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Ding X, Zhao F, Liu Z, Yao J, Yu H, Zhang X. Original antigenic sin: A potential double-edged effect for vaccine improvement. Biomed Pharmacother 2024; 178:117187. [PMID: 39084082 DOI: 10.1016/j.biopha.2024.117187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
Original antigenic sin (OAS) influences the immune response to subsequent infections with related variants following initial pathogen exposure. This phenomenon is characterized by cross-reactivity, which, although it may worsen infections, also provides a degree of protection against immune evasion caused by variations. This paradox complicates the development of creating universal vaccinations, as they frequently show diminished effectiveness against these emerging variants. This review aims to elucidate the diverse impacts of OAS on the immune response to various infections, emphasizing the complicated balance between beneficial and harmful outcomes. Moreover, we evaluate the influence of adjuvants and other variables on the extent of OAS, hence affecting the effectiveness of vaccines. Understanding the mechanisms of OAS that cause persistent infections and evasion of the immune system is crucial for the developing innovative vaccines. And it has significant potential for clinical applications.
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Affiliation(s)
- Xuan Ding
- MOE Key Lab of Rare Pediatric Diseases &Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang 421001, PR China
| | - Feijun Zhao
- MOE Key Lab of Rare Pediatric Diseases &Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang 421001, PR China; Laboratory Medicine Center, the First Affiliated Hospital of University of South ChinaHengyang 421001, PR China
| | - Zhaoping Liu
- MOE Key Lab of Rare Pediatric Diseases &Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang 421001, PR China
| | - Jiangchen Yao
- MOE Key Lab of Rare Pediatric Diseases &Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang 421001, PR China
| | - Han Yu
- MOE Key Lab of Rare Pediatric Diseases &Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang 421001, PR China
| | - Xiaohong Zhang
- MOE Key Lab of Rare Pediatric Diseases &Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan Province, Hengyang Medical College, University of South China, Hengyang 421001, PR China.
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Rosa Duque JS, Cheng SMS, Cohen CA, Leung D, Wang X, Mu X, Chung Y, Lau TM, Wang M, Zhang W, Zhang Y, Wong HHW, Tsang LCH, Chaothai S, Kwan TC, Li JKC, Chan KCK, Luk LLH, Ho JCH, Li WY, Lee AMT, Lam JHY, Chan SM, Wong WHS, Tam IYS, Mori M, Valkenburg SA, Peiris M, Tu W, Lau YL. Superior antibody and membrane protein-specific T-cell responses to CoronaVac by intradermal versus intramuscular routes in adolescents. World J Pediatr 2024; 20:353-370. [PMID: 38085470 PMCID: PMC11052846 DOI: 10.1007/s12519-023-00764-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/18/2023] [Indexed: 04/29/2024]
Abstract
BACKGROUND Optimising the immunogenicity of COVID-19 vaccines to improve their protection against disease is necessary. Fractional dosing by intradermal (ID) administration has been shown to be equally immunogenic as intramuscular (IM) administration for several vaccines, but the immunogenicity of ID inactivated whole severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the full dose is unknown. This study (NCT04800133) investigated the superiority of antibody and T-cell responses of full-dose CoronaVac by ID over IM administration in adolescents. METHODS Participants aged 11-17 years received two doses of IM or ID vaccine, followed by the 3rd dose 13-42 days later. Humoral and cellular immunogenicity outcomes were measured post-dose 2 (IM-CC versus ID-CC) and post-dose 3 (IM-CCC versus ID-CCC). Doses 2 and 3 were administered to 173 and 104 adolescents, respectively. RESULTS Spike protein (S) immunoglobulin G (IgG), S-receptor-binding domain (RBD) IgG, S IgG Fcγ receptor IIIa (FcγRIIIa)-binding, SNM [sum of individual (S), nucleocapsid protein (N), and membrane protein (M) peptide pool]-specific interleukin-2 (IL-2)+CD4+, SNM-specific IL-2+CD8+, S-specific IL-2+CD8+, N-specific IL-2+CD4+, N-specific IL-2+CD8+ and M-specific IL-2+CD4+ responses fulfilled the superior and non-inferior criteria for ID-CC compared to IM-CC, whereas IgG avidity was inferior. For ID-CCC, S-RBD IgG, surrogate virus neutralisation test, 90% plaque reduction neutralisation titre (PRNT90), PRNT50, S IgG avidity, S IgG FcγRIIIa-binding, M-specific IL-2+CD4+, interferon-γ+CD8+ and IL-2+CD8+ responses were superior and non-inferior to IM-CCC. The estimated vaccine efficacies were 49%, 52%, 66% and 79% for IM-CC, ID-CC, IM-CCC and ID-CCC, respectively. The ID groups reported more local, mild adverse reactions. CONCLUSION This is the first study to demonstrate superior antibody and M-specific T-cell responses by ID inactivated SARS-CoV-2 vaccination and serves as the basis for future research to improve the immunogenicity of inactivated vaccines.
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Affiliation(s)
- Jaime S Rosa Duque
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Samuel M S Cheng
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Carolyn A Cohen
- School of Public Health, The University of Hong Kong, Hong Kong, China
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Daniel Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Xiwei Wang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Xiaofeng Mu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Yuet Chung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Tsun Ming Lau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Manni Wang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Wenyue Zhang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Yanmei Zhang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Howard H W Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Leo C H Tsang
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Sara Chaothai
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tsz Chun Kwan
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - John K C Li
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Karl C K Chan
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Leo L H Luk
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Jenson C H Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Wing Yan Li
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Amos M T Lee
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Jennifer H Y Lam
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Sau Man Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Wilfred H S Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Issan Y S Tam
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Masashi Mori
- Research Institute for Bioresources and Biotechnology, Ishikawa Prefectural University, Nonoichi, Japan
| | - Sophie A Valkenburg
- School of Public Health, The University of Hong Kong, Hong Kong, China.
- HKU-Pasteur Research Pole, School of Public Health, The University of Hong Kong, Hong Kong, China.
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection, and Immunity, University of Melbourne, Melbourne, VIC, Australia.
| | - Malik Peiris
- School of Public Health, The University of Hong Kong, Hong Kong, China.
- Center for Immunology and Infection C2i, Hong Kong, China.
| | - Wenwei Tu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China.
| | - Yu Lung Lau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China.
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Yu Y, Wang J, Wu MX. Microneedle-Mediated Immunization Promotes Lung CD8+ T-Cell Immunity. J Invest Dermatol 2023; 143:1983-1992.e3. [PMID: 37044258 PMCID: PMC10524108 DOI: 10.1016/j.jid.2023.03.1672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023]
Abstract
Microneedle array has proven more efficient in stimulating humoral immunity than intramuscular vaccination. However, its effectiveness in inducing pulmonary CD8+ T cells remains elusive, which is essential to the frontline defense against pulmonary viral infections such as influenza and COVID-19 viruses. The current investigation reveals that superior CD8+ T-cell responses are elicited by immunization with a microneedle array over intradermal or intramuscular immunization using the model antigen ovalbumin, irrespective of whether or not the antigen is provided in the lung. Mechanistically, microneedle array-mediated immunization targeted the epidermal layer and stimulated predominantly Langerhans cells, resulting in increased expression of α4β1 adhesion molecules on the CD8+ T-cell surface, which may play a role in T-cell homing to the lung, whereas CD8+ T cells induced by intramuscular immunization did not express the adhesion molecule sufficiently. CD8+ T cells with a lung-homing propensity were also seen after intradermal vaccination, yet to a much lesser extent. Accordingly, microneedle array immunization provided stronger protection against influenza viral infection than intradermal or intramuscular immunization. The observations offer insights into a strong cross-talk between epidermal immunization and lung immunity and are valuable for designing and delivering vaccines against respiratory viral infections.
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Affiliation(s)
- Yang Yu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ji Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA; The first affiliated Hospital, Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China
| | - Mei X Wu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA.
