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Bekkat-Berkani R, Ray R, Jain VK, Chandrasekaran V, Innis BL. Evidence update: GlaxoSmithKline's inactivated quadrivalent influenza vaccines. Expert Rev Vaccines 2015; 15:201-14. [PMID: 26641539 DOI: 10.1586/14760584.2016.1113878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Inactivated trivalent influenza vaccines (IIV3s) are designed to protect against illness caused by two influenza A virus subtypes and one influenza B virus lineage. They may provide inadequate protection due to the co-circulation of viruses from two antigenically distinct influenza B lineages. Incorporating strains from both B lineages as in inactivated quadrivalent influenza vaccines (IIV4s) reduces this risk. We summarize the evidence supporting two IIV4s manufactured by GSK Vaccines. Compared to IIV3s, these two IIV4s demonstrated noninferior immunogenicity against the shared influenza strains and superior immunogenicity for the strain of the additional B lineage, particularly in subjects who were seronegative for that B strain. One IIV4's efficacy in children aged 3-8 years was 55.4% against influenza of any severity and 73.1% against moderate-to-severe influenza. Both IIV4s were well-tolerated with a similar safety profile to IIV3s. These IIV4s are more likely than IIV3s to protect against the added influenza B strain.
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Affiliation(s)
| | - Riju Ray
- a Global Medical Affairs, GSK Vaccines , Wavre , Belgium
| | - Varsha K Jain
- b Vaccine Discovery and Development, GSK Vaccines , King of Prussia , PA , USA
| | | | - Bruce L Innis
- b Vaccine Discovery and Development, GSK Vaccines , King of Prussia , PA , USA
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Lambach P, Alvarez AMR, Hirve S, Ortiz JR, Hombach J, Verweij M, Hendriks J, Palkonyay L, Pfleiderer M. Considerations of strategies to provide influenza vaccine year round. Vaccine 2015; 33:6493-8. [PMID: 26319745 PMCID: PMC8218336 DOI: 10.1016/j.vaccine.2015.08.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/27/2015] [Accepted: 08/11/2015] [Indexed: 11/20/2022]
Abstract
There is potential for influenza vaccine programmes to make a substantial impact on severe disease in low-resource settings, however questions around vaccine composition and programmatic issues will require special attention. Some countries may benefit from immunization programmes that provide year-round supply of vaccine; however the best way to ensure adequate vaccine supply has yet to be determined. In this report, we discuss vaccine composition, availability, and programmatic issues that must be considered when developing year-round influenza immunization programmes. We then explore how these considerations have influenced immunization practices in the Latin American region as a case study. We identify three different approaches to achieve year-round supply: (1) alternating between Northern Hemisphere and Southern Hemisphere formulations, (2) extending the expiration date to permit extended use of a single hemisphere formulation, and (3) local vaccine manufacture with production timelines that align with local epidemiology. Each approach has its challenges and opportunities. The growing data suggesting high influenza disease burden in low resource countries underscores the compelling public health need to determine the best strategies for vaccine delivery.
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Affiliation(s)
- Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
| | - Alba Maria Ropero Alvarez
- Immunization Unit, Pan American Health Organization, 525 Twenty Third St., NW, Washington, DC 20037, USA
| | | | - Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Joachim Hombach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Marcel Verweij
- Department of Social Sciences, Subdepartment Communication, Philosophy, and Technology, Wageningen University, Wageningen, The Netherlands
| | - Jan Hendriks
- Essential Medicines Department, World Health Organization, Geneva, Switzerland
| | - Laszlo Palkonyay
- Essential Medicines Department, World Health Organization, Geneva, Switzerland
| | - Michael Pfleiderer
- Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Institut, Langen, Germany
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253
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Thommes EW, Ismaila A, Chit A, Meier G, Bauch CT. Cost-effectiveness evaluation of quadrivalent influenza vaccines for seasonal influenza prevention: a dynamic modeling study of Canada and the United Kingdom. BMC Infect Dis 2015; 15:465. [PMID: 26503131 PMCID: PMC4623926 DOI: 10.1186/s12879-015-1193-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/07/2015] [Indexed: 02/08/2023] Open
Abstract
Background The adoption of quadrivalent influenza vaccine (QIV) to replace trivalent influenza vaccine (TIV) in immunization programs is growing worldwide, thus helping to address the problem of influenza B lineage mismatch. However, the price per dose of QIV is higher than that of TIV. In such circumstances, cost-effectiveness analyses provide important and relevant information to inform national health recommendations and implementation decisions. This analysis assessed potential vaccine impacts and cost-effectiveness of a country-wide switch from TIV to QIV, in Canada and the UK, from a third-party payer perspective. Methods An age-stratified, dynamic four-strain transmission model which incorporates strain interaction, transmission-rate seasonality and age-specific mixing in the population was used. Model input data were obtained from published literature and online databases. In Canada, we evaluated a switch from TIV to QIV in the entire population. For the UK, we considered two strategies: Children aged 2–17 years who receive the live-attenuated influenza vaccine (LAIV) switch to the quadrivalent formulation (QLAIV), while individuals aged > 18 years switch from TIV to QIV. Two different vaccination uptake scenarios in children (UK1 and UK2, which differ in the vaccine uptake level) were considered. Health and cost outcomes for both vaccination strategies, and the cost-effectiveness of switching from TIV/LAIV to QIV/QLAIV, were estimated from the payer perspective. For Canada and the UK, cost and outcomes were discounted using 5 % and 3.5 % per year, respectively. Results Overall, in an average influenza season, our model predicts that a nationwide switch from TIV to QIV would prevent 4.6 % influenza cases, 4.9 % general practitioner (GP) visits, 5.7 % each of emergency room (ER) visits and hospitalizations, and 6.8 % deaths in Canada. In the UK (UK1/UK2), implementing QIV would prevent 1.4 %/1.8 % of influenza cases, 1.6 %/2.0 % each of GP and ER visits, 1.5 %/1.9 % of hospitalizations and 4.3 %/4.9 % of deaths. Discounted incremental cost-utility ratios of $7,961 and £7,989/£7,234 per quality-adjusted life-year (QALY) gained are estimated for Canada and the UK (UK1/UK2), both of which are well within their respective cost-effectiveness threshold values. Conclusions Switching from TIV to QIV is expected to be a cost-effective strategy to further reduce the burden of influenza in both countries. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1193-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward W Thommes
- GSK, 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada. .,Department of Mathematics & Statistics, University of Guelph, Guelph, Ontario, Canada.
| | - Afisi Ismaila
- GSK, 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - Ayman Chit
- Sanofi Pasteur, Toronto, Ontario, Canada. .,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | | | - Christopher T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada.
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254
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H3N2 Mismatch of 2014-15 Northern Hemisphere Influenza Vaccines and Head-to-head Comparison between Human and Ferret Antisera derived Antigenic Maps. Sci Rep 2015; 5:15279. [PMID: 26472175 PMCID: PMC4607887 DOI: 10.1038/srep15279] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022] Open
Abstract
The poor performance of 2014–15 Northern Hemisphere (NH) influenza vaccines was attributed to mismatched H3N2 component with circulating epidemic strains. Using human serum samples collected from 2009–10, 2010–11 and 2014–15 NH influenza vaccine trials, we assessed their cross-reactive hemagglutination inhibition (HAI) antibody responses against recent H3 epidemic isolates. All three populations (children, adults, and older adults) vaccinated with the 2014–15 NH egg- or cell-based vaccine, showed >50% reduction in HAI post-vaccination geometric mean titers against epidemic H3 isolates from those against egg-grown H3 vaccine strain A/Texas/50/2012 (TX/12e). The 2014–15 NH vaccines, regardless of production type, failed to further extend HAI cross-reactivity against H3 epidemic strains from previous seasonal vaccines. Head-to-head comparison between ferret and human antisera derived antigenic maps revealed different antigenic patterns among representative egg- and cell-grown H3 viruses characterized. Molecular modeling indicated that the mutations of epidemic H3 strains were mainly located in antibody-binding sites A and B as compared with TX/12e. To improve vaccine strain selection, human serologic testing on vaccination-induced cross-reactivity need be emphasized along with virus antigenic characterization by ferret model.
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255
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Mullikin M, Tan L, Jansen JP, Van Ranst M, Farkas N, Petri E. A Novel Dynamic Model for Health Economic Analysis of Influenza Vaccination in the Elderly. Infect Dis Ther 2015; 4:459-87. [PMID: 26350238 PMCID: PMC4675767 DOI: 10.1007/s40121-015-0076-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction New vaccines are being developed to improve the efficacy of seasonal influenza immunization in elderly persons aged ≥65 years. These products require clinical and economic evaluation to aid policy decisions. Methods To address this need, a two-part model has been developed, which we have applied to examine the potential clinical and economic impact of vaccinating elderly persons with adjuvanted trivalent inactivated influenza vaccine (aTIV) relative to conventional trivalent (TIV) and quadrivalent (QIV) vaccines. We compared outcomes in the US population for (1) aTIV in persons aged ≥65 years and QIV in all other age cohorts; (2) QIV in all cohorts; (3) TIV in all cohorts. Low, average, and high intensity seasons with low, average, and high vaccine match scenarios were compared. Probabilistic sensitivity analysis was conducted within each discrete scenario to explore the impact of variation in model inputs on potential outcomes. Results Assuming current vaccination coverage rates in the US population with (a) 25% better efficacy of adjuvanted versus non-adjuvanted vaccine against any strain and (b) 35% better efficacy of non-adjuvanted vaccine against matched B versus mismatched B strains, use of aTIV in persons aged ≥65 years and QIV in persons <65 years could reduce influenza cases by 11,166–1,329,200, hospitalizations by 1365–43,674, and deaths by 421–11,320 versus use of QIV in all cohorts. These outcomes are reflected in a corresponding increase in quality-adjusted life-years (QALYs) of 3003–94,084. If the prevalence of mismatched influenza B was >54.5% of all circulating strains, use of QIV in all cohorts would offset the clinical benefits of aTIV. Elderly aTIV or QIV vaccination was associated with improved outcomes over non-adjuvanted TIV in many of the scenarios, particularly in low match seasons of any intensity. Total cost savings (including direct and indirect healthcare costs plus productivity impacts) with aTIV in the elderly versus QIV in the whole population ranged from $27 million (low intensity, low match) to $934 million (high intensity, high match). Univariate sensitivity analysis of relative vaccine prices in the average intensity, average match scenario indicated that aTIV could be marginally cost saving relative to QIV at the currently published Medicare price for influenza vaccines offering enhanced efficacy in the elderly. Elderly vaccination with aTIV was associated with a higher overall cost compared with TIV in only two scenarios (low intensity with average or high match); the incremental cost/QALY relative to TIV was $9980 in the average match scenario and $28,800 in the high match scenario. Conclusions Vaccination of persons aged ≥65 years with aTIV has the potential to provide clinical and economic benefit relative to QIV and TIV. The new model allows the assessment of various alternative strategies for available influenza vaccines. Funding Novartis Vaccines. Electronic supplementary material The online version of this article (doi:10.1007/s40121-015-0076-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Litjen Tan
- Immunization Action Coalition, Saint Paul, MN, USA
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256
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Czako R, Subbarao K. Refining the approach to vaccines against influenza A viruses with pandemic potential. Future Virol 2015; 10:1033-1047. [PMID: 26587050 DOI: 10.2217/fvl.15.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vaccination is the most effective strategy for prevention and control of influenza. Timely production and deployment of seasonal influenza vaccines is based on an understanding of the epidemiology of influenza and on global disease and virologic surveillance. Experience with seasonal influenza vaccines guided the initial development of pandemic influenza vaccines. A large investment in pandemic influenza vaccines in the last decade has resulted in much progress and a body of information that can now be applied to refine the established paradigm. Critical and complementary considerations for pandemic influenza vaccines include improved assessment of the pandemic potential of animal influenza viruses, proactive development and deployment of pandemic influenza vaccines, and application of novel platforms and strategies for vaccine production and administration.
