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Nguyen TT, Nguyen TTD, Tran NMA, Nguyen HT, Vo GV. Microneedles enable the development of skin-targeted vaccines against coronaviruses and influenza viruses. Pharm Dev Technol 2021; 27:83-94. [PMID: 34802372 DOI: 10.1080/10837450.2021.2008967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Throughout the COVID-19 pandemic, many have seriously worried that the plus burden of seasonal influenza that might create a destructive scenario, resulting in overwhelmed healthcare capacities and onwards loss of life. Many efforts to develop a safe and efficacious vaccine to prevent infection by coronavirus and influenza, highlight the importance of vaccination to combat infectious pathogens. While vaccines are traditionally given as injections into the muscle, microneedle (MN) patches designed to precisely deliver cargos into the cutaneous microenvironment, rich in immune cells, provide a noninvasive and self-applicable vaccination approach, reducing overall costs and improving access to vaccines in places with limited supply. The current review aimed to highlight advances in research on the development of MNs-mediated cutaneous vaccine delivery. Concluding remarks and challenges on MNs-based skin immunization are also provided to contribute to the rational development of safe and effective MN-delivered vaccines against these emerging infectious diseases.
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Affiliation(s)
- Thuy Trang Nguyen
- Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Thi Thuy Dung Nguyen
- Faculty of Environmental and Food Engineering, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Nguyen-Minh-An Tran
- Faculty of Chemical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Huy Truong Nguyen
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Giau Van Vo
- Department of Biomedical Engineering, School of Medicine, Vietnam National University - Ho Chi Minh City (VNU-HCM), Ho Chi Minh City, Vietnam.,Research Center for Genetics and Reproductive Health (CGRH), School of Medicine, Vietnam National University - Ho Chi Minh City (VNU-HCM), Ho Chi Minh City, Vietnam.,Vietnam National University - Ho Chi Minh City (VNU-HCM), Ho Chi Minh City, Vietnam
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2
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García-Sempere A, Orrico-Sánchez A, Muñoz-Quiles C, Hurtado I, Peiró S, Sanfélix-Gimeno G, Diez-Domingo J. Data Resource Profile: The Valencia Health System Integrated Database (VID). Int J Epidemiol 2021; 49:740-741e. [PMID: 31977043 PMCID: PMC7394961 DOI: 10.1093/ije/dyz266] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Anibal García-Sempere
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Network for Health Services Research on Chronic Patients), Valencia, Spain
| | - Alejandro Orrico-Sánchez
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain
| | - Cintia Muñoz-Quiles
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain
| | - Isabel Hurtado
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Network for Health Services Research on Chronic Patients), Valencia, Spain
| | - Salvador Peiró
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Network for Health Services Research on Chronic Patients), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Network for Health Services Research on Chronic Patients), Valencia, Spain
| | - Javier Diez-Domingo
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain
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3
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Egunsola O, Clement F, Taplin J, Mastikhina L, Li JW, Lorenzetti DL, Dowsett LE, Noseworthy T. Immunogenicity and Safety of Reduced-Dose Intradermal vs Intramuscular Influenza Vaccines: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2035693. [PMID: 33560425 PMCID: PMC7873776 DOI: 10.1001/jamanetworkopen.2020.35693] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Low-dose intradermal influenza vaccines could be a suitable alternative to full intramuscular dose during vaccine shortages. OBJECTIVE To compare the immunogenicity and safety of the influenza vaccine at reduced or full intradermal doses with full intramuscular doses to inform policy design in the event of vaccine shortages. DATA SOURCES MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies published from 2010 until June 5, 2020. STUDY SELECTION All comparative studies across all ages assessing