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Potter GE, Carnegie NB, Sugimoto JD, Diallo A, Victor JC, Neuzil KM, Halloran ME. Using social contact data to improve the overall effect estimate of a cluster-randomized influenza vaccination program in Senegal. J R Stat Soc Ser C Appl Stat 2022; 71:70-90. [PMID: 35721226 PMCID: PMC9202735 DOI: 10.1111/rssc.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study estimates the overall effect of two influenza vaccination programs consecutively administered in a cluster-randomized trial in western Senegal over the course of two influenza seasons from 2009-2011. We apply cutting-edge methodology combining social contact data with infection data to reduce bias in estimation arising from contamination between clusters. Our time-varying estimates reveal a reduction in seasonal influenza from the intervention and a nonsignificant increase in H1N1 pandemic influenza. We estimate an additive change in overall cumulative incidence (which was 6.13% in the control arm) of -0.68 percentage points during Year 1 of the study (95% CI: -2.53, 1.18). When H1N1 pandemic infections were excluded from analysis, the estimated change was -1.45 percentage points and was significant (95% CI, -2.81, -0.08). Because cross-cluster contamination was low (0-3% of contacts for most villages), an estimator assuming no contamination was only slightly attenuated (-0.65 percentage points). These findings are encouraging for studies carefully designed to minimize spillover. Further work is needed to estimate contamination - and its effect on estimation - in a variety of settings.
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Affiliation(s)
- Gail E. Potter
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, and the Emmes Company, Rockville Maryland, USA
| | | | - Jonathan D. Sugimoto
- University of Washington and Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System and Fred Hutchinson Cancer Research Center, Seattle Washington, USA
| | - Aldiouma Diallo
- Institut de Recherche pour le Développement, Niakhar Senegal
| | | | | | - M. Elizabeth Halloran
- University of Washington Department of Biostatistics and Fred Hutchinson Cancer Research Center, Seattle Washington, USA
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2
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Trieu MC, Jul-Larsen Å, Sævik M, Madsen A, Nøstbakken JK, Zhou F, Skrede S, Cox RJ. Antibody Responses to Influenza A/H1N1pdm09 Virus After Pandemic and Seasonal Influenza Vaccination in Healthcare Workers: A 5-Year Follow-up Study. Clin Infect Dis 2020; 68:382-392. [PMID: 29893797 PMCID: PMC6336911 DOI: 10.1093/cid/ciy487] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/05/2018] [Indexed: 11/12/2022] Open
Abstract
Background The 2009 influenza pandemic was caused by the A/H1N1pdm09 virus, which was subsequently included in the seasonal vaccine, up to 2016/2017, as the A/H1N1 strain. This provided a unique opportunity to investigate the antibody response to H1N1pdm09 over time. Methods Healthcare workers (HCWs) were immunized with the AS03-adjuvanted H1N1pdm09 vaccine in 2009 (N = 250), and subsequently vaccinated with seasonal vaccines containing H1N1pdm09 for 4 seasons (repeated group), <4 seasons (occasional group), or no seasons (single group). Blood samples were collected pre and at 21 days and 3, 6, and 12 months after each vaccination, or annually (pre-season) from 2010 in the single group. The H1N1pdm09-specific antibodies were measured by the hemagglutination inhibition (HI) assay. Results Pandemic vaccination robustly induced HI antibodies that persisted above the 50% protective threshold (HI titers ≥ 40) over 12 months post-vaccination. Previous seasonal vaccination and the duration of adverse events after the pandemic vaccination influenced the decision to vaccinate in subsequent seasons. During 2010/2011-2013/2014, antibodies were boosted after each seasonal vaccination, although no significant difference was observed between the repeated and occasional groups. In the single group without seasonal vaccination, 32% of HCWs seroconverted (≥4-fold increase in HI titers) during the 4 subsequent years, most of whom had HI titers <40 prior to seroconversion. When excluding these seroconverted HCWs, HI titers gradually declined from 12 to 60 months post-pandemic vaccination. Conclusions Pandemic vaccination elicited durable antibodies, supporting the incorporation of adjuvant. Our findings support the current recommendation of annual influenza vaccination in HCWs. Clinical Trials Registration NCT01003288.
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Affiliation(s)
- Mai-Chi Trieu
- Influenza Centre, Department of Clinical Science, University of Bergen.,K. G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Åsne Jul-Larsen
- Influenza Centre, Department of Clinical Science, University of Bergen.,K. G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Marianne Sævik
- Division for Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anders Madsen
- Influenza Centre, Department of Clinical Science, University of Bergen
| | | | - Fan Zhou
- Influenza Centre, Department of Clinical Science, University of Bergen.,K. G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Steinar Skrede
- Division for Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rebecca Jane Cox
- Influenza Centre, Department of Clinical Science, University of Bergen.,K. G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Research and Development, Haukeland University Hospital, Bergen, Norway
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3
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Chen CL, Chiu TW, Chen YW, Fang JM. Substituent and solvent effects in the 1,3-dipolar cycloadditions for synthesis of anti-influenza agent peramivir and its analog. Tetrahedron 2019. [DOI: 10.1016/j.tet.2019.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nationwide Study on the Course of Influenza A (H1N1) Infections in Hospitalized Children in the Netherlands During the Pandemic 2009-2010. Pediatr Infect Dis J 2018; 37:e283-e291. [PMID: 30169483 DOI: 10.1097/inf.0000000000002177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The influenza H1N1 pandemic of 2009-2010, provided a unique opportunity to assess the course of disease, as well as the analysis of risk factors for severe disease in hospitalized children (< 18 years). METHODS Retrospective national chart study on hospitalized children with H1N1 infection during the 2009-2010 pH1N1 outbreak. RESULTS Nine hundred forty patients (56% boys), median age 3.0 years, were enrolled; the majority were previously healthy. Treatment consisted of supplemental oxygen (24%), mechanical ventilation (5%) and antiviral therapy (63%). Fifteen patients died (1.6%), 5 of whom were previously healthy. Multivariable analyses confirmed pre-existent heart and lung disease as risk factors for intensive care unit admission. Risk factors for mortality included children with a neurologic or oncologic disease and psychomotor retardation. CONCLUSIONS This nationwide overview of hospitalized children confirms known risk groups for severe influenza infections. However, most of the acute and severe presentations of influenza occurred in previously healthy children.
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van der Lubbe JEM, Verspuij JWA, Huizingh J, Schmit-Tillemans SPR, Tolboom JTBM, Dekking LEHA, Kwaks T, Brandenburg B, Meijberg W, Zahn RC, Roozendaal R, Kuipers H. Mini-HA Is Superior to Full Length Hemagglutinin Immunization in Inducing Stem-Specific Antibodies and Protection Against Group 1 Influenza Virus Challenges in Mice. Front Immunol 2018; 9:2350. [PMID: 30369928 PMCID: PMC6194913 DOI: 10.3389/fimmu.2018.02350] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/21/2018] [Indexed: 12/26/2022] Open
Abstract
Seasonal influenza vaccines are updated almost annually to match the antigenic drift in influenza hemagglutinin (HA) surface glycoprotein. A new HA stem-based antigen, the so-called “mini-HA,” was recently shown to induce cross-protective antibodies. However, cross-reactive antibodies targeting the HA stem can also be found in mice and humans after administration of seasonal vaccine. This has raised the question whether in similar conditions such a mini-HA would be able to show an increased breadth of protection over immunization with full length (FL) HA. We show in mice that in a direct comparison to H1 FL HA, using the same immunization regimen, dosing and adjuvant, a group 1 mini-HA has a higher protective efficacy against group 1 influenza virus challenges not homologous to the H1 FL HA. Although both antigens induce a similar breadth of HA subtype binding, mini-HA immunization induces significantly more HA stem-specific antibodies correlating with survival. In addition, both mini-HA and H1 FL HA immunization induce influenza neutralizing antibodies while mini-HA induces significantly higher levels of mFcγRIII activation, involved in Fc-mediated antibody effector functions. In agreement with previous findings, this confirms that more than one mechanism contributes to protection against influenza. Together our results further warrant the development of a universal influenza vaccine based on the HA stem region.
