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Cargnin Faccin F, Perez DR. Pandemic preparedness through vaccine development for avian influenza viruses. Hum Vaccin Immunother 2024; 20:2347019. [PMID: 38807261 PMCID: PMC11141480 DOI: 10.1080/21645515.2024.2347019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/30/2024] Open
Abstract
Influenza A viruses pose a significant threat to global health, impacting both humans and animals. Zoonotic transmission, particularly from swine and avian species, is the primary source of human influenza outbreaks. Notably, avian influenza viruses of the H5N1, H7N9, and H9N2 subtypes are of pandemic concern through their global spread and sporadic human infections. Preventing and controlling these viruses is critical due to their high threat level. Vaccination remains the most effective strategy for influenza prevention and control in humans, despite varying vaccine efficacy across strains. This review focuses specifically on pandemic preparedness for avian influenza viruses. We delve into vaccines tested in animal models and summarize clinical trials conducted on H5N1, H7N9, and H9N2 vaccines in humans.
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Affiliation(s)
- Flavio Cargnin Faccin
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Daniel R. Perez
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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2
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Liao Y, Jin Y, Zhang H, Yang J, Fu J, Lv H. Immunogenicity of a trivalent influenza vaccine and persistence of induced immunity in adults aged ≥60 years in Taizhou City, Zhejiang Province, China, during the 2018-2019 season. Hum Vaccin Immunother 2022; 18:2071061. [PMID: 35687101 PMCID: PMC9302525 DOI: 10.1080/21645515.2022.2071061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Yearly administration of influenza vaccine with recommendations can help control seasonal influenza epidemics in adults aged ≥60 years. Here, we describe the results of a prospective study observing the immunogenicity and persistence of induced immunity of a trivalent inactivated split-virion influenza vaccine (TIV) in adults aged ≥60 years during the 2018–2019 season in Taizhou City, Zhejiang Province in China. A total of 422 participants completed the study period. Vaccinated participants (284) received a single dose of TIV, but unvaccinated participants (138) didn’t receive any vaccine. Study participants vaccinated with TIV had significantly higher GMTs of Hemagglutination Inhibition (HI) antibodies against AH1N1, AH2N3, and B/Victoria strains (all p < .0001) at day 30 post-vaccination compared with unvaccinated participants, but the antibody response to the B/Victoria strain was the weakest. Rates of seroprotection and seroconversion were generally higher in the TIV-vaccinated group. At day 180 post-vaccination, the seroconversion rates (95%CI) in the vaccinated group were 99.6% (99.0%–100.3%), 97.9% (96.2%–99.6%), and 68.3% (62.9%–73.8%) for antibodies against three influenza strains, respectively; these rates were significantly different compared with unvaccinated group only for strains AH3N2 and B/Victoria (p = .002 and p < .0001, respectively). These results confirm that in adults aged ≥60 years, a single dose of TIV can induce a protective immune response against influenza, but the protective HI antibody levels induced against strain B/Victoria do not persist through 6 months.
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Affiliation(s)
- Yuting Liao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yan Jin
- Department of Immunization Program, Taizhou Municipal Center for Disease Control and Prevention, Taizhou, Zhejiang, China
| | - Hangjie Zhang
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Juan Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jian Fu
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Huakun Lv
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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3
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Beyer WE, Palache AM, Boulfich M, Osterhaus AD. Clinical relevance of increased antibody titres in older adults upon vaccination with squalene-adjuvanted versus non-adjuvanted influenza vaccines. Vaccine 2022; 40:3098-3102. [DOI: 10.1016/j.vaccine.2022.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
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4
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Kompier R, Neels P, Beyer W, Hardman T, Lioznov D, Kharit S, Kostinov M. Analysis of the safety and immunogenicity profile of an azoximer bromide polymer-adjuvanted subunit influenza vaccine. F1000Res 2022; 11:259. [PMID: 36176546 PMCID: PMC9493399 DOI: 10.12688/f1000research.75869.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
A systematic review of clinical trials conducted with a low-dose inactivated influenza vaccine adjuvanted by azoximer bromide (AZB, Polyoxidonium), was performed to compare vaccine reactogenicity against non-adjuvant vaccines. We also assessed whether lower amounts of antigen per viral strain in AZB-adjuvanted vaccines affected antibody responses. A robust search strategy identified scientific publications reporting 30 clinical trials, comprising data on 11,736 participants and 86 trial arms, for inclusion in the analysis. Local reaction rates (R lr) appeared to be lower in AZB-adjuvanted vaccine treatment arms versus comparator vaccine treatment arms. Meta‑regression analysis revealed that AZB did not contribute to vaccine reactogenicity. Post-vaccination geometric mean titres in those exposed to AZB-adjuvanted vaccine and comparator vaccine treatment arms were similar in both children and adults aged 18-60 years, implying an antigen-sparing effect by AZB.
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Affiliation(s)
- Ronald Kompier
- Ruijgenhoeck 6, 2201 EW Noordwijk, Vaccine Consultancy, The Netherlands, Netherlands Antilles
| | | | - Walter Beyer
- Ruijgenhoeck 6, 2201 EW Noordwijk, Vaccine Consultancy, The Netherlands, Netherlands Antilles,Niche Science and Technology Ltd., Unit 26, Falstaff House, Bardolph Road, Niche Science and Technology, London, UK
| | - Tim Hardman
- Niche Science and Technology Ltd., Unit 26, Falstaff House, Bardolph Road, Niche Science and Technology, London, UK,
| | - Dmitry Lioznov
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russian Federation,First Pavlov State Medical University, Saint Petersburg, Russian Federation
| | - Susanna Kharit
- Scientific Research Institute of Children’s Infections of the Russian Federal Biomedical Agency, St. Petersburg, Russian Federation
| | - Michail Kostinov
- Department of Allergology, I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russian Federation,Moscow State Medical University, Department of Epidemiology and Modern Vaccination Technologies, Sechenov First, Moscow, Russian Federation
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5
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Why Physical Activity Should Be Considered in Clinical Trials for COVID-19 Vaccines: A Focus on Risk Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031853. [PMID: 35162875 PMCID: PMC8834774 DOI: 10.3390/ijerph19031853] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Abstract
Since the World Health Organization declared the global COVID-19 state of emergency in early 2020, several vaccine candidates have emerged to control SARS-CoV-2, and some of them have been approved and implemented in vaccination campaigns worldwide. Although clinical trials for these vaccines have been carried out using highly controlled methods with accurate immunological tests, clinical questionnaires did not include questions concerning the physical activity profile among volunteers. It has been well established that physical activity plays a pivotal role in the immune response after vaccination, led by the activation of cytokines, antibodies, and cells. This concept should have been considered when evaluating the efficacy of COVID-19 vaccine candidates, particularly in elderly and obese people. Here, we discuss data from the literature providing strong evidence regarding the importance of analyzing physical activity parameters to improve the accuracy of clinical trials on assessing the efficacy of vaccine candidates.
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Liu Y, Strohmeier S, González-Domínguez I, Tan J, Simon V, Krammer F, García-Sastre A, Palese P, Sun W. Mosaic Hemagglutinin-Based Whole Inactivated Virus Vaccines Induce Broad Protection Against Influenza B Virus Challenge in Mice. Front Immunol 2021; 12:746447. [PMID: 34603333 PMCID: PMC8481571 DOI: 10.3389/fimmu.2021.746447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/31/2021] [Indexed: 01/04/2023] Open
Abstract
Influenza viruses undergo antigenic changes in the immuno-dominant hemagglutinin (HA) head domain, necessitating annual re-formulation of and re-vaccination with seasonal influenza virus vaccines for continuing protection. We previously synthesized mosaic HA (mHA) proteins of influenza B viruses which redirect the immune response towards the immuno-subdominant conserved epitopes of the HA via sequential immunization. As ~90% of current influenza virus vaccines are manufactured using the inactivated virus platform, we generated and sequentially vaccinated mice with inactivated influenza B viruses displaying either the homologous (same B HA backbones) or the heterologous (different B HA backbones) mosaic HAs. Both approaches induced long-lasting and cross-protective antibody responses showing strong antibody-dependent cellular cytotoxicity (ADCC) activity. We believe the B virus mHA vaccine candidates represent a major step towards a universal influenza B virus vaccine.
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Affiliation(s)
- Yonghong Liu
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shirin Strohmeier
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Irene González-Domínguez
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jessica Tan
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Viviana Simon
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peter Palese
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Weina Sun
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Carre C, Wong G, Narang V, Tan C, Chong J, Chin HX, Xu W, Lu Y, Chua M, Poidinger M, Tambyah P, Nyunt M, Ng TP, Larocque D, Hessler C, Bosco N, Quemeneur L, Larbi A. Endoplasmic reticulum stress response and bile acid signatures associate with multi-strain seroresponsiveness during elderly influenza vaccination. iScience 2021; 24:102970. [PMID: 34471863 PMCID: PMC8387917 DOI: 10.1016/j.isci.2021.102970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/25/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
The elderly are an important target for influenza vaccination, and the determination of factors that underlie immune responsiveness is clinically valuable. We evaluated the immune and metabolic profiles of 205 elderly Singaporeans administered with Vaxigrip. Despite high seroprotection rates, we observed heterogeneity in the response. We stratified the cohort into complete (CR) or incomplete responders (IR), where IR exhibited signs of accelerated T cell aging. We found a higher upregulation of genes associated with the B-cell endoplasmic-reticulum stress response in CR, where XBP-1 acts as a key upstream regulator. B-cells from IR were incapable of matching the level of XBP-1 upregulation observed in CR after inducing ER stress with tunicamycin in vitro. Metabolic signatures also distinguished CR and IR - as CR presented with a greater diversity of bile acids. Our findings suggest that the ER-stress pathway activation could improve influenza vaccination in the elderly.
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Affiliation(s)
| | - Glenn Wong
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Vipin Narang
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Crystal Tan
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Joni Chong
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Hui Xian Chin
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Weili Xu
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Yanxia Lu
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Michelle Chua
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Michael Poidinger
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Paul Tambyah
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Ma Nyunt
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Tze Pin Ng
- Division of Infectious Diseases, National University Hospital, Singapore
| | | | | | - Nabil Bosco
- Nestlé Research, Nestlé Institute of Health Sciences, EPFL Innovation Park, 1015 Lausanne, Switzerland
| | | | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
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8
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Improved immunologic responses to heterologous influenza strains in children with low preexisting antibody response vaccinated with MF59-adjuvanted influenza vaccine. Vaccine 2021; 39:5351-5357. [PMID: 34393015 DOI: 10.1016/j.vaccine.2021.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/09/2021] [Accepted: 08/07/2021] [Indexed: 01/02/2023]
Abstract
Vaccination is the most effective approach to reduce the substantial morbidity and mortality caused by influenza infection. Vaccine efficacy is highly sensitive to antigenic changes causing differences between circulating and vaccine viruses. Adjuvants such as MF59 increase antibody-mediated cross-reactive immunity and therefore may provide broader seasonal protection. A recent clinical trial showed that an MF59-adjuvanted vaccine was more efficacious than a nonadjuvanted comparator in subjects < 2 years of age, although not in those ≥ 2 years, during influenza seasons in which the predominant circulating virus was an A/H3N2 strain that was antigenically different from the vaccine virus. This finding suggested that the increased efficacy of the adjuvanted vaccine in younger subjects may be mediated by strain cross-reactive antibodies. A subset of the trial population, representing subjects with distinct age and/or immunological history, was tested for antibody responses to the vaccine A/H3N2 strain as well as A/H3N2 drifted strains antigenically matching the viruses circulating during the trial seasons. The neutralizing tests showed that, compared with nonadjuvanted vaccine, the adjuvanted vaccine improved not only the neutralizing antibody response to the vaccine strain but also the cross-reactive antibody response to the drifted strains in subjects with lower preexisting antibody titers, regardless of their age or vaccine history. The results demonstrated an immunological benefit and suggested a potential efficacy benefit by adjuvanted vaccine in subjects with lower preexisting antibody responses.