the immunogenicity or safety of intradermal and intramuscular influenza vaccinations were included. DATA EXTRACTION AND SYNTHESIS Data were extracted by a single reviewer and verified by a second reviewer. Discrepancies between reviewers were resolved through consensus. Random-effects meta-analysis was conducted. MAIN OUTCOMES AND MEASURES Primary outcomes included geometric mean titer, seroconversion, seroprotection, and adverse events. RESULTS A total of 30 relevant studies were included; 29 studies were randomized clinical trials with 13 759 total participants, and 1 study was a cohort study of 164 021 participants. There was no statistically significant difference in seroconversion rates between the 3-µg, 6-µg, 7.5-µg, and 9-µg intradermal vaccine doses and the 15-µg intramuscular vaccine dose for each of the H1N1, H3N2, and B strains, but rates were significantly higher with the 15-µg intradermal dose compared with the 15-µg intramuscular dose for the H1N1 strain (rate ratio [RR], 1.10; 95% CI, 1.01-1.20) and B strain (RR, 1.40; 95% CI, 1.13-1.73). Seroprotection rates for the 9-µg and 15-µg intradermal doses did not vary significantly compared with the 15-µg intramuscular dose for all the 3 strains, except for the 15-µg intradermal dose for the H1N1 strain, for which rates were significantly higher (RR, 1.05; 95% CI, 1.01-1.09). Local adverse events were significantly higher with intradermal doses than with the 15-µg intramuscular dose, particularly erythema (3-µg dose: RR, 9.62; 95% CI, 1.07-86.56; 6-µg dose: RR, 23.79; 95% CI, 14.42-39.23; 9-µg dose: RR, 4.56; 95% CI, 3.05-6.82; 15-µg dose: RR, 3.68; 95% CI, 3.19-4.25) and swelling (3-µg dose: RR, 20.16; 95% CI, 4.68-86.82; 9-µg dose: RR, 5.23; 95% CI, 3.58-7.62; 15-µg dose: RR, 3.47 ; 95% CI, 2.21-5.45). Fever and chills were significantly more common with the 9-µg intradermal dose than the 15-µg intramuscular dose (fever: RR, 1.36; 95% CI, 1.03-1.80; chills: RR, 1.24; 95% CI, 1.03-1.50) while all other systemic adverse events were not statistically significant for all other doses. CONCLUSIONS AND RELEVANCE These findings suggest that reduced-dose intradermal influenza vaccination could be a reasonable alternative to standard dose intramuscular vaccination.
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Affiliation(s)
- Oluwaseun Egunsola
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Fiona Clement
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - John Taplin
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Liza Mastikhina
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Joyce W. Li
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Diane L. Lorenzetti
- Department Community Health Sciences, University of Calgary Alberta, Canada
- Health Sciences Library, University of Calgary, Alberta, Canada
| | - Laura E. Dowsett
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Tom Noseworthy
- Department Community Health Sciences, University of Calgary Alberta, Canada
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4
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Pan J, Cui Z. Self-Assembled Nanoparticles: Exciting Platforms for Vaccination. Biotechnol J 2020; 15:e2000087. [PMID: 33411412 DOI: 10.1002/biot.202000087] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/25/2020] [Indexed: 12/14/2022]
Abstract
Vaccination is successfully advanced to control several fatal diseases and improve human life expectancy. However, additional innovations are required in this field because there are no effective vaccines to prevent some infectious diseases. The shift from the attenuated or inactivated pathogens to safer but less immunogenic protein or peptide antigens has led to a search for effective antigen delivery carriers that can function as both antigen vehicles and intrinsic adjuvants. Among these carriers, self-assembled nanoparticles (SANPs) have shown great potential to be the best representative. For the nanoscale and multiple presentation of antigens, with accurate control over size, geometry, and functionality, these nanoparticles are assembled spontaneously and mimic pathogens, resulting in enhanced antigen presentation and increased cellular and humoral immunity responses. In addition, they may be applied through needle-free routes due to their adhesive ability, which gives them a great future in vaccination applications. This review provides an overview of various SANPs and their applications in prophylactic vaccines.