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Affiliation(s)
- Joan E M van der Lubbe
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Johan W A Verspuij
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Jeroen Huizingh
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | | | - Jeroen T B M Tolboom
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Liesbeth E H A Dekking
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Ted Kwaks
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Börries Brandenburg
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Wim Meijberg
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Roland C Zahn
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Ramon Roozendaal
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
| | - Harmjan Kuipers
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Leiden, Netherlands
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Champredon D, Laskowski M, Charland N, Moghadas SM. Assessing the benefits of early pandemic influenza vaccine availability: a case study for Ontario, Canada. Sci Rep 2018; 8:6492. [PMID: 29691450 PMCID: PMC5915538 DOI: 10.1038/s41598-018-24764-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/06/2018] [Indexed: 01/25/2023] Open
Abstract
New vaccine production technologies can significantly shorten the timelines for availability of a strain-specific vaccine in the event of an influenza pandemic. We sought to evaluate the potential benefits of early vaccination in reducing the clinical attack rate (CAR), taking into account the timing and speed of vaccination roll-out. Various scenarios corresponding to the transmissibility of a pandemic strain and vaccine prioritization strategies were simulated using an agent-based model of disease spread in Ontario, the largest Canadian province. We found that the relative reduction of the CAR reached 60% (90%CI: 44-100%) in a best-case scenario, in which the pandemic strain was moderately transmissible, vaccination started 4 weeks before the first imported case, the vaccine administration rate was 4 times higher than its average for seasonal influenza, and the vaccine efficacy was up to 90%. But the relative reductions in the CAR decreased significantly when the vaccination campaign was delayed or the administration rate reduced. In urban settings with similar characteristics to our population study, early availability and high rates of vaccine administration has the potential to substantially reduce the number of influenza cases. Low rates of vaccine administration or uptake can potentially offset the benefits of early vaccination.
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Affiliation(s)
- David Champredon
- Agent-Based Modelling Laboratory, York University, Toronto, M3J 1P3, Ontario, Canada.
| | - Marek Laskowski
- Agent-Based Modelling Laboratory, York University, Toronto, M3J 1P3, Ontario, Canada
| | - Nathalie Charland
- Medicago Inc., 1020 Route de l'Eglise, Quebec, G1V 3V9, Quebec, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, M3J 1P3, Ontario, Canada
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Wilkins AL, Kazmin D, Napolitani G, Clutterbuck EA, Pulendran B, Siegrist CA, Pollard AJ. AS03- and MF59-Adjuvanted Influenza Vaccines in Children. Front Immunol 2017; 8:1760. [PMID: 29326687 PMCID: PMC5733358 DOI: 10.3389/fimmu.2017.01760] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/27/2017] [Indexed: 12/28/2022] Open
Abstract
Influenza is a major cause of respiratory disease leading to hospitalization in young children. However, seasonal trivalent influenza vaccines (TIVs) have been shown to be ineffective and poorly immunogenic in this population. The development of live-attenuated influenza vaccines and adjuvanted vaccines are important advances in the prevention of influenza in young children. The oil-in-water emulsions MF59 and adjuvant systems 03 (AS03) have been used as adjuvants in both seasonal adjuvanted trivalent influenza vaccines (ATIVs) and pandemic monovalent influenza vaccines. Compared with non-adjuvanted vaccine responses, these vaccines induce a more robust and persistent antibody response for both homologous and heterologous influenza strains in infants and young children. Evidence of a significant improvement in vaccine efficacy with these adjuvanted vaccines resulted in the use of the monovalent (A/H1N1) AS03-adjuvanted vaccine in children in the 2009 influenza pandemic and the licensure of the seasonal MF59 ATIV for children aged 6 months to 2 years in Canada. The mechanism of action of MF59 and AS03 remains unclear. Adjuvants such as MF59 induce proinflammatory cytokines and chemokines, including CXCL10, but independently of type-1 interferon. This proinflammatory response is associated with improved recruitment, activation and maturation of antigen presenting cells at the injection site. In young children MF59 ATIV produced more homogenous and robust transcriptional responses, more similar to adult-like patterns, than did TIV. Early gene signatures characteristic of the innate immune response, which correlated with antibody titers were also identified. Differences were detected when comparing child and adult responses including opposite trends in gene set enrichment at day 3 postvaccination and, unlike adult data, a lack of correlation between magnitude of plasmablast response at day 7 and antibody titers at day 28 in children. These insights show the utility of novel approaches in understanding new adjuvants and their importance for developing improved influenza vaccines for children.
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Affiliation(s)
| | - Dmitri Kazmin
- Emory Vaccine Center, Emory University, Atlanta, GA, United States
| | - Giorgio Napolitani
- Medical Research Council (MRC), Human Immunology Unit, University of Oxford, Oxford, United Kingdom
| | - Elizabeth A. Clutterbuck
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, The NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Bali Pulendran
- Emory Vaccine Center, Emory University, Atlanta, GA, United States
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pathology, and Microbiology & Immunology, Stanford University, Stanford, CA, United States
- Institute for Immunology, Transplantation and Infection, Stanford University, Stanford, CA, United States
| | | | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, The NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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8
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Saunders-Hastings P, Quinn Hayes B, Smith? R, Krewski D. Modelling community-control strategies to protect hospital resources during an influenza pandemic in Ottawa, Canada. PLoS One 2017; 12:e0179315. [PMID: 28614365 PMCID: PMC5470707 DOI: 10.1371/journal.pone.0179315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A novel influenza virus has emerged to produce a global pandemic four times in the past one hundred years, resulting in millions of infections, hospitalizations and deaths. There is substantial uncertainty about when, where and how the next influenza pandemic will occur. METHODS We developed a novel mathematical model to chart the evolution of an influenza pandemic. We estimate the likely burden of future influenza pandemics through health and economic endpoints. An important component of this is the adequacy of existing hospital-resource capacity. Using a simulated population reflective of Ottawa, Canada, we model the potential impact of a future influenza pandemic under different combinations of pharmaceutical and non-pharmaceutical interventions. RESULTS There was substantial variation in projected pandemic impact and outcomes across intervention scenarios. In a population of 1.2 million, the illness attack rate ranged from 8.4% (all interventions) to 54.5% (no interventions); peak acute care hospital capacity ranged from 0.2% (all interventions) to 13.8% (no interventions); peak ICU capacity ranged from 1.1% (all interventions) to 90.2% (no interventions); and mortality ranged from 11 (all interventions) to 363 deaths (no interventions). Associated estimates of economic burden ranged from CAD $115 million to over $2 billion when extended mass school closure was implemented. DISCUSSION Children accounted for a disproportionate number of pandemic infections, particularly in household settings. Pharmaceutical interventions effectively reduced peak and total pandemic burden without affecting timing, while non-pharmaceutical measures delayed and attenuated pandemic wave progression. The timely implementation of a layered intervention bundle appeared likely to protect hospital resource adequacy in Ottawa. The adaptable nature of this model provides value in informing pandemic preparedness policy planning in situations of uncertainty, as scenarios can be updated in real time as more data become available. However-given the inherent uncertainties of model assumptions-results should be interpreted with caution.
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Affiliation(s)
- Patrick Saunders-Hastings
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, Ontario, Canada
- University of Ottawa, School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, Ottawa, ON, Canada
| | | | - Robert Smith?
- University of Ottawa, School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, Ottawa, ON, Canada
- University of Ottawa, Department of Mathematics, Ottawa, ON, Canada
| | - Daniel Krewski
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, Ontario, Canada
- University of Ottawa, School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, Ottawa, ON, Canada
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9
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Wang B, Russell ML, Fonseca K, Earn DJD, Horsman G, Van Caeseele P, Chokani K, Vooght M, Babiuk L, Walter SD, Loeb M. Predictors of influenza a molecular viral shedding in Hutterite communities. Influenza Other Respir Viruses 2017; 11:254-262. [PMID: 28207989 PMCID: PMC5410723 DOI: 10.1111/irv.12448] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patterns of influenza molecular viral shedding following influenza infection have been well established; predictors of viral shedding however remain uncertain. OBJECTIVES We sought to determine factors associated with peak molecular viral load, duration of shedding, and viral area under the curve (AUC) in children and adult Hutterite colony members with laboratory-confirmed influenza. METHODS A cohort study was conducted in Hutterite colonies in Alberta, Canada. Flocked nasal swabs were collected during three influenza seasons (2007-2008 to 2009-2010) from both symptomatic and asymptomatic individuals infected with influenza. Samples were tested by real-time reverse-transcription polymerase chain reaction for influenza A and influenza B, and the viral load was determined for influenza A-positive samples. RESULTS For seasonal H1N1, younger age was associated with a larger AUC, female sex was associated with decreased peak viral load and reduced viral shedding duration, while the presence of comorbidity was associated with increased peak viral load. For H3N2, younger age was associated with increased peak viral load and increased AUC. For pandemic H1N1, younger age was associated with increased peak viral load and increased viral AUC, female sex was associated with reduced peak viral load, while inapparent infection was associated with reduced peak viral load, reduced viral shedding duration, and reduced viral AUC. CONCLUSIONS Patterns of molecular viral shedding vary by age, sex, comorbidity, and the presence of symptoms. Predictor variables vary by influenza A subtype.