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Sansone M, Andersson M, Gustavsson L, Andersson LM, Nordén R, Westin J. Extensive Hospital In-Ward Clustering Revealed By Molecular Characterization of Influenza A Virus Infection. Clin Infect Dis 2021; 71:e377-e383. [PMID: 32011654 DOI: 10.1093/cid/ciaa108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/31/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nosocomial transmission of influenza A virus (InfA) infection is not fully recognized. The aim of this study was to describe the characteristics of hospitalized patients with InfA infections during an entire season and to investigate in-ward transmission at a large, acute-care hospital. METHODS During the 2016-17 season, all hospitalized patients ≥18 years old with laboratory-verified (real-time polymerase chain reaction) InfA were identified. Cases were characterized according to age; sex; comorbidity; antiviral therapy; viral load, expressed as cycle threshold values; length of hospital stay; 30-day mortality; and whether the InfA infection met criteria for a health care-associated influenza A infection (HCAI). Respiratory samples positive for InfA that were collected at the same wards within 7 days were chosen for whole-genome sequencing (WGS) and a phylogenetic analysis was performed to detect clustering. For reference, concurrent InfA strains from patients with community-acquired infection were included. RESULTS We identified a total of 435 InfA cases, of which 114 (26%) met the HCAI criteria. The overall 30-day mortality rate was higher among patients with HCAI (9.6% vs 4.6% among non-HCAI patients), although the difference was not statistically significant in a multivariable analysis, where age was the only independent risk factor for death (P < .05). We identified 8 closely related clusters (involving ≥3 cases) and another 10 pairs of strains, supporting in-ward transmission. CONCLUSIONS We found that the in-ward transmission of InfA occurs frequently and that HCAI may have severe outcomes. WGS may be used for outbreak investigations, as well as for evaluations of the effects of preventive measures.
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Affiliation(s)
- Martina Sansone
- Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Andersson
- Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Gustavsson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rickard Nordén
- Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Westin
- Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Kuznetsova TA, Persiyanova EV, Zaporozhets TS, Besednova NN. [Adjuvants of influenza vaccines: new possibilities of using sulphated polysaccharides from marine brown algae.]. Vopr Virusol 2020; 64:5-11. [PMID: 30893523 DOI: 10.18821/0507-4088-2019-64-1-5-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/31/2018] [Indexed: 06/09/2023]
Abstract
The review article presents the characteristics of the main adjuvant groups (mineral salts of aluminum, synthetic squalenebased adjuvants - MF59 and AS03, CpG-oligodeoxynucleotides, virosomes, polyoxidonium, sovidone) included in the licensed influenza vaccine. The main mechanisms of adjuvant action, advantages and disadvantages of these adjuvants are shown. The vaccines adjuvants in the phase of experimental studies and clinical trials (ISCOMs, Advax™, chitosan) are described too. Particular attention is paid to sulfated polysaccharides (fucoidans) from marine brown algae as vaccine adjuvants. Numerous results of their application in compositions of experimental vaccines are presented. The prospects of sulfated polysaccharides using in the design of influenza vaccines are estimated. These prospects are determined by high biocompatibility, low toxicity and good tolerance of the human body to fucoidans, as well as mechanisms of their adjuvant activity. Sulfated polysaccharides are agonists of toll-like receptors of innate immunity cells and powerful inducers of the cellular and humoral immune response, which is important for the development of influenza vaccines. The review is based on the information presented in the bibliographic and abstract databases of scientific publications, search engines and publishers: RSCI, Web of Science, Scopus, MEDLINE, Google Scholar, PubMed, Springer Nature, Elsevier and others.
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Affiliation(s)
- T A Kuznetsova
- Research Somov Institute of Epidemiology and Microbiology, Vladivostok, 690087, Russian Federation
| | - E V Persiyanova
- Research Somov Institute of Epidemiology and Microbiology, Vladivostok, 690087, Russian Federation
- Medical Association of Far East Branch of the Russian Academy of Sciences, Vladivostok, 690022, Russian Federation
| | - T S Zaporozhets
- Research Somov Institute of Epidemiology and Microbiology, Vladivostok, 690087, Russian Federation
| | - N N Besednova
- Research Somov Institute of Epidemiology and Microbiology, Vladivostok, 690087, Russian Federation
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Cocchio S, Gallo T, Del Zotto S, Clagnan E, Iob A, Furlan P, Fonzo M, Bertoncello C, Baldo V. Preventing the Risk of Hospitalization for Respiratory Complications of Influenza among the Elderly: Is There a Better Influenza Vaccination Strategy? A Retrospective Population Study. Vaccines (Basel) 2020; 8:E344. [PMID: 32605238 PMCID: PMC7564213 DOI: 10.3390/vaccines8030344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 12/11/2022] Open
Abstract
Influenza and its complications are an important public health concern, and vaccination remains the most effective prevention measure. However, the efficacy of vaccination depends on several variables, including the type of strategy adopted. The goal of this study was to assess the impact of different influenza vaccination strategies in preventing hospitalizations for influenza and its related respiratory complications. A retrospective cohort study was conducted on data routinely collected by the health services for six consecutive influenza seasons, considering the population aged 65 years or more at the time of their vaccination and living in northeastern Italy. Our analysis concerns 987,266 individuals vaccinated against influenza during the study period. The sample was a mean 78.0 ± 7.7 years old, and 5681 individuals (0.58%) were hospitalized for potentially influenza-related reasons. The hospitalization rate tended to increase over the years, not-significantly peaking in the 2016-2017 flu season (0.8%). Our main findings revealed that hospitalizations related to seasonal respiratory diseases were reduced as the use of the enhanced vaccine increased (R2 = 0.5234; p < 0.001). Multivariate analysis confirmed the significantly greater protective role of the enhanced vaccine over the conventional vaccination strategy, with adjusted Odds Ratio (adj OR) = 0.62 (95% CI: 0.59-0.66). A prior flu vaccination also had a protective role (adj OR: 0.752 (95% CI: 0.70-0.81)). Age, male sex, and H3N2 mismatch were directly associated with a higher risk of hospitalization for pneumonia. In the second part of our analysis, comparing MF59-adjuvanted trivalent inactivated vaccine (MF59-TIV) with conventional vaccines, we considered 479,397 individuals, of which 3176 (0.66%) were admitted to a hospital. The results show that using the former vaccine reduced the risk of hospitalization by 33% (adj OR: 0.67 (95% CI: 0.59-0.75)). This study contributes to the body of evidence of a greater efficacy of enhanced vaccines, and MF59-adjuvanted TIV in particular, over conventional vaccination strategies in the elderly.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100 Padova, Italy; (S.C.); (P.F.); (M.F.); (C.B.)
| | - Tolinda Gallo
- Public Health Department, Udine Healthcare and University Integrated Trust, Via Chiusaforte 2, 33100 Udine, Italy; (T.G.); (A.I.)
| | - Stefania Del Zotto
- Regione Friuli Venezi Giulia, Azienda Regionale di Coordinamento per la Salute, Via Pozzuolo 330, 33100 Udine, Italy; (S.D.Z.); (E.C.)
| | - Elena Clagnan
- Regione Friuli Venezi Giulia, Azienda Regionale di Coordinamento per la Salute, Via Pozzuolo 330, 33100 Udine, Italy; (S.D.Z.); (E.C.)
| | - Andrea Iob
- Public Health Department, Udine Healthcare and University Integrated Trust, Via Chiusaforte 2, 33100 Udine, Italy; (T.G.); (A.I.)
| | - Patrizia Furlan
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100 Padova, Italy; (S.C.); (P.F.); (M.F.); (C.B.)
| | - Marco Fonzo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100 Padova, Italy; (S.C.); (P.F.); (M.F.); (C.B.)
| | - Chiara Bertoncello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100 Padova, Italy; (S.C.); (P.F.); (M.F.); (C.B.)
| | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35100 Padova, Italy; (S.C.); (P.F.); (M.F.); (C.B.)
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12
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Wagner A, Weinberger B. Vaccines to Prevent Infectious Diseases in the Older Population: Immunological Challenges and Future Perspectives. Front Immunol 2020; 11:717. [PMID: 32391017 PMCID: PMC7190794 DOI: 10.3389/fimmu.2020.00717] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
Infectious diseases are a major cause for morbidity and mortality in the older population. Demographic changes will lead to increasing numbers of older persons over the next decades. Prevention of infections becomes increasingly important to ensure healthy aging for the individual, and to alleviate the socio-economic burden for societies. Undoubtedly, vaccines are the most efficient health care measure to prevent infections. Age-associated changes of the immune system are responsible for decreased immunogenicity and clinical efficacy of most currently used vaccines in older age. Efficacy of standard influenza vaccines is only 30-50% in the older population. Several approaches, such as higher antigen dose, use of MF59 as adjuvant and intradermal administration have been implemented in order to specifically target the aged immune system. The use of a 23-valent polysaccharide vaccine against Streptococcus pneumoniae has been amended by a 13-valent conjugated pneumococcal vaccine originally developed for young children several years ago to overcome at least some of the limitations of the T cell-independent polysaccharide antigens, but still is only approximately 50% protective against pneumonia. A live-attenuated vaccine against herpes zoster, which has been available for several years, demonstrated efficacy of 51% against herpes zoster and 67% against post-herpetic neuralgia. Protection was lower in the very old and decreased several years after vaccination. Recently, a recombinant vaccine containing the viral glycoprotein gE and the novel adjuvant AS01B has been licensed. Phase III studies demonstrated efficacy against herpes zoster of approx. 90% even in the oldest age groups after administration of two doses and many countries now recommend the preferential use of this vaccine. There are still many infectious diseases causing substantial morbidity in the older population, for which no vaccines are available so far. Extensive research is ongoing to develop vaccines against novel targets with several vaccine candidates already being clinically tested, which have the potential to substantially reduce health care costs and to save many lives. In addition to the development of novel and improved vaccines, which specifically target the aged immune system, it is also important to improve uptake of the existing vaccines in order to protect the vulnerable, older population.
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Affiliation(s)
- Angelika Wagner
- Department of Pathophysiology, Infectiology, and Immunology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
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Yang J, Zhang J, Han T, Liu C, Li X, Yan L, Yang B, Yang X. Effectiveness, immunogenicity, and safety of influenza vaccines with MF59 adjuvant in healthy people of different age groups: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19095. [PMID: 32049815 PMCID: PMC7035094 DOI: 10.1097/md.0000000000019095] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Influenza is a severe disease burden among all age groups. This study aimed to review the efficacy of inactivated influenza vaccines with MF59 adjuvant and non-adjuvanted inactivated influenza vaccines among all age groups against specific influenza vaccine strains. METHODS Literature search of PubMed, Embase, Medline, OVID, and Cochrane Library Trials (CENTRAL) was implemented up to March 1, 2019. Homogeneity qualified studies were included forData were extracted such as study country location, demographic characteristics, and measure outcomes, and were analyzed by a random effect model and sensitivity analyses to identify heterogeneity. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. RESULTS We retrieved 1,021 publications and selected 31 studies for full review, including 17 trials for meta-analysis and 6 trials for qualitative synthesis. MF59-adjuvanted influenza vaccines demonstrated better immunogenicity against specific vaccine virus strains compared to non-adjuvanted influenza vaccine both in healthy adult group (RR = 2.10; 95% CI: 1.28-3.44) and the healthy aged (RR = 1.26; 95% CI: 1.10-1.44). CONCLUSION The quality of evidence is moderate to high for seroconversion and seroprotection rates of influenza vaccine. MF59-adjuvanted influenza vaccines are superior to non-adjuvanted influenza vaccines to enhance immune responses of vaccination in healthy adults and older adults, and could be considered for routine use especially the monovalent prepandemic influenza vaccines.