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Low ZY, Wong KH, Wen Yip AJ, Choo WS. The convergent evolution of influenza A virus: Implications, therapeutic strategies and what we need to know. CURRENT RESEARCH IN MICROBIAL SCIENCES 2023; 5:100202. [PMID: 37700857 PMCID: PMC10493511 DOI: 10.1016/j.crmicr.2023.100202] [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: 09/14/2023] Open
Abstract
Influenza virus infection, more commonly known as the 'cold flu', is an etiological agent that gives rise to recurrent annual flu and many pandemics. Dated back to the 1918- Spanish Flu, the influenza infection has caused the loss of many human lives and significantly impacted the economy and daily lives. Influenza virus can be classified into four different genera: influenza A-D, with the former two, influenza A and B, relevant to humans. The capacity of antigenic drift and shift in Influenza A has given rise to many novel variants, rendering vaccines and antiviral therapies useless. In light of the emergence of a novel betacoronavirus, the SARS-CoV-2, unravelling the underpinning mechanisms that support the recurrent influenza epidemics and pandemics is essential. Given the symptom similarities between influenza and covid infection, it is crucial to reiterate what we know about the influenza infection. This review aims to describe the origin and evolution of influenza infection. Apart from that, the risk factors entail the implication of co-infections, especially regarding the COVID-19 pandemic is further discussed. In addition, antiviral strategies, including the potential of drug repositioning, are discussed in this context. The diagnostic approach is also critically discussed in an effort to understand better and prepare for upcoming variants and potential influenza pandemics in the future. Lastly, this review encapsulates the challenges in curbing the influenza spread and provides insights for future directions in influenza management.
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Affiliation(s)
- Zheng Yao Low
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Ka Heng Wong
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Ashley Jia Wen Yip
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Wee Sim Choo
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
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Soegiarto G, Purnomosari D. Challenges in the Vaccination of the Elderly and Strategies for Improvement. PATHOPHYSIOLOGY 2023; 30:155-173. [PMID: 37218912 DOI: 10.3390/pathophysiology30020014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
In recent years, the elderly has become a rapidly growing proportion of the world's population as life expectancy is extending. Immunosenescence and inflammaging contribute to the increased risk of chronic non-communicable and acute infectious diseases. Frailty is highly prevalent in the elderly and is associated with an impaired immune response, a higher propensity to infection, and a lower response to vaccines. Additionally, the presence of uncontrolled comorbid diseases in the elderly also contributes to sarcopenia and frailty. Vaccine-preventable diseases that threaten the elderly include influenza, pneumococcal infection, herpes zoster, and COVID-19, which contribute to significant disability-adjusted life years lost. Previous studies had shown that conventional vaccines only yielded suboptimal protection that wanes rapidly in a shorter time. This article reviews published papers on several vaccination strategies that were developed for the elderly to solve these problems: more immunogenic vaccine formulations using larger doses of antigen, stronger vaccine adjuvants, recombinant subunit or protein conjugated vaccines, newly developed mRNA vaccines, giving booster shots, and exploring alternative routes of administration. Included also are several publications on senolytic medications under investigation to boost the immune system and vaccine response in the elderly. With all those in regard, the currently recommended vaccines for the elderly are presented.
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Affiliation(s)
- Gatot Soegiarto
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Dr. Soetomo Academic General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia
- Master Program in Immunology, Postgraduate School, Universitas Airlangga, Surabaya 60286, Indonesia
| | - Dewajani Purnomosari
- Department of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gajah Mada, Yogyakarta 55281, Indonesia
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Choo JJY, McMillan CLD, Young PR, Muller DA. Microarray patches: scratching the surface of vaccine delivery. Expert Rev Vaccines 2023; 22:937-955. [PMID: 37846657 DOI: 10.1080/14760584.2023.2270598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Microneedles are emerging as a promising technology for vaccine delivery, with numerous advantages over traditional needle and syringe methods. Preclinical studies have demonstrated the effectiveness of MAPs in inducing robust immune responses over traditional needle and syringe methods, with extensive studies using vaccines targeted against different pathogens in various animal models. Critically, the clinical trials have demonstrated safety, immunogenicity, and patient acceptance for MAP-based vaccines against influenza, measles, rubella, and SARS-CoV-2. AREAS COVERED This review provides a comprehensive overview of the different types of microarray patches (MAPs) and analyses of their applications in preclinical and clinical vaccine delivery settings. This review also covers additional considerations for microneedle-based vaccination, including adjuvants that are compatible with MAPs, patient safety and factors for global vaccination campaigns. EXPERT OPINION MAP vaccine delivery can potentially be a game-changer for vaccine distribution and coverage in both high-income and low- and middle-income countries. For MAPs to reach this full potential, many critical hurdles must be overcome, such as large-scale production, regulatory compliance, and adoption by global health authorities. However, given the considerable strides made in recent years by MAP developers, it may be possible to see the first MAP-based vaccines in use within the next 5 years.
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Affiliation(s)
- Jovin J Y Choo
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Christopher L D McMillan
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Paul R Young
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - David A Muller
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
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Quach HQ, Kennedy RB. Enhancing Immunogenicity of Influenza Vaccine in the Elderly through Intradermal Vaccination: A Literature Analysis. Viruses 2022; 14:v14112438. [PMID: 36366536 PMCID: PMC9698533 DOI: 10.3390/v14112438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Aging and immunosenescence lead to a gradual decline in immune responses in the elderly and the immunogenicity of influenza vaccines in this age group is sub-optimal. Several approaches have been explored to enhance the immunogenicity of influenza vaccines in the elderly, including incorporating vaccine adjuvant, increasing antigen dosage, and changing the route of vaccine administration. METHOD We systematically compared the immunogenicity and safety of influenza vaccines administered by intradermal (ID) route and either intramuscular (IM) or subcutaneous (SC) routes in older adults aged ≥ 65. RESULTS Of 17 studies included in this analysis, 3 studies compared the immunogenicity of ID vaccination to that of SC vaccination and 14 studies compared ID and IM vaccinations. ID vaccination was typically more immunogenic than both IM and SC routes at the same dosage. Importantly, a minimum of 3 µg of hemagglutinin antigen could be formulated in an ID influenza vaccine without a significant loss of immunogenicity. ID administration of standard-dose, unadjuvanted influenza vaccine was as immunogenic as IM injection of adjuvanted influenza vaccine. Waning of influenza-specific immunity was significant after 6 months, but there was no difference in waning immunity between vaccinations in ID, IM, or SC routes. While ID vaccination elicited local adverse reactions more frequently than other routes, these reactions were mild and lasted for no more than 3 days. CONCLUSIONS We conclude that ID vaccination is superior to IM or SC routes and may be a suitable approach to compensate for the reduced immunogenicity observed in elderly adults. We also conclude that the main benefit of ID influenza vaccine lies in its dose-sparing effect. Additional research is still needed to further develop a more immunogenic ID influenza vaccine.
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8
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Çokçalışkan C, Tuncer-Göktuna P, Sareyyüpoğlu B, Türkoğlu T, Yıldız M, Deveci MNF, Aras-Uzun E, Arslan A, Kürkçü A, Uzunlu E, Asar E. Booster administration can make a difference in the antibody response to intradermal foot-and-mouth disease vaccination in cattle. Arch Virol 2022; 167:405-413. [PMID: 35034176 DOI: 10.1007/s00705-021-05273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/01/2021] [Indexed: 11/02/2022]
Abstract
Foot-and-mouth disease (FMD) is a highly contagious and economically important viral disease of cloven-hoofed animals. Routine vaccination is one of the preferred methods of protection against this disease in endemic countries. For protective immunity against FMD, repeated immunizations with frequent administration are required. Intradermal immunization has many advantages over intramuscular administration of vaccines. In this study, a commercial tetravalent FMD vaccine adjuvanted with Montanide ISA 206 was administered to cattle via the intramuscular (2 mL [n = 10] and 0.5 mL [n = 9]) and intradermal (0.5 mL [n = 11]) routes. Booster doses were administered 28 days later using the same vaccine and routes. Serum samples were collected on days 0, 7, 14, and 28 post-vaccination (pv) and at 30 and 60 days post-booster. Homologous and heterologous virus neutralization tests and liquid-phase blocking and isotype ELISAs were used to measure the antibody response. The results showed that intradermal administration of quarter doses of the vaccine provides an equal or better virus neutralization antibody response than intramuscular administration of the same dose of vaccine after booster administration in cattle. This means that four times more cattle can be immunized with the same amount of vaccine using the intradermal route without compromising immunity.