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Affiliation(s)
- Biao Wang
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonONCanada
| | - Margaret L. Russell
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Kevin Fonseca
- Department of Microbiology and Infectious Diseases and Provincial Laboratory for Public HealthUniversity of CalgaryCalgaryABCanada
| | - David J. D. Earn
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
- Michael G. De‐ Groote Institute for Infectious Disease ResearchMcMaster UniversityHamiltonONCanada
- Department of Mathematics and StatisticsMcMaster UniversityHamiltonONCanada
| | | | | | - Khami Chokani
- Saskatchewan HealthPrince Albert Parkland Health RegionPrince AlbertSKCanada
| | - Mark Vooght
- Saskatchewan HealthFive Hills Health RegionMoose JawSKCanada
| | | | - Stephen D. Walter
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
| | - Mark Loeb
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonONCanada
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonONCanada
- Michael G. De‐ Groote Institute for Infectious Disease ResearchMcMaster UniversityHamiltonONCanada
- Department of MedicineMcMaster UniversityHamiltonONCanada
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Saunders-Hastings P, Crispo JAG, Sikora L, Krewski D. Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis. Epidemics 2017; 20:1-20. [PMID: 28487207 DOI: 10.1016/j.epidem.2017.04.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 04/24/2017] [Indexed: 01/11/2023] Open
Abstract
The goal of this review was to examine the effectiveness of personal protective measures in preventing pandemic influenza transmission in human populations. We collected primary studies from Medline, Embase, PubMed, Cochrane Library, CINAHL and grey literature. Where appropriate, random effects meta-analyses were conducted using inverse variance statistical calculations. Meta-analyses suggest that regular hand hygiene provided a significant protective effect (OR=0.62; 95% CI 0.52-0.73; I2=0%), and facemask use provided a non-significant protective effect (OR=0.53; 95% CI 0.16-1.71; I2=48%) against 2009 pandemic influenza infection. These interventions may therefore be effective at limiting transmission during future pandemics. PROSPERO Registration: 42016039896.
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Affiliation(s)
- Patrick Saunders-Hastings
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - James A G Crispo
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada; University of Pennsylvania, Department of Neurology, Philadelphia, PA, United States
| | - Lindsey Sikora
- University of Ottawa, Health Sciences Library,451 Smyth Road, Ottawa, ON, Canada
| | - Daniel Krewski
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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Lansbury LE, Smith S, Beyer W, Karamehic E, Pasic-Juhas E, Sikira H, Mateus A, Oshitani H, Zhao H, Beck CR, Nguyen-Van-Tam JS. Effectiveness of 2009 pandemic influenza A(H1N1) vaccines: A systematic review and meta-analysis. Vaccine 2017; 35:1996-2006. [DOI: 10.1016/j.vaccine.2017.02.059] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/20/2017] [Accepted: 02/27/2017] [Indexed: 11/26/2022]
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Saunders-Hastings P, Reisman J, Krewski D. Assessing the State of Knowledge Regarding the Effectiveness of Interventions to Contain Pandemic Influenza Transmission: A Systematic Review and Narrative Synthesis. PLoS One 2016; 11:e0168262. [PMID: 27977760 PMCID: PMC5158032 DOI: 10.1371/journal.pone.0168262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Influenza pandemics occur when a novel influenza strain, to which humans are immunologically naïve, emerges to cause infection and illness on a global scale. Differences in the viral properties of pandemic strains, relative to seasonal ones, can alter the effectiveness of interventions typically implemented to control seasonal influenza burden. As a result, annual control activities may not be sufficient to contain an influenza pandemic. PURPOSE This study seeks to inform pandemic policy and planning initiatives by reviewing the effectiveness of previous interventions to reduce pandemic influenza transmission and infection. Results will inform the planning and design of more focused in-depth systematic reviews for specific types of interventions, thus providing the most comprehensive and current understanding of the potential for alternative interventions to mitigate the burden of pandemic influenza. METHODS A systematic review and narrative synthesis of existing systematic reviews and meta-analyses examining intervention effectiveness in containing pandemic influenza transmission was conducted using information collected from five databases (PubMed, Medline, Cochrane, Embase, and Cinahl/EBSCO). Two independent reviewers conducted study screening and quality assessment, extracting data related to intervention impact and effectiveness. RESULTS AND DISCUSSION Most included reviews were of moderate to high quality. Although the degree of statistical heterogeneity precluded meta-analysis, the present systematic review examines the wide variety of interventions that can impact influenza transmission in different ways. While it appears that pandemic influenza vaccination provides significant protection against infection, there was insufficient evidence to conclude that antiviral prophylaxis, seasonal influenza cross-protection, or a range of non-pharmaceutical strategies would provide appreciable protection when implemented in isolation. It is likely that an optimal intervention strategy will employ a combination of interventions in a layered approach, though more research is needed to substantiate this proposition. TRIAL REGISTRATION PROSPERO 42016039803.
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Affiliation(s)
- Patrick Saunders-Hastings
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
| | - Jane Reisman
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
| | - Daniel Krewski
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
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13
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Erba E, La Rosa C. A novel synthetic approach to the racemic Neuraminidase inhibitor Peramivir. Tetrahedron 2016. [DOI: 10.1016/j.tet.2016.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fléchelles O, Brissaud O, Fowler R, Ducruet T, Jouvet P, the Pediatric Canadian Critical Care Trials Group H1N1 Collaborative and Groupe Francophone de Réanimation et Urgences Pédiatriques. Pandemic influenza 2009: Impact of vaccination coverage on critical illness in children, a Canada and France observational study. World J Clin Pediatr 2016; 5:374-382. [PMID: 27872826 PMCID: PMC5099590 DOI: 10.5409/wjcp.v5.i4.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/25/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To study the impact of vaccination critical illness due to H1N1pdm09, we compared the incidence and severity of H1N1pdm09 infection in Canada and France.
METHODS We studied two national cohorts that included children with documented H1N1pdm09 infection, admitted to a pediatric intensive care unit (PICU) in Canada and in France between October 1, 2009 and January 31, 2010.
RESULTS Vaccination coverage prior to admission to PICUs was higher in Canada than in France (21% vs 2% of children respectively, P < 0.001), and in both countries, vaccination coverage prior to admission of these critically ill patients was substantially lower than in the general pediatric population (P < 0.001). In Canada, 160 children (incidence = 2.6/100000 children) were hospitalized in PICU compared to 125 children (incidence = 1.1/100000) in France (P < 0.001). Mortality rates were similar in Canada and France (4.4% vs 6.5%, P = 0.45, respectively), median invasive mechanical ventilation duration and mean PICU length of stay were shorter in Canada (4 d vs 6 d, P = 0.02 and 5.7 d vs 8.2 d, P = 0.03, respectively). H1N1pdm09 vaccination prior to PICU admission was associated with a decreased risk of requiring invasive mechanical ventilation (OR = 0.30, 95%CI: 0.11-0.83, P = 0.02).
CONCLUSION The critical illness due to H1N1pdm09 had a higher incidence in Canada than in France. Critically ill children were less likely to have received vaccination prior to hospitalization in comparison to general population and children vaccinated had lower risk of ventilation.