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Affiliation(s)
- Jing Yang
- National Institute of Engineering Technology Research in Combination Vaccine
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, Hubei province
| | - Jiayou Zhang
- National Institute of Engineering Technology Research in Combination Vaccine
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, Hubei province
| | - Tian Han
- National Institute of Engineering Technology Research in Combination Vaccine
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, Hubei province
| | - Chen Liu
- National Institute of Engineering Technology Research in Combination Vaccine
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, Hubei province
| | - Xinghang Li
- National Institute of Engineering Technology Research in Combination Vaccine
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, Hubei province
| | - Luyao Yan
- National Institute of Engineering Technology Research in Combination Vaccine
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, Hubei province
| | - Baifeng Yang
- National Institute of Engineering Technology Research in Combination Vaccine
- Wuhan Institute of Biological Products Co., Ltd., Wuhan, Hubei province
| | - Xiaoming Yang
- National Institute of Engineering Technology Research in Combination Vaccine
- China Biotechnology Co., Ltd., Peking China, China
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Panatto D, Haag M, Lai PL, Tomczyk S, Amicizia D, Lino MM. Enhanced Passive Safety Surveillance (EPSS) confirms an optimal safety profile of the use of MF59 ® -adjuvanted influenza vaccine in older adults: Results from three consecutive seasons. Influenza Other Respir Viruses 2020; 14:61-66. [PMID: 31617965 PMCID: PMC6928029 DOI: 10.1111/irv.12685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/06/2019] [Accepted: 09/18/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In Europe, the enhanced safety surveillance (ESS) of seasonal influenza vaccines is mandatory, in order to detect any potential increase in reactogenicity when the vaccine composition is updated. The MF59® -adjuvanted influenza vaccine (Fluad™) is the first and the only licensed adjuvanted seasonal influenza vaccine in Europe. OBJECTIVE Our objective was to summarize the safety data of Fluad™ over three consecutive seasons. METHODS A passive approach to ESS (EPSS) was adopted, in which reporting of spontaneous adverse events (AEs) by vaccinees and vaccine exposure was estimated, in order to generate a near real-time reporting rate. EPSS was conducted in Italy during the 2015, 2016, and 2017 influenza seasons in the primary care setting. All AEs reported within 7 days following immunization were analyzed by season, type and seriousness. Fisher's exact test was used to compare frequencies between seasons. RESULTS Total exposure accounted for approximately 1,000 doses of Fluad™ for each season. A total of 0.5% (2015), 0.7% (2016), and 0.5% (2017) individual case safety reports (ICSRs) were received, corresponding to a total of 9 (2015), 18 (2016), and 12 (2017) spontaneous AEs. The frequencies of AEs of interest were below those expected on the basis of the known safety profile of the vaccine. Most AEs were mild-to-moderate in severity. No between-season difference was found. CONCLUSIONS Our analyses confirmed that the safety data observed were consistent with the known safety profile of Fluad™, which has been amply established over the last 20 years. No significant changes in the safety profile were observed.
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Affiliation(s)
- Donatella Panatto
- Department of Health SciencesUniversity of GenoaGenoaItaly
- Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI‐IT)GenoaItaly
| | - Mendel Haag
- Clinical DevelopmentSeqirus Netherlands B.V.Amsterdamthe Netherlands
| | - Piero Luigi Lai
- Department of Health SciencesUniversity of GenoaGenoaItaly
- Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI‐IT)GenoaItaly
| | | | - Daniela Amicizia
- Department of Health SciencesUniversity of GenoaGenoaItaly
- Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI‐IT)GenoaItaly
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Beyer WEP, Palache AM, Reperant LA, Boulfich M, Osterhaus ADME. Association between vaccine adjuvant effect and pre-seasonal immunity. Systematic review and meta-analysis of randomised immunogenicity trials comparing squalene-adjuvanted and aqueous inactivated influenza vaccines. Vaccine 2019; 38:1614-1622. [PMID: 31879122 DOI: 10.1016/j.vaccine.2019.12.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
Abstract
The immunogenicity benefit of inactivated influenza vaccine (IIV) adjuvanted by squalene over non-adjuvanted aqueous IIV was explored in a meta-analysis involving 49 randomised trials published between 1999 and 2017, and 22,470 eligible persons of all age classes. Most vaccines contained 15 μg viral haemagglutinin per strain. Adjuvanted IIV mostly contained 9.75 mg squalene per dose. Homologous pre- and post-vaccination geometric mean titres (GMTs) of haemagglutination-inhibition (HI) antibody were recorded for 290 single influenza (sub-)type arms. The adjuvant effect was expressed as the ratio of post-vaccination GMTs between squalene-IIV and aqueous IIV (GMTR, 145 estimates). GMTRs > 1.0 favoured squalene-IIV over aqueous IIV. For all influenza (sub-)types, the adjuvant effect proved negatively associated with pre-vaccination GMT and mean age. The adjuvant effect appeared most pronounced in young children (mean age < 2.5 years) showing an average GMTR of 3.7 (95% CI: 2.5 to 5.5). With increasing age, GMTR values gradually decreased towards 1.4 (95% CI: 1.0 to 1.9) in older adults. Heterologous antibody titrations simulating mismatch between vaccine and circulating virus (30 GMTR estimates) again showed a larger adjuvant effect at young age. GMT values and their variances were converted to antibody-predicted protection rates using an evidence-based clinical protection curve. The adjuvant effect was expressed as the protection rate differences, which showed similar age patterns as corresponding GMTR values. However for influenza B, the adjuvant effect lasted longer than for influenza A, possibly due to a generally later influenza B virus exposure. Collectively, this meta-analysis indicates the highest benefit of squalene-IIV over aqueous IIV in young children and decreasing benefit with progressing age. This trend is similar for seasonal influenza (sub-)types and the 2009 pandemic strain, by both homologous and heterologous titration. The impact of pre-seasonal immunity on vaccine effectiveness, and its implications for age-specific vaccination recommendations, are discussed.
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Affiliation(s)
- Walter E P Beyer
- Artemis One Health, Utrecht, the Netherlands; Erasmus Medical Center, Department of Viroscience, Rotterdam, the Netherlands
| | | | | | | | - Albert D M E Osterhaus
- Artemis One Health, Utrecht, the Netherlands; University of Veterinary Medicine, Hannover, Germany.
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Immunogenicity of aIIV3, MF59-adjuvanted seasonal trivalent influenza vaccine, in older adults ≥65 years of age: Meta-analysis of cumulative clinical experience. Int J Infect Dis 2019; 85S:S1-S9. [DOI: 10.1016/j.ijid.2019.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 02/08/2023] Open
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Immunogenicity and safety of a quadrivalent plant-derived virus like particle influenza vaccine candidate-Two randomized Phase II clinical trials in 18 to 49 and ≥50 years old adults. PLoS One 2019; 14:e0216533. [PMID: 31166987 PMCID: PMC6550445 DOI: 10.1371/journal.pone.0216533] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background New influenza vaccines eliciting more effective protection are needed, particularly for the elderly who paid a large and disproportional toll of hospitalization and dead during seasonal influenza epidemics. Low (≤15 μg/strain) doses of a new plant-derived virus-like-particle (VLP) vaccine candidate have been shown to induce humoral and cellular responses against both homologous and heterologous strains in healthy adults 18–64 years of age. The two clinical trials reported here addressed the safety and immunogenicity of higher doses (≥15 μg/strain) of quadrivalent VLP candidate vaccine on 18–49 years old and ≥50 years old subjects. We also investigated the impact of alum on the immunogenicity induced by lower doses of the vaccine candidate. Method In the first Phase II trial reported here (NCT02233816), 18–49 year old subjects received 15, 30 or 60 μg/strain of a hemagglutinin-bearing quadrivalent virus-like particle (QVLP) vaccine or placebo. In the second trial (NCT02236052), ≥50 years old subjects received QVLP as above or placebo with additional groups receiving 7.5 or 15 μg/strain with alum. Along with safety recording, the humoral and cell-mediated immune responses were analyzed. Results Local and systemic side-effects were similar to those reported previously. The QVLP vaccine induced significant homologous and heterologous antibody responses at the two higher doses, the addition of alum having little-to-no effect. Serologic outcomes tended to be lower in ≥50 years old subjects previously vaccinated. The candidate vaccine also consistently elicited both homologous and heterologous antigen-specific CD4+ T cells characterized by their production of interferon-gamma (IFN-γ), interleukine-2 (IL-2) and/or tumor-necrosis factor alpha (TNF-α) upon ex vivo antigenic restimulation. Conclusion Overall, the 30 μg dose produced the most consistent humoral and cellular responses in both 18–49 and ≥50 years old subjects, strongly supporting the clinical development of this candidate vaccine. That particular dose was chosen to test in the ongoing Phase III clinical trial.
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Abstract
Infectious diseases are responsible for up to 5% of fatalities even in developed countries. In addition, there is an increasing susceptibility for infections in elderly people due to physiological aging of the immune system. The principles of vaccination are based on a targeted activation of the human immune system. Principally, a distinction is made between passive immunization, i.e. the application of specific antibodies against a pathogen and active immunization. In active immunization, i.e. vaccination, weakened (attenuated) or dead pathogens or components of pathogens (antigens) are administered. After a latency period that depends on the vaccine, complete immune protection is achieved and immunity is maintained for a certain period of time. In contrast to dead vaccines, by the use of live vaccines there is always a risk for infection with the administered vaccine. In passive immunization antibodies are administered. As a rule passive immunization is carried out in persons who have had contact with an infected person and in whom no or uncertain immunity against the corresponding disease is present. Based on the recommendations of the Standing Committee on Vaccination (STIKO), influenza, pneumococcal, herpes zoster, early summer meningoencephalitis (FSME) and travel vaccines are described.
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Affiliation(s)
- H J Heppner
- Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Witten, Deutschland. .,Geriatrische Klinik und Tagesklinik, Helios Klinikum Schwelm, Dr.-Moeller-Str. 15, 58332, Schwelm, Deutschland. .,Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland.
| | - A Leischker
- Klinik für Geriatrie, Alexianer Krefeld, Krefeld, Deutschland
| | - P Wutzler
- Institut für Virologie und Antivirale Therapie, Universitätsklinikum Jena, Jena, Deutschland
| | - A Kwetkat
- Klinik für Geriatrie, Universitätsklinikum Jena, Jena, Deutschland
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Hechter RC, Qian L, Tartof SY, Sy LS, Klein NP, Weintraub E, Mercado C, Naleway A, McLean HQ, Jacobsen SJ. Vaccine safety in HIV-infected adults within the Vaccine Safety Datalink Project. Vaccine 2019; 37:3296-3302. [PMID: 31064675 DOI: 10.1016/j.vaccine.2019.04.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We evaluate safety of routine vaccination among adults infected with human immunodeficiency virus (HIV) in five healthcare organizations in the United States. METHODS We conducted a retrospective cohort study of HIV-infected adults who received inactivated influenza vaccines, hepatitis B vaccines, pneumococcal vaccines, or tetanus, diphtheria, and acellular pertussis vaccines between 2002 and 2013. We conducted self-controlled case series analysis to estimate the relative risk (RR) for 11 pre-specified adverse events (AEs) requiring medical attention. RESULTS Among 20,417 HIV-infected adults (90.2% male), a total of 137,674 vaccine doses were administered. Based on ICD-9 codes, we detected an increased risk of cellulitis and infection (RR: 1.18, 95% CI: 1.03-1.35) among all patients, and an increased risk of stroke/cerebrovascular diseases among patients with an HIV viral load >10,000 copies/ml (adjusted RR: 3.94, 95% CI: 1.32-11.72). Further analyses on chart confirmed cases of stroke/cerebrovascular diseases indicated no statistically significant increased risk (adjusted RR: 1.72, 95% CI: 0.41-7.24). There was no evidence of increased risk for other AEs following routine vaccination in HIV-infected adults. CONCLUSIONS Routinely administered vaccines are generally safe for HIV-infected adults.