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Affiliation(s)
- Can Çokçalışkan
- Republic of Turkey, Ministry of Agriculture and Forestry, Institute of Foot and Mouth Disease (Şap), Şap Enstitüsü Dumlupınar Bulvarı, No:35 Söğütözü Çankaya, Ankara, Turkey.
| | - Pelin Tuncer-Göktuna
- Republic of Turkey, Ministry of Agriculture and Forestry, Pendik Veterinary Control Institute, Istanbul, Turkey
| | - Beyhan Sareyyüpoğlu
- Republic of Turkey, Ministry of Agriculture and Forestry, Institute of Foot and Mouth Disease (Şap), Şap Enstitüsü Dumlupınar Bulvarı, No:35 Söğütözü Çankaya, Ankara, Turkey
| | - Tunçer Türkoğlu
- Republic of Turkey, Ministry of Agriculture and Forestry, Institute of Foot and Mouth Disease (Şap), Şap Enstitüsü Dumlupınar Bulvarı, No:35 Söğütözü Çankaya, Ankara, Turkey
| | - Muhammet Yıldız
- Directorate-General for State Farms, Republic of Turkey, Ministry of Food, Agriculture and Livestock, Ankara, Turkey
| | - M Nuri Fırat Deveci
- Directorate-General for State Farms, Republic of Turkey, Ministry of Food, Agriculture and Livestock, Ankara, Turkey
| | - Eylem Aras-Uzun
- Republic of Turkey, Ministry of Agriculture and Forestry, Institute of Foot and Mouth Disease (Şap), Şap Enstitüsü Dumlupınar Bulvarı, No:35 Söğütözü Çankaya, Ankara, Turkey
| | - Abdullah Arslan
- Republic of Turkey, Ministry of Agriculture and Forestry, Institute of Foot and Mouth Disease (Şap), Şap Enstitüsü Dumlupınar Bulvarı, No:35 Söğütözü Çankaya, Ankara, Turkey
| | - Ayça Kürkçü
- Republic of Turkey, Ministry of Agriculture and Forestry, Institute of Foot and Mouth Disease (Şap), Şap Enstitüsü Dumlupınar Bulvarı, No:35 Söğütözü Çankaya, Ankara, Turkey
| | - Ergün Uzunlu
- Republic of Turkey, Ministry of Agriculture and Forestry, Institute of Foot and Mouth Disease (Şap), Şap Enstitüsü Dumlupınar Bulvarı, No:35 Söğütözü Çankaya, Ankara, Turkey
| | - Erdoğan Asar
- Republic of Turkey, Turkish Statistical Institute, Ankara, Turkey
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9
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Performance and usability evaluation of novel intradermal injection device Immucise™ and reanalysis of intradermal administration trials of influenza vaccine for the elderly. Vaccine 2022; 40:873-879. [PMID: 35031147 DOI: 10.1016/j.vaccine.2021.12.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 11/24/2022]
Abstract
Under the pandemic situation, there is an urgent need to produce and acquire sufficient quantities of prophylactic vaccines. It becomes important to devise a way to achieve reliable immunity with lower doses to distribute limited supplies of vaccines to maximum number of people very quickly. Intradermal (ID) vaccination is one such method to increase the effectiveness of vaccines. However, this method has not been widely used in general clinical practice because it is technically difficult to inject vaccines precisely into the ID tissue. Therefore, new ID delivery systems that allow reliable ID administration are under development. In this paper, we summarize its design and present the results of performance and usability testing for the Immucise™ Intradermal Injection System (Immucise™). This study showed that Immucise™ can reduce dead volume and inject drugs precisely into the ID tissues of subjects from infants to the elderly and can be used correctly and safely by healthcare professionals. This randomized controlled trial compared ID administration with Immucise™ and standard subcutaneous (SC) administration of seasonal influenza vaccine by analyzing the efficacy of the vaccine in the elderly group at 90 days and 180 days after administration. It was found that the vaccine for the ID group was as effective or more effective than that for the SC group up to 180 days later. It was also found that the geometric mean titer values, especially for B strains, were higher in the two-dose ID group than in the two-dose SC group. These findings suggest that Immucise™ is one of the best devices to distribute a small amount of vaccine quickly and widely to a larger number of people with little loss of vaccine during a pandemic.
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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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11
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Microneedle-Mediated Vaccination: Innovation and Translation. Adv Drug Deliv Rev 2021; 179:113919. [PMID: 34375682 DOI: 10.1016/j.addr.2021.113919] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/14/2022]
Abstract
Vaccine administration by subcutaneous or intramuscular injection is the most commonly prescribed route for inoculation, however, it is often associated with some deficiencies such as low compliance, high professionalism, and risk of infection. Therefore, the application of microneedles for vaccine delivery has gained widespread interests in the past few years due to its high compliance, minimal invasiveness, and convenience. This review focuses on recent advances in the development and application of microneedles for vaccination based on different delivery strategies, and introduces the current status of microneedle-mediated vaccination in clinical translation. The prospects for its application including opportunities and challenges are further discussed.
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12
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Review of Influenza Virus Vaccines: The Qualitative Nature of Immune Responses to Infection and Vaccination Is a Critical Consideration. Vaccines (Basel) 2021; 9:vaccines9090979. [PMID: 34579216 PMCID: PMC8471734 DOI: 10.3390/vaccines9090979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 01/06/2023] Open
Abstract
Influenza viruses have affected the world for over a century, causing multiple pandemics. Throughout the years, many prophylactic vaccines have been developed for influenza; however, these viruses are still a global issue and take many lives. In this paper, we review influenza viruses, associated immunological mechanisms, current influenza vaccine platforms, and influenza infection, in the context of immunocompromised populations. This review focuses on the qualitative nature of immune responses against influenza viruses, with an emphasis on trained immunity and an assessment of the characteristics of the host–pathogen that compromise the effectiveness of immunization. We also highlight innovative immunological concepts that are important considerations for the development of the next generation of vaccines against influenza viruses.
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13
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Wen S, Wu Z, Zhong S, Li M, Shu Y. Factors influencing the immunogenicity of influenza vaccines. Hum Vaccin Immunother 2021; 17:2706-2718. [PMID: 33705263 DOI: 10.1080/21645515.2021.1875761] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Annual vaccination is the best prevention of influenza. However, the immunogenicity of influenza vaccines varies among different populations. It is important to fully identify the factors that may affect the immunogenicity of the vaccines to provide best protection for vaccine recipients. This paper reviews the factors that may influence the immunogenicity of influenza vaccines from the aspects of vaccine factors, adjuvants, individual factors, repeated vaccination, and genetic factors. The confirmed or hypothesized molecular mechanisms of these factors have also been briefly summarized.
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Affiliation(s)
- Simin Wen
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, China
| | - Zhengyu Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, China
| | - Shuyi Zhong
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, China
| | - Mao Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, China
| | - Yuelong Shu
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangdong, China.,National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Prevention and Control, Beijing, China
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14
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Mombelli M, Hoschler K, Cavassini M, Pascual M, Manuel O. Seasonal trivalent inactivated influenza vaccine with topical imiquimod in immunocompromised patients: A randomized controlled trial. J Infect 2021; 83:354-360. [PMID: 34298035 DOI: 10.1016/j.jinf.2021.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/31/2021] [Accepted: 07/07/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The effect of the Toll-like receptor 7 agonist imiquimod before intradermal (ID) or intramuscular (IM) influenza vaccine in immunocompromised hosts is unknown. METHODS In this open-label randomized controlled trial, kidney transplant recipients (KT) and people living with HIV (PLWH) were randomized to receive IM trivalent inactivated influenza vaccine alone (IM), IM vaccine after topical imiquimod (imi+IM) or ID vaccine after topical imiquimod (imi+ID). Immunogenicity was assessed by hemagglutination inhibition assay. The primary outcome was vaccine response, defined as seroconversion to at least one viral strain at day 21. RESULTS Seventy patients (35 KT and 35 PLWH) received IM (24), imi+IM (22), or imi+ID (24) vaccine. Vaccine response was 61% (14/23) with IM, 59% (13/22) with imi+IM, and 65% (15/23) with imi+ID vaccine (P = 0.909). Vaccine response was associated with HIV infection compared to kidney transplantation (adjusted-OR 3.74, 95% CI 1.25 - 11.23, P = 0.019), but not with imiquimod application nor ID injection. After vaccination, seroprotection to all viral strains was 79% (19/24) with IM, 68% (15/22) with imi+IM, and 70% (16/23) with imi+ID (P = 0.657). We did not observe any vaccine-related severe adverse event. CONCLUSIONS In our study, topical imiquimod did not improve the immunogenicity of influenza vaccine in KT and in PLWH.
