagauer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029;
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Hunter P, Fryhofer SA, Szilagyi PG. Vaccination of Adults in General Medical Practice. Mayo Clin Proc 2020; 95:169-183. [PMID: 31902413 DOI: 10.1016/j.mayocp.2019.02.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 01/04/2023]
Abstract
In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. The new recombinant zoster vaccine offers significantly more efficacy against zoster outbreaks and postherpetic neuralgia than zoster vaccine live. Pertussis vaccine given during the third trimester of pregnancy may prevent between 50% and 90% of pertussis infections in infants. Shorter time for completion (1 vs 6 months) of new, adjuvanted hepatitis B vaccine may increase adherence. Clinicians can address systemic barriers to increasing vaccination rates in their clinics and health care systems by following the Centers for Disease Control and Prevention's Standards for Adult Immunization Practice. Clinicians can help increase vaccination rates by writing standing orders and by advocating for nurses or medical assistants to receive training and protected time for assessing and documenting vaccination histories and administration. Strong recommendations that presume acceptance of vaccination are effective with most patients. Communication techniques similar to motivational interviewing can help with vaccine-hesitant patients. Clinicians, as experts on providing preventive services, can educate community leaders about the benefits of immunization and can inform vaccine experts about challenges of implementing vaccination recommendations in clinical practice and strategies that can work to raise vaccination rates.
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Affiliation(s)
- Paul Hunter
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI; City of Milwaukee Health Department, WI.
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118
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Yue M, Dickens BL, Yoong JSY, I-Cheng Chen M, Teerawattananon Y, Cook AR. Cost-Effectiveness Analysis for Influenza Vaccination Coverage and Timing in Tropical and Subtropical Climate Settings: A Modeling Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1345-1354. [PMID: 31806190 DOI: 10.1016/j.jval.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The lack of seasonality in influenza epidemics in the tropics makes the application of well-established temperate zone national vaccination plans challenging. OBJECTIVES We developed an individual-based simulation model to study optimal vaccination scheduling and assess cost-effectiveness of these vaccination schedules in scenarios of no influenza seasonality and the seasonality regimes of Singapore, Taipei, and Tokyo. METHODS The simulation models heterogeneities in human contact networks, levels of protective antibodies following infection, the effectiveness of the influenza vaccine, and seasonality. Using a no intervention baseline, we consider 3 alternative vaccination strategies: (1) annual vaccination for a percentage of the elderly, (2) biannual vaccination for a percentage of the elderly, and (3) annual vaccination for all elderly and a fraction of the remaining population. We considered 5 vaccination uptake rates for each strategy and modeled the estimated costs, quality-adjusted life years, and incremental cost-effectiveness ratios (ICERs), indicating the cost-effectiveness of each scenario. RESULTS In Singapore, annual vaccination for a proportion of elderly is largely cost-effective. However, with fixed uptake rates, partial biannual vaccination for the elderly yields a higher ICER than partial annual vaccination for the elderly, resulting in a cost-ineffective ICER. The most optimal strategy is the total vaccination of all the elderly and a proportion of individuals from other age groups, which results in a cost-saving ICER. This finding is consistent across different seasonality regimes. CONCLUSIONS Tropical countries like Singapore can have comparably cost-effective vaccination strategies as found in countries with winter epidemics. The vaccination of all the elderly and a proportion of other age groups is the most cost-effective strategy, supporting the need for an extensive national influenza vaccination program.
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Affiliation(s)
- Mu Yue
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Borame L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Joanne Su-Yin Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark I-Cheng Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Statistics and Applied Probability, National University of Singapore, Singapore.
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119
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Xu C, Cowling BJ, Chen T, Wang L, Zhang Y, Huang D, Yang L, Yang J, Huang W, Wang D, Shu Y. The heterogeneity of influenza seasonality by subtype and lineage in China. J Infect 2019; 80:469-496. [PMID: 31790707 DOI: 10.1016/j.jinf.2019.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Cuiling Xu
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tao Chen
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China
| | - Lijie Wang
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China
| | - Ye Zhang
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China
| | - Dawei Huang
- Institute of Artificial Intelligence and Robotics, Xi'an Jiaotong University
| | - Lei Yang
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China
| | - Jing Yang
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China
| | - Weijuan Huang
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China
| | - Dayan Wang
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China.
| | - Yuelong Shu
- Chinese National Influenza Center, National Institute for Viral Disease Control and Prevention, Collaboration Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, P.R. China; School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, P.R. China.
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Restrained expansion of the recall germinal center response as biomarker of protection for influenza vaccination in mice. PLoS One 2019; 14:e0225063. [PMID: 31725776 PMCID: PMC6855462 DOI: 10.1371/journal.pone.0225063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/27/2019] [Indexed: 01/04/2023] Open
Abstract
Correlates of protection (CoP) are invaluable for iterative vaccine design studies, especially in pursuit of complex vaccines such as a universal influenza vaccine (UFV) where a single antigen is optimized to elicit broad protection against many viral antigenic variants. Since broadly protective antibodies against influenza virus often exhibit mutational evidence of prolonged diversification, we studied germinal center (GC) kinetics in hemagglutinin (HA) immunized mice. Here we report that as early as 4 days after secondary immunization, the expansion of HA-specific GC B cells inversely correlated to protection against influenza virus challenge, induced by the antigen. In contrast, follicular T helper (TFH) cells did not expand differently after boost vaccination, suggestive of a B-cell intrinsic difference in activation and differentiation inferred by protective antigen properties. Importantly, differences in antigen dose only affected GC B-cell frequencies after primary immunization. The absence of accompanying differences in total anti-HA or epitope-specific antibody levels induced by vaccines of different efficacy suggests that the GC B-cell response upon revaccination represents an early and unique marker of protection that may significantly accelerate the pre-clinical phase of vaccine development.
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121
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Ganczak M, Kalinowski P, Drozd-Dąbrowska M, Biesiada D, Dubiel P, Topczewska K, Molas-Biesiada A, Oszutowska-Mazurek D, Korzeń M. School life and influenza immunization: A cross-sectional study on vaccination coverage and influencing determinants among Polish teachers. Vaccine 2019; 38:5548-5555. [PMID: 31706813 DOI: 10.1016/j.vaccine.2019.10.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The general public influenza vaccination coverage in Poland is one of the lowest in the EU (3.7% in 2017/2018). Teachers have the potential to be a target group for immunization programs against influenza infection, however, there is yet to be a study in Poland, or even in the EU that has assessed influenza vaccine uptake among this group. The study objective was to evaluate influenza vaccination coverage and to assess influencing determinants amongst Polish teachers. METHOD A cross-sectional questionnaire-based study was conducted among 277 teachers from 9 primary schools of two regional capitals of two Polish regions: Szczecin and Lublin. RESULTS A quarter of teachers have ever received influenza vaccine; 4.5% reported receiving vaccination in the 2018/2019 season. The main reasons for not being vaccinated were a lack of confidence in its effectiveness (56.9%) and concerns related to adverse effects (30.6%). Forty four percent (43.8%) of teachers believed that they are at risk of influenza infection, only 62.5% indicated vaccination as an effective method of preventing influenza. Previous information about influenza (OR = 15.70), high knowledge level about influenza (OR = 2.56), family physician recommendation (OR = 2.39), belief that influenza vaccination should be mandatory for teachers (OR = 3.29), and having a vaccinated family member (OR = 2.68) were each associated with higher odds of immunization. Willingness to be vaccinated against influenza in the next season was strongly associated with current vaccination status (OR = 7.16). CONCLUSIONS Influenza vaccination coverage among Polish teachers is alarmingly low; vaccine receipt was associated with teacher attitudes and beliefs. Future interventions related to maximizing vaccination coverage in this group should take advantage of the involvement of family physicians and specifically focus on teachers who have never been vaccinated before. As knowledge about influenza positively influences vaccination decisions, education strategies should focus on reducing knowledge gaps to alter attitudes and increase uptake.
