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Thwaites RS, Uruchurtu ASS, Negri VA, Cole ME, Singh N, Poshai N, Jackson D, Hoschler K, Baker T, Scott IC, Ros XR, Cohen ES, Zambon M, Pollock KM, Hansel TT, Openshaw PJM. Early mucosal events promote distinct mucosal and systemic antibody responses to live attenuated influenza vaccine. Nat Commun 2023; 14:8053. [PMID: 38052824 PMCID: PMC10697962 DOI: 10.1038/s41467-023-43842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
Compared to intramuscular vaccines, nasally administered vaccines have the advantage of inducing local mucosal immune responses that may block infection and interrupt transmission of respiratory pathogens. Live attenuated influenza vaccine (LAIV) is effective in preventing influenza in children, but a correlate of protection for LAIV remains unclear. Studying young adult volunteers, we observe that LAIV induces distinct, compartmentalized, antibody responses in the mucosa and blood. Seeking immunologic correlates of these distinct antibody responses we find associations with mucosal IL-33 release in the first 8 hours post-inoculation and divergent CD8+ and circulating T follicular helper (cTfh) T cell responses 7 days post-inoculation. Mucosal antibodies are induced separately from blood antibodies, are associated with distinct immune responses early post-inoculation, and may provide a correlate of protection for mucosal vaccination. This study was registered as NCT04110366 and reports primary (mucosal antibody) and secondary (blood antibody, and nasal viral load and cytokine) endpoint data.
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Affiliation(s)
- Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK.
| | | | - Victor Augusti Negri
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Megan E Cole
- Department of Infectious Disease, Imperial College London, London, UK
| | - Nehmat Singh
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nelisa Poshai
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Tina Baker
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Ian C Scott
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Xavier Romero Ros
- Bioscience Asthma and Skin Immunity, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Emma Suzanne Cohen
- Bioscience Asthma and Skin Immunity, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Maria Zambon
- United Kingdom Health Security Agency, London, UK
| | - Katrina M Pollock
- Department of Infectious Disease, Imperial College London, London, UK
| | - Trevor T Hansel
- National Heart and Lung Institute, Imperial College London, London, UK
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Amendola A, Borghi E, Bianchi S, Gori M, Fappani C, Barcellini L, Forlanini F, Garancini N, Nava C, Mari A, Sala A, Gasparini C, Ottaviano E, Colzani D, Biganzoli EM, Tanzi E, Zuccotti GV. Preschool-located influenza vaccination and influenza-like illness surveillance: an Italian pilot experience. Ital J Pediatr 2023; 49:91. [PMID: 37480047 PMCID: PMC10362647 DOI: 10.1186/s13052-023-01481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/01/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND We describe the first school-located influenza vaccination campaign with quadrivalent live-attenuated influenza vaccine (LAIV) among pre-school children in Italy, coupled with an innovative school-centred influenza-like illnesses (ILIs) surveillance using a self-sampling non-invasive saliva collection method. METHODS The pilot study was proposed during the 2021/2022 influenza season to fifteen pre-schools in the Milan municipality. LAIV was offered directly in school to all healthy children without contraindications. ILI differential diagnosis was conducted by real-time RT-PCR for influenza A/B and SARS-CoV-2. RESULTS Five pre-schools were involved in the pilot project and overall, 135 families (31.2%) participated in the study, adhering to both surveillance and vaccination; 59% of families had an immigrant background. No pupil experienced adverse reactions after vaccination. Nineteen saliva samples were collected from sixteen children (11.8%). Six samples (31.6%) tested positive for SARS-CoV-2; none was positive for influenza A/B. CONCLUSIONS The participation in the immunisation campaign was good, considering possible absences due to COVID-19 pandemic, and the intranasal administration was well tolerated and helped to overcome parental hesitancy. Saliva sampling represented a useful tool to reduce children's stress and increase parents' compliance. The high participation of families with an immigrant background suggests that school-based interventions can represent an effective strategy to overcome socioeconomic and cultural barriers.
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Affiliation(s)
- Antonella Amendola
- Department of Health Sciences, Università degli Studi di Milano, Milan, 20142, Italy.