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Affiliation(s)
| | - Lei Qian
- Kaiser Permanente Southern California, USA.
| | | | - Lina S Sy
- Kaiser Permanente Southern California, USA.
| | | | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, USA.
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Samson SI, Leventhal PS, Salamand C, Meng Y, Seet BT, Landolfi V, Greenberg D, Hollingsworth R. Immunogenicity of high-dose trivalent inactivated influenza vaccine: a systematic review and meta-analysis. Expert Rev Vaccines 2019; 18:295-308. [PMID: 30689467 DOI: 10.1080/14760584.2019.1575734] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/25/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION High-dose trivalent, inactivated, split-virus influenza vaccine (IIV3-HD) has been available in the US since 2009 for adults aged ≥ 65 years. To better understand how IIV3-HD provides improved protection against influenza, we systematically reviewed clinical studies comparing immune responses to IIV3-HD and standard-dose trivalent vaccine (IIV3-SD). AREAS COVERED The primary objective was to determine the relative hemagglutination inhibition (HAI) antibody response of IIV3-HD vs. IIV3-SD in adults aged ≥ 65 years. Based on seven randomized studies including more than 18,500 adults aged ≥ 65 years, combined HAI geometric mean titer (GMT) ratios (95% confidence interval) approximately 1 month post-vaccination were 1.74 (1.65-1.83) for influenza A/H1N1, 1.84 (1.73-1.95) for influenza A/H3N2, and 1.47 (1.36-1.58) for influenza B. HAI GMT ratios in these studies were similar irrespective of sex, older age (≥ 75 years), frailty, and underlying conditions. Trends were similar for A/H3N2 neutralization and anti-neuraminidase antibody titers. In immunocompromised individuals, HAI GMT ratios were mostly > 1. EXPERT OPINION In agreement with its improved efficacy and effectiveness, IIV3-HD is consistently more immunogenic than IIV3-SD in adults aged ≥ 65 years. IIV3-HD also appears more immunogenic in immunocompromised individuals.
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Affiliation(s)
| | | | | | - Ya Meng
- a Sanofi Pasteur , Swiftwater , PA , USA
| | - Bruce T Seet
- a Sanofi Pasteur , Swiftwater , PA , USA
- d Department of Molecular Genetics , University of Toronto, Medical Science Building , Toronto , ON , Canada
| | | | - David Greenberg
- a Sanofi Pasteur , Swiftwater , PA , USA
- e Department of Pediatrics , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
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Hoffmann A, Dumke C, Hanschmann KMO, Wicker S. Local thermal reaction after influenza vaccination: Quantification by infrared imaging and biometric considerations. Vaccine 2018; 36:2783-2787. [PMID: 29653847 DOI: 10.1016/j.vaccine.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/28/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extensive clinical investigations are mandatory to evaluate the safety and reactogenicity of vaccines. The recording of common adverse events like injection site soreness or general discomfort derives from individual subjective perceptions. Thermal imaging at the injection site possibly provides a non-subjective and a non-invasive approach to supplement this evaluation. RESULTS A protocol for quantified injection-site infrared imaging included 86 participants during a flu vaccine campaign, 40% of whom had a thermal reaction of 1 °C; 25-30% had no thermal response. There was little subjective pain reporting and no clinical correlations were observed except with post-vaccination erythema. Higher responses were linked with advanced age and multiple previous vaccinations. CONCLUSION Evan if influenza vaccine was only moderately reactogenic, a thermal response was detectable in about 70% of vaccinees, though no relationship to reactogenicity was seen. Infrared imaging might however be a prospective tool for individual studies of vaccine-induced vascular responses.
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Affiliation(s)
- Andreas Hoffmann
- Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, 63225 Langen, Germany.
| | - Claudia Dumke
- Paul-Ehrlich-Institute, Federal Institute for Vaccines and Biomedicines, 63225 Langen, Germany
| | | | - Sabine Wicker
- University Hospital Frankfurt, Goethe University, Occupational Health Service, 60590 Frankfurt am Main, Germany
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Masterson SG, Lobel L, Carroll MW, Wass MN, Michaelis M. Herd Immunity to Ebolaviruses Is Not a Realistic Target for Current Vaccination Strategies. Front Immunol 2018; 9:1025. [PMID: 29867992 PMCID: PMC5954026 DOI: 10.3389/fimmu.2018.01025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022] Open
Abstract
The recent West African Ebola virus pandemic, which affected >28,000 individuals increased interest in anti-Ebolavirus vaccination programs. Here, we systematically analyzed the requirements for a prophylactic vaccination program based on the basic reproductive number (R0, i.e., the number of secondary cases that result from an individual infection). Published R0 values were determined by systematic literature research and ranged from 0.37 to 20. R0s ≥ 4 realistically reflected the critical early outbreak phases and superspreading events. Based on the R0, the herd immunity threshold (Ic) was calculated using the equation Ic = 1 - (1/R0). The critical vaccination coverage (Vc) needed to provide herd immunity was determined by including the vaccine effectiveness (E) using the equation Vc = Ic/E. At an R0 of 4, the Ic is 75% and at an E of 90%, more than 80% of a population need to be vaccinated to establish herd immunity. Such vaccination rates are currently unrealistic because of resistance against vaccinations, financial/logistical challenges, and a lack of vaccines that provide long-term protection against all human-pathogenic Ebolaviruses. Hence, outbreak management will for the foreseeable future depend on surveillance and case isolation. Clinical vaccine candidates are only available for Ebola viruses. Their use will need to be focused on health-care workers, potentially in combination with ring vaccination approaches.
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Affiliation(s)
- Stuart G Masterson
- Industrial Biotechnology Centre and School of Biosciences, University of Kent, Canterbury, United Kingdom
| | - Leslie Lobel
- Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Emerging and Re-Emerging Diseases and Special Pathogens, Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | - Miles W Carroll
- Research & Development Institute, National Infection Service, Public Health England, Porton Down, Salisbury, United Kingdom
| | - Mark N Wass
- Industrial Biotechnology Centre and School of Biosciences, University of Kent, Canterbury, United Kingdom
| | - Martin Michaelis
- Industrial Biotechnology Centre and School of Biosciences, University of Kent, Canterbury, United Kingdom
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Panatto D, Signori A, Lai PL, Gasparini R, Amicizia D. Heterogeneous estimates of influenza virus types A and B in the elderly: Results of a meta-regression analysis. Influenza Other Respir Viruses 2018; 12:533-543. [PMID: 29498477 PMCID: PMC6005586 DOI: 10.1111/irv.12550] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 02/06/2023] Open
Abstract
Influenza has many age‐dependent characteristics. A previous systematic review of randomized controlled trials showed that the detection rate of influenza B was higher in children than in non‐elderly adults. However, no comprehensive reviews have targeted the elderly, who carry the main burden of disease. We aimed to quantify the relative detection rates of virus types A and B among the elderly, to identify factors affecting these proportions, and to compare type distribution among seniors and younger age‐classes. A comprehensive literature search was conducted to identify multiseason studies reporting A and B virus type distributions in the elderly. A random‐effects meta‐analysis was planned to quantify the prevalence of type B among elderly subjects with laboratory‐confirmed influenza. Meta‐regression was then applied to explain the sources of heterogeneity. Across 27 estimates identified, the type B detection rate among seniors varied from 5% to 37%. Meta‐analysis was not feasible owing to high heterogeneity (I2 = 98.5%). Meta‐regression analysis showed that study characteristics, such as number of seasons included, hemisphere, and setting, could have contributed to the heterogeneity observed. The final adjusted model showed that studies that included both outpatients and inpatients reported a significantly (P = .024) lower proportion than those involving outpatients only. The detection rate of type B among the elderly was generally lower than in children/adolescents, but not non‐elderly adults. Influenza virus type B has a relatively low detection rate in older adults, especially in settings covering both inpatients and outpatients. Public health implications are discussed.
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Affiliation(s)
- Donatella Panatto
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Piero L Lai
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Roberto Gasparini
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Daniela Amicizia
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI-IT), Genoa, Italy
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Capri S, Barbieri M, de Waure C, Boccalini S, Panatto D. Cost-effectiveness analysis of different seasonal influenza vaccines in the elderly Italian population. Hum Vaccin Immunother 2018; 14:1331-1341. [PMID: 29425079 PMCID: PMC6037461 DOI: 10.1080/21645515.2018.1438792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In the perspective of reaching at least 75% influenza vaccination coverage in the elderly and substantial budget constraints, Italian decision makers are facing important challenges in determining an optimal immunization strategy for this growing and particularly vulnerable population. Four different influenza vaccines are currently available for Italian older adults aged 65 years or above, namely trivalent inactivated vaccines (TIVs), MF59-adjuvanted TIV (MF59-TIV), intradermal TIV (ID-TIV) and quadrivalent inactivated vaccines (QIVs). The present study is the first to compare the cost-effectiveness profiles of virtually all possible public health strategies, including the aforementioned four vaccine formulations as well non-vaccination. For this purpose, a decision tree model was built ex novo; the analysis was conducted from the third-payer perspective in the timeframe of one year. All available vaccines were cost-effective compared with non-vaccination. However, MF59-TIV had the most favorable economic profile in the Italian elderly population. Indeed, compared with non-vaccination, it was deemed highly cost-effective with an incremental cost-effectiveness ratio (ICER) of €10,750 per quality-adjusted life year (QALY). The ICER was much lower (€4,527/QALY) when MF59-TIV was directly compared with TIV. ID-TIV and QIV were dominated by MF59-TIV as the former comparators were associated with greater total costs and lower health benefits. Both deterministic and probabilistic sensitivity analyses confirmed robustness of the base case results. From the economic perspective, MF59-TIV should be considered as a preferential choice for Italian older adults aged 65 years or above.
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Affiliation(s)
- Stefano Capri
- a School of Economics and Management , Cattaneo University-LIUC , Castellanza , Italy
| | - Marco Barbieri
- b Centre for Health Economics , University of York , York , UK
| | - Chiara de Waure
- c Institute of Public Health, Section of Hygiene , Catholic University of the Sacred Heart , Rome , Italy
| | - Sara Boccalini
- d Department of Health Sciences , University of Florence , Florence , Italy
| | - Donatella Panatto
- e Department of Health Sciences , University of Genoa , Genoa , Italy.,f Inter-University Centre for Research on Influenza and Other Transmitted Diseases (CIRI-IT) , Genoa , Italy
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Rajão DS, Pérez DR. Universal Vaccines and Vaccine Platforms to Protect against Influenza Viruses in Humans and Agriculture. Front Microbiol 2018; 9:123. [PMID: 29467737 PMCID: PMC5808216 DOI: 10.3389/fmicb.2018.00123] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/18/2018] [Indexed: 01/22/2023] Open
Abstract
Influenza virus infections pose a significant threat to public health due to annual seasonal epidemics and occasional pandemics. Influenza is also associated with significant economic losses in animal production. The most effective way to prevent influenza infections is through vaccination. Current vaccine programs rely heavily on the vaccine's ability to stimulate neutralizing antibody responses to the hemagglutinin (HA) protein. One of the biggest challenges to an effective vaccination program lies on the fact that influenza viruses are ever-changing, leading to antigenic drift that results in escape from earlier immune responses. Efforts toward overcoming these challenges aim at improving the strength and/or breadth of the immune response. Novel vaccine technologies, the so-called universal vaccines, focus on stimulating better cross-protection against many or all influenza strains. However, vaccine platforms or manufacturing technologies being tested to improve vaccine efficacy are heterogeneous between different species and/or either tailored for epidemic or pandemic influenza. Here, we discuss current vaccines to protect humans and animals against influenza, highlighting challenges faced to effective and uniform novel vaccination strategies and approaches.