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15
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Mcbride WJH, Abhayaratna WP, Barr I, Booy R, Carapetis J, Carson S, De Looze F, Ellis-Pegler R, Heron L, Karrasch J, Marshall H, Mcvernon J, Nolan T, Rawlinson W, Reid J, Richmond P, Shakib S, Basser RL, Hartel GF, Lai MH, Rockman S, Greenberg ME. Efficacy of a trivalent influenza vaccine against seasonal strains and against 2009 pandemic H1N1: A randomized, placebo-controlled trial. Vaccine 2016; 34:4991-4997. [PMID: 27595443 DOI: 10.1016/j.vaccine.2016.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/31/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Before pandemic H1N1 vaccines were available, the potential benefit of existing seasonal trivalent inactivated influenza vaccines (IIV3s) against influenza due to the 2009 pandemic H1N1 influenza strain was investigated, with conflicting results. This study assessed the efficacy of seasonal IIV3s against influenza due to 2008 and 2009 seasonal influenza strains and against the 2009 pandemic H1N1 strain. METHODS This observer-blind, randomized, placebo-controlled study enrolled adults aged 18-64years during 2008 and 2009 in Australia and New Zealand. Participants were randomized 2:1 to receive IIV3 or placebo. The primary objective was to demonstrate the efficacy of IIV3 against laboratory-confirmed influenza. Participants reporting an influenza-like illness during the period from 14days after vaccination until 30 November of each study year were tested for influenza by real-time reverse transcription polymerase chain reaction. RESULTS Over a study period of 2years, 15,044 participants were enrolled (mean age±standard deviation: 35.5±14.7years; 54.4% female). Vaccine efficacy of the 2008 and 2009 IIV3s against influenza due to any strain was 42% (95% confidence interval [CI]: 30%, 52%), whereas vaccine efficacy against influenza due to the vaccine-matched strains was 60% (95% CI: 44%, 72%). Vaccine efficacy of the 2009 IIV3 against influenza due to the 2009 pandemic H1N1 strain was 38% (95% CI: 19%, 53%). No vaccine-related deaths or serious adverse events were reported. Solicited local and systemic adverse events were more frequent in IIV3 recipients than placebo recipients (local: IIV3 74.6% vs placebo 20.4%, p<0.001; systemic: IIV3 46.6% vs placebo 39.1%, p<0.001). CONCLUSIONS The 2008 and 2009 IIV3s were efficacious against influenza due to seasonal influenza strains and the 2009 IIV3 demonstrated moderate efficacy against influenza due to the 2009 pandemic H1N1 strain. Funded by CSL Limited, ClinicalTrials.gov identifier NCT00562484.
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Affiliation(s)
- William J H Mcbride
- James Cook University, Cairns Hospital Clinical School, Cairns, Queensland 4870, Australia.
| | - Walter P Abhayaratna
- Academic Unit of Internal Medicine, Canberra Hospital, Woden, Australian Capital Territory 2606, Australia; ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory 0200, Australia.
| | - Ian Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria 3051, Australia.
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The University of Sydney and The Children's Hospital at Westmead, Westmead, New South Wales 2145, Australia.
| | - Jonathan Carapetis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810, Australia.
| | - Simon Carson
- Southern Clinical Trials Ltd, Christchurch 8013, New Zealand.
| | - Ferdinandus De Looze
- Trialworks Clinical Research Pty Ltd and Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Queensland 4067, Australia.
| | | | - Leon Heron
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The University of Sydney and The Children's Hospital at Westmead, Westmead, New South Wales 2145, Australia.
| | - Jeff Karrasch
- Redcliffe Hospital, Redcliffe, Queensland 4020, Australia.
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, Robinson Research Institute and School of Medicine, University of Adelaide, Adelaide, South Australia 5006, Australia.
| | - Jodie Mcvernon
- Vaccine and Immunization Research Group, Melbourne School of Population and Global Health, University of Melbourne, and Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
| | - Terry Nolan
- Vaccine and Immunization Research Group, Melbourne School of Population and Global Health, University of Melbourne, and Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
| | - William Rawlinson
- South Eastern Sydney and Illawarra Area Health Service and University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Jim Reid
- Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - Peter Richmond
- University of Western Australia, School of Paediatrics and Child Health, Princess Margaret Hospital for Children, Perth, Western Australia 6872, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, South Australia 5001, Australia.
| | - Russell L Basser
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Gunter F Hartel
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Michael H Lai
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Steven Rockman
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Michael E Greenberg
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
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Dewar B, Barr I, Robinson P. Hospital capacity and management preparedness for pandemic influenza in Victoria. Aust N Z J Public Health 2015; 38:184-90. [PMID: 24690058 DOI: 10.1111/1753-6405.12170] [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] [Received: 06/01/2013] [Revised: 08/01/2013] [Accepted: 10/01/2013] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This study was designed to investigate acute hospital pandemic influenza preparedness in Victoria, Australia, particularly focussing on planning and management efforts. METHODS A prospective study was conducted by questionnaire and semi-structured interview of health managers across the Victorian hospital system from July to October 2011. Participants with responsibility for emergency management, planning and operations were selected from every hospital in Victoria with an emergency department to complete a questionnaire (response rate 22/43 = 51%). Each respondent was invited to participate in a phone-based semi-structured interview (response rate 11/22 = 50%). RESULTS Rural/regional hospitals demonstrated higher levels of clinical (86%) and non-clinical (86%) staff contingency planning than metropolitan hospitals (60% and 40% respectively). Pandemic plans were not being sufficiently tested in exercises or drills, which is likely to undermine their effectiveness. All respondents reported hand hygiene and standard precautions programs in place, although only one-third (33%) of metropolitan respondents and no rural/regional respondents reported being able to meet patient needs with high levels of staff absenteeism. Almost half Victoria's healthcare workers were unvaccinated against influenza. CONCLUSIONS AND IMPLICATIONS Hospitals across Victoria demonstrated different levels of influenza pandemic preparedness and planning. If a more severe influenza pandemic than that of 2009 arose, Victorian hospitals would struggle with workforce and infrastructure problems, particularly in rural/regional areas. Staff absenteeism threatens to undermine hospital pandemic responses. Various strategies, including education and communication, should be included with in-service training to provide staff with confidence in their ability to work safely during a future pandemic.
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Affiliation(s)
- Ben Dewar
- School of Public Health and Human Biosciences, La Trobe University, Victoria
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17
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He D, Lui R, Wang L, Tse CK, Yang L, Stone L. Global Spatio-temporal Patterns of Influenza in the Post-pandemic Era. Sci Rep 2015; 5:11013. [PMID: 26046930 PMCID: PMC4457022 DOI: 10.1038/srep11013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/12/2015] [Indexed: 12/11/2022] Open
Abstract
We study the global spatio-temporal patterns of influenza dynamics. This is achieved by analysing and modelling weekly laboratory confirmed cases of influenza A and B from 138 countries between January 2006 and January 2015. The data were obtained from FluNet, the surveillance network compiled by the the World Health Organization. We report a pattern of skip-and-resurgence behavior between the years 2011 and 2013 for influenza H1N1pdm, the strain responsible for the 2009 pandemic, in Europe and Eastern Asia. In particular, the expected H1N1pdm epidemic outbreak in 2011/12 failed to occur (or "skipped") in many countries across the globe, although an outbreak occurred in the following year. We also report a pattern of well-synchronized wave of H1N1pdm in early 2011 in the Northern Hemisphere countries, and a pattern of replacement of strain H1N1pre by H1N1pdm between the 2009 and 2012 influenza seasons. Using both a statistical and a mechanistic mathematical model, and through fitting the data of 108 countries, we discuss the mechanisms that are likely to generate these events taking into account the role of multi-strain dynamics. A basic understanding of these patterns has important public health implications and scientific significance.
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Affiliation(s)
- Daihai He
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong (SAR) China
| | - Roger Lui
- Department of Mathematical Sciences, Worcester Polytechnic Institute, 100 Institute Road Worcester, MA 01609, United States
| | - Lin Wang
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (SAR) China
| | - Chi Kong Tse
- Department of Electronic and Information Engineering, Hong Kong Polytechnic University Hong Kong (SAR) China
| | - Lin Yang
- School of Nursing, Hong Kong Polytechnic University, Hong Kong (SAR) China
| | - Lewi Stone
- School of Mathematical and Geospatial Sciences, RMIT University, Melbourne, 3000, Australia
- Department of Zoology, Biomathematics Unit, Tel Aviv University, Ramat Aviv, Israel
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18
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Potential effect of virus interference on influenza vaccine effectiveness estimates in test-negative designs. Epidemiol Infect 2015; 142:2642-6. [PMID: 25372226 DOI: 10.1017/s0950268814000107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A hypothetical influenza infection-induced non-specific immunity may reduce the risk of subsequent non-influenza respiratory virus (NIRV) infection and bias the influenza vaccine effectiveness (VE) estimates in test-negative designs (TNDs). We conducted a simulation study using a simple TND model and explored the degree of bias in the VE estimates. The bias was marginal during the usual seasons and most of the time during pandemics; the bias only became large when the influenza infection attack rate increased to pandemic levels (>50%), the true VE was low to moderate, and the non-specific immunity almost completely protected from NIRV infections and lasted at least half the influenza season.
