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Cargnin Faccin F, Perez DR. Pandemic preparedness through vaccine development for avian influenza viruses. Hum Vaccin Immunother 2024; 20:2347019. [PMID: 38807261 PMCID: PMC11141480 DOI: 10.1080/21645515.2024.2347019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/30/2024] Open
Abstract
Influenza A viruses pose a significant threat to global health, impacting both humans and animals. Zoonotic transmission, particularly from swine and avian species, is the primary source of human influenza outbreaks. Notably, avian influenza viruses of the H5N1, H7N9, and H9N2 subtypes are of pandemic concern through their global spread and sporadic human infections. Preventing and controlling these viruses is critical due to their high threat level. Vaccination remains the most effective strategy for influenza prevention and control in humans, despite varying vaccine efficacy across strains. This review focuses specifically on pandemic preparedness for avian influenza viruses. We delve into vaccines tested in animal models and summarize clinical trials conducted on H5N1, H7N9, and H9N2 vaccines in humans.
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Affiliation(s)
- Flavio Cargnin Faccin
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Daniel R. Perez
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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Rostad CA, Atmar RL, Walter EB, Frey S, Meier JL, Sherman AC, Lai L, Tsong R, Kao CM, Raabe V, El Sahly HM, Keitel WA, Whitaker JA, Smith MJ, Schmader KE, Swamy GK, Abate G, Winokur P, Buchanan W, Cross K, Wegel A, Xu Y, Yildirim I, Kamidani S, Rouphael N, Roberts PC, Mulligan MJ, Anderson EJ. A Phase 2 Clinical Trial to Evaluate the Safety, Reactogenicity, and Immunogenicity of Different Prime-Boost Vaccination Schedules of 2013 and 2017 A(H7N9) Inactivated Influenza Virus Vaccines Administered With and Without AS03 Adjuvant in Healthy US Adults. Clin Infect Dis 2024; 78:1757-1768. [PMID: 38537255 PMCID: PMC11175706 DOI: 10.1093/cid/ciae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION A surge of human influenza A(H7N9) cases began in 2016 in China from an antigenically distinct lineage. Data are needed about the safety and immunogenicity of 2013 and 2017 A(H7N9) inactivated influenza vaccines (IIVs) and the effects of AS03 adjuvant, prime-boost interval, and priming effects of 2013 and 2017 A(H7N9) IIVs. METHODS Healthy adults (n = 180), ages 19-50 years, were enrolled into this partially blinded, randomized, multicenter phase 2 clinical trial. Participants were randomly assigned to 1 of 6 vaccination groups evaluating homologous versus heterologous prime-boost strategies with 2 different boost intervals (21 vs 120 days) and 2 dosages (3.75 or 15 μg of hemagglutinin) administered with or without AS03 adjuvant. Reactogenicity, safety, and immunogenicity measured by hemagglutination inhibition and neutralizing antibody titers were assessed. RESULTS Two doses of A(H7N9) IIV were well tolerated, and no safety issues were identified. Although most participants had injection site and systemic reactogenicity, these symptoms were mostly mild to moderate in severity; injection site reactogenicity was greater in vaccination groups receiving adjuvant. Immune responses were greater after an adjuvanted second dose, and with a longer interval between prime and boost. The highest hemagglutination inhibition geometric mean titer (95% confidence interval) observed against the 2017 A(H7N9) strain was 133.4 (83.6-212.6) among participants who received homologous, adjuvanted 3.75 µg + AS03/2017 doses with delayed boost interval. CONCLUSIONS Administering AS03 adjuvant with the second H7N9 IIV dose and extending the boost interval to 4 months resulted in higher peak antibody responses. These observations can broadly inform strategic approaches for pandemic preparedness. Clinical Trials Registration. NCT03589807.