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Affiliation(s)
- Maria Ganczak
- Department of Infectious Diseases, University of Zielona Góra, Zyty 28, 65-046 Zielona Góra, Poland.
| | - Paweł Kalinowski
- Department of Epidemiology, Medical University of Lublin, Staszica 4-6, 20-081 Lublin, Poland
| | - Marzena Drozd-Dąbrowska
- Department of Epidemiology and Management, Pomeranian Medical University, Zolnierska 48, 71-210 Szczecin, Poland
| | - Daniel Biesiada
- Primary Medicine Clinic "Lancet", Szkolna 9, 73-240 Bierzwnik, Poland
| | - Paulina Dubiel
- Department of Epidemiology and Management, Pomeranian Medical University, Zolnierska 48, 71-210 Szczecin, Poland
| | - Katarzyna Topczewska
- Department of Epidemiology and Management, Pomeranian Medical University, Zolnierska 48, 71-210 Szczecin, Poland
| | | | - Dorota Oszutowska-Mazurek
- Department of Epidemiology and Management, Pomeranian Medical University, Zolnierska 48, 71-210 Szczecin, Poland
| | - Marcin Korzeń
- Department of Methods of Artificial Intelligence and Applied Mathematics, West Pomeranian University of Technology, Zolnierska 46, 71-210 Szczecin, Poland
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Meyer-Hermann M. Injection of Antibodies against Immunodominant Epitopes Tunes Germinal Centers to Generate Broadly Neutralizing Antibodies. Cell Rep 2019; 29:1066-1073.e5. [DOI: 10.1016/j.celrep.2019.09.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/19/2019] [Accepted: 09/18/2019] [Indexed: 12/28/2022] Open
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Caini S, Kusznierz G, Garate VV, Wangchuk S, Thapa B, de Paula Júnior FJ, Ferreira de Almeida WA, Njouom R, Fasce RA, Bustos P, Feng L, Peng Z, Araya JL, Bruno A, de Mora D, Barahona de Gámez MJ, Pebody R, Zambon M, Higueros R, Rivera R, Kosasih H, Castrucci MR, Bella A, Kadjo HA, Daouda C, Makusheva A, Bessonova O, Chaves SS, Emukule GO, Heraud JM, Razanajatovo NH, Barakat A, El Falaki F, Meijer A, Donker GA, Huang QS, Wood T, Balmaseda A, Palekar R, Arévalo BM, Rodrigues AP, Guiomar R, Lee VJM, Ang LW, Cohen C, Treurnicht F, Mironenko A, Holubka O, Bresee J, Brammer L, Le MTQ, Hoang PVM, El Guerche-Séblain C, Paget J. The epidemiological signature of influenza B virus and its B/Victoria and B/Yamagata lineages in the 21st century. PLoS One 2019; 14:e0222381. [PMID: 31513690 PMCID: PMC6742362 DOI: 10.1371/journal.pone.0222381] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/29/2019] [Indexed: 12/15/2022] Open
Abstract
We describe the epidemiological characteristics, pattern of circulation, and geographical distribution of influenza B viruses and its lineages using data from the Global Influenza B Study. We included over 1.8 million influenza cases occurred in thirty-one countries during 2000–2018. We calculated the proportion of cases caused by influenza B and its lineages; determined the timing of influenza A and B epidemics; compared the age distribution of B/Victoria and B/Yamagata cases; and evaluated the frequency of lineage-level mismatch for the trivalent vaccine. The median proportion of influenza cases caused by influenza B virus was 23.4%, with a tendency (borderline statistical significance, p = 0.060) to be higher in tropical vs. temperate countries. Influenza B was the dominant virus type in about one every seven seasons. In temperate countries, influenza B epidemics occurred on average three weeks later than influenza A epidemics; no consistent pattern emerged in the tropics. The two B lineages caused a comparable proportion of influenza B cases globally, however the B/Yamagata was more frequent in temperate countries, and the B/Victoria in the tropics (p = 0.048). B/Yamagata patients were significantly older than B/Victoria patients in almost all countries. A lineage-level vaccine mismatch was observed in over 40% of seasons in temperate countries and in 30% of seasons in the tropics. The type B virus caused a substantial proportion of influenza infections globally in the 21st century, and its two virus lineages differed in terms of age and geographical distribution of patients. These findings will help inform health policy decisions aiming to reduce disease burden associated with seasonal influenza.
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Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
- * E-mail:
| | - Gabriela Kusznierz
- National Institute of Respiratory Diseases "Emilio Coni", Santa Fe, Argentina
| | | | - Sonam Wangchuk
- Royal Centre for Disease Control, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Binay Thapa
- Royal Centre for Disease Control, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | | | | | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Rodrigo A. Fasce
- Sub-Department of Viral Diseases, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Patricia Bustos
- Sub-Department of Viral Diseases, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Luzhao Feng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Zhibin Peng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Jenny Lara Araya
- National Influenza Center, Ministry of Health, San José, Costa Rica
| | - Alfredo Bruno
- National Institute of Public Health Research (INSPI), National Reference Centre for Influenza and Other Respiratory Viruses, Guayaquil, Ecuador
- Agricultural University of Ecuador, Guayaquil, Ecuador
| | - Doménica de Mora
- National Institute of Public Health Research (INSPI), National Reference Centre for Influenza and Other Respiratory Viruses, Guayaquil, Ecuador
| | | | | | - Maria Zambon
- Public Health England, London, England, United Kingdom
| | - Rocio Higueros
- National Influenza Center, Ministry of Health, Guatemala City, Guatemala
| | | | | | - Maria Rita Castrucci
- National Influenza Center, Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Hervé A. Kadjo
- Department of Epidemic Virus, Institut Pasteur, Abidjan, Côte d'Ivoire
| | - Coulibaly Daouda
- Service of Epidemiological Diseases Surveillance, National Institute of Public Hygiene, Abidjan, Côte d'Ivoire
| | - Ainash Makusheva
- National Center of Expertise, Committee of Public Health Protection, Ministry of Health, Astana, Kazakhstan
| | - Olga Bessonova
- National Center of Expertise, Committee of Public Health Protection, Ministry of Health, Uralsk City, Kazakhstan
| | - Sandra S. Chaves
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Gideon O. Emukule
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jean-Michel Heraud
- National Influenza Center, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Norosoa H. Razanajatovo
- National Influenza Center, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Amal Barakat
- National Influenza Center, Institut National d'Hygiène, Ministry of Health, Rabat, Morocco
| | - Fatima El Falaki
- National Influenza Center, Institut National d'Hygiène, Ministry of Health, Rabat, Morocco
| | - Adam Meijer
- National Institute for Public Health and the Environment, Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Bilthoven, The Netherlands
| | - Gé A. Donker
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Q. Sue Huang
- Institute of Environmental Science and Research, Weillngton, New Zealand
| | - Tim Wood
- Institute of Environmental Science and Research, Weillngton, New Zealand
| | - Angel Balmaseda
- National Influenza Center, Ministry of Health, Managua, Nicaragua
| | - Rakhee Palekar
- Pan American Health Organization, Washington, District of Columbia, United States of America
| | | | - Ana Paula Rodrigues
- Department of epidemiology, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Raquel Guiomar
- National Influenza Reference Laboratory, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | | | - Li Wei Ang
- Public Health Group, Ministry of Health, Singapore, Singapore
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Alla Mironenko
- L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases, National Academy of Medical Science of Ukraine, Department of Respiratory and other Viral Infections, Kyiv, Ukraine
| | - Olha Holubka
- L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases, National Academy of Medical Science of Ukraine, Department of Respiratory and other Viral Infections, Kyiv, Ukraine
| | - Joseph Bresee
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lynnette Brammer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mai T. Q. Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Clotilde El Guerche-Séblain
- Global Vaccine Epidemiology and Modeling Department (VEM), Franchise Epidemiologist, Sanofi Pasteur, Lyon, France
| | - John Paget
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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Mameli C, Cocchi I, Fumagalli M, Zuccotti G. Influenza Vaccination: Effectiveness, Indications, and Limits in the Pediatric Population. Front Pediatr 2019; 7:317. [PMID: 31417886 PMCID: PMC6682587 DOI: 10.3389/fped.2019.00317] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/12/2019] [Indexed: 12/24/2022] Open
Abstract
Influenza vaccine is considered the most effective way to prevent influenza. Nonetheless, every year vaccine coverage is lower than recommended in the pediatric population. Many factors are supposed to contribute to this phenomenon such as the uncertainty about the indication for vaccination, and the suboptimal vaccine-effectiveness in pediatric age, especially in the youngest children. In this review we discuss the effectiveness, indications, and limits of influenza vaccination in the pediatric population based on the most recent evidences.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
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125
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Khan S, Jain A, Taghavian O, Nakajima R, Jasinskas A, Supnet M, Felgner J, Davies J, de Assis RR, Jan S, Obiero J, Strahsburger E, Pone EJ, Liang L, Davies DH, Felgner PL. Use of an Influenza Antigen Microarray to Measure the Breadth of Serum Antibodies Across Virus Subtypes. J Vis Exp 2019:10.3791/59973. [PMID: 31403629 PMCID: PMC11177630 DOI: 10.3791/59973] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The influenza virus remains a significant cause of mortality worldwide due to the limited effectiveness of currently available vaccines. A key challenge to the development of universal influenza vaccines is high antigenic diversity resulting from antigenic drift. Overcoming this challenge requires novel research tools to measure the breadth of serum antibodies directed against many virus strains across different antigenic subtypes. Here, we present a protocol for analyzing the breadth of serum antibodies against diverse influenza virus strains using a protein microarray of influenza antigens. This influenza antigen microarray is constructed by printing purified hemagglutinin and neuraminidase antigens onto a nitrocellulose-coated membrane using a microarray printer. Human sera are incubated on the microarray to bind antibodies against the influenza antigens. Quantum-dot-conjugated secondary antibodies are used to simultaneously detect IgG and IgA antibodies binding to each antigen on the microarray. Quantitative antibody binding is measured as fluorescence intensity using a portable imager. Representative results are shown to demonstrate assay reproducibility in measuring subtype-specific and cross-reactive influenza antibodies in human sera. Compared to traditional methods such as ELISA, the influenza antigen microarray provides a high throughput multiplexed approach capable of testing hundreds of sera for multiple antibody isotypes against hundreds of antigens in a short time frame, and thus has applications in sero-surveillance and vaccine development. A limitation is the inability to distinguish binding antibodies from neutralizing antibodies.