- EpiSoMI CRC-Coordinated Research Centre, Università degli Studi di Milano, Milan, 20133, Italy.
| | - Elisa Borghi
- Department of Health Sciences, Università degli Studi di Milano, Milan, 20142, Italy
- EpiSoMI CRC-Coordinated Research Centre, Università degli Studi di Milano, Milan, 20133, Italy
| | - Silvia Bianchi
- Department of Health Sciences, Università degli Studi di Milano, Milan, 20142, Italy
- EpiSoMI CRC-Coordinated Research Centre, Università degli Studi di Milano, Milan, 20133, Italy
| | - Maria Gori
- Department of Health Sciences, Università degli Studi di Milano, Milan, 20142, Italy
- EpiSoMI CRC-Coordinated Research Centre, Università degli Studi di Milano, Milan, 20133, Italy
| | - Clara Fappani
- Department of Health Sciences, Università degli Studi di Milano, Milan, 20142, Italy
- EpiSoMI CRC-Coordinated Research Centre, Università degli Studi di Milano, Milan, 20133, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, 20133, Italy
| | - Lucia Barcellini
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, Milan, 20154, Italy
| | - Federica Forlanini
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, Milan, 20154, Italy
| | - Nicolò Garancini
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, Milan, 20154, Italy
| | - Chiara Nava
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, Milan, 20154, Italy
| | - Alessandra Mari
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, Milan, 20154, Italy
| | - Anna Sala
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, Milan, 20154, Italy
| | - Chiara Gasparini
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, Milan, 20154, Italy
| | - Emerenziana Ottaviano
- Department of Health Sciences, Università degli Studi di Milano, Milan, 20142, Italy
- EpiSoMI CRC-Coordinated Research Centre, Università degli Studi di Milano, Milan, 20133, Italy
| | - Daniela Colzani
- Department of Health Sciences, Università degli Studi di Milano, Milan, 20142, Italy
| | - Elia Mario Biganzoli
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, 20157, Italy
| | - Elisabetta Tanzi
- Department of Health Sciences, Università degli Studi di Milano, Milan, 20142, Italy
- EpiSoMI CRC-Coordinated Research Centre, Università degli Studi di Milano, Milan, 20133, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, Università degli Studi di Milano, Milan, 20154, Italy
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Hoschler K, Ijaz S, Andrews N, Ho S, Dicks S, Jegatheesan K, Poh J, Warrener L, Kankeyan T, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Brown KE, Ramsay ME, Brown D, Parry JV, Ladhani SN, Zambon M. SARS Antibody Testing in Children: Development of Oral Fluid Assays for IgG Measurements. Microbiol Spectr 2022; 10:e0078621. [PMID: 34985331 PMCID: PMC8729769 DOI: 10.1128/spectrum.00786-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/01/2021] [Indexed: 12/31/2022] Open
Abstract
Seroepidemiological studies to monitor antibody kinetics are important for assessing the extent and spread of SARS-CoV-2 in a population. Noninvasive sampling methods are advantageous for reducing the need for venipuncture, which may be a barrier to investigations, particularly in pediatric populations. Oral fluids are obtained by gingiva-crevicular sampling from children and adults and are very well accepted. Enzyme immunoassays (EIAs) based on these samples have acceptable sensitivity and specificity compared to conventional serum-based antibody EIAs and are suitable for population-based surveillance. We describe the development and evaluation of SARS-CoV-2 IgG EIAs using SARS-CoV-2 viral nucleoprotein (NP) and spike (S) proteins in IgG isotype capture format and an indirect receptor-binding-domain (RBD) IgG EIA, intended for use in children as a primary endpoint. All three assays were assessed using a panel of 1,999 paired serum and oral fluids from children and adults participating in school SARS-CoV-2 surveillance studies during and after the first and second pandemic wave in the United Kingdom. The anti-NP IgG capture assay was the best candidate, with an overall sensitivity of 75% (95% confidence interval [CI]: 71 to 79%) and specificity of 99% (95% CI: 78 to 99%) compared with paired serum antibodies. Sensitivity observed in children (80%, 95% CI: 71 to 88%) was higher than that in adults (67%, CI: 60% to 74%). Oral fluid assays (OF) using spike protein and RBD antigens were also 99% specific and achieved reasonable but lower sensitivity in the target population (78%, 95% CI [68% to 86%] and 53%, 95% CI [43% to 64%], respectively). IMPORTANCE We report on the first large-scale assessment of the suitability of oral fluids for detection of SARS-CoV-2 antibody obtained from healthy children attending school. The sample type (gingiva-crevicular fluid, which is a transudate of blood but is not saliva) can be self collected. Although detection of antibodies in oral fluids is less sensitive than that in blood, our study suggests an optimal format for operational use. The laboratory methods we have developed can reliably measure antibodies in children, who are able to take their own samples. Our findings are of immediate practical relevance for use in large-scale seroprevalence studies designed to measure exposure to infection, as they typically require venipuncture. Overall, our data indicate that OF assays based on the detection of SARS-CoV-2 antibodies are a tool suitable for population-based seroepidemiology studies in children and highly acceptable in children and adults, as venipuncture is no longer necessary.