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Affiliation(s)
- Daniela S. Rajão
- Department of Population Health, University of Georgia, Athens, GA, United States
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Abstract
In spite of current influenza vaccines being immunogenic, evolution of the influenza virus can reduce efficacy and so influenza remains a major threat to public health. One approach to improve influenza vaccines is to include adjuvants; substances that boost the immune response. Adjuvants are particularly beneficial for influenza vaccines administered during a pandemic when a rapid response is required or for use in patients with impaired immune responses, such as infants and the elderly. This review outlines the current use of adjuvants in human influenza vaccines, including what they are, why they are used and what is known of their mechanism of action. To date, six adjuvants have been used in licensed human vaccines: Alum, MF59, AS03, AF03, virosomes and heat labile enterotoxin (LT). In general these adjuvants are safe and well tolerated, but there have been some rare adverse events when adjuvanted vaccines are used at a population level that may discourage the inclusion of adjuvants in influenza vaccines, for example the association of LT with Bell's Palsy. Improved understanding about the mechanisms of the immune response to vaccination and infection has led to advances in adjuvant technology and we describe the experimental adjuvants that have been tested in clinical trials for influenza but have not yet progressed to licensure. Adjuvants alone are not sufficient to improve influenza vaccine efficacy because they do not address the underlying problem of mismatches between circulating virus and the vaccine. However, they may contribute to improved efficacy of next-generation influenza vaccines and will most likely play a role in the development of effective universal influenza vaccines, though what that role will be remains to be seen.
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Affiliation(s)
- John S Tregoning
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
| | - Ryan F Russell
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
| | - Ekaterina Kinnear
- a Mucosal Infection and Immunity group, Section of Virology, Department of Medicine , St Mary's Campus, Imperial College London , UK
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McKimm-Breschkin JL, Jiang S, Hui DS, Beigel JH, Govorkova EA, Lee N. Prevention and treatment of respiratory viral infections: Presentations on antivirals, traditional therapies and host-directed interventions at the 5th ISIRV Antiviral Group conference. Antiviral Res 2018; 149:118-142. [PMID: 29162476 PMCID: PMC7133686 DOI: 10.1016/j.antiviral.2017.11.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
Abstract
The International Society for Influenza and other Respiratory Virus Diseases held its 5th Antiviral Group (isirv-AVG) Conference in Shanghai, China, in conjunction with the Shanghai Public Health Center and Fudan University from 14-16 June 2017. The three-day programme encompassed presentations on some of the clinical features, management, immune responses and virology of respiratory infections, including influenza A(H1N1)pdm09 and A(H7N9) viruses, MERS-CoV, SARS-CoV, adenovirus Type 80, enterovirus D68, metapneumovirus and respiratory syncytial virus (RSV). Updates were presented on several therapeutics currently in clinical trials, including influenza polymerase inhibitors pimodivir/JNJ6362387, S033188, favipiravir, monoclonal antibodies MHAA45449A and VIS410, and host directed strategies for influenza including nitazoxanide, and polymerase ALS-008112 and fusion inhibitors AK0529, GS-5806 for RSV. Updates were also given on the use of the currently licensed neuraminidase inhibitors. Given the location in China, there were also presentations on the use of Traditional Chinese Medicines. Following on from the previous conference, there were ongoing discussions on appropriate endpoints for severe influenza in clinical trials from regulators and clinicians, an issue which remains unresolved. The aim of this conference summary is to provide information for not only conference participants, but a detailed referenced review of the current status of clinical trials, and pre-clinical development of therapeutics and vaccines for influenza and other respiratory diseases for a broader audience.
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Affiliation(s)
| | - Shibo Jiang
- College of Basic Medical Sciences, Fudan University, Shanghai, China; Lindsley F. Kimball Research Institute, New York Blood Center, NY, USA
| | - David S Hui
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - John H Beigel
- Leidos Biomedical Research, Inc., Support to National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Elena A Govorkova
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, USA
| | - Nelson Lee
- Faculty of Medicine and Dentistry, University of Alberta, Canada
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Wilkinson K, Wei Y, Szwajcer A, Rabbani R, Zarychanski R, Abou-Setta AM, Mahmud SM. Efficacy and safety of high-dose influenza vaccine in elderly adults: A systematic review and meta-analysis. Vaccine 2017; 35:2775-2780. [PMID: 28431815 DOI: 10.1016/j.vaccine.2017.03.092] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 03/08/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Older adults are prioritized for influenza vaccination but also have lowered antibody responses to the vaccine. Higher-doses of influenza antigen may increase immune response and thus be more effective. Our objectives were to compare the efficacy and safety of the high-dose influenza vaccine to the standard-dose influenza vaccine in the elderly (age>65). METHODS Data sources: Randomized trials (RCTs) from Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley), ClinicalTrials.gov, reference lists of relevant articles, and gray literature. STUDY SELECTION Two reviewers independently identified RCTs comparing high-dose influenza vaccine (60μg of hemagglutinin per strain) to standard-dose influenza vaccine (15μg of hemagglutinin per strain) in adults over the age of 65years. DATA EXTRACTION Two reviewers independently extracted trial-level data including population characteristics, interventions, outcomes, and funding sources. Risk of bias was assessed using the Cochrane Risk of Bias tool. RESULTS We included seven eligible trials; all were categorized as having a low (n=3) or unclear (n=4) risk of bias. Patients receiving the high-dose vaccine had significantly less risk of developing laboratory-confirmed influenza infections (Relative Risk 0.76, 95%CI 0.65 to 0.90; I2 0%, 2 trials, 41,141 patients). Post-vaccination geometric mean titres and seroprotection rates were also higher in high-dose vaccine recipients. There were no protocol-defined serious adverse events in the included trials in either group. CONCLUSIONS In elderly adults, the high-dose influenza vaccine was well-tolerated, more immunogenic, and more efficacious in preventing influenza infections than the standard-dose vaccine. Further pragmatic trials are needed to determine if the higher efficacy translates into higher vaccine effectiveness in adults over the age of 65.
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Affiliation(s)
- Krista Wilkinson
- Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Public Health Branch, Manitoba Health, Healthy Living and Seniors, Winnipeg, Manitoba, Canada.
| | - Yichun Wei
- Public Health Branch, Manitoba Health, Healthy Living and Seniors, Winnipeg, Manitoba, Canada
| | - Andrea Szwajcer
- University of Manitoba Libraries, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada; Department of Internal Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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Kang K, Han S, Hong T, Jeon S, Paek J, Kang JH, Yim DS. Immunogenicity and Safety of Trivalent Split Influenza Vaccine in Healthy Korean Adults with Low Pre-Existing Antibody Levels: An Open Phase I Trial. Yonsei Med J 2016; 57:1354-60. [PMID: 27593862 PMCID: PMC5011266 DOI: 10.3349/ymj.2016.57.6.1354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 12/02/2022] Open
Abstract
PURPOSE A phase I clinical trial was conducted to evaluate the immunogenicity and safety of newly developed egg-cultivated trivalent inactivated split influenza vaccine (TIV) in Korea. MATERIALS AND METHODS The TIV was administered to 43 healthy male adults. Subjects with high pre-existing titers were excluded in a screening step. Immune response was measured by a hemagglutination inhibition (HI) assay. RESULTS The seroprotection rates against A/California/7/2009 (H1N1), A/Perth/16/2009 (H3N2) and B/Brisbane/60/2009 were 74.42% [95% confidence interval (CI): 61.38-87.46], 72.09% (95% CI: 58.69-85.50), and 86.05% (95% CI: 75.69-96.40), respectively. Calculated seroconversion rates were 74.42% (95% CI: 61.38-87.46), 74.42% (95% CI: 61.38-87.46), and 79.07% (95% CI: 66.91-91.23), respectively. There were 25 episodes of solicited local adverse events in 21 subjects (47.73%), 21 episodes of solicited general adverse events in 16 subjects (36.36%) and 5 episodes of unsolicited adverse events in 5 subjects (11.36%). All adverse events were grade 1 or 2 and disappeared within three days. CONCLUSION The immunogenicity and safety of TIV established in this phase I trial are sufficient to plan a larger scale clinical trial.
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Affiliation(s)
- Kyuri Kang
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seunghoon Han
- Department of Clinical Pharmacology and Therapeutics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Taegon Hong
- Department of Clinical Pharmacology and Therapeutics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sangil Jeon
- Department of Clinical Pharmacology and Therapeutics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeongki Paek
- Department of Clinical Pharmacology and Therapeutics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Han Kang
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Seok Yim
- Department of Clinical Pharmacology and Therapeutics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Gianchecchi E, Trombetta C, Piccirella S, Montomoli E. Evaluating influenza vaccines: progress and perspectives. Future Virol 2016. [DOI: 10.2217/fvl-2016-0012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Severe influenza infections are responsible for 3–5 million cases worldwide and 250,000–500,000 deaths per year. Although vaccination is the primary and most effective means of inducing protection against influenza viruses, it also presents limitations. This review outlines the promising steps that have been taken toward the development of a broadly protective influenza virus vaccine through the use of new technologies. The future challenge is to develop a broadly protective vaccine that is able to induce long-term protection against antigenically variant influenza viruses, regardless of antigenic shift and drift, and thus to protect against seasonal and pandemic influenza viruses.
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Affiliation(s)
- Elena Gianchecchi
- VisMederi Srl, Enterprise of Service in Life Sciences, Via Fiorentina 1, 53100 Siena, Italy
| | - Claudia Trombetta
- Department of Molecular & Developmental Medicine, University of Siena, Via Aldo Moro, 53100 Siena, Italy
| | - Simona Piccirella
- VisMederi Srl, Enterprise of Service in Life Sciences, Via Fiorentina 1, 53100 Siena, Italy
| | - Emanuele Montomoli
- VisMederi Srl, Enterprise of Service in Life Sciences, Via Fiorentina 1, 53100 Siena, Italy
- Department of Molecular & Developmental Medicine, University of Siena, Via Aldo Moro, 53100 Siena, Italy
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Cheng MP, Kozoriz MG, Ahmadi AA, Kelsall J, Paquette K, Onrot JM. Post-vaccination myositis and myocarditis in a previously healthy male. Allergy Asthma Clin Immunol 2016; 12:6. [PMID: 26877725 PMCID: PMC4751718 DOI: 10.1186/s13223-016-0114-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/17/2016] [Indexed: 01/06/2023] Open
Abstract
Background The immunological literature has been redefining clinical phenomena as hypotheses emerge regarding causal links between triggers, immunologic manifestations, and their specific inflammatory cascades. Of late, autoimmune manifestations that appear to be caused by an external adjuvant have been grouped into a complex syndrome referred to as autoimmune/inflammatory syndrome induced by adjuvants (ASIA). This syndrome may present with diverse clinical problems, which may include neurocognitive impairment, inflammatory musculoskeletal changes, and constitutional symptoms. There is evidence in the literature linking vaccines to different auto-immune manifestations. Vaccines have not traditionally been reported to trigger ASIA, although reports are emerging linking the human papilloma virus and hepatitis B vaccines to it. Case presentation We report the first suspected case of ASIA in a previously healthy patient who received the Fluad seasonal influenza vaccine, which contains the MF59 adjuvant. He presented to hospital with profound weakness and was diagnosed with severe rhabdomyolysis. He also had elevated troponin-I and extensive cardiac investigations enabled the diagnosis of myocarditis. His infectious and rheumatologic work-ups were negative. He responded well to conservative management and did not require immune suppressive therapy. Conclusion Given the benefits of the influenza vaccine, and the low incidence of clinically significant complications, we encourage ongoing seasonal influenza immunization. However, ongoing surveillance is required to evaluate the occurrence of rare adverse events, including ASIA.