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Affiliation(s)
- Saahir Khan
- Division of Infectious Diseases, Department of Medicine, University of California Irvine Health
| | - Aarti Jain
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Omid Taghavian
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Rie Nakajima
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Algis Jasinskas
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Medalyn Supnet
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Jiin Felgner
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Jenny Davies
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Rafael Ramiro de Assis
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Sharon Jan
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Joshua Obiero
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Erwin Strahsburger
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Egest J Pone
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Li Liang
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - D Huw Davies
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine
| | - Philip L Felgner
- Vaccine Research and Development Center, Department of Physiology, University of California Irvine;
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126
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Chen HJ, Su CP, Liu MT, Tsou TP. Comparative epidemiology of influenza B by lineage in intensive care unit-admitted patients with complications: A nationwide study in Taiwan, 2013-2017. Int J Infect Dis 2019; 87:67-74. [PMID: 31357058 DOI: 10.1016/j.ijid.2019.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We describe the relative proportions and epidemiological features of influenza B/Victoria and B/Yamagata, using data from nationwide surveillance systems. METHODS We collected respiratory samples from outpatients with influenza-like illness (ILI) and intensive care unit (ICU)-admitted patients with complications (pulmonary or neurological complications, myocarditis/pericarditis or invasive bacterial infection) for virus isolation and lineage typing. Demographics, epidemiological features, and vaccination history from ICU-admitted patients with complications were analyzed. RESULTS From July 2013-June 2017, 21% of 11517 influenza isolates were influenza B. B/Victoria was the predominant circulating strain in 2013-2014, accounted for 56% of all influenza B positive samples and B/Yamagata was predominant in 2014-2017 (82%, 69%, and 85%, respectively). Among all typed viruses, the proportion of B/Yamagata was higher among specimens from ICU-admitted patients with complications (77%, 154/199) than from ILI outpatients (66%, 276/418, p<0.005). Compared to B/Victoria, B/Yamagata infected ICU-admitted patients with complications were older, median age (71 vs. 59 years, p<0.05), had longer durations of hospitalization (15 vs. 7.5 days, p<0.05) and ICU stays (8.5 vs. 5.5 days, p<0.05). CONCLUSIONS Two lineages of influenza B viruses co-circulate annually in Taiwan. Among ICU-admitted patients with complications, B/Yamagata causes more severe illness than B/Victoria.
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Affiliation(s)
- Hsueh-Ju Chen
- Office of Preventive Medicine, Centers for Disease Control, Ministry of Health and Welfare, Taiwan
| | - Chia-Ping Su
- Office of Preventive Medicine, Centers for Disease Control, Ministry of Health and Welfare, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
| | - Ming-Tsan Liu
- Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taiwan
| | - Tsung-Pei Tsou
- Division of Preparedness and Emerging Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, Taiwan.
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127
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Broecker F, Liu STH, Suntronwong N, Sun W, Bailey MJ, Nachbagauer R, Krammer F, Palese P. A mosaic hemagglutinin-based influenza virus vaccine candidate protects mice from challenge with divergent H3N2 strains. NPJ Vaccines 2019; 4:31. [PMID: 31341648 PMCID: PMC6642189 DOI: 10.1038/s41541-019-0126-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/27/2019] [Indexed: 01/27/2023] Open
Abstract
Current seasonal influenza virus vaccines only provide limited, short-lived protection, and antigenic drift in the hemagglutinin surface glycoprotein necessitates their annual re-formulation and re-administration. To overcome these limitations, universal vaccine strategies that aim at eliciting broadly protective antibodies to conserved epitopes of the hemagglutinin show promise for protecting against diverse and drifted influenza viruses. Here a vaccination strategy that focuses antibody responses to conserved epitopes of the H3 hemagglutinin is described. The approach is based on antigenic silencing of the immunodominant major antigenic sites of an H3 protein from 2014 by replacing them with corresponding sequences of exotic avian hemagglutinins, yielding "mosaic" hemagglutinins. In mice, vaccination with inactivated viruses expressing mosaic hemagglutinins induced highly cross-reactive antibodies against the H3 stalk domain that elicited Fc-mediated effector functions in vitro. In addition, the mosaic viruses elicited head-specific antibodies with neutralizing and hemagglutination-inhibiting activity against recent H3N2 viruses in vitro. Immune sera protected mice from heterologous challenge with viruses carrying H3 proteins from 1968 and 1982, whereas immune sera generated with a seasonal vaccine did not protect. Consequently, the mosaic vaccination approach provides a promising avenue toward a universal influenza virus vaccine.
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Affiliation(s)
- Felix Broecker
- 1Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sean T H Liu
- 1Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Nungruthai Suntronwong
- 2Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Weina Sun
- 1Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Mark J Bailey
- 1Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Raffael Nachbagauer
- 1Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Florian Krammer
- 1Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Peter Palese
- 1Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY USA.,3Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
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128
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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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129
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Moser MJ, Hatta Y, Gabaglia C, Sanchez A, Dias P, Sarawar S, Kawaoka Y, Hatta M, Neumann G, Bilsel P. Single-replication BM2SR vaccine provides sterilizing immunity and cross-lineage influenza B virus protection in mice. Vaccine 2019; 37:4533-4542. [PMID: 31280945 DOI: 10.1016/j.vaccine.2019.06.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
Abstract
Both influenza A and B viruses cause outbreaks of seasonal influenza resulting in significant morbidity and mortality. There are two antigenically distinct lineages of influenza B virus, Yamagata lineage (YL) and Victoria lineage (VL). Since both B lineages have been co-circulating for years, more than 70% of influenza vaccines currently manufactured are quadrivalent consisting of influenza A (H1N1), influenza A (H3N2), influenza B (YL) and influenza B (VL) antigens. Although quadrivalent influenza vaccines tend to elevate immunity to both influenza B lineages, estimated overall vaccine efficacy against influenza B is still only around 42%. Thus, a more effective influenza B vaccine is needed. To meet this need, we generated BM2-deficient, single-replication (BM2SR) influenza B vaccine viruses that encode surface antigens from influenza B/Wisconsin/01/2010 (B/WI01, YL) and B/Brisbane/60/2008 (B/Bris60, VL) viruses. The BM2SR-WI01 and BM2SR-Bris60 vaccine viruses are replication-deficient in vitro and in vivo, and can only replicate in a cell line that expresses the complementing BM2 protein. Both BM2SR viruses were non-pathogenic to mice, and vaccinated animals showed elevated mucosal and serum antibody responses to both Yamagata and Victoria lineages in addition to cellular responses. Serum antibody responses included lineage-specific hemagglutinin inhibition antibody (HAI) responses as well as responses to the stem region of the hemagglutinin (HA). BM2SR vaccine viruses provided apparent sterilizing immunity to mice against intra- and inter-lineage drifted B virus challenge. The data presented here support the feasibility of BM2SR as a platform for next-generation trivalent influenza vaccine development.