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19
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Li ZY, Chen JY, Zhang YL, Fu WM. Partial protection against 2009 pandemic influenza A (H1N1) of seasonal influenza vaccination and related regional factors: Updated systematic review and meta-analyses. Hum Vaccin Immunother 2015; 11:1337-44. [PMID: 25692308 PMCID: PMC4514212 DOI: 10.4161/21645515.2014.985495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 01/02/2023] Open
Abstract
This updated systematic review and meta-analyses aims to systematically evaluate the cross-protection of seasonal influenza vaccines against the 2009 pandemic A (H1N1) influenza infection, and investigate the potential effect of the influenza strains circulating previous to the pandemic on the association between vaccine receipt and pandemic infection. In addition, subgroup analysis was performed based on the study locations and previous circulating influenza viruses. Relevant articles in English and Chinese from 2009 to October 2013 were systematically searched, and 21 eligible studies were included. For case-control studies, an insignificant 20% reduced risk for pandemic influenza infection based on combined national data (OR = 0.80; 95%CI: 0.60, 1.05) was calculated for people receiving seasonal influenza vaccination. However, for RCTs, an insignificant increase in the risk of seasonal influenza vaccines was observed (RR = 1.27; 95% CI: 0.46, 3.53). For the subgroup analysis, a significant 35% cross-protection was observed in the subgroup where influenza A outbreaks were detected before the 2009 pandemic. Moreover, the results indicated that seasonal influenza vaccination may reduce the risk of influenza-like illnesses (ILIs) (RR = 0.91; 95% CI: 0.84, 0.99). Our findings partially support the hypothesis that seasonal vaccines may offer moderate cross-protection for adults against laboratory-confirmed pandemic influenza A (H1N1) infection and ILIs. Further immunological studies are needed to understand the mechanism underlying these findings.
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Affiliation(s)
- Zhi-Yuan Li
- Guangzhou Institute of Advanced Technology; Chinese Academy of Sciences; Guangzhou, PR China
| | | | - Yan-Ling Zhang
- School of Medical Technology and Nursing; Shenzhen Polytechnic; Shenzhen, PR China
| | - Wei-Ming Fu
- Guangzhou Institute of Advanced Technology; Chinese Academy of Sciences; Guangzhou, PR China
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20
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Zhang XS, Pebody R, De Angelis D, White PJ, Charlett A, McCauley JW. The Possible Impact of Vaccination for Seasonal Influenza on Emergence of Pandemic Influenza via Reassortment. PLoS One 2014; 9:e114637. [PMID: 25494180 PMCID: PMC4262424 DOI: 10.1371/journal.pone.0114637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 11/12/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND One pathway through which pandemic influenza strains might emerge is reassortment from coinfection of different influenza A viruses. Seasonal influenza vaccines are designed to target the circulating strains, which intuitively decreases the prevalence of coinfection and the chance of pandemic emergence due to reassortment. However, individual-based analyses on 2009 pandemic influenza show that the previous seasonal vaccination may increase the risk of pandemic A(H1N1) pdm09 infection. In view of pandemic influenza preparedness, it is essential to understand the overall effect of seasonal vaccination on pandemic emergence via reassortment. METHODS AND FINDINGS In a previous study we applied a population dynamics approach to investigate the effect of infection-induced cross-immunity on reducing such a pandemic risk. Here the model was extended by incorporating vaccination for seasonal influenza to assess its potential role on the pandemic emergence via reassortment and its effect in protecting humans if a pandemic does emerge. The vaccination is assumed to protect against the target strains but only partially against other strains. We find that a universal seasonal vaccine that provides full-spectrum cross-immunity substantially reduces the opportunity of pandemic emergence. However, our results show that such effectiveness depends on the strength of infection-induced cross-immunity against any novel reassortant strain. If it is weak, the vaccine that induces cross-immunity strongly against non-target resident strains but weakly against novel reassortant strains, can further depress the pandemic emergence; if it is very strong, the same kind of vaccine increases the probability of pandemic emergence. CONCLUSIONS Two types of vaccines are available: inactivated and live attenuated, only live attenuated vaccines can induce heterosubtypic immunity. Current vaccines are effective in controlling circulating strains; they cannot always help restrain pandemic emergence because of the uncertainty of the oncoming reassortant strains, however. This urges the development of universal vaccines for prevention of pandemic influenza.
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Affiliation(s)
- Xu-Sheng Zhang
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
- * E-mail:
| | - Richard Pebody
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - Daniela De Angelis
- Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Medical Research Council Biostatistics Unit, University Forvie Site, Cambridge, United Kingdom
| | - Peter J. White
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
- NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Andre Charlett
- Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - John W. McCauley
- Medical Research Council National Institute for Medical Research, Mill Hill, London, United Kingdom
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21
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Milanetti F, Germano V, Nisini R, Donatelli I, Di Martino A, Facchini M, Ferlito C, Cappella A, Crialesi D, Caporuscio S, Biselli R, Rossi F, Salemi S, D'Amelio R. Safety and immunogenicity of co-administered MF59-adjuvanted 2009 pandemic and plain 2009-10 seasonal influenza vaccines in rheumatoid arthritis patients on biologicals. Clin Exp Immunol 2014; 177:287-94. [PMID: 24666311 DOI: 10.1111/cei.12292] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 11/28/2022] Open
Abstract
Rheumatoid arthritis (RA) patients under immunosuppressive therapy are particularly susceptible to infections, mainly of the respiratory tract, thus vaccination may represent a strategy to reduce their incidence in this vulnerable population. In the 2009-10 influenza season, the safety and immunogenicity of co-administered non-adjuvanted seasonal and MF59-adjuvanted pandemic influenza vaccines were evaluated in this study in 30 RA patients under therapy with anti-tumour necrosis factor (TNF)-α agents or Abatacept and in 13 healthy controls (HC). Patients and HC underwent clinical and laboratory evaluation before (T0), 1 (T1) and 6 months (T2) after vaccinations. No severe adverse reactions, but a significant increase in total mild side effects in patients versus HC were observed. Both influenza vaccines fulfilled the three criteria of the Committee for Proprietary Medicinal Products (CPMP). Seroconversion rate for any viral strain in patients and HC was, respectively, 68 versus 45 for H1-A/Brisbane/59/07, 72 versus 81 for H3-A/Brisbane/10/07, 68 versus 54 for B/Brisbane/60/08 and 81 versus 54 for A/California/7/2009. A slight increase in activated interferon (IFN)-γ-, TNF-α- or interleukin (IL)-17A-secreting T cells at T1 compared to T0, followed by a reduction at T2 in both patients and HC, was registered. In conclusion, simultaneous administration of adjuvanted pandemic and non-adjuvanted seasonal influenza vaccines is safe and highly immunogenic. The largely overlapping results between patients and HC, in terms of antibody response and cytokine-producing T cells, may represent further evidence for vaccine safety and immunogenicity in RA patients on biologicals.