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Affiliation(s)
- Rita Czako
- Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD, USA
| | - Kanta Subbarao
- Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD, USA
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257
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Nunes MC, Madhi SA. Review on the effects of influenza vaccination during pregnancy on preterm births. Hum Vaccin Immunother 2015; 11:2538-48. [PMID: 26267701 DOI: 10.1080/21645515.2015.1059976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pregnant women are considered to be susceptible to severe influenza illness and are recommended as a priority group to be targeted for influenza vaccination in countries with vaccination programs. Increased rates of poor birth outcomes have also been temporally associated with influenza infection, especially when pandemics strains emerge. Even though the primary purpose for influenza vaccination during pregnancy is to decrease the risk of influenza infection in the women, other potential benefits include protection of their young infants against influenza illness and possibly improving birth outcomes. The 2009 influenza A/H1N1 pandemic highlighted the importance of influenza vaccination during pregnancy, after pregnant women were identified as a group with heightened morbidity and mortality during the pandemic. A few studies conducted before the 2009/10 season and a large number of reports during and after the 2009 pandemic have assessed the association between maternal influenza vaccination and birth outcomes. Although these studies indicate that influenza vaccination is safe for both the mother and the fetus, there are conflicting data on the effect of vaccination in improving preterm birth rates. We reviewed the 2 published randomized control trials and other observational studies that explored the relationship between maternal influenza vaccination and preterm births.
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Affiliation(s)
- Marta C Nunes
- a Medical Research Council: Respiratory and Meningeal Pathogens Research Unit ; University of the Witwatersrand ; Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases ; University of the Witwatersrand ; Johannesburg , South Africa
| | - Shabir A Madhi
- a Medical Research Council: Respiratory and Meningeal Pathogens Research Unit ; University of the Witwatersrand ; Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases ; University of the Witwatersrand ; Johannesburg , South Africa.,c National Institute for Communicable Diseases: A Division of National Health Laboratory Service; Center for Vaccines and Immunology ; Johannesburg , South Africa
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258
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Jennings Z, Carter I, McPhie K, Kok J, Dwyer DE. Increased prevalence of influenza B/Victoria lineage viruses during early stages of the 2015 influenza season in New South Wales, Australia: implications for vaccination and planning. ACTA ACUST UNITED AC 2015; 20. [PMID: 26290426 DOI: 10.2807/1560-7917.es2015.20.31.21201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the early weeks of the 2015 Australian influenza season, influenza B accounted for 67% (821/1,234) of all positive influenza tests in New South Wales. Of 81 successive influenza B viruses characterised, 33 (41%) were from children aged < 16 years; 23/81 (28%) belonged to the B/Victoria lineage. This lineage is not contained in the southern hemisphere's 2015 trivalent influenza vaccine. The significant B/Victoria lineage activity in the southern hemisphere suggests that the quadrivalent vaccine should be considered for the northern hemisphere.
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Affiliation(s)
- Z Jennings
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Pathology West, Westmead Hospital, Westmead, New South Wales, Australia
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259
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Ortiz de Lejarazu R, Tamames S. Vacunación antigripal. Efectividad de las vacunas actuales y retos de futuro. Enferm Infecc Microbiol Clin 2015; 33:480-90. [DOI: 10.1016/j.eimc.2015.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 01/09/2023]
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260
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Chit A, Roiz J, Aballea S. An Assessment of the Expected Cost-Effectiveness of Quadrivalent Influenza Vaccines in Ontario, Canada Using a Static Model. PLoS One 2015. [PMID: 26222538 PMCID: PMC4519190 DOI: 10.1371/journal.pone.0133606] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ontario, Canada, immunizes against influenza using a trivalent inactivated influenza vaccine (IIV3) under a Universal Influenza Immunization Program (UIIP). The UIIP offers IIV3 free-of-charge to all Ontarians over 6 months of age. A newly approved quadrivalent inactivated influenza vaccine (IIV4) offers wider protection against influenza B disease. We explored the expected cost-utility and budget impact of replacing IIV3 with IIV4, within the context of Ontario’s UIIP, using a probabilistic and static cost-utility model. Wherever possible, epidemiological and cost data were obtained from Ontario sources. Canadian or U.S. sources were used when Ontario data were not available. Vaccine efficacy for IIV3 was obtained from the literature. IIV4 efficacy was derived from meta-analysis of strain-specific vaccine efficacy. Conservatively, herd protection was not considered. In the base case, we used IIV3 and IIV4 prices of $5.5/dose and $7/dose, respectively. We conducted a sensitivity analysis on the price of IIV4, as well as standard univariate and multivariate statistical uncertainty analyses. Over a typical influenza season, relative to IIV3, IIV4 is expected to avert an additional 2,516 influenza cases, 1,683 influenza-associated medical visits, 27 influenza-associated hospitalizations, and 5 influenza-associated deaths. From a societal perspective, IIV4 would generate 76 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $4,784,112. The incremental cost effectiveness ratio for this comparison was $63,773/QALY. IIV4 remains cost-effective up to a 53% price premium over IIV3. A probabilistic sensitivity analysis showed that IIV4 was cost-effective with a probability of 65% for a threshold of $100,000/QALY gained. IIV4 is expected to achieve reductions in influenza-related morbidity and mortality compared to IIV3. Despite not accounting for herd protection, IIV4 is still expected to be a cost-effective alternative to IIV3 up to a price premium of 53%. Our conclusions were robust in the face of sensitivity analyses.
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Affiliation(s)
- Ayman Chit
- Health Outcomes and Economics—North America, Sanofi Pasteur, Toronto, Ontario, Canada
- Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Julie Roiz
- Creativ-Ceutical Ltd, London, United Kingdom
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261
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Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev 2015; 28:743-800. [PMID: 26085551 PMCID: PMC4475643 DOI: 10.1128/cmr.00039-14] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | | | - James F Cummings
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, Rochester, Minnesota, USA
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA Oak Ridge Institute for Science and Education, Postgraduate Research Participation Program, U.S. Army Public Health Command, Aberdeen Proving Ground, Aberdeen, Maryland, USA
| | - Charlotte A Gaydos
- International STD, Respiratory, and Biothreat Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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262
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Protein sequence conservation and stable molecular evolution reveals influenza virus nucleoprotein as a universal druggable target. INFECTION GENETICS AND EVOLUTION 2015; 34:200-10. [PMID: 26140959 DOI: 10.1016/j.meegid.2015.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 06/16/2015] [Accepted: 06/29/2015] [Indexed: 01/05/2023]
Abstract
The high mutation rate in influenza virus genome and appearance of drug resistance calls for a constant effort to identify alternate drug targets and develop new antiviral strategies. The internal proteins of the virus can be exploited as a potential target for therapeutic interventions. Among these, the nucleoprotein (NP) is the most abundant protein that provides structural and functional support to the viral replication machinery. The current study aims at analysis of protein sequence polymorphism patterns, degree of molecular evolution and sequence conservation as a function of potential druggability of nucleoprotein. We analyzed a universal set of amino acid sequences, (n=22,000) and, in order to identify and correlate the functionally conserved, druggable regions across different parameters, classified them on the basis of host organism, strain type and continental region of sample isolation. The results indicated that around 95% of the sequence length was conserved, with at least 7 regions conserved across the protein among various classes. Moreover, the highly variable regions, though very limited in number, were found to be positively selected indicating, thereby, the high degree of protein stability against various hosts and spatio-temporal references. Furthermore, on mapping the conserved regions on the protein, 7 drug binding pockets in the functionally important regions of the protein were revealed. The results, therefore, collectively indicate that nucleoprotein is a highly conserved and stable viral protein that can potentially be exploited for development of broadly effective antiviral strategies.
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263
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Wohlbold TJ, Nachbagauer R, Margine I, Tan GS, Hirsh A, Krammer F. Vaccination with soluble headless hemagglutinin protects mice from challenge with divergent influenza viruses. Vaccine 2015; 33:3314-21. [PMID: 26026378 DOI: 10.1016/j.vaccine.2015.05.038] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/13/2015] [Accepted: 05/17/2015] [Indexed: 12/24/2022]
Abstract
Current influenza virus vaccines provide solid protection from infection with viruses that are well matched with the vaccine strains. However, they do not protect efficiently against drifted or shifted strains. We developed an antigen based on the conserved stalk domain of the influenza virus hemagglutinin and tested its efficacy as a vaccine in a mouse virus challenge model. Although the antigen lacked the correct conformation of the native stalk domain and was not recognized by a panel of neutralizing stalk-reactive antibodies, it did induce considerable protection against H1N1, H5N1 and H6N1 challenge strains. Protection was enhanced when mice had pre-existing immunity against the stalk domain. Since pre-existing immunity is also present in the human population, we hypothesize that a similar antigen could show efficacy in humans as well.