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Affiliation(s)
- Katja Hoschler
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Samreen Ijaz
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Nick Andrews
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Sammy Ho
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Steve Dicks
- Virus Reference Department, Public Health England, London, United Kingdom
- Microbiology Services Laboratory, NHS Blood and Transplant, Bristol, United Kingdom
| | - Keerthana Jegatheesan
- Virus Reference Department, Public Health England, London, United Kingdom
- Microbiology Services Laboratory, NHS Blood and Transplant, Bristol, United Kingdom
| | - John Poh
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Lenesha Warrener
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Thivya Kankeyan
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Frances Baawuah
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | | | | | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Aston, United Kingdom
| | - Andrew J. Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Bernadette Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Kevin E. Brown
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Mary E. Ramsay
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - David Brown
- Virus Reference Department, Public Health England, London, United Kingdom
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Vírus Respiratórios e do Sarampo, Rio de Janeiro, Rio de Janeiro, Brasil
| | - John V. Parry
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Shamez N. Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George’s University of London, London, United Kingdom
| | - Maria Zambon
- Virus Reference Department, Public Health England, London, United Kingdom
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Tsunetsugu-Yokota Y, Ito S, Adachi Y, Onodera T, Kageyama T, Takahashi Y. Saliva as a useful tool for evaluating upper mucosal antibody response to influenza. PLoS One 2022; 17:e0263419. [PMID: 35130308 PMCID: PMC8820602 DOI: 10.1371/journal.pone.0263419] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
Mucosal immunity plays a crucial role in controlling upper respiratory infections, including influenza. We established a quantitative ELISA to measure the amount of influenza virus-specific salivery IgA (sIgA) and salivary IgG (sIgG) antibodies using a standard antibody broadly reactive to the influenza A virus. We then analyzed saliva and serum samples from seven individuals infected with the A(H1N1)pdm09 influenza virus during the 2019-2020 flu seasons. We detected an early (6-10 days post-infection) increase of sIgA in five of the seven samples and a later (3-5 weeks) increase of sIgG in six of the seven saliva samples. Although the conventional parenteral influenza vaccine did not induce IgA production in saliva, vaccinated individuals with a history of influenza infection had higher basal levels of sIgA than those without a history. Interestingly, we observed sIgA and sIgG in an asymptomatic individual who had close contact with two influenza cases. Both early mucosal sIgA secretion and late systemically induced sIgG in the mucosal surface may protect against virus infection. Despite the small sample size, our results indicate that the saliva test system can be useful for analyzing upper mucosal immunity in influenza.