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MESH Headings
- Humans
- Influenza Vaccines/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/adverse effects
- Adult
- Male
- Female
- Middle Aged
- Influenza A Virus, H7N9 Subtype/immunology
- Vaccines, Inactivated/immunology
- Vaccines, Inactivated/administration & dosage
- Vaccines, Inactivated/adverse effects
- Antibodies, Viral/blood
- Influenza, Human/prevention & control
- Influenza, Human/immunology
- Young Adult
- Immunization, Secondary
- Immunization Schedule
- Hemagglutination Inhibition Tests
- United States
- Immunogenicity, Vaccine
- Antibodies, Neutralizing/blood
- Polysorbates/administration & dosage
- Polysorbates/adverse effects
- alpha-Tocopherol/administration & dosage
- alpha-Tocopherol/adverse effects
- Squalene/administration & dosage
- Squalene/adverse effects
- Squalene/immunology
- Healthy Volunteers
- Drug Combinations
- Adjuvants, Vaccine/administration & dosage
- Vaccination/methods
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/adverse effects
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Affiliation(s)
- Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Robert L Atmar
- Departments of Medicine and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Emmanuel B Walter
- Department of Pediatrics and Duke Human Vaccine Institute, Duke University, Durham, North Carolina, USA
| | - Sharon Frey
- Center for Vaccine Development, Saint Louis University, St. Louis, Missouri, USA
| | - Jeffery L Meier
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Amy C Sherman
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lilin Lai
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Carol M Kao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Vanessa Raabe
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- New York University Langone Vaccine Center, NYU Grossman School of Medicine, New York, New York, USA
| | - Hana M El Sahly
- Departments of Medicine and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Wendy A Keitel
- Departments of Medicine and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer A Whitaker
- Departments of Medicine and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Michael J Smith
- Department of Pediatrics and Duke Human Vaccine Institute, Duke University, Durham, North Carolina, USA
| | - Kenneth E Schmader
- Department of Medicine-Geriatrics, Duke University and GRECC, Durham VA Health Care System, Durham, North Carolina, USA
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology and Duke Human Vaccine Institute, Duke University, Durham, North Carolina, USA
| | - Getahun Abate
- Center for Vaccine Development, Saint Louis University, St. Louis, Missouri, USA
| | - Patricia Winokur
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Wendy Buchanan
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | | | | | - Yongxian Xu
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Satoshi Kamidani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Nadine Rouphael
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Mark J Mulligan
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- New York University Langone Vaccine Center, NYU Grossman School of Medicine, New York, New York, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Jackson LA, Stapleton JT, Walter EB, Chen WH, Rouphael NG, Anderson EJ, Neuzil KM, Winokur PL, Smith MJ, Schmader KE, Swamy GK, Thompson AB, Mulligan MJ, Rostad CA, Cross K, Tsong R, Wegel A, Roberts PC. Immunogenicity and safety of varying dosages of a fifth-wave influenza A/H7N9 inactivated vaccine given with and without AS03 adjuvant in healthy adults. Vaccine 2024; 42:295-309. [PMID: 38105137 PMCID: PMC10790638 DOI: 10.1016/j.vaccine.2023.12.001] [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: 09/19/2023] [Revised: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Human infections with the avian influenza A(H7N9) virus were first reported in China in 2013 and continued to occur in annual waves. In the 2016/2017 fifth wave, Yangtze River Delta (YRD) lineage viruses, which differed antigenically from those of earlier waves, predominated. METHODS In this phase 2 double-blinded trial we randomized 720 adults ≥ 19 years of age to receive two injections of a YRD lineage inactivated A/Hong Kong/125/2017 fifth-wave H7N9 vaccine, given 21 days apart, at doses of 3.75, 7.5, and 15 µg of hemagglutinin (HA) with AS03A adjuvant and at doses of 15 and 45 µg of HA without adjuvant. RESULTS Two doses of adjuvanted vaccine were required to induce HA inhibition (HI) antibody titers ≥ 40 in most participants. After two doses of the 15 µg H7N9 formulation, given with or without AS03 adjuvant, the proportion achieving a HI titer ≥ 40 against the vaccine strain at 21 days after the second vaccination was 65 % (95 % CI, 57 %-73 %) and 0 % (95 % CI, 0 %-4%), respectively. Among those who received two doses of the 15 µg adjuvanted formulation the proportion with HI titer ≥ 40 at 21 days after the second vaccination was 76 % (95 % CI, 66 %-84 %) in those 19-64 years of age and 49 % (95 % CI, 37 %-62 %) in those ≥ 65 years of age. Responses to the adjuvanted vaccine formulations did not vary by HA content. Antibody responses declined over time and responses against drifted H7N9 strains were diminished. Overall, the vaccines were well tolerated but, as expected, adjuvanted vaccines were associated with more frequent solicited systemic and local adverse events. CONCLUSIONS AS03 adjuvant improved the immune responses to an inactivated fifth-wave H7N9 influenza vaccine, particularly in younger adults, but invoked lower responses to drifted H7N9 strains. These findings may inform future influenza pandemic preparedness strategies.