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Affiliation(s)
- Teddy John Wohlbold
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Graduate School of Biological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raffael Nachbagauer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Irina Margine
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Graduate School of Biological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gene S Tan
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ariana Hirsh
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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264
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Krammer F. Emerging influenza viruses and the prospect of a universal influenza virus vaccine. Biotechnol J 2015; 10:690-701. [PMID: 25728134 DOI: 10.1002/biot.201400393] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/06/2015] [Accepted: 02/03/2015] [Indexed: 11/07/2022]
Abstract
Influenza viruses cause annual seasonal epidemics and pandemics at irregular intervals. Several cases of human infections with avian and swine influenza viruses have been detected recently, warranting enhanced surveillance and the development of more effective countermeasures to address the pandemic potential of these viruses. The most effective countermeasure against influenza virus infection is the use of prophylactic vaccines. However, vaccines that are currently in use for seasonal influenza viruses have to be re-formulated and re-administered in a cumbersome process every year due to the antigenic drift of the virus. Furthermore, current seasonal vaccines are ineffective against novel pandemic strains. This paper reviews zoonotic influenza viruses with pandemic potential and technological advances towards better vaccines that induce broad and long lasting protection from influenza virus infection. Recent efforts have focused on the development of broadly protective/universal influenza virus vaccines that can provide immunity against drifted seasonal influenza virus strains but also against potential pandemic viruses.
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Affiliation(s)
- Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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265
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Abstract
Influenza virus infections are a major public health concern and cause significant morbidity and mortality worldwide. Current influenza virus vaccines are an effective countermeasure against infection but need to be reformulated almost every year owing to antigenic drift. Furthermore, these vaccines do not protect against novel pandemic strains, and the timely production of pandemic vaccines remains problematic because of the limitations of current technology. Several improvements have been made recently to enhance immune protection induced by seasonal and pandemic vaccines, and to speed up production in case of a pandemic. Importantly, vaccine constructs that induce broad or even universal influenza virus protection are currently in preclinical and clinical development.
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266
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Developing Universal Influenza Vaccines: Hitting the Nail, Not Just on the Head. Vaccines (Basel) 2015; 3:239-62. [PMID: 26343187 PMCID: PMC4494343 DOI: 10.3390/vaccines3020239] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/11/2015] [Accepted: 03/17/2015] [Indexed: 12/29/2022] Open
Abstract
Influenza viruses have a huge impact on public health. Current influenza vaccines need to be updated annually and protect poorly against antigenic drift variants or novel emerging subtypes. Vaccination against influenza can be improved in two important ways, either by inducing more broadly protective immune responses or by decreasing the time of vaccine production, which is relevant especially during a pandemic outbreak. In this review, we outline the current efforts to develop so-called “universal influenza vaccines”, describing antigens that may induce broadly protective immunity and novel vaccine production platforms that facilitate timely availability of vaccines.
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267
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Vaccination with adjuvanted recombinant neuraminidase induces broad heterologous, but not heterosubtypic, cross-protection against influenza virus infection in mice. mBio 2015; 6:e02556. [PMID: 25759506 PMCID: PMC4453582 DOI: 10.1128/mbio.02556-14] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In an attempt to assess the cross-protective potential of the influenza virus neuraminidase (NA) as a vaccine antigen, different subtypes of recombinant NA were expressed in a baculovirus system and used to vaccinate mice prior to lethal challenge with homologous, heterologous, or heterosubtypic viruses. Mice immunized with NA of subtype N2 were completely protected from morbidity and mortality in a homologous challenge and displayed significantly reduced viral lung titers. Heterologous challenge with a drifted strain resulted in morbidity but no mortality. Similar results were obtained for challenge experiments with N1 NA. Mice immunized with influenza B virus NA (from B/Yamagata/16/88) displayed no morbidity when sublethally infected with the homologous strain and, importantly, were completely protected from morbidity and mortality when lethally challenged with the prototype Victoria lineage strain or a more recent Victoria lineage isolate. Upon analyzing the NA content in 4 different inactivated-virus vaccine formulations from the 2013-2014 season via Western blot assay and enzyme-linked immunosorbent assay quantification, we found that the amount of NA does indeed vary across vaccine brands. We also measured hemagglutinin (HA) and NA endpoint titers in pre- and postvaccination human serum samples from individuals who received a trivalent inactivated seasonal influenza vaccine from the 2004-2005 season; the induction of NA titers was statistically less pronounced than the induction of HA titers. The demonstrated homologous and heterologous protective capacity of recombinant NA suggests that supplementing vaccine formulations with a standard amount of NA may offer increased protection against influenza virus infection. Despite the existence of vaccine prophylaxis and antiviral therapeutics, the influenza virus continues to cause morbidity and mortality in the human population, emphasizing the continued need for research in the field. While the majority of influenza vaccine strategies target the viral hemagglutinin, the immunodominant antigen on the surface of the influenza virion, antibodies against the viral neuraminidase (NA) have been correlated with less severe disease and decreased viral shedding in humans. Nevertheless, the amount of NA is not standardized in current seasonal vaccines, and the exact breadth of NA-based protection is unknown. Greater insight into the cross-protective potential of influenza virus NA as a vaccine antigen may pave the way for the development of influenza vaccines of greater breadth and efficacy.
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268
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Kittikraisak W, Suntarattiwong P, Levy J, Fernandez S, Dawood FS, Olsen SJ, Chotpitayasunondh T. Influenza vaccination coverage and effectiveness in young children in Thailand, 2011-2013. Influenza Other Respir Viruses 2015; 9:85-93. [PMID: 25557920 PMCID: PMC4353321 DOI: 10.1111/irv.12302] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Since 2009, Thailand has recommended influenza vaccine for children aged 6 months through 2 years, but no estimates of influenza vaccine coverage or effectiveness are available for this target group. METHODS During August 2011-May 2013, high-risk and healthy children aged ≤36 months were enrolled in a 2-year prospective cohort study. Parents were contacted weekly about acute respiratory illness (ARI) in their child. Ill children had combined nasal and throat swabs tested for influenza viruses by real-time reverse transcription-polymerase chain reaction. Influenza vaccination status was verified with vaccination cards. The Cox proportional hazards approach was used to estimate hazard ratios. Vaccine effectiveness (VE) was estimated as 100% x (1-hazard ratio). RESULTS During 2011-2013, 968 children were enrolled (median age, 10·3 months); 948 (97·9%) had a vaccination record and were included. Of these, 394 (41·6%) had ≥1 medical conditions. Vaccination coverage for the 2011-2012 and 2012-2013 seasons was 29·3% (93/317) and 30·0% (197/656), respectively. In 2011-2012, there were 213 ARI episodes, of which 10 (4·6%) were influenza positive (2·3 per 1000 vaccinated and 3·8 per 1000 unvaccinated child-weeks). The VE was 55% (95% confidence interval [CI], -72, 88). In 2012-2013, there were 846 ARIs, of which 52 (6·2%) were influenza positive (1·8 per 1000 vaccinated and 4·5 per 1000 unvaccinated child-weeks). The VE was 64% (CI, 13%, 85%). CONCLUSION Influenza vaccination coverage among young children in Thailand was low, although vaccination was moderately effective. Continued efforts are needed to increase influenza vaccination coverage and evaluate VE among young children in Thailand.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburi, Thailand
| | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Ministry of Public HealthBangkok, Thailand
| | - Jens Levy
- Influenza Program, Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburi, Thailand
| | - Stefan Fernandez
- Armed Forces Research Institute of Medical SciencesBangkok, Thailand
| | - Fatimah S Dawood
- Influenza Division, U.S. Centers for Disease Control and PreventionAtlanta, GA, USA
| | - Sonja J Olsen
- Influenza Program, Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburi, Thailand
- Influenza Division, U.S. Centers for Disease Control and PreventionAtlanta, GA, USA
| | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public HealthBangkok, Thailand
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269
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Puig-Barbera J, Mira-Iglesias A, Tortajada-Girbes M, Lopez-Labrador FX, Belenguer-Varea A, Carballido-Fernandez M, Carbonell-Franco E, Carratala-Munuera C, Limon-Ramirez R, Mollar-Maseres J, Del Carmen Otero-Reigada M, Schwarz-Chavarri G, Tuells J, Gil-Guillen V. Effectiveness of influenza vaccination programme in preventing hospital admissions, Valencia, 2014/15 early results. ACTA ACUST UNITED AC 2015; 20. [PMID: 25742432 DOI: 10.2807/1560-7917.es2015.20.8.21044] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Preliminary results for the 2014/15 season indicate low to null effect of vaccination against influenza A(H3N2)-related disease. As of week 5 2015, there have been 1,136 hospital admissions, 210 were due to influenza and 98% of subtype A strains were H3. Adjusted influenza vaccine effectiveness was 33% (range: 6-53%) overall and 40% (range: 13% to 59%) in those 65 years and older. Vaccination reduced by 44% (28-68%) the probability of admission with influenza.
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Affiliation(s)
- J Puig-Barbera
- Fundacion para el Fomento de la Investigacion Sanitaria y Biomedica de la Comunitat Valenciana (FISABIO), Valencia, Spain
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270
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Voellmy R, Bloom DC, Vilaboa N. A novel approach for addressing diseases not yielding to effective vaccination? Immunization by replication-competent controlled virus. Expert Rev Vaccines 2015; 14:637-51. [PMID: 25676927 DOI: 10.1586/14760584.2015.1013941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Vaccination involves inoculation of a subject with a disabled disease-causing microbe or parts thereof. While vaccination has been highly successful, we still lack sufficiently effective vaccines for important infectious diseases. We propose that a more complete immune response than that elicited from a vaccine may be obtained from immunization with a disease-causing virus modified to subject replication-essential genes to the control of a gene switch activated by non-lethal heat in the presence of a drug-like compound. Upon inoculation, strictly localized replication of the virus would be triggered by a heat dose administered to the inoculation site. Activated virus would transiently replicate with an efficiency approaching that of the disease-causing virus and express all viral antigens. It may also vector heterologous antigens or control co-infecting microbes.