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Affiliation(s)
- Matteo Mombelli
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Katja Hoschler
- Public Health England, Microbiology Services Colindale, London, United Kingdom
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Manuel Pascual
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oriol Manuel
- Transplantation Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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15
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Scheiblhofer S, Drothler S, Braun W, Braun R, Boesch M, Weiss R. Laser-facilitated epicutaneous immunization of mice with SARS-CoV-2 spike protein induces antibodies inhibiting spike/ACE2 binding. Vaccine 2021; 39:4399-4403. [PMID: 34226102 PMCID: PMC8233963 DOI: 10.1016/j.vaccine.2021.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
The skin represents an attractive target tissue for vaccination against respiratory viruses such as SARS-CoV-2. Laser-facilitated epicutaneous immunization (EPI) has been established as a novel technology to overcome the skin barrier, which combines efficient delivery via micropores with an inherent adjuvant effect due to the release of danger-associated molecular patterns. Here we delivered the S1 subunit of the Spike protein of SARS-CoV-2 to the skin of BALB/c mice via laser-generated micropores with or without CpG-ODN1826 or the B subunit of heat-labile enterotoxin of E.coli (LT-B). EPI induced serum IgG titers of 1:3200 that could be boosted 5 to 10-fold by co-administration of LT-B and CpG, respectively. Sera were able to inhibit binding of the spike protein to its receptor ACE2. Our data indicate that delivery of recombinant spike protein via the skin may represent an alternative route for vaccines against Covid-19.
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Affiliation(s)
| | - Stephan Drothler
- University of Salzburg, Department of Biosciences, Salzburg, Austria
| | | | | | | | - Richard Weiss
- University of Salzburg, Department of Biosciences, Salzburg, Austria.
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16
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Palacios-Pedrero MÁ, Osterhaus ADME, Becker T, Elbahesh H, Rimmelzwaan GF, Saletti G. Aging and Options to Halt Declining Immunity to Virus Infections. Front Immunol 2021; 12:681449. [PMID: 34054872 PMCID: PMC8149791 DOI: 10.3389/fimmu.2021.681449] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Immunosenescence is a process associated with aging that leads to dysregulation of cells of innate and adaptive immunity, which may become dysfunctional. Consequently, older adults show increased severity of viral and bacterial infections and impaired responses to vaccinations. A better understanding of the process of immunosenescence will aid the development of novel strategies to boost the immune system in older adults. In this review, we focus on major alterations of the immune system triggered by aging, and address the effect of chronic viral infections, effectiveness of vaccination of older adults and strategies to improve immune function in this vulnerable age group.
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Affiliation(s)
| | - Albert D M E Osterhaus
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Tanja Becker
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Husni Elbahesh
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Guus F Rimmelzwaan
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Giulietta Saletti
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
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17
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Leboux RJT, Schipper P, van Capel TMM, Kong L, van der Maaden K, Kros A, Jiskoot W, de Jong EC, Bouwstra JA. Antigen Uptake After Intradermal Microinjection Depends on Antigen Nature and Formulation, but Not on Injection Depth. FRONTIERS IN ALLERGY 2021; 2:642788. [PMID: 35386985 PMCID: PMC8974696 DOI: 10.3389/falgy.2021.642788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
The skin is an attractive alternative administration route for allergy vaccination, as the skin is rich in dendritic cells (DCs) and is easily accessible. In the skin multiple subsets of DCs with distinct roles reside at different depths. In this study antigen (=allergen for allergy) formulations were injected in ex vivo human skin in a depth-controlled manner by using a hollow microneedle injection system. Biopsies were harvested at the injection site, which were then cultured for 72 h. Subsequently, the crawled-out cells were collected from the medium and analyzed with flow cytometry. Intradermal administration of ovalbumin (OVA, model antigen) solution at various depths in the skin did not affect the migration and maturation of DCs. OVA was taken up efficiently by the DCs, and this was not affected by the injection depth. In contrast, Bet v 1, the major allergen in birch pollen allergy, was barely taken up by dermal DCs (dDCs). Antigens were more efficiently taken up by CD14+ dDCs than CD1a+ dDCs, which in turn were more efficient at taken up antigen than Langerhans cells. Subsequently, both OVA and Bet v 1 were formulated in cationic and anionic liposomes, which altered antigen uptake drastically following intradermal microinjection. While OVA uptake was reduced by formulation in liposomes, Bet v 1 uptake in dDCs was increased by encapsulation in both cationic and anionic liposomes. This highlights the potential use of liposomes as adjuvant in intradermal allergy vaccine delivery. In conclusion, we observed that antigen uptake after intradermal injection was not affected by injection depth, but varied between different antigens and formulation.
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Affiliation(s)
- Romain J. T. Leboux
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Pim Schipper
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Toni M. M. van Capel
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, Netherlands
| | - Lily Kong
- Division of Supramolecular Chemistry, Leiden Institute of Chemistry, Leiden University, Leiden, Netherlands
- Tongji School of Pharmacy, HuaZhong University of Science and Technology, Wuhan, China
| | - Koen van der Maaden
- Tumor Immunology Group, Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
- TECO Development GmbH, Rheinbach, Germany
| | - Alexander Kros
- Division of Supramolecular Chemistry, Leiden Institute of Chemistry, Leiden University, Leiden, Netherlands
| | - Wim Jiskoot
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Esther C. de Jong
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, Netherlands
- Esther C. de Jong
| | - Joke A. Bouwstra
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
- *Correspondence: Joke A. Bouwstra
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18
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Tanner AR, Dorey RB, Brendish NJ, Clark TW. Influenza vaccination: protecting the most vulnerable. Eur Respir Rev 2021; 30:200258. [PMID: 33650528 PMCID: PMC9488965 DOI: 10.1183/16000617.0258-2020] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022] Open
Abstract
Influenza virus infection causes seasonal epidemics and occasional pandemics, leading to huge morbidity and mortality worldwide. Vaccination against influenza is needed annually as protection from constantly mutating strains is required. Groups at high risk of poor outcomes include the elderly, the very young, pregnant women and those with chronic health conditions. However, vaccine effectiveness in the elderly is generally poor due to immunosenescence and may be altered due to "original antigenic sin". Strategies to overcome these challenges in the elderly include high-dose or adjuvant vaccines. Other options include vaccinating healthcare workers and children as this reduces community-level influenza transmission. Current guidelines in the UK are that young children receive a live attenuated nasal spray vaccine, adults aged >65 years receive an adjuvanted trivalent inactivated vaccine and adults aged <65 years with comorbidities receive a quadrivalent inactivated vaccine. The goal of a universal influenza vaccine targeting conserved regions of the virus and avoiding the need for annual vaccination is edging closer with early-phase trials under way.
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Affiliation(s)
- Alex R Tanner
- Dept of Medicine for the Elderly, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Robert B Dorey
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nathan J Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Dept of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Dept of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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19
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Pereira B, Xu XN, Akbar AN. Targeting Inflammation and Immunosenescence to Improve Vaccine Responses in the Elderly. Front Immunol 2020; 11:583019. [PMID: 33178213 PMCID: PMC7592394 DOI: 10.3389/fimmu.2020.583019] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
One of the most appreciated consequences of immunosenescence is an impaired response to vaccines with advanced age. While most studies report impaired antibody responses in older adults as a correlate of vaccine efficacy, it is now widely appreciated that this may fail to identify important changes occurring in the immune system with age that may affect vaccine efficacy. The impact of immunosenescence on vaccination goes beyond the defects on antibody responses as T cell-mediated responses are reshaped during aging and certainly affect vaccination. Likewise, age-related changes in the innate immune system may have important consequences on antigen presentation and priming of adaptive immune responses. Importantly, a low-level chronic inflammatory status known as inflammaging has been shown to inhibit immune responses to vaccination and pharmacological strategies aiming at blocking baseline inflammation can be potentially used to boost vaccine responses. Yet current strategies aiming at improving immunogenicity in the elderly have mainly focused on the use of adjuvants to promote local inflammation. More research is needed to understand the role of inflammation in vaccine responses and to reconcile these seemingly paradoxical observations. Alternative approaches to improve vaccine responses in the elderly include the use of higher vaccine doses or alternative routes of vaccination showing only limited benefits. This review will explore novel targets and potential new strategies for enhancing vaccine responses in older adults, including the use of anti-inflammatory drugs and immunomodulators.