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Affiliation(s)
- Jingdi Pan
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Zongqiang Cui
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430071, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
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5
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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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6
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Joyce JC, Carroll TD, Collins ML, Chen MH, Fritts L, Dutra JC, Rourke TL, Goodson JL, McChesney MB, Prausnitz MR, Rota PA. A Microneedle Patch for Measles and Rubella Vaccination Is Immunogenic and Protective in Infant Rhesus Macaques. J Infect Dis 2018; 218:124-132. [PMID: 29701813 PMCID: PMC5989599 DOI: 10.1093/infdis/jiy139] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/13/2018] [Indexed: 01/16/2023] Open
Abstract
Background New methods to increase measles and rubella (MR) vaccination coverage are needed to achieve global and regional MR elimination goals. Methods Here, we developed microneedle (MN) patches designed to administer MR vaccine by minimally trained personnel, leave no biohazardous sharps waste, remove the need for vaccine reconstitution, and provide thermostability outside the cold chain. This study evaluated the immunogenicity of MN patches delivering MR vaccine to infant rhesus macaques. Results Protective titers of measles neutralizing antibodies (>120 mIU/mL) were detected in 100% of macaques in the MN group and 75% of macaques in the subcutaneous (SC) injection group. Rubella neutralizing antibody titers were >10 IU/mL for all groups. All macaques in the MN group were protected from challenge with wild-type measles virus, whereas 75% were protected in the SC group. However, vaccination by the MN or SC route was unable to generate protective immune responses to measles in infant macaques pretreated with measles immunoglobulin to simulate maternal antibody. Conclusions These results show, for the first time, that MR vaccine delivered by MN patch generated protective titers of neutralizing antibodies to both measles and rubella in infant rhesus macaques and afforded complete protection from measles virus challenge.
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Affiliation(s)
- Jessica C Joyce
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta
| | - Timothy D Carroll
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | | | - Min-hsin Chen
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Linda Fritts
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | - Joseph C Dutra
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | - Tracy L Rourke
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | | | - Michael B McChesney
- Center for Comparative Medicine, and California National Primate Research Center, University of California, Davis, CA
| | - Mark R Prausnitz
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Paul A Rota
- Centers for Disease Control and Prevention, Atlanta, GA
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7
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Puig-Barberà J, Guglieri-López B, Tortajada-Girbés M, López-Labrador FX, Carballido-Fernández M, Mollar-Maseres J, Schwarz-Chavarri G, Baselga-Moreno V, Mira-Iglesias A, Díez-Domingo J. Low influenza vaccine effectiveness and the effect of previous vaccination in preventing admission with A(H1N1)pdm09 or B/Victoria-Lineage in patients 60 years old or older during the 2015/2016 influenza season. Vaccine 2017; 35:7331-7338. [PMID: 29128380 DOI: 10.1016/j.vaccine.2017.10.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/15/2017] [Accepted: 10/31/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The 2015/2016 influenza season was characterized in Europe by the circulation of A(H1N1)pdm09 clade 6B.1 and B/Victoria-lineage influenza viruses. The components of the vaccines used in the current and past two seasons in the Valencia region were similar but not well matched to the 2015/2016 dominant influenza-circulating strains. We estimate influenza vaccine effectiveness (IVE) and interference of previous vaccination in preventing admission with A(H1N1)pdm09 or B/Victoria-lineage in this particular season. METHODS The Valencia Hospital Network for the Study of Influenza runs an active surveillance hospital-based study to collect clinical and virological data from consecutive admissions possibly related to influenza. Combined nasopharyngeal and pharyngeal swabs are analyzed by reverse transcription polymerase chain reaction, and the hemagglutinin is sequenced in a sample of positive influenza specimens. Vaccination is ascertained consulting a population vaccine information system. We estimate IVE using a test-negative approach. RESULTS During the 2015-2016 season, we recruited 1049 eligible admissions of patients 60 years or older, and 187 tested positive for influenza. The adjusted IVE in preventing admission with A(H1N1)pdm09 was 20.2%; 95% confidence interval (CI) -21.3-47.5% and -33.2%; 95% CI, -140.1-26.1% in preventing admission with B/Victoria-lineage. The majority of A(H1N1)pdm09 sequenced viruses belonged to the emerging 6B.1 subclade, defined by S162N and I216T mutations in the hemagglutinin protein. When we restricted our analysis to those not vaccinated in the previous year, unadjusted IVE was 84.9% (95% CI 9.9-100.0) overall, 77.9% (-32.7-100.0%) in preventing A(H1N1)pdm09 and 48.8% (-219.5-100.0%) in preventing B/Yamagata-lineage admission. CONCLUSIONS Our findings indicate that IVE was low in preventing A(H1N1)pdm09 and strongly correlated with vaccination in the previous season. No effect in preventing admission with B/Victoria-lineage was observed. For the 2015/2016 season, IVE was low due to a mismatch and lack of concordance between the circulating and vaccine viruses.