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Affiliation(s)
- F Milanetti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, 'Sapienza' University of Rome, Rome, Italy
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22
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Pfleiderer M, Trouvin JH, Brasseur D, Gränstrom M, Shivji R, Mura M, Cavaleri M. Summary of knowledge gaps related to quality and efficacy of current influenza vaccines. Vaccine 2014; 32:4586-4591. [PMID: 24954696 DOI: 10.1016/j.vaccine.2014.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/09/2014] [Indexed: 02/05/2023]
Abstract
Influenza viruses are a public health threat, as they are pathogenic, highly transmissible and prone to genetic changes. For decades vaccination strategies have been based on trivalent inactivated vaccines, which are regulated by specific guidelines. The progress in scientific knowledge and the lessons learned from the A(H1N1)2009 pandemic have highlighted further the need to improve current guidelines, including the immunogenicity criteria set by the CHMP in 1997, and to promote the discussion on the shortcomings encountered, e.g. the evaluation of vaccine efficacy in the paediatric and elderly populations, the measurement of the naivety of a population, the impact of prior immunity on subsequent vaccinations, and the technical issues with the serological assays for detection of immunity and immunogenicity. The authors attempted to summarise and tackle key gaps in the existing evidence concerning quality and efficacy of influenza vaccines, aiming at favouring a common understanding and a coordinated approach across stakeholders.
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Affiliation(s)
- Michael Pfleiderer
- Vaccine Working Party of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA); Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Straße 51-59, 63225 Langen, Germany
| | - Jean-Hugues Trouvin
- Paris Descartes University, School of Pharmacy, Health Safety and Public Health Department, Paris, France
| | - Daniel Brasseur
- Vaccine Working Party of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA); Agence Fédérale des Médicaments et des Produits de Santé, Batiment EUROSTATION, bloc 2, place Victor Horta, 40/40, B-1060 Brussels, Belgium; Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA)
| | - Marta Gränstrom
- Vaccine Working Party of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA); MTC, Karolinska Institutet, Stockholm, Sweden; Paediatric Committee of the European Medicines Agency (EMA)
| | - Ragini Shivji
- European Medicines Agency (EMA), 7 Westferry Circus, Canary Wharf, London E14 4HB, United Kingdom
| | - Manuela Mura
- European Medicines Agency (EMA), 7 Westferry Circus, Canary Wharf, London E14 4HB, United Kingdom.
| | - Marco Cavaleri
- European Medicines Agency (EMA), 7 Westferry Circus, Canary Wharf, London E14 4HB, United Kingdom
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Prospective cohort study of the safety of an influenza A(H1N1) vaccine in pregnant Chinese women. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1282-7. [PMID: 24990911 DOI: 10.1128/cvi.00375-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To monitor and evaluate the safety of the influenza A(H1N1) vaccine in pregnant women and its influence on the fetus and neonate, we performed a prospective study in which 122 pregnant Chinese women who received the influenza A(H1N1) vaccine and 104 pregnant women who did not receive any vaccine (serving as controls) were observed. The results indicated that the seroconversion rate in the vaccinated group was 90.4% (95% confidence interval [CI], 82.6% to 95.5%). The rate of adverse events following immunization in the pregnant women who received the influenza A(H1N1) vaccine was 3.3%. The spontaneous abortion rates in the vaccinated group and the unvaccinated group were 0.8% and 1.9%, respectively (exact probability test, P = 0.470), the prolonged-pregnancy rates were 8.2% and 4.8%, respectively (χ(2) = 1.041, P = 0.308), the low-birth-weight rates were 1.6% and 0.95%, respectively (exact probability test, P = 1.000), and the spontaneous-labor rates were 70.5% and 75%, respectively (χ(2) = 0.573, P = 0.449). All newborns who have an Apgar score of ≥7 are considered healthy; Apgar scores of ≥9 were observed in 38.5% and 57.7% of newborns in the vaccinated group and the unvaccinated group, respectively (χ(2) = 8.274, P = 0.004). From these results, we conclude that the influenza A(H1N1) vaccine is safe for pregnant women and has no observed adverse effects on fetal growth. (This study has been registered at ClinicalTrials.gov under registration no. NCT01842997.).
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Yokouchi Y, Katsumori H, Shirakawa S, Fujiwara M, Kashima K, Kozawa R, Koike Y. Protective effects of influenza A (H1N1) pandemic 2009 vaccination against the onset of influenza-like illness and asthma exacerbation in Japanese children. J Asthma 2014; 51:825-31. [PMID: 24739075 DOI: 10.3109/02770903.2014.915567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Vaccination against influenza A(H1N1)pdm09 in Japan started in October 2009. Children with asthma are considered as a high-risk group and are recommended to preferentially receive the vaccine. OBJECTIVE To identify the clinical effects of vaccination in Japanese children with and without asthma. METHODS We conducted a cross-sectional, questionnaire-based survey to compare vaccination rates, vaccine effectiveness against physician-diagnosed influenza A infection (PDIA), and consecutive asthma exacerbations between children with and without asthma. RESULTS Of the 460 children included in this study, those with asthma had higher vaccination rates (46.5%, 67/144) than those without asthma (30.4%, 96/316). Influenza A infections were diagnosed in 28 of 163 vaccinated children (17.2%) compared to 164 of 297 unvaccinated children (55.2%, p < 0.001). Comparison of positive influenza diagnosis rates between vaccinated and unvaccinated children with and without asthma showed that unvaccinated children with asthma had an elevated odds ratio (13.235; 95% confidence interval [CI], 5.564-32.134) and that treatment for asthma exacerbations was needed in a larger proportion of unvaccinated children. Vaccine effectiveness against PDIA was 87% (95% CI, 78-93%) overall, 92% (95% CI, 81-96%) in children with asthma and 81% (95% CI, 63-91%) in children without asthma, respectively. CONCLUSIONS The administration of an inactivated, split-virus, non-adjuvanted monovalent A(H1N1)pdm09 vaccine during the pandemic period reduced the number of physician-diagnosed influenza A infections and asthma exacerbations in children with asthma. Therefore, we strongly recommend that high-risk children with a history of asthma receive vaccines during pandemics.
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Affiliation(s)
- Yukako Yokouchi
- Department of Pediatrics, Disaster Medical Center , Tokyo , Japan
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25
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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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Pandemic influenza A(H1N1)pdm09: risk of infection in primary healthcare workers. Br J Gen Pract 2014; 63:e416-22. [PMID: 23735413 DOI: 10.3399/bjgp13x668212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Healthcare workers in primary care are at risk of infection during an influenza pandemic. The 2009 influenza pandemic provided an opportunity to assess this risk. AIM To measure the prevalence of seropositivity to influenza A(H1N1)pdm09 among primary healthcare workers in Canterbury, New Zealand, following the 2009 influenza pandemic, and to examine associations between seropositivity and participants' sociodemographic characteristics, professional roles, work patterns, and seasonal influenza vaccination status. DESIGN AND SETTING An observational study involving a questionnaire and testing for influenza A(H1N1)pdm09 seropositivity in all primary healthcare workers in Canterbury, New Zealand between December 2009 and February 2010. Method Participants completed a questionnaire that recorded sociodemographic and professional data, symptoms of influenza-like illness, history of seasonal influenza vaccination, and work patterns. Serum samples were collected and haemagglutination inhibition antibody titres to influenza A(H1N1)pdm09 measured. RESULTS Questionnaires and serum samples were received from 1027 participants, from a workforce of 1476 (response rate 70%). Seropositivity was detected in 224 participants (22%). Receipt of seasonal influenza vaccine (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.2 to 3.3), recall of influenza (OR = 1.9, 95% CI = 1.3 to 2.8), and age ≤45 years (OR = 1.4, 95% CI = 1.0 to 1.9) were associated with seropositivity. CONCLUSION A total of 22% of primary care healthcare workers were seropositive. Younger participants, those who recalled having influenza, and those who had been vaccinated against seasonal influenza were more likely to be seropositive. Working in a dedicated influenza centre was not associated with an increased risk of seropositivity.