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Affiliation(s)
- Matthew P Cheng
- Division of Infectious Diseases and Department of Medical Microbiology, Glen site, McGill University Health Centre, 1001 Boulevard Décarie, Room E05. 1811.2, Montreal, QC H4A 3J1 Canada
| | - Michael G Kozoriz
- Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Amir A Ahmadi
- Department of Cardiology, University of British Columbia, Vancouver, BC Canada
| | - John Kelsall
- Division of Rheumatology, University of British Columbia, Vancouver, BC Canada ; Division of Internal Medicine, University of British Columbia, Vancouver, BC Canada
| | - Katryn Paquette
- Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Jake M Onrot
- Division of Internal Medicine, University of British Columbia, Vancouver, BC Canada
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Thompson MG, Naleway A, Fry AM, Ball S, Spencer SM, Reynolds S, Bozeman S, Levine M, Katz JM, Gaglani M. Effects of Repeated Annual Inactivated Influenza Vaccination among Healthcare Personnel on Serum Hemagglutinin Inhibition Antibody Response to A/Perth/16/2009 (H3N2)-like virus during 2010-11. Vaccine 2016; 34:981-8. [PMID: 26813801 PMCID: PMC5218812 DOI: 10.1016/j.vaccine.2015.10.119] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/10/2015] [Accepted: 10/28/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recently, lower estimates of influenza vaccine effectiveness (VE) against A(H3N2) virus illness among those vaccinated during the previous season or multiple seasons have been reported; however, it is unclear whether these effects are due to differences in immunogenicity. METHODS We performed hemagglutination inhibition antibody (HI) assays on serum collected at preseason, ∼ 30 days post-vaccination, and postseason from a prospective cohort of healthcare personnel (HCP). Eligible participants had medical and vaccination records for at least four years (since July, 2006), including 578 HCP who received 2010-11 trivalent inactivated influenza vaccine [IIV3, containing A/Perth/16/2009-like A(H3N2)] and 209 HCP who declined vaccination. Estimates of the percentage with high titers (≥ 40 and>100) and geometric mean fold change ratios (GMRs) to A/Perth/16/2009-like virus by number of prior vaccinations were adjusted for age, sex, race, education, household size, hospital care responsibilities, and study site. RESULTS Post-vaccination GMRs were inversely associated with the number of prior vaccinations, increasing from 2.3 among those with 4 prior vaccinations to 6.2 among HCP with zero prior vaccinations (F[4,567]=9.97, p<.0005). Thirty-two percent of HCP with 1 prior vaccination achieved titers >100 compared to only 11% of HCP with 4 prior vaccinations (adjusted odds ratio=6.8, 95% CI=3.1 - 15.3). CONCLUSION Our findings point to an exposure-response association between repeated IIV3 vaccination and HI for A(H3N2) and are consistent with recent VE observations. Ultimately, better vaccines and vaccine strategies may be needed in order to optimize immunogenicity and VE for HCP and other repeated vaccinees.
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Affiliation(s)
- Mark G Thompson
- Epidemiology and Prevention Branch, Influenza Division/NCIRD/CDC, Atlanta, GA 30333.
| | - Allison Naleway
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227
| | - Alicia M Fry
- Epidemiology and Prevention Branch, Influenza Division/NCIRD/CDC, Atlanta, GA 30333
| | | | - Sarah M Spencer
- Epidemiology and Prevention Branch, Influenza Division/NCIRD/CDC, Atlanta, GA 30333
| | - Sue Reynolds
- Epidemiology and Prevention Branch, Influenza Division/NCIRD/CDC, Atlanta, GA 30333
| | - Sam Bozeman
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227
| | - Min Levine
- Epidemiology and Prevention Branch, Influenza Division/NCIRD/CDC, Atlanta, GA 30333
| | - Jacqueline M Katz
- Epidemiology and Prevention Branch, Influenza Division/NCIRD/CDC, Atlanta, GA 30333
| | - Manjusha Gaglani
- Division of Pediatric Infectious Diseases, Baylor Scott & White Health, Texas A&M HSC COM, Temple, TX 76508
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Zholobak NM, Mironenko AP, Shcherbakov AB, Shydlovska OA, Spivak MY, Radchenko LV, Marinin AI, Ivanova OS, Baranchikov AE, Ivanov VK. Cerium dioxide nanoparticles increase immunogenicity of the influenza vaccine. Antiviral Res 2016; 127:1-9. [PMID: 26769398 DOI: 10.1016/j.antiviral.2015.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 11/19/2022]
Abstract
We have demonstrated the influence of cerium dioxide nanoparticles on the immunogenicity of the influenza vaccine on an example of liquid split inactivated Vaxigrip vaccine. Antibody titers were analyzed using the hemagglutination inhibition (HI) assay. Seroprotection, seroconversion, the geometric mean titers (GMTs) and the factor increase (FI) in the GMTs were calculated. The effect of nano-ceria surface stabilizer on the enhancement of immunogenicity was shown. The vaccine modified by citrate-stabilized nano-ceria, in contrast to a non-modified Vaxigrip vaccine, did not provide an adequate level of seroprotection, and seroconversion after vaccination was 66.7% on days 49-63 for virus strain А(H1N1) and 100% on day 49 for virus strain B/Yamagata. For the low immunogenic influenza B virus, the rise in antibody titers (GMT/IF) was 24.38/3.28 after the first injection and 50.40/6.79 on day 49. For the vaccine modified by non-stabilized nano-ceria, for all virus strains under study, on day 63, upon immunization notable levels of seroprotection, seroconversion and GMT/IF were registered (higher than for the non-modified Vaxigrip vaccine). The successful attempt to modify the influenza vaccine demonstrates the possible ways of increasing the specific activity of vaccines using nano-ceria.
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Affiliation(s)
- Nadezhda M Zholobak
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv D0368, Ukraine
| | - Alla P Mironenko
- Gromashevsky Research Institute of Epidemiology and Infectious Diseases of Medical Academy of Sciences of Ukraine, Kyiv 03038, Ukraine
| | - Alexander B Shcherbakov
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv D0368, Ukraine
| | - Olga A Shydlovska
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv D0368, Ukraine
| | - Mykola Ya Spivak
- Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv D0368, Ukraine
| | - Larysa V Radchenko
- Gromashevsky Research Institute of Epidemiology and Infectious Diseases of Medical Academy of Sciences of Ukraine, Kyiv 03038, Ukraine
| | | | - Olga S Ivanova
- Kurnakov Institute of General and Inorganic Chemistry of the Russian Academy of Sciences, Moscow 119991, Russia
| | - Alexander E Baranchikov
- Kurnakov Institute of General and Inorganic Chemistry of the Russian Academy of Sciences, Moscow 119991, Russia
| | - Vladimir K Ivanov
- Kurnakov Institute of General and Inorganic Chemistry of the Russian Academy of Sciences, Moscow 119991, Russia; National Research Tomsk State University, Tomsk 634050, Russia.
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Knuf M, Leroux-Roels G, Rümke H, Rivera L, Pedotti P, Arora AK, Lattanzi M, Kieninger D, Cioppa GD. Immunogenicity and safety of cell-derived MF59®-adjuvanted A/H1N1 influenza vaccine for children. Hum Vaccin Immunother 2015; 11:358-76. [PMID: 25621884 DOI: 10.4161/21645515.2014.987014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mass immunization of children has the potential to decrease infection rates and prevent the transmission of influenza. We evaluated the immunogenicity, safety, and tolerability of different formulations of cell-derived MF59-adjuvanted and nonadjuvanted A/H1N1 influenza vaccine in children and adolescents. This was a randomized, single-blind, multicenter study with a total of 666 healthy subjects aged 6 months-17 y in one of 3 vaccination groups, each receiving formulations containing different amounts of influenza A/H1N1 antigen with or without MF59. A booster trivalent seasonal MF59 vaccine was administered one year after primary vaccinations. Antibody titers were assessed by hemagglutination inhibition (HI) and microneutralization assays obtained on days 1, 22, 43, 366, and 387 (3 weeks post booster). Safety was monitored throughout the study. One vaccination with 3.75 μg of A/H1N1 antigen formulated with 50% MF59 (3.75_halfMF59) or 7.5 μg of A/H1N1 antigen formulated with 100% MF59 (7.5_fullMF59) induced an HI titer ≥1:40 in >70% of children in the 1-<3, 3-8, and 9-17 y cohorts; however, 2 vaccinations with nonadjuvanted 15 μg A/H1N1 antigen were needed to achieve this response in the 1-<3 and 3-8 y cohorts. Among children aged 6-11 months, 1 dose of 7.5_fullMF59 resulted in an HI titer ≥1:40 in >70% while 2 doses of 3.75_halfMF59 were required to achieve this result. All vaccines were well tolerated. Our findings support the immunogenicity and safety of the 3.75_halfMF59 (2 doses for children <12 months) and 7.5_fullMF59 vaccine formulations for use in children and adolescents aged 6 months to 17 y The use of the 3.75_halfMF59 could have the benefit of antigen and adjuvant sparing, increasing the available vaccine doses allowing vaccination of more people.
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Key Words
- AE, adverse event
- CHMP, European Committee for Medicinal Products for Human Use
- CI, confidence interval
- GMR, geometric mean ratio
- GMT, geometric mean titer
- H1N1
- HI, hemagglutination inhibition
- MF59
- MN, microneutralization
- PPS, per-protocol set
- SAE, serious adverse event
- WHO, World Health Organization
- adjuvant
- cell-culture
- pandemic
- pediatric
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Affiliation(s)
- Markus Knuf
- a Clinic for Children and Youth; Dr. Horst Schmidt Clinics ; Wiesbaden , Germany
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Singh SM, Alkie TN, Hodgins DC, Nagy É, Shojadoost B, Sharif S. Systemic immune responses to an inactivated, whole H9N2 avian influenza virus vaccine using class B CpG oligonucleotides in chickens. Vaccine 2015; 33:3947-52. [PMID: 26092309 DOI: 10.1016/j.vaccine.2015.06.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/03/2015] [Accepted: 06/05/2015] [Indexed: 11/26/2022]
Abstract
Commercial vaccines against avian influenza viruses (AIV) in chickens consist mainly of inactivated AIV, requiring parenteral administration and co-delivery of an adjuvant. Limitations in T helper 1 or T helper 2 biased responses generated by these vaccines emphasize the need for alternative, more efficacious adjuvants. The Toll-like receptor (TLR) 21 ligand, CpG oligodeoxynucleotides (ODN), has been established as immunomodulatory in chickens. Therefore, the objective of this study was to investigate the adjuvant potential of high (20μg) and low (2μg) doses of CpG ODN 2007 (CpG 2007) and CpG ODN 1826 (CpG 1826) when administered to chickens with a formalin-inactivated H9N2 AIV. Antibody responses in sera were evaluated in 90 specific pathogen free (SPF) chickens after intramuscular administration of vaccine formulations at 7 and 21 days post-hatch. Antibody responses were assessed based on haemagglutination inhibition (HI) and virus neutralization (VN) assays; virus-specific IgM and IgY antibody responses were evaluated by ELISA. The results suggest that the vaccine formulation containing low dose CpG 2007 was significantly more effective at generating neutralizing (both HI and VN) responses than formulations with high or low doses of CpG 1826 or high dose CpG 2007. Neutralizing responses elicited by low dose CpG 2007 significantly exceeded those generated by a squalene-based adjuvanted vaccine formulation during peak responses. A significantly higher IgM response was elicited by the formulation containing low dose CpG 2007 compared to high and low doses of 1826. Although the low dose of CpG 2007 elicited a higher IgY response than CpG 1826, the difference was not statistically significant. In conclusion, 2μg of CpG 2007 is potentially promising as a vaccine adjuvant when delivered intramuscularly with inactivated H9N2 virus to chickens. Future studies may be directed at determining the mucosal antibody responses to the same vaccine formulations.