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Affiliation(s)
- Joan Puig-Barberà
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain; Centro de Salud Pública de Castellón, Castellón, Spain.
| | - Beatriz Guglieri-López
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | | | - F Xavier López-Labrador
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Víctor Baselga-Moreno
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
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8
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Puig-Barberà J, Mira-Iglesias A, Tortajada-Girbés M, López-Labrador FX, Librero-López J, Díez-Domingo J, Carballido-Fernández M, Carratalá-Munuera C, Correcher-Medina P, Gil-Guillén V, Limón-Ramírez R, Mollar-Maseres J, Otero-Reigada MC, Schwarz H. Waning protection of influenza vaccination during four influenza seasons, 2011/2012 to 2014/2015. Vaccine 2017; 35:5799-5807. [PMID: 28941618 DOI: 10.1016/j.vaccine.2017.09.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/06/2017] [Accepted: 09/12/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Concerns have been raised about intraseasonal waning of the protection conferred by influenza vaccination. METHODS During four influenza seasons, we consecutively recruited individuals aged 18years or older who had received seasonal influenza vaccine and were subsequently admitted to the hospital for influenza infection, asassessed by reverse transcription polymerase chain reaction. We estimated the adjusted odds ratio (aOR) of influenza infection by date of vaccination, defined by tertiles, as early, intermediate or late vaccination. We used a test-negative approach with early vaccination as reference to estimate the aOR of hospital admission with influenza among late vaccinees. We conducted sensitivity analyses by means of conditional logistic regression, Cox proportional hazards regression, and using days between vaccination and hospital admission rather than vaccination date. RESULTS Among 3615 admitted vaccinees, 822 (23%) were positive for influenza. We observed a lower risk of influenza among late vaccinees during the 2011/2012 and 2014/2015A(H3N2)-dominant seasons: aOR=0.68 (95% CI: 0.47-1.00) and 0.69 (95% CI: 0.50-0.95). We found no differences in the risk of admission with influenza among late versus early vaccinees in the 2012/2013A(H1N1)pdm09-dominant or 2013/2014B/Yamagata lineage-dominant seasons: aOR=1.18 (95% CI: 0.58-2.41) and 0.98 (95% CI: 0.56-1.72). When we restricted our analysis to individuals aged 65years or older, we found a statistically significant lower risk of admission with influenza among late vaccinees during the 2011/2012 and 2014/2015A(H3N2)-dominant seasons: aOR=0.61 (95% CI: 0.41-0.91) and 0.69 (95% CI: 0.49-0.96). We observed 39% (95% CI: 9-59%) and 31% (95% CI: 5-50%) waning of vaccine effectiveness among participants aged 65years or older during the two A(H3N2)-dominant seasons. Similar results were obtained in the sensitivity analyses. CONCLUSION Waning of vaccine protection was observed among individuals aged 65years old or over in two A(H3N2)-dominant influenza seasons.
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Affiliation(s)
- J Puig-Barberà
- FISABIO-Salud Pública, 46020 Valencia, Spain; Centro de Salud Pública de Castellón, 12003 Castellón, Spain.
| | | | | | - F X López-Labrador
- FISABIO-Salud Pública, 46020 Valencia, Spain; CIBERESP, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - J Librero-López
- Navarrabiomed - Fundación Miguel Servet, 31008 Pamplona, Spain; REDISSEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - M Carballido-Fernández
- Universidad CEU-UCH, 12006 Castellón, Spain; Hospital General Universitario de Castellón, 12004 Castellón, Spain
| | - C Carratalá-Munuera
- Universidad Miguel Hernández, 03202 Elche, Spain; Hospital San Juan de Alicante, 03550 Alicante, Spain
| | | | | | | | | | | | - H Schwarz
- Hospital General de Alicante, 03010 Alicante, Spain
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9