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Kapoor S, Dhama K. Prevention and Control of Influenza Viruses. INSIGHT INTO INFLUENZA VIRUSES OF ANIMALS AND HUMANS 2014. [PMCID: PMC7121144 DOI: 10.1007/978-3-319-05512-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The 2003–2004 outbreaks of highly pathogenic avian influenza (HPAI) have proven to be disastrous to the regional poultry industry in Asia, and have raised serious worldwide public health apprehension regarding the steps that should be taken to urgently control HPAI. Control measures must be taken based on the principles of biosecurity and disease management and at the same time making public aware of the precautionary measures at the verge of outbreak. Creation of protection and surveillance zones, various vaccination strategies viz. routine, preventive, emergency, mass and targeted vaccination programmes using live, inactivated and recombinant vaccines are the common strategies adopted in different parts of the globe. The new generation vaccines include recombinant vaccines and recombinant fusion vaccine. The pro-poor disease control programmes, giving compensation and subsidies to the farmers along with effective and efficient Veterinary Services forms integral part of control of HPAI. Following biosecurity principles and vaccination forms integral part of control programme against swine and equine influenza as well. Use of neuraminidase (NA) inhibitors (Zanamivir and Oseltamivir) for the treatment of human influenza has been widely accepted worldwide. The threat of increasing resistance of the flu viruses to these antivirals has evoked interest in the development of novel antiviral drugs for influenza virus such as inhibitors of cellular factors and host signalling cascades, cellular miRNAs, siRNA and innate immune peptides (defensins and cathelicidins). Commercial licensed inactivated vaccines for humans against influenza A and B viruses are available consisting of three influenza viruses: influenza type A subtype H3N2, influenza type A subtype H1N1 (seasonal) virus strain and influenza type B virus strain. As per WHO, use of tetravaccine consisting of antigens of influenza virus serotypes H3N2, H1N1, B and H5 is the most promising method to control influenza pandemic. All healthy children in many countries are required to be vaccinated between 6 and 59 months of age. The seasonal vaccines currently used in humans induce strain-specific humoral immunity as the antibodies. Universal influenza virus vaccines containing the relatively conserved ectodomain of M2 (M2e), M1, HA fusion peptide and stalk domains, NA, NP alone or in combination have been developed which have been shown to induce cross-protection. The T cell-based vaccines are another recent experimental approach that has been shown to elicit broad-spectrum heterosubtypic immunity in the host. As far as HPAI is concerned, various pandemic preparedness strategies have been documented.
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Affiliation(s)
- Sanjay Kapoor
- Department of Veterinary Microbiology, LLR University of Veterinary and Animal Sciences, Hisar, 125004 Haryana India
| | - Kuldeep Dhama
- Division of Pathology, Indian Veterinary Research Institute (IVRI), Izatnagar, Bareilly, 243122 Uttar Pradesh India
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Thompson MG, Li DK, Shifflett P, Sokolow LZ, Ferber JR, Kurosky S, Bozeman S, Reynolds SB, Odouli R, Henninger ML, Kauffman TL, Avalos LA, Ball S, Williams JL, Irving SA, Shay DK, Naleway AL, Chu S, Cragan J, McIntyre A, Villanueva J, Fry A, Bresee J, Tokars J, Seward J. Effectiveness of Seasonal Trivalent Influenza Vaccine for Preventing Influenza Virus Illness Among Pregnant Women: A Population-Based Case-Control Study During the 2010–2011 and 2011–2012 Influenza Seasons. Clin Infect Dis 2013; 58:449-57. [DOI: 10.1093/cid/cit750] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark G. Thompson
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - De-Kun Li
- Division of Research, Kaiser Foundation Research Institute, Oakland, California
- Department of Health Research and Policy, School of Medicine, Stanford University, California
| | | | - Leslie Z. Sokolow
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- Battelle Memorial Institute, Atlanta, Georgia
| | - Jeannette R. Ferber
- Division of Research, Kaiser Foundation Research Institute, Oakland, California
| | - Samantha Kurosky
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Sam Bozeman
- Abt Associates, Inc, Cambridge, Massachusetts
| | - Sue B. Reynolds
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Roxana Odouli
- Division of Research, Kaiser Foundation Research Institute, Oakland, California
| | | | - Tia L. Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Lyndsay A. Avalos
- Division of Research, Kaiser Foundation Research Institute, Oakland, California
| | - Sarah Ball
- Abt Associates, Inc, Cambridge, Massachusetts
| | - Jennifer L. Williams
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | | | - David K. Shay
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Jia F, Hong J, Sun PH, Chen JX, Chen WM. Facile Synthesis of the Neuraminidase Inhibitor Peramivir. SYNTHETIC COMMUN 2013. [DOI: 10.1080/00397911.2012.729279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Fei Jia
- a College of Pharmacy, Jinan University , Guangzhou , China
| | - Juan Hong
- a College of Pharmacy, Jinan University , Guangzhou , China
| | - Ping-Hua Sun
- a College of Pharmacy, Jinan University , Guangzhou , China
| | - Jian-Xin Chen
- b College of Veterinary Medicine, South China Agricultural University , Guangzhou , China
| | - Wei-Min Chen
- a College of Pharmacy, Jinan University , Guangzhou , China
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Uno S, Kimachi K, Matsuo F, Miyazaki K, Oohama A, Kei J, Nishimura T, Odoh K, Kino Y. Cross-reactive antibody response to the pandemic A (H1N1) 2009 influenza virus induced by vaccination with a seasonal trivalent influenza vaccine: a longitudinal study of three influenza seasons in Japan. Microbiol Immunol 2013; 56:810-6. [PMID: 23009167 DOI: 10.1111/j.1348-0421.2012.00511.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The cross-reactivity of antibody to the swine-origin pandemic influenza A (H1N1) 2009 virus induced by vaccination with a seasonal trivalent influenza vaccine was studied. Paired sera from a cohort of adult volunteers vaccinated with a trivalent seasonal influenza vaccine every year from 2006 to 2008 were collected each year and tested by hemagglutination inhibition (HI) for antibody against the pandemic influenza A (H1N1) 2009 virus. There was little increase in the geometric mean titer overall; a slight increase was detected in the sera obtained in the 2007-2008 season but not in the other two seasons. The proportion of individuals with HI antibody titers ≥ 1:40 did not change significantly from year to year. These results indicate that cross-reactivity of the antibodies induced by a trivalent seasonal vaccine to the pandemic influenza A (H1N1) 2009 virus is marginal.
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Affiliation(s)
- Shingo Uno
- Headquarters, Chemo-Sero-Therapeutic Research Institute Kaketsuken, Kumamoto 860-8568, Japan.
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Intervention strategies for emerging respiratory virus infections: policy and public health considerations. Curr Opin Virol 2013; 3:192-8. [PMID: 23477831 PMCID: PMC7102792 DOI: 10.1016/j.coviro.2013.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/15/2013] [Indexed: 01/17/2023]
Abstract
Respiratory viruses have emerged and re-emerged in humans for hundreds of years. In the recent past avian and animal influenza viruses have caused human disease ranging from conjunctivitis to respiratory illnesses, including the 2009–10 A(H1N1)pdm09 pandemic. Coronaviruses, human metapneumovirus (hMPV) and enteroviruses have also impacted humans globally. Since the likely public health impacts are common, plans and policies for intervention strategies can be developed, encompassing early detection through surveillance and diagnostics, as well as treatment and prevention through clinical and non-clinical interventions. The global comprehensiveness of these varies according to differing resources, competing health priorities and the causative agent, yet, irrespective of this, activities must be proportional to the threat. Pandemics and severe epidemics enable policies to be tested and gaps identified.
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Klick B, Durrani S, Chan KH, Ip DKM, Chou ESK, Kwok HKH, Ng S, Chiu SS, Peiris JSM, Leung GM, Cowling BJ. Live attenuated seasonal and pandemic influenza vaccine in school-age children: a randomized controlled trial. Vaccine 2013; 31:1937-43. [PMID: 23434387 DOI: 10.1016/j.vaccine.2013.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/09/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The novel influenza A(H1N1pdm09) virus emerged in North America in early 2009 and rapidly spread worldwide. In this study we report the efficacy of the live attenuated monovalent H1N1pdm09 vaccine and 2009-10 seasonal influenza vaccine in a randomized double-blind placebo-controlled trial. METHODS We enrolled 703 children aged 7-11. Each child was randomly allocated in the ratio 3:2 to receive one dose of live attenuated monovalent H1N1pdm09 vaccine or saline placebo between November 2009 and January 2010, followed after 3-10 weeks by independent random allocation to one dose of live attenuated trivalent 2009-10 seasonal influenza vaccine or saline placebo in the same ratio. Children were followed up through September 2010 with biweekly telephone calls and symptom diaries. Seasonal and pandemic influenza infections were confirmed by virologic testing of nose and throat swabs collected during acute respiratory illnesses. RESULTS Overall, 30 children had confirmed influenza including 3 (0.43%) H1N1pdm09, 10 (1.4%) seasonal A(H3N2), and 17 (2.4%) influenza B. There were no significant differences in incidence rates of H1N1pdm09 or A(H3N2) between the four study arms, but receipt of the seasonal influenza vaccine was associated with a significant reduction in risk of influenza B (p<0.01). Vaccine efficacy against confirmed H1N1pdm09 infection associated with receipt of the monovalent H1N1pdm09 vaccine was 65% (95% confidence interval, CI: -281%, 97%). Vaccine efficacies against confirmed seasonal influenza A(H3N2) and B infection associated with receipt of the seasonal influenza vaccine were 31% (95% CI: -138%, 80%) and 96% (95% CI: 67%, 99%) respectively. CONCLUSIONS Vaccine efficacy was consistent with other studies of the monovalent H1N1pdm09 vaccine and seasonal influenza vaccines. Our study was underpowered to provide precise estimates of vaccine efficacy due to low incidence of influenza A viruses during the study period.