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Affiliation(s)
- Branca Pereira
- HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Xiao-Ning Xu
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Arne N Akbar
- Division of Medicine, University College London, London, United Kingdom
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20
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Saitoh A, Nirei J, Tanaka T, Haniu H, Sakai T, Okubo S, Hirano H. Skin thickness in neonates: Implications for intradermal vaccination. Vaccine 2020; 38:5659-5664. [PMID: 32654901 DOI: 10.1016/j.vaccine.2020.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Intradermal (ID) injection is an alternate route that enhances vaccine immunogenicity and decreases vaccine dose. Regular immunization usually starts at age 2 months, and the limited immune capacity of neonates and young infants makes them vulnerable to infection. Successful ID vaccine delivery in this population requires knowledge of skin thickness. Although skin thickness has been evaluated in infants aged 2 months or older, no comparable data are available for neonates, including preterm neonates. METHODS This prospective observational study used ultrasonography to assess skin thickness in 70 neonates (35 full-term and 35 preterm neonates) at deltoid, suprascapular, and thigh sites. The measurements were compared in relation to anatomical site, between full-term and preterm infants, and with skin thickness values for children aged 2 months or older, which were collected in our previous study using the same measurement technique. RESULTS In full-term neonates, skin was significantly thicker at the suprascapular site than at the deltoid and thigh sites (P < 0.05); in preterm neonates, skin was significantly thicker at the suprascapular site than at the thigh site (P < 0.05). Skin thickness values at all three sites were significantly lower in preterm neonates than in full-term neonates (P < 0.05). As compared with skin thickness values for infants aged 2 months, values for full-term neonates were significantly lower for the deltoid and suprascapular sites (P < 0.001). CONCLUSIONS Skin thickness values for neonates were affected by prematurity and were significantly lower than those for infants aged 2 months. These findings are important in the design of ID injection devices for neonates and young infants.
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Affiliation(s)
- Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Jun Nirei
- Department of Pediatrics, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takeshi Tanaka
- Department of Pediatrics, Saiseikai Niigata Hospital, Niigata, Japan
| | - Hisanori Haniu
- Department of Pediatrics, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takatsugu Sakai
- Department of Pediatrics, Saiseikai Niigata Hospital, Niigata, Japan
| | - Soichiro Okubo
- Department of Pediatrics, Saiseikai Niigata Hospital, Niigata, Japan
| | - Harunobu Hirano
- Department of Pediatrics, Saiseikai Niigata Hospital, Niigata, Japan
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21
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Liu Y, Wen Z, Carrion R, Nunneley J, Staples H, Ticer A, Patterson JL, Compans RW, Ye L, Yang C. Intradermal Immunization of EBOV VLPs in Guinea Pigs Induces Broader Antibody Responses Against GP Than Intramuscular Injection. Front Microbiol 2020; 11:304. [PMID: 32174901 PMCID: PMC7056717 DOI: 10.3389/fmicb.2020.00304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/11/2020] [Indexed: 11/20/2022] Open
Abstract
Ebolavirus (EBOV) infection in humans causes severe hemorrhagic fevers with high mortality rates that range from 30 to 80% as shown in different outbreaks. Thus the development of safe and efficacious EBOV vaccines remains an important goal for biomedical research. We have shown in early studies that immunization with insect cell-produced EBOV virus-like particles (VLPs) is able to induce protect vaccinated mice against lethal EBOV challenge. In the present study, we investigated immune responses induced by Ebola VLPs via two different routes, intramuscular and intradermal immunizations, in guinea pigs. Analyses of antibody responses revealed that similar levels of total IgG antibodies against the EBOV glycoprotein (GP) were induced by the two different immunization methods. However, further characterization showed that the EBOV GP-specific antibodies induced by intramuscular immunization were mainly of the IgG2 subtype whereas both IgG1 and IgG2 antibodies against EBOV GP were induced by intradermal immunization. In contrast, antibody responses against the EBOV matrix protein VP40 induced by intramuscular or intradermal immunizations exhibited similar IgG1 and IgG2 profiles. More interestingly, we found that the sites that the IgG1 antibodies induced by intradermal immunizations bind to in GP are different from those that bind to the IgG2 antibodies induced by intramuscular immunization. Further analyses revealed that sera from all vaccinated guinea pigs exhibited neutralizing activity against Ebola GP-mediated HIV pseudovirion infection at high levels. Moreover, all EBOV VLP-vaccinated guinea pigs survived the challenge by a high dose (1000 pfu) of guinea pig-adapted EBOV, while all control guinea pigs immunized with irrelevant VLPs succumbed to the challenge. The induction of both IgG1 and IgG2 antibody responses that recognized broader sites in GP by intradermal immunization of EBOV VLPs indicates that this approach may represent a more advantageous route of vaccination against virus infection.
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Affiliation(s)
- Ying Liu
- State Key Laboratory of Food Nutrition and Safety, Institute of Health Biotechnology, College of Biotechnology, Tianjin University of Science and Technology, Tianjin, China
- Department of Microbiology and Immunology and Emory Vaccine Center, School of Medicine, Emory University, Atlanta, GA, United States
| | - Zhiyuan Wen
- Department of Microbiology and Immunology and Emory Vaccine Center, School of Medicine, Emory University, Atlanta, GA, United States
- Harbin Veterinary Research Institute, Harbin, China
| | - Ricardo Carrion
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Jerritt Nunneley
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Hilary Staples
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Anysha Ticer
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | | | - Richard W. Compans
- Department of Microbiology and Immunology and Emory Vaccine Center, School of Medicine, Emory University, Atlanta, GA, United States
| | - Ling Ye
- Department of Microbiology and Immunology and Emory Vaccine Center, School of Medicine, Emory University, Atlanta, GA, United States
| | - Chinglai Yang
- Department of Microbiology and Immunology and Emory Vaccine Center, School of Medicine, Emory University, Atlanta, GA, United States
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22
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Jamaledin R, Di Natale C, Onesto V, Taraghdari ZB, Zare EN, Makvandi P, Vecchione R, Netti PA. Progress in Microneedle-Mediated Protein Delivery. J Clin Med 2020; 9:E542. [PMID: 32079212 PMCID: PMC7073601 DOI: 10.3390/jcm9020542] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023] Open
Abstract
The growing demand for patient-compliance therapies in recent years has led to the development of transdermal drug delivery, which possesses several advantages compared with conventional methods. Delivering protein through the skin by transdermal patches is extremely difficult due to the presence of the stratum corneum which restricts the application to lipophilic drugs with relatively low molecular weight. To overcome these limitations, microneedle (MN) patches, consisting of micro/miniature-sized needles, are a promising tool to perforate the stratum corneum and to release drugs and proteins into the dermis following a non-invasive route. This review investigates the fabrication methods, protein delivery, and translational considerations for the industrial scaling-up of polymeric MNs for dermal protein delivery.
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Affiliation(s)
- Rezvan Jamaledin
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125 Naples, Italy;
| | - Concetta Di Natale
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
| | - Valentina Onesto
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
| | - Zahra Baghban Taraghdari
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125 Naples, Italy;
| | | | - Pooyan Makvandi
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125 Naples, Italy;
- Institute for polymers, Composites and biomaterials (IPCB), National research council (CNR), 80125 Naples, Italy
- Chemistry Department, Faculty of Science, Shahid Chamran University of Ahvaz, P.O. Box: 61537-53843, Ahvaz, Iran
| | - Raffaele Vecchione
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
| | - Paolo Antonio Netti
- Center for Advanced Biomaterials for Health Care, Istituto Italiano di Tecnologia (IIT@CRIB), 80125 Naples, Italy; (R.J.); (V.O.)