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Levin Y, Kochba E, Shukarev G, Rusch S, Herrera-Taracena G, van Damme P. A phase 1, open-label, randomized study to compare the immunogenicity and safety of different administration routes and doses of virosomal influenza vaccine in elderly. Vaccine 2016; 34:5262-5272. [PMID: 27667332 DOI: 10.1016/j.vaccine.2016.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/30/2016] [Accepted: 09/04/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Influenza remains a significant problem in elderly despite widespread vaccination coverage. This randomized, phase-I study in elderly compared different strategies of improving vaccine immunogenicity. METHODS A total of 370 healthy participants (⩾65years) were randomized equally 1:1:1:1:1:1 to six influenza vaccine treatments (approximately 60-63 participants per treatment arm) at day 1 that consisted of three investigational virosomal vaccine formulations at doses of 7.5, 15, and 45μg HA antigen/strain administered intradermally (ID) by MicronJet600™ microneedle device (NanoPass Technologies) or intramuscularly (IM), and three comparator registered seasonal vaccines; Inflexal V™ (Janssen) and MF59 adjuvanted Fluad™ (Novartis) administered IM and Intanza™ (Sanofi Pasteur) administered ID via Soluvia™ prefilled microinjection system (BD). Serological evaluations were performed at days 22 and 90 and safety followed-up for 6months. RESULTS Intradermal delivery of virosomal vaccine using MicronJet600™ resulted in significantly higher immunogenicity than the equivalent dose of virosomal Inflexal V™ administered intramuscularly across most of the parameters and strains, as well as in some of the readouts and strains as compared with the 45μg dose of virosomal vaccine formulation. Of 370 participants, 300 (81.1%) reported ⩾1 adverse event (AE); more participants reported solicited local AEs (72.2%) than solicited systemic AEs (12.2%). CONCLUSIONS Intradermal delivery significantly improved influenza vaccine immunogenicity compared with intramuscular delivery. Triple dose (45μg) virosomal vaccine did not demonstrate any benefit on vaccine's immunogenicity over 15μg commercial presentation. All treatments were generally safe and well-tolerated.
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MESH Headings
- Adjuvants, Immunologic
- Aged
- Aged, 80 and over
- Aging/immunology
- Antibodies, Viral/blood
- Dose-Response Relationship, Immunologic
- Drug Administration Routes
- Female
- Humans
- Immunogenicity, Vaccine
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/adverse effects
- Influenza Vaccines/immunology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Injections, Intradermal
- Injections, Intramuscular
- Male
- Vaccines, Virosome/administration & dosage
- Vaccines, Virosome/adverse effects
- Vaccines, Virosome/immunology
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Affiliation(s)
| | | | | | - Sarah Rusch
- Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Pierre van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Belgium
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10
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Kelchen MN, Siefers KJ, Converse CC, Farley MJ, Holdren GO, Brogden NK. Micropore closure kinetics are delayed following microneedle insertion in elderly subjects. J Control Release 2016; 225:294-300. [DOI: 10.1016/j.jconrel.2016.01.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/01/2015] [Accepted: 01/27/2016] [Indexed: 11/24/2022]
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11
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Microneedle patches for vaccination in developing countries. J Control Release 2015; 240:135-141. [PMID: 26603347 DOI: 10.1016/j.jconrel.2015.11.019] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/31/2015] [Accepted: 11/17/2015] [Indexed: 12/17/2022]
Abstract
Millions of people die of infectious diseases each year, mostly in developing countries, which could largely be prevented by the use of vaccines. While immunization rates have risen since the introduction of the Expanded Program on Immunization (EPI), there remain major challenges to more effective vaccination in developing countries. As a possible solution, microneedle patches containing an array of micron-sized needles on an adhesive backing have been developed to be used for vaccine delivery to the skin. These microneedle patches can be easily and painlessly applied by pressing against the skin and, in some designs, do not leave behind sharps waste. The patches are single-dose, do not require reconstitution, are easy to administer, have reduced size to simplify storage, transportation and waste disposal, and offer the possibility of improved vaccine immunogenicity, dose sparing and thermostability. This review summarizes vaccination challenges in developing countries and discusses advantages that microneedle patches offer for vaccination to address these challenges. We conclude that microneedle patches offer a powerful new technology that can enable more effective vaccination in developing countries.