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Affiliation(s)
- Brendan Klick
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region
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Co-circulation of influenza A virus strains and emergence of pandemic via reassortment: the role of cross-immunity. Epidemics 2012; 5:20-33. [PMID: 23438428 DOI: 10.1016/j.epidem.2012.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 10/09/2012] [Accepted: 10/29/2012] [Indexed: 12/24/2022] Open
Abstract
Reassortment is an important evolutionary route for influenza A viruses to generate pandemic strains. The pre-requisite for reassortment to occur is co-infection of different influenza virus strains in the same host population. Empirical evidence suggests that co-circulation of influenza A virus strains is common and co-infection in patients has been reported. Whether a novel virus can successfully spread among a host population is determined by its life-history (infectivity and infectious period). It is also well known that different influenza A strains interfere through the immune response of human body cells. The reassortant virus strain generated from co-infections deviates dramatically in antigenic and genetic properties from its parental strains such that human populations have limited immunity against it. We consider a mathematical model which includes two strains of influenza virus within a standard SIR model and integrate life history and cross-immunity into the evolutionary dynamics of influenza virus. We assume that, following primary infection by one strain and recovery, individuals are susceptible to secondary infection by the other strain only but with reduced probability due to cross-immunity. Co-infection is included to examine how life-history and cross-immunity interplay to regulate the co-circulation and co-infection of different influenza A virus strains in human populations. Further, we introduce novel strains via reassortment and investigate how the opportunities of a reassortant strain developing into a pandemic are constrained by its life-history and the residual immunity within human populations. We find that though the probability of pandemic emergence via reassortment increases with transmissibility of reassortant strains and the rate of reassortment, the existence of cross-immunity acquired through previous infections or vaccination can greatly constrain pandemic emergence.
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Effectiveness of trivalent and monovalent influenza vaccines against laboratory-confirmed influenza infection in persons with medically attended influenza-like illness in Bavaria, Germany, 2010/2011 season. Epidemiol Infect 2012; 141:1807-15. [PMID: 23098364 DOI: 10.1017/s0950268812002282] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We estimated the vaccine effectiveness (VE) of trivalent and monovalent influenza vaccines,respectively, against laboratory-confirmed influenza infections in patients with influenza-likeillness who visited physicians participating in the Bayern Influenza Sentinel in Bavaria, Germany during 2010/2011. Swab specimens were analysed for influenza A(H1N1)pdm09, A(H3) andB by PCR. VE was estimated using the test-negative case-control study design and logistic regression. In total, 1866 patients (790 cases, 1076 controls) were included. The VE of trivalentvaccines administered in season 2010/2011 against laboratory-confirmed infection with any influenza virus, adjusted for age group, sex, chronic illness and week of arrival of the specimen,was 67.8% [95% confidence interval (CI) 39.2–82.9)]. The adjusted VE of monovalent influenza vaccines administered in season 2009/2010 against laboratory-confirmed influenza A(H1N1)pdm09 infection in 2010/2011 was 38.6% (95% CI x 70.0 to 77 . 8). This is the first VE study conducted in Bavaria. We concluded that the trivalent influenza vaccines were effective in our study population
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Zhang Y, Seale H, Yang P, MacIntyre CR, Blackwell B, Tang S, Wang Q. Factors associated with the transmission of pandemic (H1N1) 2009 among hospital healthcare workers in Beijing, China. Influenza Other Respir Viruses 2012; 7:466-71. [PMID: 23078163 PMCID: PMC5779818 DOI: 10.1111/irv.12025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND With the increase in patient activity during the 2009 H1N1 pandemic, came an associated increase in occupational infections of healthcare workers (HCWs). OBJECTIVES The aim of this study was to examine factors associated with the transmission of pandemic (H1N1) 2009 among HCWs. METHODS A 1:4 matched case-control study by hospital, ward, age, and gender was conducted in HCWs from hospitals in Beijing during February 2010. Cases were diagnosed with pandemic (H1N1) 2009, and controls had neither influenza-like illness nor diagnosis with pandemic (H1N1) 2009 during August 2009 to January 2010. Information during 7 days before symptom onset of case was collected, and controls were queried about the same period. RESULTS A total of 51 cases identified via National Notifiable Infectious Disease Surveillance System participated in this study. Controls were matched to cases for a total of 255 individuals. About 19·6% (10/51) of cases and 26·0% (53/204) of controls recalled they had conducted a high-risk procedure on a patient with pandemic (H1N1) 2009. 72·5% (37/51) of cases and 71·6% (146/204) of controls stated they wore medical masks in ≥80% of working time. Only 5·9% (3/51) and 36·3% (74/204) of cases and controls, respectively, reported receiving pandemic vaccination. Participants receiving pandemic vaccination had a significantly lower risk of infection during the pandemic (OR = 0·150, 95% CI: 0·047-0·479, P = 0·001). The estimated vaccine effectiveness was 85·0%. CONCLUSIONS We showed a high vaccine effectiveness of the pandemic vaccine and that vaccination was the only factor significantly associated with risk of infection in HCWs.
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Affiliation(s)
- Yi Zhang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China
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Peeters M, Regner S, Vaman T, Devaster JM, Rombo L. Safety and immunogenicity of an AS03-adjuvanted A(H1N1)pmd09 vaccine administered simultaneously or sequentially with a seasonal trivalent vaccine in adults 61 years or older: data from two multicentre randomised trials. Vaccine 2012; 30:6483-91. [PMID: 22885014 DOI: 10.1016/j.vaccine.2012.07.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 07/23/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
Abstract
During the 2009-2010 Northern Hemisphere influenza season, both seasonal and pandemic influenza vaccines were expected to be administered to elderly people, which is an important target group for influenza vaccination. Two multicentre randomised clinical studies were conducted in participants aged ≥61 years to assess the immunogenicity and reactogenicity following vaccination with two doses of an AS03-adjuvanted A(H1N1)pmd09 vaccine when either sequentially administered (21 days before first dose [N=73] or 21 days after second dose [N=72]) or co-administered (first dose [N=84] or second dose [N=84]) with a licensed trivalent seasonal influenza vaccine (TIV). Overall, 313 participants from 2 centres in Sweden (ClinicalTrials.gov, NCT00968890) and 6 centres in Germany (NCT00971425) were randomised to one of the four treatment groups. The AS03-adjuvanted A(H1N1)pmd09 vaccine elicited a good immune response against A(H1N1)pmd09-like virus in all treatment groups after the first and second dose, meeting and exceeding the European licensing criteria for pandemic influenza vaccines. After one dose of the AS03-adjuvanted A(H1N1)pmd09 vaccine, haemagglutination inhibition seroconversion rates ranged from 85% (95% confidence interval: 74-93%) to 93% (85-97%), seroprotection rates from 87% (76-94%) to 96% (90-99%) and geometric mean fold rise from 15 (11-19) to 20 (16-25). The haemagglutination inhibition immune responses to the AS03-adjuvanted A(H1N1)pmd09 vaccine seemed lower when TIV was administered 3 weeks before, while immune responses to TIV seemed not affected by either vaccination schedule. Solicited symptoms were more frequently reported following administration of the AS03-adjuvanted A(H1N1)pmd09 vaccine compared to TIV, but these were mainly mild to moderate in intensity and transient in the four treatment groups. These results suggest that sequential or co-administration of the AS03-adjuvanted A(H1N1)pmd09 vaccine and TIV induced a good immune response to both vaccines and had a clinically acceptable safety profile in people aged ≥61 years.
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