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, 80125 Naples, Italy;
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23
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Arrazuria R, Ladero I, Molina E, Fuertes M, Juste R, Fernández M, Pérez V, Garrido J, Elguezabal N. Alternative Vaccination Routes against Paratuberculosis Modulate Local Immune Response and Interference with Tuberculosis Diagnosis in Laboratory Animal Models. Vet Sci 2020; 7:vetsci7010007. [PMID: 31936741 PMCID: PMC7157726 DOI: 10.3390/vetsci7010007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/29/2019] [Accepted: 01/08/2020] [Indexed: 01/21/2023] Open
Abstract
Paratuberculosis (PTB) is an enteric granulomatous disease caused by Mycobacterium avium subsp. paratuberculosis (MAP) that mainly affects ruminants. Current vaccines have shown to be cost–effective control reagents, although they are restricted due to cross-interference with bovine tuberculosis (bTB). Therefore, novel vaccination strategies are needed and this study is focused on evaluating alternative vaccination routes and their effect on the local immune response. The MAP oral challenge rabbit model was used to evaluate and compare an experimental inactivated MAP vaccine through oral (VOR) and intradermal (VID) routes. The VID group presented the highest proportion of animals with no visible lesions and the lowest proportion of animals with MAP positive tissues. Immunohistochemistry analysis revealed that the VID group presented a dominantly M1 polarized response indicating an ability to control MAP infection. In general, all vaccinated groups showed lower calprotectin levels compared to the non-vaccinated challenged group suggesting less active granulomatous lesions. The VID group showed some degree of skin test reactivity, whereas the same vaccine through oral administration was completely negative. These data show that PTB vaccination has an effect on macrophage polarization and that the route influences infection outcome and can also have an impact on bTB diagnosis. Future evaluation of new immunological products against mycobacterial diseases should consider assaying different vaccination routes.
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Affiliation(s)
- Rakel Arrazuria
- Animal Health Department, NEIKER-Instituto Vasco de Investigación y Desarrollo Agrario. Derio, E-48160 Bizkaia, Spain; (R.A.); (I.L.); (E.M.); (M.F.); (R.J.); (J.G.)
| | - Iraia Ladero
- Animal Health Department, NEIKER-Instituto Vasco de Investigación y Desarrollo Agrario. Derio, E-48160 Bizkaia, Spain; (R.A.); (I.L.); (E.M.); (M.F.); (R.J.); (J.G.)
| | - Elena Molina
- Animal Health Department, NEIKER-Instituto Vasco de Investigación y Desarrollo Agrario. Derio, E-48160 Bizkaia, Spain; (R.A.); (I.L.); (E.M.); (M.F.); (R.J.); (J.G.)
| | - Miguel Fuertes
- Animal Health Department, NEIKER-Instituto Vasco de Investigación y Desarrollo Agrario. Derio, E-48160 Bizkaia, Spain; (R.A.); (I.L.); (E.M.); (M.F.); (R.J.); (J.G.)
| | - Ramón Juste
- Animal Health Department, NEIKER-Instituto Vasco de Investigación y Desarrollo Agrario. Derio, E-48160 Bizkaia, Spain; (R.A.); (I.L.); (E.M.); (M.F.); (R.J.); (J.G.)
| | - Miguel Fernández
- Department of Animal Health, Instituto de Ganadería de Montaña (CSIC-ULE), Facultad de Veterinaria, Universidad de León, E-24071 Leon, Spain; (M.F.); (V.P.)
| | - Valentín Pérez
- Department of Animal Health, Instituto de Ganadería de Montaña (CSIC-ULE), Facultad de Veterinaria, Universidad de León, E-24071 Leon, Spain; (M.F.); (V.P.)
| | - Joseba Garrido
- Animal Health Department, NEIKER-Instituto Vasco de Investigación y Desarrollo Agrario. Derio, E-48160 Bizkaia, Spain; (R.A.); (I.L.); (E.M.); (M.F.); (R.J.); (J.G.)
| | - Natalia Elguezabal
- Animal Health Department, NEIKER-Instituto Vasco de Investigación y Desarrollo Agrario. Derio, E-48160 Bizkaia, Spain; (R.A.); (I.L.); (E.M.); (M.F.); (R.J.); (J.G.)
- Correspondence: ; Tel.: +34-94-403-4300
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Balmert SC, Carey CD, Falo GD, Sethi SK, Erdos G, Korkmaz E, Falo LD. Dissolving undercut microneedle arrays for multicomponent cutaneous vaccination. J Control Release 2020; 317:336-346. [PMID: 31756393 PMCID: PMC8237702 DOI: 10.1016/j.jconrel.2019.11.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/08/2019] [Accepted: 11/18/2019] [Indexed: 01/21/2023]
Abstract
The skin is an attractive tissue target for vaccination, as it is readily accessible and contains a dense population of antigen-presenting and immune-accessory cells. Microneedle arrays (MNAs) are emerging as an effective tool for in situ engineering of the cutaneous microenvironment to enable diverse immunization strategies. Here, we present novel dissolving undercut MNAs and demonstrate their application for effective multicomponent cutaneous vaccination. The MNAs are composed of micron-scale needles featuring pyramidal heads supported by undercut stem regions with filleted bases to ensure successful skin penetration and retention during application. Prior efforts to fabricate dissolving undercut microstructures were limited and required complex and lengthy processing and assembly steps. In the current study, we strategically combine three-dimensional (3D) laser lithography, an emerging micro-additive manufacturing method with unique geometric capabilities and nanoscale resolution, and micromolding with favorable materials. This approach enables reproducible production of dissolving MNAs with undercut microneedles that can be tip-loaded with multiple biocargos, such as antigen (ovalbumin) and adjuvant (Poly(I:C)). The resulting MNAs fulfill the geometric (sharp tips and smooth edges) and mechanical-strength requirements for failure-free penetration of human and murine skin to simultaneously deliver multicomponent (antigen plus adjuvant) vaccines to the same cutaneous microenvironment. Cutaneous vaccination of mice using these MNAs induces more potent antigen-specific cellular and humoral immune responses than those elicited by traditional intramuscular injection. Together, the unique geometric features of these undercut MNAs and the associated manufacturing strategy, which is compatible with diverse drugs and biologics, could enable a broad range of non-cutaneous and cutaneous drug delivery applications, including multicomponent vaccination.
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Affiliation(s)
- Stephen C Balmert
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Cara Donahue Carey
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Gabriel D Falo
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Shiv K Sethi
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Geza Erdos
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Emrullah Korkmaz
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
| | - Louis D Falo
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15261, United States; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15213, United States; UPMC Hillman Cancer Center, Pittsburgh, PA 15232, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, United States.
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25
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Biomaterials for Immunoengineering. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Chuaychoo B, Kositanont U, Niyomthong P, Rittayamai N, Srisuma S, Rattanasaengloet K, Wongsrisakunkaew W, Thongam J, Songserm T. Comparison of immunogenicity between intradermal and intramuscular injections of repeated annual identical influenza virus strains post-pandemic (2011-2012) in COPD patients. Hum Vaccin Immunother 2019; 16:1371-1379. [PMID: 31770051 DOI: 10.1080/21645515.2019.1692559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We compared the antibody responses and persistence of the reduced-dose, 9 µg hemagglutinin (HA)/strain intradermal (ID) injection via the Mantoux technique and the 15 μg HA/strain intramuscular (IM) injection of the repeated annual identical trivalent, inactivated, split-virion vaccine 2011-2012 in chronic obstructive pulmonary disease (COPD) patients. Eighty patients were randomized to ID (n = 41) and IM (n = 39) groups. Four weeks post-vaccination, the antibody responses of the two groups were similar; those for influenza A(H1N1)pdm09 and influenza A(H3N2)-but not influenza B-met the criteria of the Committee for Proprietary Medicinal Products (CPMP). The antibody responses for influenza A(H1N1)pdm09 rapidly declined in both groups, especially with the ID injection, whereas those for influenza A(H3N2) maintained above the CPMP criteria throughout 12 months post-vaccination. The geometric mean titres for influenza A(H1N1)pdm09 persisted above the protective threshold (≥ 40) until 6 months post-vaccination in both the ID and IM groups. The seroprotection rates of the ID and IM groups were above 60% until 3 months and 6 months post-vaccination, respectively. In conclusion, the 9 μg HA/strain ID injection of vaccine 2011-2012 elicited antibody responses similar to the standard dose of 15 μg of the HA/strain IM injection at 4 weeks post-vaccination. However, the antibody responses for influenza A(H1N1)pdm09 rapidly declined, especially in the case of the ID injection, whereas they were comparable for influenza A(H3N2). Additional strategies for increasing vaccine durability should be considered, especially for new pandemic strains affecting elderly COPD patients.