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Affiliation(s)
- Richard Voellmy
- Department of Physiological Sciences, University of Florida College of Veterinary Sciences, Gainesville, FL, USA
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271
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Kelly HA. Safety and effectiveness of influenza vaccines. Med J Aust 2015; 201:560-1. [PMID: 25390245 DOI: 10.5694/mja14.01281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/07/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Heath A Kelly
- Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, VIC, Australia.
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272
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Roos A, Roozendaal R, Theeuwsen J, Riahi S, Vaneman J, Tolboom J, Dekking L, Koudstaal W, Goudsmit J, Radošević K. Protection against H5N1 by multiple immunizations with seasonal influenza vaccine in mice is correlated with H5 cross-reactive antibodies. Vaccine 2015; 33:1739-47. [PMID: 25659276 DOI: 10.1016/j.vaccine.2015.01.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/03/2014] [Accepted: 01/27/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current seasonal influenza vaccines are believed to confer protection against a narrow range of virus strains. However, their protective ability is commonly estimated based on an in vitro correlate of protection that only considers a subset of anti-influenza antibodies that are typically strain specific, i.e., hemagglutination inhibiting antibodies. Here, we evaluate the breadth of protection induced with a seasonal trivalent influenza vaccine (composition H1N1 A/California/07/09, H3N2 A/Victoria/210/08, B/Brisbane/60/08) against influenza challenge in mice. METHODS Balb/c mice were immunized once, twice, or three times with seasonal influenza vaccine to assess protection against heterosubtypic H5N1 influenza challenge, or homologous H1N1 influenza virus as a control. Passive transfer of immune serum was used to determine the contribution of humoral immunity to protection. RESULTS Multiple immunizations with seasonal influenza vaccine induced up to 80% protection against heterosubtypic H5N1 influenza challenge in mice without eliciting detectable H5N1 neutralizing antibodies. Comparable levels of protection were reached by passive transfer of immune serum, and protection was correlated with the titer of vaccine-induced, H5 cross-reactive, non-neutralizing antibodies that are at least in part directed against conserved HA epitopes. CONCLUSIONS Here, we demonstrate that seasonal vaccine has the ability to induce broad serum-mediated protection, and that the mechanism of this protection is different from the vaccine-induced homologous protection.
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Affiliation(s)
- Anna Roos
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Infectious Diseases and Vaccines Therapeutic area, Janssen Research and Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands
| | - Ramon Roozendaal
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Infectious Diseases and Vaccines Therapeutic area, Janssen Research and Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands.
| | - Jessica Theeuwsen
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Infectious Diseases and Vaccines Therapeutic area, Janssen Research and Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands
| | - Sarra Riahi
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Infectious Diseases and Vaccines Therapeutic area, Janssen Research and Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands
| | - Joost Vaneman
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Infectious Diseases and Vaccines Therapeutic area, Janssen Research and Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands
| | - Jeroen Tolboom
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Infectious Diseases and Vaccines Therapeutic area, Janssen Research and Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands
| | - Liesbeth Dekking
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Infectious Diseases and Vaccines Therapeutic area, Janssen Research and Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands
| | - Wouter Koudstaal
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Janssen Prevention Center, Center of Excellence within Janssen Research & Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands
| | - Jaap Goudsmit
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Janssen Prevention Center, Center of Excellence within Janssen Research & Development, A Division of Janssen Pharmaceutica, Leiden, The Netherlands
| | - Katarina Radošević
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland B.V., Leiden, The Netherlands; Sanofi, Global Biotherapeutics, Vitry-sur-Seine, France
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273
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Affiliation(s)
- S van der Werf
- Unit of Molecular Genetics of RNA viruses, Institut Pasteur, Universite Paris Diderot-Sorbonne Paris Cite, Paris, France
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274
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Affiliation(s)
- H Kelly
- Australian National University, Canberra. Australia
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275
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Meier G, Gregg M, Poulsen Nautrup B. Cost-effectiveness analysis of quadrivalent influenza vaccination in at-risk adults and the elderly: an updated analysis in the U.K. J Med Econ 2015; 18:746-61. [PMID: 25903831 DOI: 10.3111/13696998.2015.1044456] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To update an earlier evaluation estimating the cost-effectiveness of quadrivalent influenza vaccination (QIV) compared with trivalent influenza vaccination (TIV) in the adult population currently recommended for influenza vaccination in the UK (all people aged ≥65 years and people aged 18-64 years with clinical risk conditions). METHODS This analysis takes into account updated vaccine prices, reference costs, influenza strain circulation, and burden of illness data. A lifetime, multi-cohort, static Markov model was constructed with seven age groups. The model was run in 1-year cycles for a lifetime, i.e., until the youngest patients at entry reached the age of 100 years. The base-case analysis was from the perspective of the UK National Health Service, with a secondary analysis from the societal perspective. Costs and benefits were discounted at 3.5%. Herd effects were not included. Inputs were derived from systematic reviews, peer-reviewed articles, and government publications and databases. One-way and probabilistic sensitivity analyses were performed. RESULTS In the base-case, QIV would be expected to avoid 1,413,392 influenza cases, 41,780 hospitalizations, and 19,906 deaths over the lifetime horizon, compared with TIV. The estimated incremental cost-effectiveness ratio (ICER) was £14,645 per quality-adjusted life-year (QALY) gained. From the societal perspective, the estimated ICER was £13,497/QALY. A strategy of vaccinating only people aged ≥65 years had an estimated ICER of £11,998/QALY. Sensitivity analysis indicated that only two parameters, seasonal variation in influenza B matching and influenza A circulation, had a substantial effect on the ICER. QIV would be likely to be cost-effective compared with TIV in 68% of simulations with a willingness-to-pay threshold of <£20,000/QALY and 87% with a willingness-to-pay threshold of <£30,000/QALY. CONCLUSIONS In this updated analysis, QIV was estimated to be cost-effective compared with TIV in the U.K.
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Affiliation(s)
- G Meier
- a a Health Economics, GSK Vaccines , Wavre , Belgium
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276
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Feng L, Yang P, Zhang T, Yang J, Fu C, Qin Y, Zhang Y, Ma C, Liu Z, Wang Q, Zhao G, Yu H. Technical guidelines for the application of seasonal influenza vaccine in China (2014-2015). Hum Vaccin Immunother 2015; 11:2077-101. [PMID: 26042462 PMCID: PMC4635867 DOI: 10.1080/21645515.2015.1027470] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022] Open
Abstract
Influenza, caused by the influenza virus, is a respiratory infectious disease that can severely affect human health. Influenza viruses undergo frequent antigenic changes, thus could spread quickly. Influenza causes seasonal epidemics and outbreaks in public gatherings such as schools, kindergartens, and nursing homes. Certain populations are at risk for severe illness from influenza, including pregnant women, young children, the elderly, and people in any ages with certain chronic diseases.
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Affiliation(s)
- Luzhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Peng Yang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Tao Zhang
- School of Public Health; Fudan University; Shanghai, China
| | - Juan Yang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Chuanxi Fu
- Guangzhou Center for Disease Control and Prevention; Guangzhou, China
| | - Ying Qin
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
| | - Yi Zhang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Chunna Ma
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Zhaoqiu Liu
- Hua Xin Hospital; First Hospital of Tsinghua University; Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Control and Prevention; Beijing, China
| | - Genming Zhao
- School of Public Health; Fudan University; Shanghai, China
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease; Division of Infectious Disease; Chinese Center for Disease Control and Prevention; Beijing, China
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277
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Chiu C, Openshaw PJ. Antiviral B cell and T cell immunity in the lungs. Nat Immunol 2015; 16:18-26. [PMID: 25521681 PMCID: PMC7097128 DOI: 10.1038/ni.3056] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/14/2014] [Indexed: 12/13/2022]
Abstract
Respiratory viruses are frequent causes of repeated common colds, bronchitis and pneumonia, which often occur unpredictably as epidemics and pandemics. Despite those decimating effects on health and decades of intensive research, treatments remain largely supportive. The only commonly available vaccines are against influenza virus, and even these need improvement. The lung shares some features with other mucosal sites, but preservation of its especially delicate anatomical structures necessitates a fine balance of pro- and anti-inflammatory responses; well-timed, appropriately placed and tightly regulated T cell and B cell responses are essential for protection from infection and limitation of symptoms, whereas poorly regulated inflammation contributes to tissue damage and disease. Recent advances in understanding adaptive immunity should facilitate vaccine development and reduce the global effect of respiratory viruses.
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Affiliation(s)
- Christopher Chiu
- Centre for Respiratory Infection, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter J Openshaw
- Centre for Respiratory Infection, National Heart and Lung Institute, Imperial College London, London, UK
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278
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Jayasundara K, Soobiah C, Thommes E, Tricco AC, Chit A. Natural attack rate of influenza in unvaccinated children and adults: a meta-regression analysis. BMC Infect Dis 2014; 14:670. [PMID: 25495228 PMCID: PMC4272519 DOI: 10.1186/s12879-014-0670-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 11/27/2014] [Indexed: 11/26/2022] Open
Abstract
Background The natural (i.e. unvaccinated population) attack rate of an infectious disease is an important parameter required for understanding disease transmission. As such, it is an input parameter in infectious disease mathematical models. Influenza is an infectious disease that poses a major health concern worldwide and the natural attack rate of this disease is crucial in determining the effectiveness and cost-effectiveness of public health interventions and informing surveillance program design. We estimated age-stratified, strain-specific natural attack rates of laboratory-confirmed influenza in unvaccinated individuals. Methods Utilizing an existing systematic review, we calculated the attack rates in the trial placebo arms using a random effects model and a meta-regression analysis (GSK study identifier: 117102). Results This post-hoc analysis included 34 RCTs (Randomized Control Trials) contributing to 47 influenza seasons from 1970 to 2009. Meta-regression analyses showed that age and type of influenza were important covariates. The attack rates (95% CI (Confidence Interval)) in adults for all influenza, type A and type B were 3.50% (2.30%, 4.60%), 2.32% (1.47%, 3.17%) and 0.59% (0.28%, 0.91%) respectively. For children, they were 15.20% (11.40%, 18.90%), 12.27% (8.56%, 15.97%) and 5.50% (3.49%, 7.51%) respectively. Conclusions This analysis demonstrated that unvaccinated children have considerably higher exposure risk than adults and influenza A can cause more disease than influenza B. Moreover, a higher ratio of influenza B:A in children than adults was observed. This study provides a new, stratified and up to-date natural attack rates that can be used in influenza infectious disease models and are consistent with previous published work in the field. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0670-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Charlene Soobiah
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Edward Thommes
- GSK Inc, 7333 Mississauga Road North, Mississauga, ON, L5N 6L4, Canada. .,Department of Mathematics & Statistics, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Ayman Chit
- GSK Inc, 7333 Mississauga Road North, Mississauga, ON, L5N 6L4, Canada. .,Present address: Sanofi Pasteur, 1755 Steeles Avenue West, Toronto, ON, M2R 3T4, Canada.