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Affiliation(s)
- Shirene M Singh
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada N1G 2W1.
| | - Tamiru N Alkie
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada N1G 2W1.
| | - Douglas C Hodgins
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada N1G 2W1.
| | - Éva Nagy
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada N1G 2W1.
| | - Bahram Shojadoost
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada N1G 2W1.
| | - Shayan Sharif
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada N1G 2W1.
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Persistence and avidity maturation of antibodies to A(H1N1)pdm09 in healthcare workers following repeated annual vaccinations. Vaccine 2015; 33:4146-54. [PMID: 26057137 DOI: 10.1016/j.vaccine.2015.05.081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/12/2015] [Accepted: 05/27/2015] [Indexed: 12/24/2022]
Abstract
Healthcare workers are at increased risk of influenza infection through direct patient care, particularly during the early stages of a pandemic. Although influenza vaccination is widely recommended in Healthcare workers, data on long-term immunogenicity of vaccination in healthcare workers are lacking. The present study was designed to assess the persistence of the humoral response after pandemic vaccination as well as the impact of repeated annual vaccination in healthcare workers (n=24). Pandemic influenza vaccination resulted in a significant increase in haemagglutination inhibition (HI) antibody titers with 93-100% of subjects achieving protective titers 21-days post each of the three annual vaccinations. Seroprotective antibodies measured by HI, microneutralization and single radial hemolysis assays were present in 77-94% of healthcare workers 6 months post-vaccination. Repeated vaccination resulted in an increased duration of seroprotective antibodies with seroprotective titers increasing from 35-62% 12 months after 2009 pandemic vaccination to 50-75% 12 months after 2010 vaccination. Furthermore, repeated annual vaccination augmented the avidity of influenza-specific IgG antibodies. In conclusion, we have shown that A(H1N1)pdm09 vaccination induces high seroprotective titers that persist for at least 6 months. We demonstrate that repeated vaccination is beneficial to healthcare workers and results in further avidity maturation of vaccine-induced antibodies.
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Soema PC, Kompier R, Amorij JP, Kersten GFA. Current and next generation influenza vaccines: Formulation and production strategies. Eur J Pharm Biopharm 2015; 94:251-63. [PMID: 26047796 DOI: 10.1016/j.ejpb.2015.05.023] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
Vaccination is the most effective method to prevent influenza infection. However, current influenza vaccines have several limitations. Relatively long production times, limited vaccine capacity, moderate efficacy in certain populations and lack of cross-reactivity are important issues that need to be addressed. We give an overview of the current status and novel developments in the landscape of influenza vaccines from an interdisciplinary point of view. The feasibility of novel vaccine concepts not only depends on immunological or clinical outcomes, but also depends on biotechnological aspects, such as formulation and production methods, which are frequently overlooked. Furthermore, the next generation of influenza vaccines is addressed, which hopefully will bring cross-reactive influenza vaccines. These developments indicate that an exciting future lies ahead in the influenza vaccine field.
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Affiliation(s)
- Peter C Soema
- Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands; Division of Drug Delivery and Technology, Leiden Academic Centre for Drug Research, Leiden University, The Netherlands
| | - Ronald Kompier
- Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands; FluConsult, Noordwijk, The Netherlands
| | - Jean-Pierre Amorij
- Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands.
| | - Gideon F A Kersten
- Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands; Division of Drug Delivery and Technology, Leiden Academic Centre for Drug Research, Leiden University, The Netherlands
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Nafziger AN, Pratt DS. Seasonal influenza vaccination and technologies. J Clin Pharmacol 2014; 54:719-31. [PMID: 24691877 DOI: 10.1002/jcph.299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/26/2014] [Indexed: 11/06/2022]
Abstract
Seasonal influenza is a serious respiratory illness that causes annual worldwide epidemics resulting in significant morbidity and mortality. Influenza pandemics occur about every 40 yrs, and may carry a greater burden of illness and death than seasonal influenza. Both seasonal influenza and pandemic influenza have profound economic consequences. The combination of current vaccine efficacy and viral antigenic drifts and shifts necessitates annual vaccination. New manufacturing technologies in influenza vaccine development employ cell culture and recombinant techniques. Both allow more rapid vaccine creation and production. In the past 5 years, brisk, highly creative activity in influenza vaccine research and development has begun. New vaccine technologies and vaccination strategies are addressing the need for viable alternatives to egg production methods and improved efficacy. At present, stubborn problems of sub-optimal efficacy and the need for annual immunization persist. There is an obvious need for more efficacious vaccines and improved vaccination strategies to make immunization easier for providers and patients. Mitigating this serious annual health threat remains an important public health priority.
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MESH Headings
- Animals
- Antigenic Variation
- Antigens, Viral/chemistry
- Antigens, Viral/genetics
- Antigens, Viral/metabolism
- Health Priorities
- Humans
- Influenza A virus/immunology
- Influenza A virus/metabolism
- Influenza Vaccines/biosynthesis
- Influenza Vaccines/therapeutic use
- Influenza, Human/epidemiology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Betainfluenzavirus/immunology
- Betainfluenzavirus/metabolism
- Mass Vaccination
- Pandemics/prevention & control
- Seasons
- Technology, Pharmaceutical/trends
- Vaccines, Synthetic/chemistry
- Vaccines, Synthetic/metabolism
- Vaccines, Synthetic/therapeutic use
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Affiliation(s)
- Anne N Nafziger
- Bertino Consulting, Schenectady, NY, USA; Adjunct Research Professor, School of Pharmacy & Pharmaceutical Sciences, Department of Pharmacy Practice, University at Buffalo, State University of New York, Buffalo, NY, USA
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Camilloni B, Basileo M, Di Martino A, Donatelli I, Iorio AM. Antibody responses to intradermal or intramuscular MF59-adjuvanted influenza vaccines as evaluated in elderly institutionalized volunteers during a season of partial mismatching between vaccine and circulating A(H3N2) strains. IMMUNITY & AGEING 2014; 11:10. [PMID: 24860610 PMCID: PMC4032355 DOI: 10.1186/1742-4933-11-10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/04/2014] [Indexed: 11/12/2022]
Abstract
Background The age-related weakening of the immune system makes elderly subjects less responsive to influenza vaccination. In the last years, two “enhanced vaccines” were licensed for individuals aged ≥65 years, one being a subunit vaccine (Fluad®) containing the MF59 adjuvant administered intramuscularly (IM-MF59) and the other one a split non-adjuvanted vaccine administered intradermally (Intanza® 15mcg) (ID). In the present study, we evaluated and compared the antibody responses against the three vaccine antigens and heterovariant A(H3N2) circulating viruses induced by IM-MF59 and ID influenza vaccines in 80 elderly institutionalized volunteers (40 per group) during the Winter season 2011–2012. Results Hemagglutination inhibiting (HI) antibody titers were assessed in blood samples collected before, 1 and 6 months after vaccination. One month after vaccination both the IM-MF59 and ID vaccines induced increases in HI titers against all the three vaccine strains. The results in the two groups were similar against the A(H3N2) and A(H1N1) strains. Responses against the B strain typically tended to be higher after ID than IM-MF59, yet both vaccines stimulated lower responses against the B strain than against the two A strains. The two vaccines induced favorable results also against four epidemic drifted A(H3N2) viruses circulating in Winter 2011–2012. Six months after vaccination, the HI titers decreased in both groups. Conclusion The responses induced by IM-MF59 and ID vaccines in institutionalized elderly people were similar against the A(H3N2) and A(H1N1) strains but frequently higher, for the ID, against the B strain. The two vaccines induced positive responses against drifted A(H3N2) circulating viruses.
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Affiliation(s)
- Barbara Camilloni
- Department Experimental Medicine, University of Perugia, Piazza Gambuli, Perugia 06132, Italy
| | - Michela Basileo
- Department Experimental Medicine, University of Perugia, Piazza Gambuli, Perugia 06132, Italy
| | - Angela Di Martino
- Department MIPI Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy
| | - Isabella Donatelli
- Department MIPI Istituto Superiore di Sanità, Viale Regina Elena 299, Rome 00161, Italy
| | - Anna Maria Iorio
- Department Experimental Medicine, University of Perugia, Piazza Gambuli, Perugia 06132, Italy
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Remschmidt C, Wichmann O, Harder T. Methodological quality of systematic reviews on influenza vaccination. Vaccine 2014; 32:1678-84. [PMID: 24513008 DOI: 10.1016/j.vaccine.2014.01.060] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/26/2013] [Accepted: 01/21/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is a growing body of evidence on the risks and benefits of influenza vaccination in various target groups. Systematic reviews are of particular importance for policy decisions. However, their methodological quality can vary considerably. OBJECTIVES To investigate the methodological quality of systematic reviews on influenza vaccination (efficacy, effectiveness, safety) and to identify influencing factors. METHODS A systematic literature search on systematic reviews on influenza vaccination was performed, using MEDLINE, EMBASE and three additional databases (1990-2013). Review characteristics were extracted and the methodological quality of the reviews was evaluated using the assessment of multiple systematic reviews (AMSTAR) tool. U-test, Kruskal-Wallis test, chi-square test, and multivariable linear regression analysis were used to assess the influence of review characteristics on AMSTAR-score. RESULTS Fourty-six systematic reviews fulfilled the inclusion criteria. Average methodological quality was high (median AMSTAR-score: 8), but variability was large (AMSTAR range: 0-11). Quality did not differ significantly according to vaccination target group. Cochrane reviews had higher methodological quality than non-Cochrane reviews (p=0.001). Detailed analysis showed that this was due to better study selection and data extraction, inclusion of unpublished studies, and better reporting of study characteristics (all p<0.05). In the adjusted analysis, no other factor, including industry sponsorship or journal impact factor had an influence on AMSTAR score. CONCLUSIONS Systematic reviews on influenza vaccination showed large differences regarding their methodological quality. Reviews conducted by the Cochrane collaboration were of higher quality than others. When using systematic reviews to guide the development of vaccination recommendations, the methodological quality of a review in addition to its content should be considered.
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Affiliation(s)
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Berlin, Germany.
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41
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Gaglani M, Spencer S, Ball S, Song J, Naleway A, Henkle E, Bozeman S, Reynolds S, Sessions W, Hancock K, Thompson M. Antibody response to influenza A(H1N1)pdm09 among healthcare personnel receiving trivalent inactivated vaccine: effect of prior monovalent inactivated vaccine. J Infect Dis 2013; 209:1705-14. [PMID: 24363436 PMCID: PMC7313942 DOI: 10.1093/infdis/jit825] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background. Few data are available on the immunogenicity of repeated annual doses of influenza A(H1N1)pdm09-containing vaccines. Methods. We enrolled healthcare personnel (HCP) in direct patient care during the autumn of 2010 at 2 centers with voluntary immunization. We verified the receipt of A(H1N1)pdm09-containing monovalent inactivated influenza vaccine (MIIV) and 2010–2011 trivalent inactivated vaccine (TIV). We performed hemagglutination inhibition antibody (HI) assays on preseason, post-TIV, and end-of-season serum samples. We compared the proportion of HCPs with HI titer ≥40 against A(H1N1)pdm09 per receipt of prior-season MIIV, current-season TIV, both, or neither. Results. At preseason (n = 1417), HI ≥ 40 was significantly higher among those who received MIIV (34%) vs those who did not (14%) (adjusted relative risk [ARR], 3.26; 95% confidence interval [CI], 2.72–3.81). At post-TIV (n = 865), HI ≥ 40 was lower among HCP who received MIIV and TIV (66%) than among those receiving only TIV (85%) (ARR, 0.93 [95% CI, .84–.997]). At end-of-season (n = 1254), HI ≥ 40 was 40% among those who received both MIIV and TIV and 67% among those receiving only TIV (ARR, 0.76 [95% CI, .65–.88]), 52% among those who received MIIV only, and 12% among those receiving neither. Conclusions. HCP immunization programs should consider effects of host immune response and vaccine antigenic distance on immunogenicity of repeated annual doses of influenza vaccines.