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Affiliation(s)
| | | | - Claudia Gabaglia
- The Biomedical Research Institute of Southern California, Oceanside, CA 92056, USA
| | - Adriana Sanchez
- The Biomedical Research Institute of Southern California, Oceanside, CA 92056, USA
| | - Peter Dias
- The Biomedical Research Institute of Southern California, Oceanside, CA 92056, USA
| | - Sally Sarawar
- The Biomedical Research Institute of Southern California, Oceanside, CA 92056, USA
| | - Yoshihiro Kawaoka
- Influenza Research Institute, Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53711, USA; Division of Virology, Department of Microbiology and Immunology, International Research Center for Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan; Division of Virology, Department of Special Pathogens, International Research Center for Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Masato Hatta
- Influenza Research Institute, Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53711, USA
| | - Gabriele Neumann
- Influenza Research Institute, Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53711, USA
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Fox A, Quinn KM, Subbarao K. Extending the Breadth of Influenza Vaccines: Status and Prospects for a Universal Vaccine. Drugs 2019; 78:1297-1308. [PMID: 30088204 DOI: 10.1007/s40265-018-0958-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite the widespread use of seasonal influenza vaccines, there is urgent need for a universal influenza vaccine to provide broad, long-term protection. A number of factors underpin this urgency, including threats posed by zoonotic and pandemic influenza A viruses, suboptimal effectiveness of seasonal influenza vaccines, and concerns surrounding the effects of annual vaccination. In this article, we discuss approaches that are being investigated to increase influenza vaccine breadth, which are near-term, readily achievable approaches to increase the range of strains recognized within a subtype, or longer-term more challenging approaches to produce a truly universal influenza vaccine. Adjuvanted and neuraminidase-optimized vaccines are emerging as the most feasible and promising approaches to extend protection to cover a broader range of strains within a subtype. The goal of developing a universal vaccine has also been advanced with the design of immunogenic influenza HA-stem constructs that induce broadly neutralizing antibodies. However, these constructs are not yet sufficiently immunogenic to induce lasting universal immunity in humans. Advances in understanding how T cells mediate protection, and how viruses are packaged, have facilitated the rationale design and delivery of replication-incompetent virus vaccines that induce broad protection mediated by lung-resident memory T cells. While the lack of clear mechanistic correlates of protection, other than haemagglutination-inhibiting antibodies, remains an impediment to further advancing novel influenza vaccines, the pressing need for such a vaccine is supporting development of highly innovative and effective strategies.
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Affiliation(s)
- Annette Fox
- WHO Collaborating Centre for Reference and Research on Influenza, and the Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC, Australia
| | - Kylie M Quinn
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia
| | - Kanta Subbarao
- WHO Collaborating Centre for Reference and Research on Influenza, and the Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC, Australia.
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131
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Von Holle TA, Moody MA. Influenza and Antibody-Dependent Cellular Cytotoxicity. Front Immunol 2019; 10:1457. [PMID: 31316510 PMCID: PMC6611398 DOI: 10.3389/fimmu.2019.01457] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/10/2019] [Indexed: 12/26/2022] Open
Abstract
Despite the availability of yearly vaccinations, influenza continues to cause seasonal, and pandemic rises in illness and death. An error prone replication mechanism results in antigenic drift and viral escape from immune pressure, and recombination results in antigenic shift that can rapidly move through populations that lack immunity to newly emergent strains. The development of a “universal” vaccine is a high priority and many strategies have been proposed, but our current understanding of influenza immunity is incomplete making the development of better influenza vaccines challenging. Influenza immunity has traditionally been measured by neutralization of virions and hemagglutination inhibition, but in recent years there has been a growing appreciation of other responses that can contribute to protection such as antibody-dependent cellular cytotoxicity (ADCC) that can kill influenza-infected cells. ADCC has been shown to provide cross-strain protection and to assist in viral clearance, making it an attractive target for “universal” vaccine designs. Here we provide a brief overview of the current state of influenza research that leverages “the other end of the antibody.”
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Affiliation(s)
- Tarra A Von Holle
- Duke University Human Vaccine Institute, Duke University School of Medicine, Durham, NC, United States
| | - M Anthony Moody
- Duke University Human Vaccine Institute, Duke University School of Medicine, Durham, NC, United States.,Department of Immunology, Duke University School of Medicine, Durham, NC, United States.,Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
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132
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Influenza vaccination for Hajj for the next decade: A case for quadrivalent SH vaccine. Vaccine 2019; 37:3625-3627. [PMID: 31104882 DOI: 10.1016/j.vaccine.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
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Pharmacokinetics of MHAA4549A, an Anti-Influenza A Monoclonal Antibody, in Healthy Subjects Challenged with Influenza A Virus in a Phase IIa Randomized Trial. Clin Pharmacokinet 2019. [PMID: 28639229 DOI: 10.1007/s40262-017-0564-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES MHAA4549A, a human anti-influenza immunoglobulin (Ig) G1 monoclonal antibody, is being developed to treat patients hospitalized for influenza A infection. This study examined the pharmacokinetics (PKs) of MHAA4549A in a phase IIa, randomized, double-blind, dose-ranging trial in healthy volunteers challenged with influenza A virus. METHODS Serum PK data were collected from 60 subjects in three single-dose groups (400, 1200, or 3600 mg) who received MHAA4549A intravenously 24-36 h after inoculation with the influenza A virus. Nasopharyngeal swab MHAA4549A concentration data were collected on days 1-8, and all subjects, including the placebo group, received 75 mg oseltamivir twice daily from days 7 to 11. Plasma samples were collected 4 h postdose on day 8 for oseltamivir and its active metabolite oseltamivir carboxylate (OC) (all subjects, n = 100), including subjects treated with oseltamivir alone and placebo. Noncompartmental analysis was performed for both nasal and serum PKs. RESULTS MHAA4549A showed dose-proportional serum PKs with a long terminal half-life (approximately 21.9-24.6 days) and slow clearance (approximately 152-240 mL/day); however, nasopharyngeal swab PKs were not dose proportional. No differences in mean plasma concentrations of oseltamivir and OC at 4 h postdose on day 8 were observed between the MHAA4549A treatment and placebo groups. No subjects who received MHAA4549A developed anti-drug antibodies. CONCLUSION MHAA4549A serum PKs were consistent with that of a human IgG1antibody without known endogenous targets. MHAA4549A showed nonlinear PKs in nasopharyngeal swab samples, which will guide future dose selection to achieve the high drug concentrations needed at the site of action for efficacy. These data demonstrate no PK interactions between MHAA4549A and oseltamivir, and support flat dosing. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01980966.
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134
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Development of Influenza B Universal Vaccine Candidates Using the "Mosaic" Hemagglutinin Approach. J Virol 2019; 93:JVI.00333-19. [PMID: 30944178 DOI: 10.1128/jvi.00333-19] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022] Open
Abstract
Influenza B viruses cause seasonal epidemics and are a considerable burden to public health. However, protection by current seasonal vaccines is suboptimal due to the antigenic changes of the circulating strains. In this study, we report a novel universal influenza B virus vaccination strategy based on "mosaic" hemagglutinins. We generated mosaic B hemagglutinins by replacing the major antigenic sites of the type B hemagglutinin with corresponding sequences from exotic influenza A hemagglutinins and expressed them as soluble trimeric proteins. Sequential vaccination with recombinant mosaic B hemagglutinin proteins conferred cross-protection against both homologous and heterologous influenza B virus strains in the mouse model. Of note, we rescued recombinant influenza B viruses expressing mosaic B hemagglutinins, which could serve as the basis for a universal influenza B virus vaccine.IMPORTANCE This work reports a universal influenza B virus vaccination strategy based on focusing antibody responses to conserved head and stalk epitopes of the hemagglutinin. Recombinant mosaic influenza B hemagglutinin proteins and recombinant viruses have been generated as novel vaccine candidates. This vaccine strategy provided broad cross-protection in the mouse model. Our findings will inform and drive development toward a more effective influenza B virus vaccine.
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135
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Honce R, Schultz-Cherry S. Influenza in obese travellers: increased risk and complications, decreased vaccine effectiveness. J Travel Med 2019; 26:taz020. [PMID: 30924873 PMCID: PMC6509472 DOI: 10.1093/jtm/taz020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Obesity is a worldwide epidemic and was empirically shown to increase the risk of developing severe influenza virus infection. As international travel becomes more common and obesity is now prevalent even in low- and middle-income countries, travellers may have an increased risk of contracting influenza virus especially during peak influenza season. METHODS An analysis of the literature, centred on publications from 2014-19, was performed, with an emphasis on human epidemiological data, human studies ex vivo and studies in mouse models of obesity. Our search efforts focused on influenza disease severity, pathogenesis, evolutionary dynamics and measures of infection control in the obese and overweight host. RESULTS Obesity is associated with an increased risk of infection, as well as a greater chance for hospitalization and severe complications. Studies in mouse models of obesity have uncovered that obese hosts suffer increased viral spread, delayed viral clearance and heightened damage to the respiratory epithelium. Innate and adaptive immune responses are delayed, thus increasing morbidity and mortality. Further, infection control measures, including vaccination and antivirals, prove less effective in obese hosts. Finally, the obese microenvironment allows for increased duration and amount of viral shedding and potentially increases the chance for emergence of virulent minor variants in the viral population. Together, obese hosts are at high risk of influenza infection, as well as severe sequelae following infection. CONCLUSION Obese travellers should be aware of influenza activity in the regions visited, as well as take protective measures prior to travel. Vaccination is highly recommended for all travellers, but especially highly susceptible obese travellers.