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279
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Understanding influenza vaccine protection in the community: an assessment of the 2013 influenza season in Victoria, Australia. Vaccine 2014; 33:341-5. [PMID: 25448093 DOI: 10.1016/j.vaccine.2014.11.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/05/2014] [Accepted: 11/12/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The influenza virus undergoes frequent antigenic drift, necessitating annual review of the composition of the influenza vaccine. Vaccination is an important strategy for reducing the impact and burden of influenza, and estimating vaccine effectiveness (VE) each year informs surveillance and preventative measures. We aimed to describe the influenza season and to estimate the effectiveness of the influenza vaccine in Victoria, Australia, in 2013. METHODS Routine laboratory notifications, general practitioner sentinel surveillance (including a medical deputising service) data, and sentinel hospital admission surveillance data for the influenza season (29 April to 27 October 2013) were collated in Victoria, Australia, to describe influenza-like illness or confirmed influenza during the season. General practitioner sentinel surveillance data were used to estimate VE against medically-attended laboratory confirmed influenza. VE was estimated using the case test negative design as 1-adjusted odds ratio (odds of vaccination in cases compared with controls) × 100%. Cases tested positive for influenza while non-cases (controls) tested negative. Estimates were adjusted for age group, week of onset, time to swabbing and co-morbidities. RESULTS The 2013 influenza season was characterised by relatively low activity with a late peak. Influenza B circulation preceded that of influenza A(H1)pdm09, with very little influenza A(H3) circulation. Adjusted VE for all influenza was 55% (95%CI: -11, 82), for influenza A(H1)pdm09 was 43% (95%CI: -132, 86), and for influenza B was 56% (95%CI: -51, 87) Imputation of missing data raised the influenza VE point estimate to 64% (95%CI: 13, 85). CONCLUSIONS Clinicians can continue to promote a positive approach to influenza vaccination, understanding that inactivated influenza vaccines prevent at least 50% of laboratory-confirmed outcomes in hospitals and the community.
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280
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Su WJ, Chan TC, Chuang PH, Liu YL, Lee PI, Liu MT, Chuang JH. Estimating influenza vaccine effectiveness using routine surveillance data among children aged 6-59 months for five consecutive influenza seasons. Int J Infect Dis 2014; 30:115-21. [PMID: 25462180 PMCID: PMC7110782 DOI: 10.1016/j.ijid.2014.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 11/28/2022] Open
Abstract
Multiyear studies are preferred for estimating robust influenza vaccine effectiveness over time. An efficient way to evaluate the influenza vaccine effectiveness was used, through data linkage of two already established systems in the public health sector. We applied both fixed-effects and random-effects meta-analysis of case–control studies to estimate the pooled vaccine effectiveness for children aged 6–59 months across five influenza seasons and considered the variation in antigenic match and epidemics year by year as the heterogeneity between studies.
Objectives We aimed to estimate the pooled vaccine effectiveness (VE) in children over five winters through data linkage of two existing surveillance systems. Methods Five test-negative case–control studies were conducted from November to February during the 2004/2005 to 2008/2009 seasons. Sentinel physicians from the Viral Surveillance Network enrolled children aged 6–59 months with influenza-like illness to collect throat swabs. Through linking with a nationwide vaccination registry, we measured the VE with a logistic regression model adjusting for age, gender, and week of symptom onset. Both fixed-effects and random-effects models were used in the meta-analysis. Results Four thousand four hundred and ninety-four subjects were included. The proportion of influenza test-positive subjects across the five seasons was 11.5% (132/1151), 7.2% (41/572), 23.9% (189/791), 6.6% (75/1135), and 11.2% (95/845), respectively. The pooled VE was 62% (95% confidence interval (CI) 48–83%) in both meta-analysis models. By age category, VE was 51% (95% CI 23–68%) for those aged 6–23 months and 75% (95% CI 60–84%) for those aged 24–59 months. Conclusions Influenza vaccination provided measurable protection against laboratory-confirmed influenza among children aged 6–59 months despite variations in the vaccine match during the 2004/2005 to 2008/2009 influenza seasons in Taiwan.
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Affiliation(s)
- Wei-Ju Su
- Centers for Disease Control, Ministry of Health and Welfare, Taipei 10050, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | | | - Yu-Lun Liu
- Centers for Disease Control, Ministry of Health and Welfare, Taipei 10050, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tsan Liu
- Centers for Disease Control, Ministry of Health and Welfare, Taipei 10050, Taiwan.
| | - Jen-Hsiang Chuang
- Centers for Disease Control, Ministry of Health and Welfare, Taipei 10050, Taiwan; Institute of Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
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281
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Chit A, Roiz J, Briquet B, Greenberg DP. Expected cost effectiveness of high-dose trivalent influenza vaccine in US seniors. Vaccine 2014; 33:734-41. [PMID: 25444791 DOI: 10.1016/j.vaccine.2014.10.079] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Seniors are particularly vulnerable to complications resulting from influenza infection. Numerous influenza vaccines are available to immunize US seniors, and practitioners must decide which product to use. Options include trivalent and quadrivalent standard-dose inactivated influenza vaccines (IIV3 and IIV4 respectively), as well as a high-dose IIV3 (HD). Our research examines the public health impact, budget impact, and cost-utility of HD versus IIV3 and IIV4 for immunization of US seniors 65 years of age and older. METHODS Our model was based on US influenza-related health outcome data. Health care costs and vaccine prices were obtained from the Centers for Medicare and Medicaid Services. Efficacies of IIV3 and IIV4 were estimated from various meta-analyses of IIV3 efficacy. The results of a head-to-head randomized controlled trial of HD vs. IIV3 were used to estimate relative efficacy of HD. Conservatively, herd protection was not considered. RESULTS Compared to IIV3, HD would avert 195,958 cases of influenza, 22,567 influenza-related hospitalizations, and 5423 influenza-related deaths among US seniors. HD generates 29,023 more Quality Adjusted Life Years (QALYs) and a net societal budget impact of $154 million. The Incremental Cost Effectiveness Ratio (ICER) for this comparison is $5299/QALY. 71% of the probabilistic sensitivity analysis (PSA) simulations were <$100,000/QALY. Compared to IIV4, HD would avert 169,257 cases of influenza, 21,222 hospitalizations and 5212 deaths. HD generates 27,718 more QALYs and a net societal budget impact of -$17 million and as such dominates IIV4. For this comparison, 81% of PSA simulations were <$100,000/QALY. CONCLUSIONS HD is expected to achieve significant reductions in influenza-related morbidity and mortality. Further, HD is a cost effective alternative to both IIV3 and IIV4 in seniors. Our conclusions were robust in the face of sensitivity analyses.
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Affiliation(s)
- Ayman Chit
- Sanofi Pasteur, Toronto, Ontario, Canada; University of Toronto Faculty of Pharmacy, Toronto, ON, Canada.
| | | | | | - David P Greenberg
- Sanofi Pasteur, Swiftwater, PA, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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282
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Antibody persistence and T-cell balance: two key factors confronting HIV vaccine development. Proc Natl Acad Sci U S A 2014; 111:15614-21. [PMID: 25349379 DOI: 10.1073/pnas.1413550111] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The quest for a prophylactic AIDS vaccine is ongoing, but it is now clear that the successful vaccine must elicit protective antibody responses. Accordingly, intense efforts are underway to identify immunogens that elicit these responses. Regardless of the mechanism of antibody-mediated protection, be it neutralization, Fc-mediated effector function, or both, antibody persistence and appropriate T-cell help are significant problems confronting the development of a successful AIDS vaccine. Here, we discuss the evidence illustrating the poor persistence of antibody responses to Env, the envelope glycoprotein of HIV-1, and the related problem of CD4(+) T-cell responses that compromise vaccine efficacy by creating excess cellular targets of HIV-1 infection. Finally, we propose solutions to both problems that are applicable to all Env-based AIDS vaccines regardless of the mechanism of antibody-mediated protection.
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283
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Jegaskanda S, Reading PC, Kent SJ. Influenza-specific antibody-dependent cellular cytotoxicity: toward a universal influenza vaccine. THE JOURNAL OF IMMUNOLOGY 2014; 193:469-75. [PMID: 24994909 DOI: 10.4049/jimmunol.1400432] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
There is an urgent need for universal influenza vaccines that can control emerging pandemic influenza virus threats without the need to generate new vaccines for each strain. Neutralizing Abs to the influenza virus hemagglutinin glycoprotein are effective at controlling influenza infection but generally target highly variable regions. Abs that can mediate other functions, such as killing influenza-infected cells and activating innate immune responses (termed "Ab-dependent cellular cytotoxicity [ADCC]-mediating Abs"), may assist in protective immunity to influenza. ADCC-mediating Abs can target more conserved regions of influenza virus proteins and recognize a broader array of influenza strains. We review recent research on influenza-specific ADCC Abs and their potential role in improved influenza-vaccination strategies.