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Affiliation(s)
- Benjamas Chuaychoo
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand
| | - Uraiwan Kositanont
- Department of Microbiology, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand.,Faculty of Public Health, Thammasat University , Bangkok, Thailand
| | - Parichat Niyomthong
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand.,Medicine Unit, Phrae Medical Education Center, Naresuan University , Phitsanulok, Thailand
| | - Nuttapol Rittayamai
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand
| | - Sorachai Srisuma
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Kanokwan Rattanasaengloet
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand
| | - Walaiporn Wongsrisakunkaew
- Division of Respiratory Disease and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital , Bangkok, Thailand
| | - Julalux Thongam
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Thaweesak Songserm
- Department of Veterinary Pathology, Kamphaeng Saen, Kasetsart University , Nakhon Pathom, Thailand
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27
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Study of the Immune Response in the Elderly: Is It Necessary to Develop a Vaccine against Neisseria meningitidis for the Aged? J Aging Res 2019; 2019:9287121. [PMID: 31534800 PMCID: PMC6724425 DOI: 10.1155/2019/9287121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/01/2019] [Indexed: 02/08/2023] Open
Abstract
Literature reports the association between aging and decline in the immune system function. The elderly have a higher risk of developing infectious diseases and are often less responsive to vaccines that are effective in the young. The case fatality rate of invasive meningococcal disease is higher in the elderly; therefore, vaccination for this population should be evaluated. Although new vaccines have been developed against Neisseria meningitidis, there is still a need to evaluate a vaccine for those older than 60 years, as the currently licensed vaccines are not indicated for this population.
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28
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Ng TWY, Cowling BJ, Gao HZ, Thompson MG. Comparative Immunogenicity of Enhanced Seasonal Influenza Vaccines in Older Adults: A Systematic Review and Meta-analysis. J Infect Dis 2019; 219:1525-1535. [PMID: 30551178 PMCID: PMC6775043 DOI: 10.1093/infdis/jiy720] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A number of enhanced influenza vaccines have been developed for use in older adults, including high-dose, MF59-adjuvanted, and intradermal vaccines. METHODS We conducted a systematic review examining the improvements in antibody responses measured by the hemagglutination inhibition assay associated with these enhanced vaccines, compared with each other and with the standard-dose (SD) vaccine using random effects models. RESULTS Thirty-nine trials were included. Compared with adults aged ≥60 years receiving SD vaccines, those receiving enhanced vaccines had significantly higher postvaccination titers (for all vaccine strains) and higher proportions with elevated titers ≥40 (for most vaccine strains). High-dose vaccine elicited 82% higher postvaccination titer to A(H3N2) compared with SD vaccine; this was significantly higher than the 52% estimated for MF59-adjuvanted versus SD vaccines (P = .04), which was higher than the 32% estimated for intradermal versus SD vaccines (P < .01). CONCLUSIONS Overall, by summarizing current evidence, we found that enhanced vaccines had greater antibody responses than the SD vaccine. Indications of differences among enhanced vaccines highlight the fact that further research is needed to compare new vaccine options, especially during seasons with mismatched circulating strains and for immune outcomes other than hemagglutination inhibition titers as well as vaccine efficacy.
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Affiliation(s)
- Tiffany W Y Ng
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Benjamin J Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Hui Zhi Gao
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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29
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Schaumburg F, De Pijper CA, Grobusch MP. Intradermal travel vaccinations-when less means more. Travel Med Infect Dis 2019; 28:3-5. [PMID: 30878310 DOI: 10.1016/j.tmaid.2019.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149, Münster, Germany.
| | - Cornelis A De Pijper
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, Meibergdreef 9, 1100, DD, Amsterdam, Netherlands
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity, Amsterdam Public Health, Meibergdreef 9, 1100, DD, Amsterdam, Netherlands
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30
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Gonçalves E, Bonduelle O, Soria A, Loulergue P, Rousseau A, Cachanado M, Bonnabau H, Thiebaut R, Tchitchek N, Behillil S, van der Werf S, Vogt A, Simon T, Launay O, Combadière B. Innate gene signature distinguishes humoral versus cytotoxic responses to influenza vaccination. J Clin Invest 2019; 129:1960-1971. [PMID: 30843873 DOI: 10.1172/jci125372] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systems vaccinology allows cutting-edge analysis of innate biomarkers of vaccine efficacy. We have been exploring novel strategies to shape the adaptive immune response, by targeting innate immune cells through novel immunization routes. METHODS This randomized phase I/II clinical study (n=60 healthy subjects aged 18-45 years old) used transcriptomic analysis to discover early biomarkers of immune response quality after transcutaneous (t.c.), intradermal (i.d.), and intramuscular (i.m.) administration of a trivalent influenza vaccine (TIV season 2012-2013) (1:1:1 ratio). Safety and immunogenicity (hemagglutinin inhibition (HI), microneutralization (MN) antibodies and CD4, CD8 effector T cells) were measured at baseline Day (D)0 and at D21. Blood transcriptome was analyzed at D0 and D1. RESULTS TIV-specific CD8+GranzymeB+(GRZ) T cells appeared in more individuals immunized by the t.c. and i.d. routes, while immunization by the i.d. and i.m. routes prompted high levels of HI antibody titers and MN against A/H1N1 and A/H3N2 influenza viral strains. The early innate gene signature anticipated immunological outcome by discriminating two clusters of individuals with either distinct humoral or CD8 cytotoxic responses. Several pathways explained this dichotomy confirmed by nine genes and serum level of CXCL10 were correlated with either TIV-specific cytotoxic CD8+GRZ+ T-cell or antibody responses. A logistic regression analysis demonstrated that these nine genes and serum levels of CXCL10 (D1/D0) best foreseen TIV-specific CD8+GRZ+ T-cell and antibody responses at D21. CONCLUSION This study provides new insight into the impact of immunization routes and innate signature in the quality of adaptive immune responses.
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Affiliation(s)
- Eléna Gonçalves
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Paris, France
| | - Olivia Bonduelle
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Paris, France
| | - Angèle Soria
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Paris, France.,Service de Dermatologie et Allergologie, Hôpital Tenon, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Pierre Loulergue
- Université Paris Descartes, Sorbonne Paris Cité, Centre d'Investigation Clinique Cochin Pasteur, INSERM CIC 1417, French Clinical Research Infrastructure Network, Innovative Clinical Research Network in Vaccinology, AP-HP, Hôpital Cochin, Paris, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, Assistance Publique-Hôpitaux de Paris, Paris, France. Sorbonne Université, Paris, France
| | - Marine Cachanado
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, Assistance Publique-Hôpitaux de Paris, Paris, France. Sorbonne Université, Paris, France
| | - Henri Bonnabau
- INSERM U1219, INRIA SISTM, Université de Bordeaux, Bordeaux France
| | | | - Nicolas Tchitchek
- CEA - Université Paris Sud 11 - INSERM U1184, Immunology of Viral Infections and Autoimmune Diseases, Institut de Biologie François Jacob, 92265 Fontenay-aux-Roses, France
| | - Sylvie Behillil
- Institut Pasteur, CNR des Virus des Infections Respiratoires, Département de Virologie and Centre National de Recherche Scientifique UMR CNRS 3569, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Unité de Génétique Moléculaire des Virus à ARN, Paris, France
| | - Sylvie van der Werf
- Institut Pasteur, CNR des Virus des Infections Respiratoires, Département de Virologie and Centre National de Recherche Scientifique UMR CNRS 3569, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Unité de Génétique Moléculaire des Virus à ARN, Paris, France
| | - Annika Vogt
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Paris, France.,Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, Assistance Publique-Hôpitaux de Paris, Paris, France. Sorbonne Université, Paris, France
| | - Odile Launay
- Université Paris Descartes, Sorbonne Paris Cité, Centre d'Investigation Clinique Cochin Pasteur, INSERM CIC 1417, French Clinical Research Infrastructure Network, Innovative Clinical Research Network in Vaccinology, AP-HP, Hôpital Cochin, Paris, France
| | - Behazine Combadière
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Paris, France
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Schepens B, Vos PJ, Saelens X, van der Maaden K. Vaccination with influenza hemagglutinin-loaded ceramic nanoporous microneedle arrays induces protective immune responses. Eur J Pharm Biopharm 2019; 136:259-266. [DOI: 10.1016/j.ejpb.2019.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/26/2018] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
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Zareian N, Aprile S, Cristaldi L, Ligotti ME, Vasto S, Farzaneh F. Triggering of Toll-like Receptors in Old Individuals. Relevance for Vaccination. Curr Pharm Des 2019; 25:4163-4167. [PMID: 31713478 DOI: 10.2174/1381612825666191111155800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/07/2019] [Indexed: 11/22/2022]
Abstract
Aging is characterized by a general decline in a range of physiological functions, with a consequent increase in the risk of developing a variety of chronic diseases and geriatric syndromes. Additionally, increasing age is accompanied by a progressive decline in both innate and acquired immune system, referred to as immunosenescence. This impaired ability to mount an efficient immune response after exposure to microorganisms or vaccines represents a major challenge in acquiring protection against pathogens in aging. Therefore, there is still a great need for vaccines that are tailored to optimally stimulate the aged immune system, thus promoting more successful aging. Various strategies can be used to improve vaccine efficacy in old people. Despite this, metaanalyses have clearly shown that the magnitude of protection obtained remains lower in older adults. Recent studies show that stimulation of Toll-like receptors, using stimulatory ligands, can enhance vaccine efficacy by a number of mechanisms, including the activation of innate immune cells and the consequent production of inflammatory cytokines. Therefore, a possible strategy for more effective vaccination in the older population is the triggering of multiple TLRs, using a combined adjuvant for the synergistic activation of cellular immunity. Preliminary in vitro data suggest that in humans the presence of multiple TLR agonists can result in the greater stimulation of antigen-specific immune responses in immune cells both in the young healthy and in the immune senescent older donors. These data suggest that appropriately selected combinations of TLR agonists could enhance the efficacy of vaccination mediated immunity in older people.