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Affiliation(s)
- Rebekah Honce
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stacey Schultz-Cherry
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Rondy M, Kissling E, Emborg HD, Gherasim A, Pebody R, Trebbien R, Pozo F, Larrauri A, McMenamin J, Valenciano M. Interim 2017/18 influenza seasonal vaccine effectiveness: combined results from five European studies. ACTA ACUST UNITED AC 2019; 23. [PMID: 29510782 PMCID: PMC5840921 DOI: 10.2807/1560-7917.es.2018.23.9.18-00086] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Between September 2017 and February 2018, influenza A(H1N1)pdm09, A(H3N2) and B viruses (mainly B/Yamagata, not included in 2017/18 trivalent vaccines) co-circulated in Europe. Interim results from five European studies indicate that, in all age groups, 2017/18 influenza vaccine effectiveness was 25 to 52% against any influenza, 55 to 68% against influenza A(H1N1)pdm09, −42 to 7% against influenza A(H3N2) and 36 to 54% against influenza B. 2017/18 influenza vaccine should be promoted where influenza still circulates.
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Affiliation(s)
- Marc Rondy
- MR and EK contributed equally to the study and manuscript writing.,EpiConcept, Paris, France
| | - Esther Kissling
- MR and EK contributed equally to the study and manuscript writing.,EpiConcept, Paris, France
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Alin Gherasim
- National Epidemiology Centre, Institute of Health Carlos III, Madrid Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
| | | | - Ramona Trebbien
- Department of Virus and Microbiological Special diagnostics, National Influenza Center, Statens Serum Institut, Copenhagen, Denmark
| | - Francisco Pozo
- Inmaculada Casas National Centre for Microbiology, National Influenza Reference Laboratory, World Health Organization National Influenza Centre, Institute of Health Carlos III
| | - Amparo Larrauri
- National Epidemiology Centre, Institute of Health Carlos III, Madrid Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid Spain
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- The members of the I-MOVE/I-MOVE+ group are listed at the end of the article
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137
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Liu WC, Nachbagauer R, Stadlbauer D, Solórzano A, Berlanda-Scorza F, García-Sastre A, Palese P, Krammer F, Albrecht RA. Sequential Immunization With Live-Attenuated Chimeric Hemagglutinin-Based Vaccines Confers Heterosubtypic Immunity Against Influenza A Viruses in a Preclinical Ferret Model. Front Immunol 2019; 10:756. [PMID: 31105689 PMCID: PMC6499175 DOI: 10.3389/fimmu.2019.00756] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022] Open
Abstract
Due to continuous antigenic drift and occasional antigenic shift, influenza viruses escape from human adaptive immunity resulting in significant morbidity and mortality in humans. Therefore, to avoid the need for annual reformulation and readministration of seasonal influenza virus vaccines, we are developing a novel chimeric hemagglutinin (cHA)-based universal influenza virus vaccine, which is comprised of sequential immunization with antigens containing a conserved stalk domain derived from a circulating pandemic H1N1 strain in combination with “exotic” head domains. Here, we show that this prime-boost sequential immunization strategy redirects antibody responses toward the conserved stalk region. We compared the vaccine efficacy elicited by distinct vaccination approaches in the preclinical ferret model of influenza. All ferrets immunized with cHA-based vaccines developed stalk-specific and broadly cross-reactive antibody responses. Two consecutive vaccinations with live-attenuated influenza viruses (LAIV-LAIV) conferred superior protection against pH1N1 and H6N1 challenge infection. Sequential immunization with LAIV followed by inactivated influenza vaccine (LAIV-IIV regimen) also induced robust antibody responses. Importantly, the LAIV-LAIV immunization regimen also induced HA stalk-specific CD4+IFN-γ+ and CD8+IFN-γ+ effector T cell responses in peripheral blood that were recalled by pH1N1 viral challenge. The findings from this preclinical study suggest that an LAIV-LAIV vaccination regimen would be more efficient in providing broadly protective immunity against influenza virus infection as compared to other approaches tested here.
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Affiliation(s)
- Wen-Chun Liu
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Raffael Nachbagauer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel Stadlbauer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alicia Solórzano
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peter Palese
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Randy A Albrecht
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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138
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Robson C, Baskar SR, Booy R, Ferguson PE, Gilroy N, Kok J, Sandaradura I, Dwyer D. Influenza: overview on prevention and therapy. Aust Prescr 2019; 42:51-55. [PMID: 31048938 PMCID: PMC6478960 DOI: 10.18773/austprescr.2019.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
QUADRIVALENT INFLUENZA VACCINATION IS RECOMMENDED ANNUALLY FOR ADULTS AND CHILDREN AGED SIX MONTHS TO 64 YEARS HIGH-DOSE OR ADJUVANTED TRIVALENT VACCINES ARE RECOMMENDED ANNUALLY FOR PEOPLE 65 YEARS AND OVER IF STARTED EARLY ENOUGH NEURAMINIDASE INHIBITORS REDUCE SYMPTOM DURATION BY APPROXIMATELY ONE DAY TREATMENT SHOULD BE CONSIDERED IN PATIENTS WITH SEVERE DISEASE REQUIRING HOSPITALISATION OR WHO ARE AT RISK OF COMPLICATIONS CHEMOPROPHYLAXIS IS NOT A SUBSTITUTE FOR VACCINATION BUT CAN BE CONSIDERED IN HIGH-RISK INDIVIDUALS WITH AN INADEQUATE OR INEFFECTIVE VACCINATION STATUS
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Affiliation(s)
- Christopher Robson
- Department of Infectious Diseases, Westmead Hospital, Sydney
- National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney
- School of Medicine, University of Sydney
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Sai Rupa Baskar
- Department of Infectious Diseases, Westmead Hospital, Sydney
- National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney
- School of Medicine, University of Sydney
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Robert Booy
- Department of Infectious Diseases, Westmead Hospital, Sydney
- National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney
- School of Medicine, University of Sydney
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Patricia E Ferguson
- Department of Infectious Diseases, Westmead Hospital, Sydney
- National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney
- School of Medicine, University of Sydney
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Nicole Gilroy
- Department of Infectious Diseases, Westmead Hospital, Sydney
- National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney
- School of Medicine, University of Sydney
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Jen Kok
- Department of Infectious Diseases, Westmead Hospital, Sydney
- National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney
- School of Medicine, University of Sydney
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Indy Sandaradura
- Department of Infectious Diseases, Westmead Hospital, Sydney
- National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney
- School of Medicine, University of Sydney
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
| | - Dominic Dwyer
- Department of Infectious Diseases, Westmead Hospital, Sydney
- National Centre for Immunisation Research and Surveillance, Kids Research Institute at The Children's Hospital at Westmead, Sydney
- School of Medicine, University of Sydney
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology, Sydney
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139
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Skowronski DM, Chambers C, Sabaiduc S, De Serres G, Winter AL, Dickinson JA, Gubbay JB, Drews SJ, Martineau C, Charest H, Krajden M, Bastien N, Li Y. Beyond Antigenic Match: Possible Agent-Host and Immuno-epidemiological Influences on Influenza Vaccine Effectiveness During the 2015-2016 Season in Canada. J Infect Dis 2019; 216:1487-1500. [PMID: 29029166 PMCID: PMC5853508 DOI: 10.1093/infdis/jix526] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Vaccine effectiveness (VE) estimates for 2015-2016 seasonal influenza vaccine are reported from Canada's Sentinel Practitioner Surveillance Network (SPSN). This season was characterized by a delayed 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09) epidemic and concurrent influenza B(Victoria) virus activity. Potential influences on VE beyond antigenic match are explored, including viral genomic variation, birth cohort effects, prior vaccination, and epidemic period. Methods VE was estimated by a test-negative design comparing the adjusted odds ratio for influenza test positivity among vaccinated compared to unvaccinated participants. Vaccine-virus relatedness was assessed by gene sequencing and hemagglutination inhibition assay. Results Analyses included 596 influenza A(H1N1)pdm09 and 305 B(Victoria) cases and 926 test-negative controls. A(H1N1)pdm09 viruses were considered antigenically related to vaccine (unchanged since 2009), despite phylogenetic clustering within emerging clade 6B.1. The adjusted VE against A(H1N1)pdm09 was 43% (95% confidence interval [CI], 25%-57%). Compared to other age groups, VE against A(H1N1)pdm09 was lower for adults born during 1957-1976 (25%; 95% CI, -16%-51%). The VE against A(H1N1)pdm09 was also lower for participants consecutively vaccinated during both the current and prior seasons (41%; 95% CI, 18%-57%) than for those vaccinated during the current season only (75%; 95% CI, 45%-88%), and the VE among participants presenting in March-April 2016 (19%; 95% CI, -15%-44%) was lower than that among those presenting during January-February 2016 (62%; 95% CI, 44%-74%). The adjusted VE for B(Victoria) viruses was 54% (95% CI, 32%-68%), despite lineage-level mismatch to B(Yamagata) vaccine. The further variation in VE as observed for A(H1N1)pdm09 was not observed for B(Victoria). Conclusions Influenza VE findings may require consideration of other agent-host and immuno-epidemiologic influences on vaccine performance beyond antigenic match, including viral genomic variation, repeat vaccination, birth (immunological) cohort effects, and potential within-season waning of vaccine protection.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