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Affiliation(s)
- Sinthujan Jegaskanda
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Victoria 3010, Australia; and
| | - Patrick C Reading
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Victoria 3010, Australia; and World Health Organization Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria 3051, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Victoria 3010, Australia; and
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284
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Sullivan SG, Chilver MBN, Higgins G, Cheng AC, Stocks NP. Influenza vaccine effectiveness in Australia: results from the Australian Sentinel Practices Research Network. Med J Aust 2014; 201:109-11. [PMID: 25045991 DOI: 10.5694/mja14.00106] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate influenza vaccine coverage and effectiveness against medically attended laboratory-confirmed influenza for the 2012 season. DESIGN, SETTING AND PARTICIPANTS Test-negative design involving patients recruited as part of the Australian Sentinel Practices Research Network, a network of sentinel general practitioners throughout Australia. Throughout 2012, at the discretion of the GP at one of 102 participating practices, patients presenting with influenza-like illness were swabbed and included in the study. MAIN OUTCOME MEASURE Influenza vaccine effectiveness (VE) estimated as (1-OR)*100% by logistic regression. RESULTS 1775 patients were swabbed. The epidemic period was identified as Weeks 10 to 43 of 2012. After exclusions, there were 1414 patients for the VE analysis, including 593 (42%) who tested influenza-positive and 821 who tested negative. 27% of test-negative patients were vaccinated, of whom most were aged 50 years and over. The overall VE, adjusted for age group, month of presentation and state or territory, was 23% (95% CI, -4% to 43%) against all influenza types, 15% (95% CI, -17% to 38%) against influenza A, 13% (95% CI, -20% to 36%) against influenza A(not H1) and 53% (95% CI, 5% to 77%) against influenza B. CONCLUSION Vaccination against influenza was modestly protective, reducing the risk of medical presentation with influenza by around 23%.
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Affiliation(s)
- Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
| | - Monique B-N Chilver
- Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
| | - Geoff Higgins
- Microbiology and Infectious Diseases, SA Pathology, Adelaide, SA, Australia
| | - Allen C Cheng
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nigel P Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
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285
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Examining Ontario's universal influenza immunization program with a multi-strain dynamic model. Vaccine 2014; 32:5098-117. [DOI: 10.1016/j.vaccine.2014.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/13/2014] [Accepted: 06/02/2014] [Indexed: 11/20/2022]
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286
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Roozendaal R, Tolboom J, Roos A, Riahi S, Theeuwsen J, Bujny MV, Klaren V, Korse HJWM, Dekking L, Grootenhuis A, Weverling GJ, Koudstaal W, Goudsmit J, Radošević K. Transient humoral protection against H5N1 challenge after seasonal influenza vaccination of humans. PLoS One 2014; 9:e103550. [PMID: 25075622 PMCID: PMC4116209 DOI: 10.1371/journal.pone.0103550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/28/2014] [Indexed: 11/20/2022] Open
Abstract
Current influenza vaccines are believed to confer protection against a narrow range of virus strains. The identification of broadly influenza neutralizing antibodies (bnAbs) has triggered efforts to develop vaccines providing ‘universal’ protection against influenza. Several bnAbs were isolated from humans recently vaccinated with conventional influenza vaccines, suggesting that such vaccines could, in principle, be broadly protective. Assessing the breadth-of-protection conferred to humans by influenza vaccines is hampered by the lack of in vitro correlates for broad protection. We designed and employed a novel human-to-mouse serum transfer and challenge model to analyze protective responses in serum samples from clinical trial subjects. One dose of seasonal vaccine induces humoral protection not only against vaccine-homologous H1N1 challenge, but also against H5N1 challenge. This heterosubtypic protection is neither detected, nor accurately predicted by in vitro immunogenicity assays. Moreover, heterosubtypic protection is transient and not boosted by repeated inoculations. Strategies to increase the breadth and duration of the protective response against influenza are required to obtain ‘universal’ protection against influenza by vaccination. In the absence of known correlates of protection for broadly protective vaccines, the human-to-mouse serum transfer and challenge model described here may aid the development of such vaccines.
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Affiliation(s)
- Ramon Roozendaal
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Jeroen Tolboom
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Anna Roos
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Sarra Riahi
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Jessica Theeuwsen
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Miriam V. Bujny
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Vincent Klaren
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Hans J. W. M. Korse
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Liesbeth Dekking
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | | | - Gerrit Jan Weverling
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Wouter Koudstaal
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Jaap Goudsmit
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
| | - Katarina Radošević
- Crucell Vaccine Institute, Janssen Center of Excellence for Immunoprophylaxis, Crucell Holland BV, Leiden, the Netherlands
- * E-mail:
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287
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Eichner M, Schwehm M, Hain J, Uphoff H, Salzberger B, Knuf M, Schmidt-Ott R. 4Flu - an individual based simulation tool to study the effects of quadrivalent vaccination on seasonal influenza in Germany. BMC Infect Dis 2014; 14:365. [PMID: 24993051 PMCID: PMC4099094 DOI: 10.1186/1471-2334-14-365] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 06/03/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Influenza vaccines contain Influenza A and B antigens and are adjusted annually to match the characteristics of circulating viruses. In Germany, Influenza B viruses belonged to the B/Yamagata lineage, but since 2001, the antigenically distinct B/Victoria lineage has been co-circulating. Trivalent influenza vaccines (TIV) contain antigens of the two A subtypes A(H3N2) and A(H1N1), yet of only one B lineage, resulting in frequent vaccine mismatches. Since 2012, the WHO has been recommending vaccine strains from both B lineages, paving the way for quadrivalent influenza vaccines (QIV). METHODS Using an individual-based simulation tool, we simulate the concomitant transmission of four influenza strains, and compare the effects of TIV and QIV on the infection incidence. Individuals are connected in a dynamically evolving age-dependent contact network based on the POLYMOD matrix; their age-distribution reproduces German demographic data and predictions. The model considers maternal protection, boosting of existing immunity, loss of immunity, and cross-immunizing events between the B lineages. Calibration to the observed annual infection incidence of 10.6% among young adults yielded a basic reproduction number of 1.575. Vaccinations are performed annually in October and November, whereby coverage depends on the vaccinees' age, their risk status and previous vaccination status. New drift variants are introduced at random time points, leading to a sudden loss of protective immunity for part of the population and occasionally to reduced vaccine efficacy. Simulations run for 50 years, the first 30 of which are used for initialization. During the final 20 years, individuals receive TIV or QIV, using a mirrored simulation approach. RESULTS Using QIV, the mean annual infection incidence can be reduced from 8,943,000 to 8,548,000, i.e. by 395,000 infections, preventing 11.2% of all Influenza B infections which still occur with TIV (95% CI: 10.7-11.8%). Using a lower B lineage cross protection than the baseline 60%, the number of Influenza B infections increases and the number additionally prevented by QIV can be 5.5 times as high. CONCLUSIONS Vaccination with TIV substantially reduces the Influenza incidence compared to no vaccination. Depending on the assumed degree of B lineage cross protection, QIV further reduces Influenza B incidence by 11-33%.
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Affiliation(s)
- Martin Eichner
- Department for Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstr. 5, 72076 Tübingen, Germany
- Epimos GmbH, Uhlandstr. 3, 72144 Dusslingen, Germany
| | - Markus Schwehm
- ExploSYS GmbH, Otto-Hahn-Weg 6, 70771 Leinfelden-Echterdingen, Germany
| | - Johannes Hain
- GlaxoSmithKline GmbH & Co. KG, Prinzregentenplatz 9, 81675 München, Germany
| | - Helmut Uphoff
- Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen, Zentrum für Gesundheitsschutz, Wolframstr. 33, 35683 Dillenburg, Germany
| | - Bernd Salzberger
- Klinik f. Innere Medizin, Universitätsklinikum Regensburg, 93042 Regensburg, Germany
| | - Markus Knuf
- Dr. Horst Schmidt Klinik, Klinik für Kinder und Jugendliche, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany
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288
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Chan TC, Fu YC, Wang DW, Chuang JH. Determinants of receiving the pandemic (H1N1) 2009 vaccine and intention to receive the seasonal influenza vaccine in Taiwan. PLoS One 2014; 9:e101083. [PMID: 24971941 PMCID: PMC4074160 DOI: 10.1371/journal.pone.0101083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/02/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The paper examines the factors associated with both receiving pandemic (H1N1) 2009 vaccines and individuals' intentions to get the next seasonal influenza vaccine in Taiwan. METHODS We conducted a representative nationwide survey with in-person household interviews during April-July 2010. Multivariate logistic regression incorporated socio-demographic background, household characteristics, health status, behaviors, and perceptions of influenza and vaccination. RESULTS We completed interviews with 1,954 respondents. Among those, 548 (28.0%) received the pandemic (H1N1) 2009 vaccination, and 469 (24.0%) intended to get the next seasonal influenza vaccine. Receipt of the H1N1 vaccine was more prevalent among schoolchildren, the elderly, those who had contact with more people in their daily lives, and those who had received influenza vaccinations in previous years. In comparison, the intention to receive the next seasonal influenza vaccine tended to be stronger among children, the elderly, and those who reported less healthy status or lived with children, who received a seasonal influenza vaccination before, and who worried more about a possible new pandemic. CONCLUSIONS Children, the elderly, and those who had gotten seasonal flu shots before in Taiwan were more likely to both receive a pandemic H1N1 vaccination and intend to receive a seasonal influenza vaccine.
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Affiliation(s)
- Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan, Republic of China
| | - Yang-chih Fu
- Institute of Sociology, Academia Sinica, Taipei, Taiwan, Republic of China
| | - Da-Wei Wang
- Institute of Information Science, Academia Sinica, Taipei, Taiwan, Republic of China
| | - Jen-Hsiang Chuang
- Deputy Director-General’s Office, Centers for Disease Control, Taipei, Taiwan, Republic of China
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, Republic of China
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289
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Van Bellinghen LA, Meier G, Van Vlaenderen I. The potential cost-effectiveness of quadrivalent versus trivalent influenza vaccine in elderly people and clinical risk groups in the UK: a lifetime multi-cohort model. PLoS One 2014; 9:e98437. [PMID: 24905235 PMCID: PMC4048201 DOI: 10.1371/journal.pone.0098437] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 05/02/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK. METHODS A lifetime, multi-cohort, static Markov model was constructed, with nine age groups each divided into healthy and at-risk categories. Influenza A and B were accounted for separately. The model was run in one-year cycles for a lifetime (maximum age: 100 years). The analysis was from the perspective of the UK National Health Service. Costs and benefits were discounted at 3.5%. 2010 UK vaccination policy (vaccination of people at risk and those aged ≥65 years) was applied. Herd effect was not included. Inputs were derived from national databases and published sources where possible. The quadrivalent influenza vaccine price was not available when the study was conducted. It was estimated at £6.72,15% above the trivalent vaccine price of £5.85. Sensitivity analyses used an incremental price of up to 50%. RESULTS Compared with trivalent influenza vaccine, the quadrivalent influenza vaccine would be expected to reduce the numbers of influenza cases by 1,393,720, medical visits by 439,852 complications by 167,357, hospitalisations for complications by 26,424 and influenza deaths by 16,471. The estimated base case incremental cost-effectiveness ratio (ICER) was £5,299/quality-adjusted life-year (QALY). Sensitivity analyses indicated that the ICER was sensitive to changes in circulation of influenza virus subtypes and vaccine mismatch; all other parameters had little effect. In 96% of simulations the ICER was <£20,000/QALY. Since this analysis was completed, quadrivalent influenza vaccine has become available in the UK at a list price of £9.94. Using this price in the model, the estimated ICER for quadrivalent compared with trivalent vaccination was £27,378/QALY, still within the NICE cost-effectiveness threshold (£20,000-£30,000). CONCLUSIONS Quadrivalent influenza vaccine could reduce influenza disease burden and would be cost-effective compared with trivalent influenza vaccine in elderly people and clinical risk groups in the UK.