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MESH Headings
- Adult
- Aged
- Antibodies, Viral/analysis
- Antibodies, Viral/metabolism
- Antibody Formation
- Cohort Studies
- Female
- History, 21st Century
- Humans
- Immunity, Mucosal/physiology
- Immunoglobulin A/analysis
- Immunoglobulin A/metabolism
- Immunoglobulin A, Secretory/analysis
- Immunoglobulin A, Secretory/metabolism
- Immunoglobulin G/analysis
- Immunoglobulin G/metabolism
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza Vaccines/therapeutic use
- Influenza, Human/diagnosis
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Japan
- Longitudinal Studies
- Male
- Predictive Value of Tests
- Prognosis
- Saliva/chemistry
- Saliva/immunology
- Saliva/metabolism
- Young Adult
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Affiliation(s)
- Yasuko Tsunetsugu-Yokota
- Department of Medical Technology, School of Human Sciences, Tokyo University of Technology, Tokyo, Japan
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Sayaka Ito
- Department of Medical Technology, School of Human Sciences, Tokyo University of Technology, Tokyo, Japan
- Department of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Yu Adachi
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Taishi Onodera
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tsutomu Kageyama
- Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshimasa Takahashi
- Research Center for Drug and Vaccine Development, National Institute of Infectious Diseases, Tokyo, Japan
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5
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Cole ME, Kundu R, Abdulla AF, Andrews N, Hoschler K, Southern J, Jackson D, Miller E, Zambon M, Turner PJ, Tregoning JS. Pre-existing influenza-specific nasal IgA or nasal viral infection does not affect live attenuated influenza vaccine immunogenicity in children. Clin Exp Immunol 2021; 204:125-133. [PMID: 33314126 PMCID: PMC7944357 DOI: 10.1111/cei.13564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
The United Kingdom has a national immunization programme which includes annual influenza vaccination in school-aged children, using live attenuated influenza vaccine (LAIV). LAIV is given annually, and it is unclear whether repeat administration can affect immunogenicity. Because LAIV is delivered intranasally, pre-existing local antibody might be important. In this study, we analysed banked samples from a study performed during the 2017/18 influenza season to investigate the role of pre-existing influenza-specific nasal immunoglobulin (Ig)A in children aged 6-14 years. Nasopharyngeal swabs were collected prior to LAIV immunization to measure pre-existing IgA levels and test for concurrent upper respiratory tract viral infections (URTI). Oral fluid samples were taken at baseline and 21-28 days after LAIV to measure IgG as a surrogate of immunogenicity. Antibody levels at baseline were compared with a pre-existing data set of LAIV shedding from the same individuals, measured by reverse transcription-polymerase chain reaction. There was detectable nasal IgA specific to all four strains in the vaccine at baseline. However, baseline nasal IgA did not correlate with the fold change in IgG response to the vaccine. Baseline nasal IgA also did not have an impact upon whether vaccine virus RNA was detectable after immunization. There was no difference in fold change of antibody between individuals with and without an URTI at the time of immunization. Overall, we observed no effect of pre-existing influenza-specific nasal antibody levels on immunogenicity, supporting annual immunization with LAIV in children.
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MESH Headings
- Administration, Intranasal
- Adolescent
- Antibodies, Viral/immunology
- Child
- Female
- Humans
- Immunogenicity, Vaccine/immunology
- Immunoglobulin A/immunology
- Immunoglobulin G/immunology
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Nasal Cavity/immunology
- Nasal Cavity/virology
- Vaccination/methods
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/immunology
- Virus Shedding/immunology
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Affiliation(s)
- M. E. Cole
- Department of Infectious DiseaseImperial College London (St Mary’s Campus)LondonUK
- Present address:
MEC – The Pirbright InstitutePirbrightUK
| | - R. Kundu
- Health Protection Research Unit in Respiratory InfectionsImperial College LondonLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - A. F. Abdulla
- Department of Infectious DiseaseImperial College London (St Mary’s Campus)LondonUK
| | - N. Andrews
- Public Health England (Colindale)LondonUK
| | | | | | - D. Jackson
- Public Health England (Colindale)LondonUK
| | - E. Miller
- Public Health England (Colindale)LondonUK
| | - M. Zambon
- Public Health England (Colindale)LondonUK
| | - P. J. Turner
- Health Protection Research Unit in Respiratory InfectionsImperial College LondonLondonUK
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - J. S. Tregoning
- Department of Infectious DiseaseImperial College London (St Mary’s Campus)LondonUK
- Health Protection Research Unit in Respiratory InfectionsImperial College LondonLondonUK
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