| | | | | | - Gaston De Serres
- Institut National de Santé Publique du Québec.,Laval University, Québec.,Centre Hospitalier Universitaire de Québec, Québec
| | | | | | | | - Steven J Drews
- Alberta Provincial Laboratory, Edmonton.,University of Alberta, Edmonton
| | | | | | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver.,University of British Columbia, Vancouver
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
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140
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Pepin S, Samson SI, Alvarez FP, Dupuy M, Gresset-Bourgeois V, De Bruijn I. Impact of a quadrivalent inactivated influenza vaccine on influenza-associated complications and health care use in children aged 6 to 35 months: Analysis of data from a phase III trial in the Northern and Southern Hemispheres. Vaccine 2019; 37:1885-1888. [PMID: 30745147 DOI: 10.1016/j.vaccine.2019.01.059] [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] [Received: 07/09/2018] [Revised: 01/14/2019] [Accepted: 01/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND A multi-season phase III trial conducted in the Northern and Southern Hemispheres demonstrated the efficacy of a quadrivalent split-virion inactivated influenza vaccine (IIV4) in children 6-35 months of age. METHODS Data collected during the phase III trial were analysed to examine the vaccine efficacy (VE) of IIV4 in preventing laboratory-confirmed influenza in age subgroups and to determine the relative risk for IIV4 vs. placebo for severe outcomes, healthcare use, and parental absenteeism from work associated with laboratory-confirmed influenza. RESULTS VE (95% confidence interval [CI]) to prevent laboratory-confirmed influenza due to any A or B strain was 54.76% (40.24-66.03%) for participants aged 6-23 months and 46.91% (23.57-63.53%) for participants aged 24-35 months. VE (95% CI) to prevent laboratory-confirmed influenza due to vaccine-similar strains was 74.51% (53.55-86.91%) for participants aged 6-23 months and 59.78% (19.11-81.25%) for participants aged 24-35 months. Compared to placebo, IIV4 reduced the risk (95% CI) by 31.28% (8.96-89.34%) for acute otitis media, 21.76% (6.46-58.51%) for acute lower respiratory infection, 40.80% (29.62-55.59%) for healthcare medical visits, 29.71% (11.66-67.23%) for parent absenteeism from work, and 39.20% (26.89-56.24%) for antibiotic use. CONCLUSION In children aged 6-35 months, vaccination with IIV4 reduces severe outcomes of influenza as well as the associated burden for their parents and the healthcare system. In addition, vaccination with IIV4 is effective at preventing against influenza in children aged 6-23 and 24-35 months. TRIAL REGISTRATION EudraCT no. 2013-001231-51.
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Affiliation(s)
- Stephanie Pepin
- Sanofi Pasteur, 1541 Avenue Marcel Merieux, 69820 Marcy-l'Étoile, France.
| | | | | | - Martin Dupuy
- Sanofi Pasteur, 1541 Avenue Marcel Merieux, 69820 Marcy-l'Étoile, France.
| | | | - Iris De Bruijn
- Sanofi Pasteur, 1541 Avenue Marcel Merieux, 69820 Marcy-l'Étoile, France.
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141
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Agarkhedkar S, Chhatwal J, Kompithra RZ, Lalwani SK, Narayan A, Muninarayanaswam V, Gogtay N, Dotter K, Gresset-Bourgeois V. Immunogenicity and safety of an intramuscular split-virion quadrivalent inactivated influenza vaccine in individuals aged ≥ 6 months in India. Hum Vaccin Immunother 2019; 15:973-977. [PMID: 30762467 PMCID: PMC6605869 DOI: 10.1080/21645515.2019.1565259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
A quadrivalent split-virion inactivated influenza vaccine (IIV4; Fluzone® Quadrivalent, Sanofi Pasteur) has been available in the US since 2013 for individuals aged ≥ 6 months. Here, we describe the results of an open-label, multicenter trial (WHO Universal Trial Number U1111-1143-8370) evaluating the immunogenicity and safety of IIV4 in Indian children aged 6-35 months and 3-8 years, adolescents aged 9-17 years, and adults aged ≥ 18 years (n = 100 per group). Post-vaccination hemagglutination inhibition titers for all strains in all age groups were ≥ 8 fold higher than at baseline (range, 8-51). At least 70% of participants in all age groups seroconverted or had a significant increase in titer for each strain. The most common solicited reactions were injection-site pain and tenderness, plus fever in participants 6-23 months and myalgia in older children and adolescents. All injection-site reactions and most systemic reactions were grade 1 or 2 and resolved within 3 days. Only three vaccine-related unsolicited adverse events were reported, all of which were grade 1 or 2 and transient. No immediate adverse events, adverse events leading to study discontinuation, adverse events of special interest, or serious adverse events were reported. This study showed that IIV4 was well tolerated and highly immunogenic in all age groups. This adds important data on the safety, tolerability, and immunogenicity of influenza vaccines in India.
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Affiliation(s)
- Sharad Agarkhedkar
- a Dr. D. Y. Patil Medical College, Hospital & Research Centre , Pune , Maharashtra , India
| | - Jugesh Chhatwal
- b Department of Pediatrics , Christian Medical College & Hospital , Ludhiana , Punjab , India
| | - Rajeev Zachariah Kompithra
- c Well Baby Immunization Clinic, Department of Pediatrics , Christian Medical College & Hospital , Vellore , Tamil Nadu , India
| | - Sanjay K Lalwani
- d Department of Pediatrics , Medical College Road , Pune , Maharashtra , India
| | - Arun Narayan
- e Department of Medicine , M.S. Ramaiah Medical College and Hospitals , Bangalore , India
| | - Vinay Muninarayanaswam
- f Department of Community Medicine , Mandya Institute of Medical Sciences , Mandya , Karnataka , India
| | - Nithya Gogtay
- g Department of Clinical Pharmacology , Seth GS Medical College & KEM Hospital , Mumbai , Maharashtra , India
| | - Kristin Dotter
- h Medical Operations , Sanofi Pasteur , Swiftwater , PA , USA
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142
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Samuel R, Miller J. Is the influenza vaccine effective in decreasing infection, hospitalization, pneumonia, and mortality in healthy adults? THE JOURNAL OF THE OKLAHOMA STATE MEDICAL ASSOCIATION 2019; 112:86-87. [PMID: 31379394 PMCID: PMC6677258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The annual influenza vaccine is universally recommended by the CDC for individuals greater than six months of age. However, unlike the other 16 routinely recommended vaccines, influenza vaccination is annual and developed based on circulating strains that are constantly modifying the primary immune targets, the hemagglutinin and neuraminidase receptors. Given the variation in these critical receptors, the need to predict changes in the protein structure, and the necessity of such frequent immunizations it is reasonable to question the annual vaccinations efficacy, especially in otherwise healthy adults. This article will review literature on inactivated influenza vaccine efficacy on preventing infection, decreasing hospitalizations and pneumonia, and mortality.
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143
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Pepin S, Dupuy M, Borja-Tabora CFC, Montellano M, Bravo L, Santos J, de Castro JA, Rivera-Medina DM, Cutland C, Ariza M, Diez-Domingo J, Gonzalez CD, Martinón-Torres F, Papadopoulou-Alataki E, Theodoriadou M, Kazek-Duret MP, Gurunathan S, De Bruijn I. Efficacy, immunogenicity, and safety of a quadrivalent inactivated influenza vaccine in children aged 6–35 months: A multi-season randomised placebo-controlled trial in the Northern and Southern Hemispheres. Vaccine 2019; 37:1876-1884. [DOI: 10.1016/j.vaccine.2018.11.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
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144
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Skowronski DM, Chambers C, De Serres G, Dickinson JA, Winter AL, Hickman R, Chan T, Jassem AN, Drews SJ, Charest H, Gubbay JB, Bastien N, Li Y, Krajden M. Early season co-circulation of influenza A(H3N2) and B(Yamagata): interim estimates of 2017/18 vaccine effectiveness, Canada, January 2018. ACTA ACUST UNITED AC 2019; 23. [PMID: 29409570 PMCID: PMC5801641 DOI: 10.2807/1560-7917.es.2018.23.5.18-00035] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Using a test-negative design, we assessed interim vaccine effectiveness (VE) for the 2017/18 epidemic of co-circulating influenza A(H3N2) and B(Yamagata) viruses. Adjusted VE for influenza A(H3N2), driven by a predominant subgroup of clade 3C.2a viruses with T131K + R142K + R261Q substitutions, was low at 17% (95% confidence interval (CI): −14 to 40). Adjusted VE for influenza B was higher at 55% (95% CI: 38 to 68) despite prominent use of trivalent vaccine containing lineage-mismatched influenza B(Victoria) antigen, suggesting cross-lineage protection.