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290
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Inactivated quadrivalent split-virus seasonal influenza vaccine (Fluarix® quadrivalent): a review of its use in the prevention of disease caused by influenza A and B. Drugs 2014; 73:1587-94. [PMID: 24022123 DOI: 10.1007/s40265-013-0114-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The inactivated quadrivalent split-virus seasonal influenza vaccine [Fluarix® quadrivalent, manufactured in Dresden (D-QIV)] contains 15 μg haemagglutinin from each of the four influenza virus strains expected to circulate in the upcoming influenza season. Unlike seasonal trivalent influenza vaccines (TIVs), which have been used previously, quadrivalent influenza vaccines (QIVs) contain two influenza A subtype viruses and two B type viruses. As two different B viruses have co-circulated in recent years, incorporating both B lineages reduces the risk of the dominant B strain not being included in the vaccine. D-QIV is approved for active immunization of individuals aged ≥3 years to prevent disease caused by the influenza A subtype viruses and B type viruses contained in the vaccine. In large randomized, controlled trials, D-QIV was highly immunogenic in healthy adults (including individuals aged ≥65 years) and children, and exceeded the criteria for vaccine licensure. Immune responses for D-QIV, compared with those for TIVs, were non-inferior against influenza A strains and common B strains and superior against the additional B strain. D-QIV was generally well tolerated in all age groups studied and, overall, reactogenicity and tolerability were generally similar to observations with TIVs. Quadrivalent influenza vaccines are expected to offer substantial cost-effectiveness benefits in seasons where the B lineage selected for inclusion in TIVs does not match the dominant circulating strain. Thus, by incorporating both circulating influenza B lineages, vaccination with D-QIV is likely to reduce the risk of the dominant circulating B type virus not matching the strain selected for the vaccine and, therefore, more effectively protect target populations from influenza than TIVs.
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291
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Turner N, Pierse N, Bissielo A, Huang QS, Baker MG, Widdowson MA, Kelly H. The effectiveness of seasonal trivalent inactivated influenza vaccine in preventing laboratory confirmed influenza hospitalisations in Auckland, New Zealand in 2012. Vaccine 2014; 32:3687-93. [PMID: 24768730 DOI: 10.1016/j.vaccine.2014.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 03/24/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Few studies report the effectiveness of trivalent inactivated influenza vaccine (TIV) in preventing hospitalisation for influenza-confirmed respiratory infections. Using a prospective surveillance platform, this study reports the first such estimate from a well-defined ethnically diverse population in New Zealand (NZ). METHODS A case test-negative design was used to estimate propensity adjusted vaccine effectiveness. Patients with a severe acute respiratory infection (SARI), defined as a patient of any age requiring hospitalisation with a history of a fever or a measured temperature ≥38°C and cough and onset within the past 7 days, admitted to public hospitals in South and Central Auckland were eligible for inclusion in the study. Cases were SARI patients who tested positive for influenza, while non-cases (controls) were SARI patients who tested negative. Results were adjusted for the propensity to be vaccinated and the timing of the influenza season. RESULTS The propensity and season adjusted vaccine effectiveness (VE) was estimated as 39% (95% CI 16;56). The VE point estimate against influenza A (H1N1) was lower than for influenza B or influenza A (H3N2) but confidence intervals were wide and overlapping. Estimated VE was 59% (95% CI 26;77) in patients aged 45-64 years but only 8% (-78;53) in those aged 65 years and above. CONCLUSION Prospective surveillance for SARI has been successfully established in NZ. This study for the first year, the 2012 influenza season, has shown low to moderate protection by TIV against influenza positive hospitalisation.
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Affiliation(s)
- Nikki Turner
- The University of Auckland, Private Bag 92019, Victoria St West, Auckland, New Zealand.
| | - Nevil Pierse
- The University of Otago, PO Box 7343 Wellington South 6242, Wellington, New Zealand.
| | - Ange Bissielo
- Institute of Environmental Science and Research, PO Box 40-158 Upper Hutt 5140, Wellington, New Zealand.
| | - Q Sue Huang
- Institute of Environmental Science and Research, PO Box 40-158 Upper Hutt 5140, Wellington, New Zealand.
| | - Michael G Baker
- The University of Otago, PO Box 7343 Wellington South 6242, Wellington, New Zealand.
| | | | - Heath Kelly
- The Australian National University, Canberra 0200, ACT, Australia; Victorian Infectious Diseases Reference Laboratory, 10 Wrecklyn St., North Melbourne, 3051 Melbourne, VIC, Australia.
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Quinn E, Jit M, Newall AT. Key issues and challenges in estimating the impact and cost-effectiveness of quadrivalent influenza vaccination. Expert Rev Pharmacoecon Outcomes Res 2014; 14:425-35. [PMID: 24734967 DOI: 10.1586/14737167.2014.908713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Evidence has shown that quadrivalent influenza vaccines containing all four subtypes are safe and immunogenic. However, to date there have been few published studies exploring the population-level clinical and economic impact of quadrivalent compared to trivalent influenza vaccines. Economic evaluation studies need to be conducted in order to inform country-level decision making about whether (and how to) introduce and replace the current trivalent influenza vaccines with quadrivalent influenza vaccination programs. Several key issues associated with estimating the clinical and economic impact of the trivalent versus quadrivalent vaccines are discussed in this article, particularly the complexities involved in estimating the incremental preventable disease and economic burden. Other factors, such as the indirect (herd) protection from quadrivalent influenza vaccination and the timing of the replacement of trivalent influenza vaccination programs are also discussed.
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Affiliation(s)
- Emma Quinn
- NSW Ministry of Health , Sydney , Australia
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293
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Influenza epidemiology and vaccine effectiveness among patients with influenza-like illness, viral watch sentinel sites, South Africa, 2005-2009. PLoS One 2014; 9:e94681. [PMID: 24736452 PMCID: PMC3988097 DOI: 10.1371/journal.pone.0094681] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background There is limited data on the epidemiology of influenza and few published estimates of influenza vaccine effectiveness (VE) from Africa. In April 2009, a new influenza virus strain infecting humans was identified and rapidly spread globally. We compared the characteristics of patients ill with influenza A(H1N1)pdm09 virus to those ill with seasonal influenza and estimated influenza vaccine effectiveness during five influenza seasons (2005–2009) in South Africa. Methods Epidemiological data and throat and/or nasal swabs were collected from patients with influenza-like illness (ILI) at sentinel sites. Samples were tested for seasonal influenza viruses using culture, haemagglutination inhibition tests and/or polymerase chain reaction (PCR) and for influenza A(H1N1)pdm09 by real-time PCR. For the vaccine effectiveness (VE) analysis we considered patients testing positive for influenza A and/or B as cases and those testing negative for influenza as controls. Age-adjusted VE was calculated as 1-odds ratio for influenza in vaccinated and non-vaccinated individuals. Results From 2005 through 2009 we identified 3,717 influenza case-patients. The median age was significantly lower among patients infected with influenza A(H1N1)pdm09 virus than those with seasonal influenza, 17 and 27 years respectively (p<0.001). The vaccine coverage during the influenza season ranged from 3.4% in 2009 to 5.1% in 2006 and was higher in the ≥50 years (range 6.9% in 2008 to 13.2% in 2006) than in the <50 years age group (range 2.2% in 2007 to 3.7% in 2006). The age-adjusted VE estimates for seasonal influenza were 48.6% (4.9%, 73.2%); −14.2% (−9.7%, 34.8%); 12.0% (−70.4%, 55.4%); 67.4% (12.4%, 90.3%) and 29.6% (−21.5%, 60.1%) from 2005 to 2009 respectively. For the A(H1N1)pdm09 season, the efficacy of seasonal vaccine was −6.4% (−93.5%, 43.3%). Conclusion Influenza vaccine demonstrated a significant protective effect in two of the five years evaluated. Low vaccine coverage may have reduced power to estimate vaccine effectiveness.