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Affiliation(s)
- Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Jack T Stapleton
- Departments of Internal Medicine and Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
| | - Emmanuel B Walter
- Duke Human Vaccine Institute, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nadine G Rouphael
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patricia L Winokur
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael J Smith
- Duke Human Vaccine Institute, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine and GRECC, Durham VA Health Care System, Durham, NC, USA
| | - Geeta K Swamy
- Duke Human Vaccine Institute and Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Amelia B Thompson
- Duke Human Vaccine Institute, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Mark J Mulligan
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Christina A Rostad
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
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Lu D, Han Y, Xu R, Qin M, Shi J, Zhang C, Zhang J, Ye F, Luo Z, Wang Y, Wang C, Wang C. Evaluation of the efficacy, safety and influencing factors of concomitant and sequential administration of viral respiratory infectious disease vaccines: a systematic review and meta-analysis. Front Immunol 2023; 14:1259399. [PMID: 38179050 PMCID: PMC10764558 DOI: 10.3389/fimmu.2023.1259399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Background There is no clear conclusion on the immunogenicity and adverse events of concomitant administration the viral respiratory infectious disease vaccines. We aimed to evaluate the impact of concomitant administering viral respiratory infectious disease vaccines on efficiencies, safety and influencing factors. Methods This meta-analysis included studies from PubMed, Embase, Cochrane Central Register of Clinical Trials, Web of Science, WHO COVID-19 Research, and ClinicalTrials.gov databases. Randomized controlled trials of the adult participants concomitant administered with viral respiratory infectious disease vaccine and other vaccines were included. The main outcomes were the seroconversion rate and seroprotection rate of each vaccine. Used the Mantel-Haenszel fixed effects method as the main analysis to estimate the pooled RRs and the corresponding 95% confidence intervals. The risk of bias for each trial was assessed using the Cochrane Handbook for Systematic Reviews of Interventions, while evidence certainty was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Results A total of 21 studies comprising 14060 participants with two types of vaccines were retained for the meta-analysis. Concomitant immunization reduced the geometric mean titer (RR: 0.858, 95% CI: (0.785 to 0.939)) and the geometric mean fold rise (0.754 (0.629 to 0.902)) in the SARS-COV-2 vaccine group but increased the seroconversion rate (1.033 (1.0002 to 1.067)) in the seasonal influenza vaccine group. Concomitant administration were influenced by the type of vaccine, adjuvant content, booster immunization, and age and gender of the recipient. Conclusion This meta-analysis suggested that the short-term protection and safety of concomitant administered were effective. Appropriate adjuvants, health promotion and counselling and booster vaccines could improve the efficiency and safety of Concomitant vaccination. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022343709.
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Affiliation(s)
- Dafeng Lu
- Department of Infectious Disease Prevention and Control, Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
- Department of Infectious Disease Prevention and Control, Quzhou Center for Disease Prevention and Control, Quzhou, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yifang Han
- Department of Infectious Disease Prevention and Control, Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Ruowei Xu
- Department of Infectious Disease Prevention and Control, Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
- College of Life Science, Nanjing Normal University, Nanjing, China
| | - Mingke Qin
- Department of Occupational Health, Third Military Medical University, Chongqing, China
| | - Jianwei Shi
- Department of Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Caihong Zhang
- School of Public Health, Bengbu Medical College, Bengbu, China
| | - Jinhai Zhang
- Department of Infectious Disease Prevention and Control, Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Fuqiang Ye
- Department of Infectious Disease Prevention and Control, Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Zhenghan Luo
- Department of Infectious Disease Prevention and Control, Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
| | - Yuhe Wang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chunfang Wang
- Department of Infectious Disease Prevention and Control, Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chunhui Wang
- Department of Infectious Disease Prevention and Control, Nanjing Bioengineering (Gene) Technology Center for Medicines, Nanjing, China
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Jang H, Matsuoka M, Freire M. Oral mucosa immunity: ultimate strategy to stop spreading of pandemic viruses. Front Immunol 2023; 14:1220610. [PMID: 37928529 PMCID: PMC10622784 DOI: 10.3389/fimmu.2023.1220610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/11/2023] [Indexed: 11/07/2023] Open
Abstract
Global pandemics are most likely initiated via zoonotic transmission to humans in which respiratory viruses infect airways with relevance to mucosal systems. Out of the known pandemics, five were initiated by respiratory viruses including current ongoing coronavirus disease 2019 (COVID-19). Striking progress in vaccine development and therapeutics has helped ameliorate the mortality and morbidity by infectious agents. Yet, organism replication and virus spread through mucosal tissues cannot be directly controlled by parenteral vaccines. A novel mitigation strategy is needed to elicit robust mucosal protection and broadly neutralizing activities to hamper virus entry mechanisms and inhibit transmission. This review focuses on the oral mucosa, which is a critical site of viral transmission and promising target to elicit sterile immunity. In addition to reviewing historic pandemics initiated by the zoonotic respiratory RNA viruses and the oral mucosal tissues, we discuss unique features of the oral immune responses. We address barriers and new prospects related to developing novel therapeutics to elicit protective immunity at the mucosal level to ultimately control transmission.
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Affiliation(s)
- Hyesun Jang
- Genomic Medicine and Infectious Diseases, J. Craig Venter Institute, La Jolla, CA, United States
| | - Michele Matsuoka
- Genomic Medicine and Infectious Diseases, J. Craig Venter Institute, La Jolla, CA, United States
| | - Marcelo Freire
- Genomic Medicine and Infectious Diseases, J. Craig Venter Institute, La Jolla, CA, United States
- Division of Infectious Diseases and Global Public Health Department of Medicine, University of California San Diego, La Jolla, CA, United States
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