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12
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Arakane R, Annaka R, Takahama A, Ishida K, Yoshiike M, Nakayama T, Takeshita F. Superior immunogenicity profile of the new intradermal influenza vaccine compared to the standard subcutaneous vaccine in subjects 65 years and older: A randomized controlled phase III study. Vaccine 2015; 33:6650-8. [PMID: 26519549 DOI: 10.1016/j.vaccine.2015.10.088] [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: 07/10/2015] [Revised: 10/09/2015] [Accepted: 10/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the elderly are at high risk for influenza, the immunogenicity in the elderly is lower than that in younger adults. We developed the new type of seasonal influenza vaccine with the novel intradermal (ID) injection system. In the previous exploratory phase I/II study of the ID vaccine with a dose of 15 μg HA per strain showed the superior immunogenicity profile to that of the standard subcutaneous (SC) injection vaccine in subjects aged 20 years and older. METHODS In this multicenter, randomized, double-blind, active controlled study, 900 adults aged 65 years and older were randomized at an equal ratio to either the ID vaccine group or the licensed standard SC vaccine group. Immunogenicity was assessed using serum hemagglutination inhibition (HAI) titers. The co-primary endpoints were the geometrical mean titers (GMT) and the seroconversion rates (SCR) of HAI titers against 3 vaccine strains on Day 21 (21 days after vaccination). To evaluate the early phase immunogenicity, the GMTs and SCRs on Day 7 were also assessed in the same way as the secondary endpoints. RESULTS The superiority of the ID vaccine in the GMTs and SCRs were demonstrated in all 3 vaccine strains both on Day 7 and Day 21. The frequency of any injection-site reactions was higher in the ID vaccine group, while the severity of injection-site reactions and the frequency of systemic AEs were comparable between the ID and the SC vaccine groups. CONCLUSIONS A single-dose of the influenza vaccine with the novel ID injection system and a dose of 15 μg HA was suggested as an appropriate regimen for clinical use in influenza prevention and associated disease burden reduction. It was also suggested that the new ID vaccine has the potential to replace the standard influenza vaccine from the view point of immunogenicity and safety. TRIAL REGISTRATION JAPIC Clinical Trials Information (JapicCTI-142493).
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Affiliation(s)
| | | | | | | | | | - Tetsuo Nakayama
- Kitasato Institute for Life Sciences, Laboratory of Viral Infection, Japan
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13
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Levin Y, Kochba E, Hung I, Kenney R. Intradermal vaccination using the novel microneedle device MicronJet600: Past, present, and future. Hum Vaccin Immunother 2015; 11:991-7. [PMID: 25745830 PMCID: PMC4514308 DOI: 10.1080/21645515.2015.1010871] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/24/2014] [Accepted: 01/06/2015] [Indexed: 02/08/2023] Open
Abstract
Intradermal immunization has become a forefront of vaccine improvement, both scientifically and commercially. Newer technologies are being developed to address the need to reduce the dose required for vaccination and to improve the reliability and ease of injection, which have been major hurdles in expanding the number of approved vaccines using this route of administration. In this review, 7 y of clinical experience with a novel intradermal delivery device, the MicronJet600, which is a registered hollow microneedle that simplifies the delivery of liquid vaccines, are summarized. This device has demonstrated both significant dose-sparing and superior immunogenicity in various vaccine categories, as well as in diverse subject populations and age groups. These studies have shown that intradermal delivery using this device is safe, effective, and preferred by the subjects. Comparison with other intradermal devices and potential new applications for intradermal delivery that could be pursued in the future are also discussed.
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Key Words
- AE, adverse event
- BCG, Bacillus Calmette–Guérin
- BD, Becton Dickinson
- CDC, Center of Disease Control
- DTP, diphtheria, pertussis and tetanus
- EMEA, European Medicines Agency
- FDA, Food and Drug Administration
- GMT, geometric mean titer
- HA, hemagglutinin
- HBV, hepatitis B virus
- HIV, Human immunodeficiency virus
- HPV, human papilloma virus
- ID, intradermal
- IM, Intramuscular
- IPV, inactivated polio vaccine
- MEMS, Micro Electro Mechanical System
- Mantoux
- PPD, Purified protein derivative
- SAGE, Strategic Advisory Group of Experts
- SQ, subcutaneous
- WHO, World Health Organization
- dose-sparing
- icddr,b, International Center for Diarrheal Disease Research, Bangladesh
- immunogenicity
- influenza vaccine
- intradermal
- microneedles
- vaccine delivery
- vaccine device
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Affiliation(s)
| | | | - Ivan Hung
- State Key Laboratory for Emerging Infectious Diseases; Carol Yu's Center for Infection and Division of Infectious Diseases; The University of Hong Kong; Queen Mary Hospital;Hong Kong Special Administrative Region; Hong Kong, China
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