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Skowronski DM, Janjua NZ, De Serres G, Sabaiduc S, Eshaghi A, Dickinson JA, Fonseca K, Winter AL, Gubbay JB, Krajden M, Petric M, Charest H, Bastien N, Kwindt TL, Mahmud SM, Van Caeseele P, Li Y. Low 2012-13 influenza vaccine effectiveness associated with mutation in the egg-adapted H3N2 vaccine strain not antigenic drift in circulating viruses. PLoS One 2014; 9:e92153. [PMID: 24667168 PMCID: PMC3965421 DOI: 10.1371/journal.pone.0092153] [Citation(s) in RCA: 317] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/17/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Influenza vaccine effectiveness (VE) is generally interpreted in the context of vaccine match/mismatch to circulating strains with evolutionary drift in the latter invoked to explain reduced protection. During the 2012-13 season, however, detailed genotypic and phenotypic characterization shows that low VE was instead related to mutations in the egg-adapted H3N2 vaccine strain rather than antigenic drift in circulating viruses. METHODS/FINDINGS Component-specific VE against medically-attended, PCR-confirmed influenza was estimated in Canada by test-negative case-control design. Influenza A viruses were characterized genotypically by amino acid (AA) sequencing of established haemagglutinin (HA) antigenic sites and phenotypically through haemagglutination inhibition (HI) assay. H3N2 viruses were characterized in relation to the WHO-recommended, cell-passaged vaccine prototype (A/Victoria/361/2011) as well as the egg-adapted strain as per actually used in vaccine production. Among the total of 1501 participants, influenza virus was detected in 652 (43%). Nearly two-thirds of viruses typed/subtyped were A(H3N2) (394/626; 63%); the remainder were A(H1N1)pdm09 (79/626; 13%), B/Yamagata (98/626; 16%) or B/Victoria (54/626; 9%). Suboptimal VE of 50% (95%CI: 33-63%) overall was driven by predominant H3N2 activity for which VE was 41% (95%CI: 17-59%). All H3N2 field isolates were HI-characterized as well-matched to the WHO-recommended A/Victoria/361/2011 prototype whereas all but one were antigenically distinct from the egg-adapted strain as per actually used in vaccine production. The egg-adapted strain was itself antigenically distinct from the WHO-recommended prototype, and bore three AA mutations at antigenic sites B [H156Q, G186V] and D [S219Y]. Conversely, circulating viruses were identical to the WHO-recommended prototype at these positions with other genetic variation that did not affect antigenicity. VE was 59% (95%CI:16-80%) against A(H1N1)pdm09, 67% (95%CI: 30-85%) against B/Yamagata (vaccine-lineage) and 75% (95%CI: 29-91%) against B/Victoria (non-vaccine-lineage) viruses. CONCLUSIONS These findings underscore the need to monitor vaccine viruses as well as circulating strains to explain vaccine performance. Evolutionary drift in circulating viruses cannot be regulated, but influential mutations introduced as part of egg-based vaccine production may be amenable to improvements.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Canada
- Case-Control Studies
- Child
- Child, Preschool
- DNA, Viral/genetics
- Female
- Hemagglutinin Glycoproteins, Influenza Virus/genetics
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Humans
- Immunization
- Infant
- Infant, Newborn
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/genetics
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Middle Aged
- Molecular Sequence Data
- Mutation/genetics
- Protein Conformation
- Seasons
- Young Adult
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Affiliation(s)
- Danuta M. Skowronski
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- Department of Biological and Occupational Risks, Institut National de Santé Publique du Québec, Québec (Québec), Canada
- Department of Social and Preventive Medicine, Laval University, Québec (Québec), Canada
| | - Suzana Sabaiduc
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Alireza Eshaghi
- Department of Molecular Research, Public Health Ontario, Toronto, Ontario, Canada
| | - James A. Dickinson
- Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Fonseca
- Department of Virology, Provincial Laboratory of Public Health, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Luise Winter
- Communicable Disease Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Jonathan B. Gubbay
- Department of Microbiology, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mel Krajden
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Martin Petric
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hugues Charest
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
- Département De Microbiologie, Infectiologie et Immunologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Bastien
- Influenza and Respiratory Virus Section, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Trijntje L. Kwindt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Salaheddin M. Mahmud
- Community Health Sciences and Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yan Li
- Influenza and Respiratory Virus Section, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
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295
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Clements KM, Meier G, McGarry LJ, Pruttivarasin N, Misurski DA. Cost-effectiveness analysis of universal influenza vaccination with quadrivalent inactivated vaccine in the United States. Hum Vaccin Immunother 2014; 10:1171-80. [PMID: 24609063 PMCID: PMC4896600 DOI: 10.4161/hv.28221] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/06/2014] [Accepted: 02/14/2014] [Indexed: 11/19/2022] Open
Abstract
To address influenza B lineage mismatch and co-circulation, several quadrivalent inactivated influenza vaccines (IIV4s) containing two type A strains and both type B lineages have recently been approved in the United States. Currently available trivalent inactivated vaccines (IIV3s) or trivalent live attenuated influenza vaccines (LAIV3s) comprise two influenza A strains and one of the two influenza B lineages that have co-circulated in the United States since 2001. The objective of this analysis was to evaluate the cost-effectiveness of a policy of universal vaccination with IIV4 vs. IIV3/LAIV3 during 1 year in the United States. On average per influenza season, IIV4 was predicted to result in 30,251 fewer influenza cases, 3512 fewer hospitalizations, 722 fewer deaths, 4812 fewer life-years lost, and 3596 fewer quality-adjusted life-years (QALYs) lost vs. IIV3/LAIV3. Using the Fluarix Quadrivalent(TM) (GlaxoSmithKline) prices and the weighted average IIV3/LAIV3 prices, the model predicts that the vaccination program costs would increase by $452.2 million, while direct medical and indirect costs would decrease by $111.6 million and $218.7 million, respectively, with IIV4. The incremental cost-effectiveness ratio (ICER) comparing IIV4 to IIV3/LAIV3 is predicted to be $90,301/QALY gained. Deterministic sensitivity analyses found that influenza B vaccine-matched and mismatched efficacies among adults aged ≥65 years had the greatest impact on the ICER. Probabilistic sensitivity analysis showed that the cost per QALY remained below $100,000 for 61% of iterations. In conclusion, vaccination with IIV4 in the US is predicted to reduce morbidity and mortality. This strategy is also predicted to be cost-effective vs. IIV3/LAIV3 at conventional willingness-to-pay thresholds.
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296
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Skowronski DM, Janjua NZ, Sabaiduc S, De Serres G, Winter AL, Gubbay JB, Dickinson JA, Fonseca K, Charest H, Bastien N, Li Y, Kwindt TL, Mahmud SM, Van Caeseele P, Krajden M, Petric M. Influenza A/Subtype and B/Lineage Effectiveness Estimates for the 2011–2012 Trivalent Vaccine: Cross-Season and Cross-Lineage Protection With Unchanged Vaccine. J Infect Dis 2014; 210:126-37. [DOI: 10.1093/infdis/jiu048] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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297
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Chiu C, Ellebedy AH, Wrammert J, Ahmed R. B cell responses to influenza infection and vaccination. Curr Top Microbiol Immunol 2014; 386:381-98. [PMID: 25193634 DOI: 10.1007/82_2014_425] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
Abstract
Although vaccines against influenza are widely available, control of the disease remains elusive. In part, this is due to the inability of current vaccines to induce durable, broadly protective immune responses. Prevention of influenza depends primarily on effective antibody responses that block virus entry. Following infection, high-affinity IgA antibodies are generated in the respiratory tract that lead to immune exclusion, while IgG prevents systemic spread. These are effective and long-lasting but also exert immune pressure. Mutation of the antigenic determinants of influenza therefore rapidly leads to emergence of novel variants that evade previously generated protective responses. Not only do vaccines suffer from this strain-specific limitation, but also they are suboptimal in their ability to induce durable immunity. However, recent evidence has demonstrated the possibility of inducing broadly cross-reactive antibody responses. Further understanding of the ways in which high-titer, long-lived antibody responses directed against such cross-reactive epitopes can be induced would lead to the development of novel vaccines that may remove the requirement for recurrent vaccination.
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Affiliation(s)
- Christopher Chiu
- Centre for Respiratory Infection, National Heart and Lung Institute, Imperial College London, London, W2 1PG, UK
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298
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Advances in universal influenza virus vaccine design and antibody mediated therapies based on conserved regions of the hemagglutinin. Curr Top Microbiol Immunol 2014; 386:301-21. [PMID: 25007847 DOI: 10.1007/82_2014_408] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The threat of novel influenza viruses emerging into the human population from animal reservoirs, as well as the short duration of protection conferred by licensed vaccines against human seasonal strains has spurred research efforts to improve upon current vaccines and develop novel therapeutics against influenza viruses. In recent years these efforts have resulted in the identification of novel, highly conserved epitopes for neutralizing antibodies on the influenza virus hemagglutinin protein, which are present in both the stalk and globular head domains of the molecule. The existence of such epitopes may allow for generation of novel therapeutic antibodies, in addition to serving as attractive targets of novel vaccine design. The aims of developing improved vaccines include eliciting broader protection from drifted strains, inducing long-lived immunity against seasonal strains, and allowing for the rational design of vaccines that can be stockpiled for use as pre-pandemic vaccines. In addition, an increased focus on influenza virus vaccine research has prompted an improved understanding of how the immune system responds to influenza virus infection.
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299
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Dormitzer PR. Rapid Production of Synthetic Influenza Vaccines. Curr Top Microbiol Immunol 2014; 386:237-73. [DOI: 10.1007/82_2014_399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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300
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Sullivan SG, Komadina N, Grant K, Jelley L, Papadakis G, Kelly H. Influenza vaccine effectiveness during the 2012 influenza season in Victoria, Australia: influences of waning immunity and vaccine match. J Med Virol 2013; 86:1017-25. [PMID: 24395730 DOI: 10.1002/jmv.23847] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2013] [Indexed: 11/08/2022]
Abstract
Vaccine effectiveness may wane with increasing time since vaccination. This analysis used the Victorian sentinel general practitioner (GP) network to estimate vaccine effectiveness for trivalent inactivated vaccines in the 2012 season. A test-negative design was used where patients presenting to GPs with influenza-like illness who tested positive for influenza were cases and noncases were those who tested negative. Vaccination status was recorded by GPs. Vaccine effectiveness was calculated as (1-odds ratio) × 100%. Estimates were compared early versus late in the season and by time since vaccination. Virus isolates were assessed antigenically by hemagglutination inhibition assay in a selection of positive samples and viruses from healthy adults who experienced a vaccine breakthrough were analyzed genetically. The adjusted vaccine effectiveness estimate for any type of influenza was 45% (95% CI: 8,66) and for influenza A(H3) was 35% (95% CI: -11,62). A non-significant effect of waning effectiveness by time since vaccination was observed for A(H3). For those vaccinated <93 days of presentation vaccine effectiveness was 37% (95% CI: -29,69), while for those vaccinated ≥93 days before presentation it was 18% (95% CI: -83,63). Comparison of early versus late in the season estimates was very sensitive to the cut off week chosen for analysis. Antigenic data suggested that low vaccine effectiveness was not associated with poor vaccine match among the A(H3) viruses. However, genetic analysis suggested nucleotide substitutions in antigenic sites. In 2012, the trivalent influenza vaccine provided moderate protection against influenza and showed limited evidence for waning effectiveness. Antigenic and genetic data can provide additional insight into understanding these estimates.
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Affiliation(s)
- Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Victoria, Australia
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