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Affiliation(s)
- Danuta M Skowronski
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Gaston De Serres
- Centre Hospitalier Universitaire de Québec, Québec, Canada.,Laval University, Quebec, Canada.,Institut National de Santé Publique du Québec, Québec, Canada
| | | | | | - Rebecca Hickman
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Tracy Chan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Agatha N Jassem
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
| | - Steven J Drews
- University of Alberta, Edmonton, Canada.,Alberta Provincial Laboratory, Edmonton, Canada
| | - Hugues Charest
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Jonathan B Gubbay
- University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Mel Krajden
- University of British Columbia, Vancouver, Canada.,British Columbia Centre for Disease Control, Vancouver, Canada
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145
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Yun JW, Choi MJ, Shin GS, Lim JO, Noh JY, Kim YK, Song JY, Kim WJ, Choi SE, Cheong HJ. Cost-effectiveness of influenza vaccine strategies for the elderly in South Korea. PLoS One 2019; 14:e0209643. [PMID: 30682030 PMCID: PMC6347274 DOI: 10.1371/journal.pone.0209643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 12/10/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Despite a high vaccine uptake rate of over 80% in South Korea, the disease burden of influenza is still high among the elderly, which may be due to low effectiveness of vaccines. Therefore, the cost-effectiveness of use among the elderly was analyzed in order to compare the current trivalent influenza vaccine (TIV) with a quadrivalent influenza vaccine (QIV) or MF59-adjuvanted trivalent influenza vaccine (ATIV). METHODS A static lifetime Markov model was used. It was assumed that the model would be repeated until individuals reached the age of 100. Cost-effectiveness was analyzed across three age groups (65-74 years, 75-84 years, and ≥85 years), and the at-risk group was studied. RESULTS Compared to the TIV, the QIV was expected to reduce the number of influenza infections by 342,873, complications by 17,011, hospitalizations by 8,568, and deaths by 2,031. The QIV was highly cost-effective when compared to the TIV, with a base case incremental cost-effectiveness ratio (ICER) estimated at USD 17,699/QALY (1USD = 1,151KRW), and the ICER decreased with age and was USD 3,431/QALY in the group aged 85 and above. Sensitivity analysis revealed that the ICER was sensitive to the QIV price, the proportion of influenza B, and vaccine mismatching. On the other hand, the ATIV was expected to reduce the number of influenza cases and complications by 1,812,395 and 89,747, respectively, annually, yielding cost-saving among all ages. ATIV price and vaccine efficacy were the most influential parameters for the ICER of ATIV. CONCLUSIONS The QIV and ATIV strategies were considered more cost-effective in comparison to the TIV for vaccination strategies implemented for the elderly. However, owing to a lack of data on the effectiveness of ATIV among the elderly, a large-scale effectiveness study is required.
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Affiliation(s)
- Jae-Won Yun
- Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Min Joo Choi
- Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - Jae-Ok Lim
- Korea University College of Pharmacy, Sejong, Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yun-Kyung Kim
- Department of Pediatrics, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea
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146
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Del Campo J, Pizzorno A, Djebali S, Bouley J, Haller M, Pérez-Vargas J, Lina B, Boivin G, Hamelin ME, Nicolas F, Le Vert A, Leverrier Y, Rosa-Calatrava M, Marvel J, Hill F. OVX836 a recombinant nucleoprotein vaccine inducing cellular responses and protective efficacy against multiple influenza A subtypes. NPJ Vaccines 2019; 4:4. [PMID: 30701093 PMCID: PMC6344521 DOI: 10.1038/s41541-019-0098-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 12/21/2018] [Indexed: 11/18/2022] Open
Abstract
Inactivated influenza vaccines (IIVs) lack broad efficacy. Cellular immunity to a conserved internal antigen, the nucleoprotein (NP), has been correlated to protection against pandemic and seasonal influenza and thus could have the potential to broaden vaccine efficacy. We developed OVX836, a recombinant protein vaccine based on an oligomerized NP, which shows increased uptake by dendritic cells and immunogenicity compared with NP. Intramuscular immunization in mice with OVX836 induced strong NP-specific CD4+ and CD8+ T-cell systemic responses and established CD8+ tissue memory T cells in the lung parenchyma. Strikingly, OVX836 protected mice against viral challenge with three different influenza A subtypes, isolated several decades apart and induced a reduction in viral load. When co-administered with IIV, OVX836 was even more effective in reducing lung viral load. Circulating influenza A virus (IAV) strains differ in their surface proteins each year, and vaccines eliciting an immune response to these proteins are often only partially protective. Internal viral proteins, such as the nucleoprotein (NP), are highly conserved, and cellular immunity to NP has been correlated with protection from diverse strains. However, current IAV vaccines induce a poor immune response to NP. In this study, led by Fergal Hill from Osivax, researchers develop an oligomeric version of NP with improved immunogenicity. Vaccination of mice with oligomeric NP results in an improved NP-specific T-cell response, including CD8+ tissue memory T cells in the lung, and protects mice against three different IAV subtypes. Co-administration with the currently used inactivated influenza vaccine further improves protection against virus infection in mice. These results encourage further pre-clinical and clinical development for this vaccine candidate.
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Affiliation(s)
| | - Andres Pizzorno
- 2Virologie et Pathologie Humaine - VirPath Team, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, École Normale Supérieure de Lyon, Université Claude Bernard Lyon 1. Université de Lyon, Lyon, F- 69008 France
| | - Sophia Djebali
- 3Immunity and Cytotoxic Lymphocytes, Centre International de Recherche en Infectiologie, INSERM, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon. Université de Lyon, F-69007 Lyon, France
| | | | | | - Jimena Pérez-Vargas
- Osivax, 99, rue de Gerland, 69007 Lyon, France.,6Present Address: Enveloped Viruses, Vectors and Immunotherapy Team, Centre International de Recherché en Infectiologie (CIRI), INSERM U1111, Université de Lyon, Lyon, France
| | - Bruno Lina
- 2Virologie et Pathologie Humaine - VirPath Team, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, École Normale Supérieure de Lyon, Université Claude Bernard Lyon 1. Université de Lyon, Lyon, F- 69008 France.,Hospices Civils de Lyon, Centre National de Référence des Virus Influenza France Sud, Laboratoire de Virologie, Groupement Hospitalier Nord, Lyon, France
| | - Guy Boivin
- 5Centre de Recherche en Infectiologie of the Centre Hospitalier Universitaire de Québec and Université Laval, Québec, Canada
| | - Marie-Eve Hamelin
- 5Centre de Recherche en Infectiologie of the Centre Hospitalier Universitaire de Québec and Université Laval, Québec, Canada
| | | | | | - Yann Leverrier
- 3Immunity and Cytotoxic Lymphocytes, Centre International de Recherche en Infectiologie, INSERM, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon. Université de Lyon, F-69007 Lyon, France
| | - Manuel Rosa-Calatrava
- 2Virologie et Pathologie Humaine - VirPath Team, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, École Normale Supérieure de Lyon, Université Claude Bernard Lyon 1. Université de Lyon, Lyon, F- 69008 France
| | - Jacqueline Marvel
- 3Immunity and Cytotoxic Lymphocytes, Centre International de Recherche en Infectiologie, INSERM, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon. Université de Lyon, F-69007 Lyon, France
| | - Fergal Hill
- Osivax, 99, rue de Gerland, 69007 Lyon, France
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147
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Liu Y, Tan HX, Koutsakos M, Jegaskanda S, Esterbauer R, Tilmanis D, Aban M, Kedzierska K, Hurt AC, Kent SJ, Wheatley AK. Cross-lineage protection by human antibodies binding the influenza B hemagglutinin. Nat Commun 2019; 10:324. [PMID: 30659197 PMCID: PMC6338745 DOI: 10.1038/s41467-018-08165-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/20/2018] [Indexed: 11/10/2022] Open
Abstract
Influenza B viruses (IBV) drive a significant proportion of influenza-related hospitalisations yet are understudied compared to influenza A. Current vaccines target the head of the viral hemagglutinin (HA) which undergoes rapid mutation, significantly reducing vaccine effectiveness. Improved vaccines to control IBV are needed. Here we developed novel IBV HA probes to interrogate humoral responses to IBV in humans. A significant proportion of IBV HA-specific B cells recognise both B/Victoria/2/87-like and B/Yamagata/16/88-like lineages in a distinct pattern of cross-reactivity. Monoclonal antibodies (mAbs) were reconstituted from IBV HA-specific B cells, including mAbs providing broad protection in murine models of lethal IBV infection. Protection was mediated by neutralising antibodies targeting the receptor binding domain, or via Fc-mediated functions of non-neutralising antibodies binding alternative epitopes including the IBV HA stem. This work defines antigenic cross-recognition between IBV lineages and provides guidance for the rational design of improved IBV vaccines for broad and durable protection. Immune recognition of Influenza B virus (IBV) is poorly understood. Here, Liu et al. use flow cytometry to characterize IBV-specific memory B cell responses following seasonal vaccination and show that elicited cross-reactive antibodies can protect against infection, providing a platform for vaccine design.