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Van Buynder P, Konrad S, Van Buynder J, Brodkin E, Krajden M, Ramler G, Bigham M. The comparative effectiveness of adjuvanted and unadjuvanted trivalent inactivated influenza vaccine (TIV) in the elderly. Vaccine 2013; 31:6122-8. [DOI: 10.1016/j.vaccine.2013.07.059] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/16/2013] [Accepted: 07/25/2013] [Indexed: 10/26/2022]
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Effler PV, Tomlin S, Joyce S, Mak DB. Adult preferences for influenza vaccines with lower likelihood of side effects. Hum Vaccin Immunother 2013; 10:456-60. [PMID: 24193216 DOI: 10.4161/hv.26835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Concerns about possible side effects are a well-recognized barrier to influenza vaccination and emerging data indicate rates of reactogenicity for inactivated influenza vaccines may vary by manufacturer. We surveyed adults to assess their preference for hypothetical influenza vaccines with equivalent efficacy but differing rates of serious and minor adverse events. RESULTS The response rate was 94% (1006/1071); 44% of respondents reported receiving influenza vaccine at least once in the past. Seventy-two percent of respondents expressed a preference for vaccines that provided the same level of protection, but were less likely to produce serious side effects, and 55% expressed a preference for vaccines less likely to produce minor side effects. No significant differences by prior influenza vaccination history, age group or gender were identified. CONCLUSIONS A substantive proportion of adults have a strong preference for influenza vaccine formulations less likely to produce even minor side-effects, such as injection site reactions. Identifying influenza vaccines with equivalent efficacy but lower reactogenicity is important because experience with side effects may negatively impact future vaccine uptake. METHODS Computer assisted telephone interviews were conducted as part of a population-based survey using a stratified random sample drawn from the residential White Pages® telephone directory.
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Affiliation(s)
- Paul V Effler
- Western Australia Department of Health, Communicable Disease Control Directorate; Perth, WA Australia
| | - Stephania Tomlin
- Western Australia Department of Health, Health Survey Unit; Epidemiology Branch; Perth, WA Australia
| | - Sarah Joyce
- Western Australia Department of Health, Health Survey Unit; Epidemiology Branch; Perth, WA Australia
| | - Donna B Mak
- Western Australia Department of Health, Communicable Disease Control Directorate; Perth, WA Australia
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A novel emulsion-type adjuvant containing CpG oligodeoxynucleotides enhances CD8+ T-cell-mediated anti-tumor immunity. J Control Release 2013; 173:158-65. [PMID: 24177312 DOI: 10.1016/j.jconrel.2013.10.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/02/2013] [Accepted: 10/21/2013] [Indexed: 01/31/2023]
Abstract
PELC is a novel emulsion-type adjuvant that contains the bioresorbable polymer poly (ethylene glycol)-block-poly (lactide-co-ε-caprolactone) (PEG-b-PLACL), Span®85 and squalene. To investigate whether PELC is able to enhance CTL responses of antigens for treating tumor, peptides or protein antigens derived from HPV16 E7 were formulated with PELC nanoparticles and CpG oligodeoxynucleotide. We identified that PELC formulation could delay the release of antigens in vitro and in vivo. We assessed the immunogenicity of an H-2D(b)-restricted CTL epitope RAHYNIVTF (RAH) formulated with PELC or PELC/CpG and investigated the ability of these formulations to promote tumor regression. Following a single-dose subcutaneous injection in mice, we found that the RAH peptide formulated with PELC/CpG (RAH/PELC/CpG) resulted in increased numbers of IFN-γ-secreting cells and RAH-specific CD8(+) T cells and an enhanced cytotoxic T cell response compared with RAH formulated with PELC or CpG alone. The tumor-bearing mice received a single-dose injection of RAH/PELC/CpG, which induced complete tumor regression. These results demonstrated that peptide antigen formulated with PELC/CpG nanoparticles is feasible for cancer immunotherapy.
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45
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46
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Liu H, de Vries-Idema J, Ter Veer W, Wilschut J, Huckriede A. Influenza virosomes supplemented with GPI-0100 adjuvant: a potent vaccine formulation for antigen dose sparing. Med Microbiol Immunol 2013; 203:47-55. [PMID: 24062182 DOI: 10.1007/s00430-013-0313-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 09/07/2013] [Indexed: 01/31/2023]
Abstract
Adjuvants can stimulate vaccine-induced immune responses and can contribute decisively to antigen dose sparing when vaccine antigen production is limited, as for example during a pandemic influenza outbreak. We earlier showed that GPI-0100, a semi-synthetic saponin derivative with amphiphilic structure, significantly stimulates the immunogenicity and protective efficacy of influenza subunit vaccine administered via a systemic route. Here, we evaluated the adjuvant effect of GPI-0100 on a virosomal influenza vaccine formulation. In contrast to influenza subunit vaccine adjuvanted with GPI-0100, virosomal vaccine supplemented with the same dose of GPI-0100 provided full protection of mice against infection at the extremely low antigen dose of 2 × 8 ng hemagglutinin. Overall, adjuvanted virosomes elicited higher antibody and T-cell responses than did adjuvanted subunit vaccine. The enhanced immunogenicity of the GPI-0100-adjuvanted virosomes, particularly at low antigen doses, is possibly due to a physical association of the amphiphilic adjuvant with the virosomal membrane. These results show that a combination of GPI-0100 and a virosomal influenza vaccine formulation is highly immunogenic and allows the use of very low antigen doses without compromising the protective potential of the vaccine.
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Affiliation(s)
- Heng Liu
- Department of Medical Microbiology, Molecular Virology Section, University Medical Center Groningen, University of Groningen, P.O.Box 30.001, EB 88, 9700 RB, Groningen, The Netherlands,
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Scheifele DW, Dionne M, Ward BJ, Cooper C, Vanderkooi OG, Li Y, Halperin SA. Safety and immunogenicity of 2010–2011 A/H1N1pdm09-containing trivalent inactivated influenza vaccine in adults previously given AS03-adjuvanted H1N1 2009 pandemic vaccine: results of a randomized trial. Hum Vaccin Immunother 2013; 9:136-43. [PMID: 23570051 PMCID: PMC3667929 DOI: 10.4161/hv.22619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/16/2012] [Accepted: 10/22/2012] [Indexed: 12/04/2022] Open
Abstract
Many Canadians received a novel AS03-adjuvanted vaccine during the 2009 influenza A/H1N1 pandemic. Longer term implications of adjuvant use were unclear: would anti-H1N1 immune responses persist at high levels and, if so, could that result in increased or unusual adverse effects upon re-exposure to H1N1pdm09 antigen in the trivalent influenza vaccine (TIV) for 2010-11? To answer these questions, adults given AS03-adjuvanted H1N1pdm09 vaccine (Arepanrix®, GSK Canada) 9-10 mo earlier were enrolled in an evaluator-blinded, crossover trial to receive 2010-2011 non-adjuvanted TIV (Fluviral®, GSK Canada) and placebo 10 d apart, in random order. Adverse effects were monitored for 7 d after each injection. Vaccine-attributable adverse event (VAAE) rates were calculated by subtracting rates after placebo from those after vaccine. Blood was obtained pre-vaccination and 21-30 d afterward to measure hemagglutination inhibiting antibody titers. In total, 326 participants were enrolled and 321 completed the study. VAAE rates were low except for myalgia (18.6%) and injection site pain (63.2%). At baseline, H1N1pdm09 titers ≥ 40 were present in 176/325 subjects (54.2%, 95% confidence interval 48.6, 59.7), with a geometric mean titer (GMT) of 37.4 (95% CI 32.8, 42.6). Post-immunization, 96.0% (95% CI 92.3, 97.8) had H1N1pdm09 titers ≥ 40, with GMT of 167.4 (95% CI 148.7, 188.5). Responses to both influenza A strains in TIV were similar, implying no lasting effect of adjuvant exposure. In summary, titers ≥ 40 persisted in only half the participants 9-10 mo after adjuvanted pandemic vaccine but were restored in nearly all after TIV vaccination, with minimal increase in adverse effects.
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Affiliation(s)
- David W Scheifele
- Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, BC Canada.
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48
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Koutsonanos DG, Compans RW, Skountzou I. Targeting the skin for microneedle delivery of influenza vaccine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 785:121-32. [PMID: 23456844 DOI: 10.1007/978-1-4614-6217-0_13] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Influenza infection represents a major socioeconomic burden worldwide. Skin represents a new target that has gained much attention in recent years for delivery of influenza vaccine as an alternative to the conventional intramuscular route of immunization. In this review we describe different microneedle vaccination approaches used in vivo, including metal and dissolving microneedle patches that have demonstrated promising results. Additionally we analyze the immunological basis for microneedle skin immunization and targeting of the skin's dense population of antigen presenting cells, their role, characterization, and function. Additionally we analyze the importance of inflammatory signaling in the skin after microneedle delivery.
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Affiliation(s)
- Dimitrios G Koutsonanos
- Department of Microbiology and Immunology and Emory Vaccine Center, Emory University School of Medicine, Influenza Pathogenesis and Research Center (Emory University-UGA), 1518 Clifton Road, Atlanta, GA 30322, USA
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Riphagen-Dalhuisen J, Kuiphuis JCF, Procé AR, Luytjes W, Postma MJ, Hak E. Contributing factors to influenza vaccine uptake in general hospitals: an explorative management questionnaire study from the Netherlands. BMC Public Health 2012; 12:1101. [PMID: 23259743 PMCID: PMC3545720 DOI: 10.1186/1471-2458-12-1101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 12/12/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The influenza vaccination rate in hospitals among health care workers in Europe remains low. As there is a lack of research about management factors we assessed factors reported by administrators of general hospitals that are associated with the influenza vaccine uptake among health care workers. METHODS All 81 general hospitals in the Netherlands were approached to participate in a self-administered questionnaire study. The questionnaire was directed at the hospital administrators. The following factors were addressed: beliefs about the effectiveness of the influenza vaccine, whether the hospital had a written policy on influenza vaccination and how the hospital informed their staff about influenza vaccination. The questionnaire also included questions about mandatory vaccination, whether it was free of charge and how delivered as well as the vaccination campaign costs. The outcome of this one-season survey is the self-reported overall influenza vaccination rate of health care workers. RESULTS In all, 79 of 81 hospitals that were approached were willing to participate and therefore received a questionnaire. Of these, 42 were returned (response rate 52%). Overall influenza vaccination rate among health care workers in our sample was 17.7% (95% confidence interval: 14.6% to 20.8%). Hospitals in which the administrators agreed with positive statements concerning the influenza vaccination had a slightly higher, but non-significant, vaccine uptake. There was a 9% higher vaccine uptake in hospitals that spent more than €1250,- on the vaccination campaign (24.0% versus 15.0%; 95% confidence interval from 0.7% to 17.3%). CONCLUSIONS Agreement with positive statements about management factors with regard to influenza vaccination were not associated with the uptake. More economic investments were related with a higher vaccine uptake; the reasons for this should be explored further.
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Affiliation(s)
- Josien Riphagen-Dalhuisen
- Department of Pharmacy, Division of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, Antonius Deusinglaan 1, Groningen, the Netherlands.
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Mihigo R, Torrealba CV, Coninx K, Nshimirimana D, Kieny MP, Carrasco P, Hedman L, Widdowson MA. 2009 Pandemic Influenza A Virus Subtype H1N1 Vaccination in Africa—Successes and Challenges. J Infect Dis 2012; 206 Suppl 1:S22-8. [DOI: 10.1093/infdis/jis535] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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