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Affiliation(s)
- Yi Liu
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Hyon-Xhi Tan
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Marios Koutsakos
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Sinthujan Jegaskanda
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Robyn Esterbauer
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Danielle Tilmanis
- World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, 3000, Australia
| | - Malet Aban
- World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, 3000, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia
| | - Aeron C Hurt
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia.,World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, 3000, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia. .,Melbourne Sexual Health Centre and Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia. .,ARC Centre for Excellence in Convergent Bio-Nano Science and Technology, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Adam K Wheatley
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3000, Australia.
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148
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Bufan B. Application of prophylactic vaccines in the elderly. ARHIV ZA FARMACIJU 2019. [DOI: 10.5937/arhfarm1906469b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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149
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Fay EJ, Aron SL, Stone IA, Waring BM, Plemper RK, Langlois RA. Engineered Small-Molecule Control of Influenza A Virus Replication. J Virol 2019; 93:e01677-18. [PMID: 30282710 PMCID: PMC6288343 DOI: 10.1128/jvi.01677-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 01/01/2023] Open
Abstract
Influenza A virus (IAV) remains a global health concern despite the availability of a seasonal vaccine. It is difficult to predict which strains will circulate during influenza season, and therefore, it is extremely challenging to test novel vaccines in the human population. To overcome this obstacle, new vaccines must be tested in challenge studies. This approach poses significant safety problems, since current pharmacological interventions for IAV are poorly efficacious. New methods are needed to enhance the safety of these challenge studies. In this study, we have generated a virus expressing a small-molecule-assisted shutoff (SMASh) tag as a safety switch for IAV replication. The addition of the SMASh tag to an essential IAV protein allows for small-molecule-mediated inhibition of replication. Treatment with this drug controls the replication of a SMASh-tagged virus in vitro and in vivo This model for restriction of viral replication has potential for broad applications in vaccine studies, virotherapy, and basic virus research.IMPORTANCE Influenza A virus (IAV) causes significant morbidity and mortality annually worldwide, despite the availability of new formulations of the vaccine each season. There is a critical need to develop more-efficacious vaccines. However, testing novel vaccines in the human population in controlled studies is difficult due to the limited availability and efficacy of intervention strategies should the vaccine fail. There are also significant safety concerns for work with highly pathogenic IAV strains in the laboratory. Therefore, novel strategies are needed to improve the safety of vaccine studies and of research on highly pathogenic IAV. In this study, we developed an IAV strain engineered to contain a small-molecule-mediated safety switch. This tag, when attached to an essential viral protein, allows for the regulation of IAV replication in vitro and in vivo This strategy provides a platform for the regulation of virus replication without targeting viral proteins directly.
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Affiliation(s)
- Elizabeth J Fay
- Biochemistry, Molecular Biology, and Biophysics Graduate Program, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Immunology, University of Minnesota Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephanie L Aron
- Center for Immunology, University of Minnesota Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ian A Stone
- Center for Immunology, University of Minnesota Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Barbara M Waring
- Center for Immunology, University of Minnesota Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Richard K Plemper
- Institute for Biomedical Sciences, Georgia State University, Atlanta, Georgia, USA
| | - Ryan A Langlois
- Biochemistry, Molecular Biology, and Biophysics Graduate Program, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Immunology, University of Minnesota Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
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150
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Rudenko L, Kiseleva I, Krutikova E, Stepanova E, Rekstin A, Donina S, Pisareva M, Grigorieva E, Kryshen K, Muzhikyan A, Makarova M, Sparrow EG, Torelli G, Kieny MP. Rationale for vaccination with trivalent or quadrivalent live attenuated influenza vaccines: Protective vaccine efficacy in the ferret model. PLoS One 2018; 13:e0208028. [PMID: 30507951 PMCID: PMC6277076 DOI: 10.1371/journal.pone.0208028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM The majority of seasonal influenza vaccines are trivalent, containing two A virus strains (H1N1 and H3N2) and one B virus strain. The co-circulation of two distinct lineages of B viruses can lead to mismatch between the influenza B virus strain recommended for the trivalent seasonal vaccine and the circulating B virus. This has led some manufacturers to produce quadrivalent influenza vaccines containing one strain from each B lineage in addition to H1N1 and H3N2 strains. However, it is also important to know whether vaccines containing a single influenza B strain can provide cross-protectivity against viruses of the antigenically distinct lineage. The aim of this study was to assess in naïve ferrets the potential cross-protective activity of trivalent live attenuated influenza vaccine (T-LAIV) against challenge with a heterologous wild-type influenza B virus belonging to the genetically different lineage and to compare this activity with effectiveness of quadrivalent LAIV (Q-LAIV) in the ferret model. METHODS AND RESULTS Ferrets were vaccinated with either one dose of trivalent LAIV containing B/Victoria or B/Yamagata lineage virus, or quadrivalent LAIV (containing both B lineages), or placebo. They were then challenged with B/Victoria or B/Yamagata lineage wild-type virus 28 days after vaccination. The ferrets were monitored for clinical signs and morbidity. Nasal swabs and lung tissue samples were analyzed for the presence of challenge virus. Antibody response to vaccination was assessed by routine hemagglutination inhibition assay. All LAIVs tested were found to be safe and effective against wild-type influenza B viruses based on clinical signs, and virological and histological data. The absence of interference between vaccine strains in trivalent and quadrivalent vaccine formulations was confirmed. Trivalent LAIVs were shown to have the potential to be cross-protective against infection with genetically different influenza B/Victoria and B/Yamagata lineages. CONCLUSIONS In this ferret model, quadrivalent vaccine provided higher protection to challenge against both B/Victoria and B/Yamagata lineage viruses. However, T-LAIV provided some cross-protection in the case of a mismatch between circulating and vaccine type B strains. Notably, B/Victoria-based T-LAIV was more protective compared to B/Yamagata-based T-LAIV.
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MESH Headings
- Administration, Intranasal
- Animals
- Antibodies, Viral/blood
- Cross Protection/genetics
- Cross Protection/immunology
- Disease Models, Animal
- Female
- Ferrets
- Humans
- Immunogenicity, Vaccine
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/pathogenicity
- Influenza B virus/genetics
- Influenza B virus/immunology
- Influenza B virus/pathogenicity
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/blood
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Vaccination/methods
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/immunology
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Affiliation(s)
- Larisa Rudenko
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Irina Kiseleva
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Elena Krutikova
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Ekaterina Stepanova
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Andrey Rekstin
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Svetlana Donina
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Maria Pisareva
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Elena Grigorieva
- Department of Virology, Institute of Experimental Medicine, St Petersburg, Russia
| | - Kirill Kryshen
- Department of Toxicology and Microbiology, Institute of Preclinical Research Ltd, St Petersburg, Russia
| | - Arman Muzhikyan
- Department of Toxicology and Microbiology, Institute of Preclinical Research Ltd, St Petersburg, Russia
| | - Marina Makarova
- Department of Toxicology and Microbiology, Institute of Preclinical Research Ltd, St Petersburg, Russia
| | - Erin Grace Sparrow
- Universal Health Coverage and Health Systems, World Health Organization, Geneva, Switzerland
| | - Guido Torelli
- Universal Health Coverage and Health Systems, World Health Organization, Geneva, Switzerland
| | - Marie-Paule Kieny
- International Institutional Cooperation, Institut national de la santé et de la recherche médicale (INSERM), Paris, France
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