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Affiliation(s)
- Nahid Zareian
- The Rayne Institute, School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Stefano Aprile
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, Laboratory of Immunopathology and Immunosenescence, University of Palermo, Palermo, Italy
| | - Laura Cristaldi
- The Rayne Institute, School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, Laboratory of Immunopathology and Immunosenescence, University of Palermo, Palermo, Italy
| | - Mattia Emanuela Ligotti
- The Rayne Institute, School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, Laboratory of Immunopathology and Immunosenescence, University of Palermo, Palermo, Italy
| | - Sonya Vasto
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Palermo, Italy
| | - Farzin Farzaneh
- The Rayne Institute, School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
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33
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Bufan B. Application of prophylactic vaccines in the elderly. ARHIV ZA FARMACIJU 2019. [DOI: 10.5937/arhfarm1906469b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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34
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Schaffner W, van Buynder P, McNeil S, Osterhaus ADME. Seasonal influenza immunisation: Strategies for older adults. Int J Clin Pract 2018; 72:e13249. [PMID: 30216647 DOI: 10.1111/ijcp.13249] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Abstract
Adults over the age of 60-65 years suffer disproportionally from seasonal influenza, experiencing high rates of complications, exacerbation of underlying medical comorbidities, and excess mortality. Thus, older adults are an important priority for influenza immunisation campaigns. Unfortunately, older adults generally display lower immune responses to standard influenza vaccines because of immunosenescence, with resulting suboptimal vaccine effectiveness. Thus, the development of improved vaccines that heighten immune responses and improve effectiveness is an important medical need. To this end, enhanced influenza vaccines specifically targeting this age group have been developed, which seek to overcome the inherent limitations in the immune responses of older adults. Both the licensed high-dose trivalent influenza vaccine (hdTIV) containing fourfold higher antigen contents than standard vaccine, and the MF59® -adjuvanted trivalent influenza vaccine (aTIV) have been proven to be safe and well-tolerated while enhancing the immune response. Healthcare providers for populations of older adults should be advised to routinely use these enhanced influenza vaccines in seasonal immunisation campaigns to provide improved immunity against influenza and its consequences in this particularly susceptible age group.
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Affiliation(s)
| | - Paul van Buynder
- School of Medicine, Griffith University, Gold Coast, Qld, Australia
| | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Center and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Albert D M E Osterhaus
- Research Centre for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hanover, LS, Germany
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Schlaudecker EP, Ambroggio L, McNeal MM, Finkelman FD, Way SS. Declining responsiveness to influenza vaccination with progression of human pregnancy. Vaccine 2018; 36:4734-4741. [PMID: 29941326 DOI: 10.1016/j.vaccine.2018.05.117] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/24/2018] [Accepted: 05/26/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND Influenza immunization is universally recommended during pregnancy to protect mothers and their offspring. However, pregnancy-induced shifts in vaccine responsiveness remain poorly defined. METHODS Quantitative and qualitative shifts in the serological response to influenza vaccination were evaluated in healthy women throughout the course of pregnancy. Serum was obtained before and after vaccination among 71 pregnant and 67 non-pregnant women during the 2011-12 and 2012-13 influenza seasons. Serum hemagglutination inhibition (HAI) assay was used to investigate anti-influenza antibody responses by comparing pre-vaccine and post-vaccine geometric mean titers (GMTs) between groups for each antigen. IgG1, IgG2, IgG3, and IgG4 anti-influenza titers were also evaluated by enzyme-linked immunosorbent assay (ELISA). Pregnancy induced shifts in HAI titers and levels of each anti-influenza antibody isotype were evaluated using linear regression models. RESULTS Post-vaccine GMTs at day 28 were significantly reduced for women vaccinated during pregnancy for A/California (H1N1) in 2011 (p = 0.027), A/Perth (H3N2) in 2011 (p = 0.037), and B/Wisconsin in 2012 (p = 0.039). Vaccine responses progressively declined with the initiation of vaccination later in pregnancy. Anti-H1N1 IgG1, IgG2, and IgG3 titers were reduced in pregnant women compared to non-pregnant controls, and these titers declined with pregnancy progression. The most striking differences were found for anti-H1N1 IgG1, where titers decreased by approximately 7% each week throughout pregnancy. CONCLUSIONS HAI responses elicited by immunization were significantly reduced during pregnancy for three different influenza vaccine antigens. Anti-H1N1 IgG1 was significantly lower in pregnant women and decreased throughout the course of pregnancy. Waning serological responsiveness to influenza vaccination with the progression of human pregnancy has important translational implications for when immunization should be optimally administered during pregnancy.
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Affiliation(s)
- Elizabeth P Schlaudecker
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Lilliam Ambroggio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Monica M McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Fred D Finkelman
- Department of Medicine, Cincinnati Veterans Affairs Medical Center, Division of Allergy, Immunology and Rheumatology, University of Cincinnati College of Medicine and Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Sing Sing Way
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Donnelly RF, Larrañeta E. Microarray patches: potentially useful delivery systems for long-acting nanosuspensions. Drug Discov Today 2018; 23:1026-1033. [DOI: 10.1016/j.drudis.2017.10.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/30/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
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Smetana J, Chlibek R, Shaw J, Splino M, Prymula R. Influenza vaccination in the elderly. Hum Vaccin Immunother 2018; 14:540-549. [PMID: 28708957 PMCID: PMC5861798 DOI: 10.1080/21645515.2017.1343226] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/25/2017] [Accepted: 06/13/2017] [Indexed: 02/08/2023] Open
Abstract
Seasonal influenza is a prevalent and serious annual illness resulting in widespread morbidity and economic disruption throughout the population; the elderly and immunocompromised are particularly vulnerable to serious sequelae and mortality. The changing demographics worldwide to an aging society have important implications for public health policy and pharmaceutical innovations. For instance, primary prevention via immunization is effective in reducing the burden of influenza illness among the elderly. However, the elderly may be insufficiently protected by vaccination due to the immunosenescence which accompanies aging. In addition, vaccine hesitancy among the younger populations increases the likelihood of circulating infectious diseases, and thus concomitant exposure. While it is clear that the development of more immunogenic vaccines is an imperative and worthy endeavor, clinical trials continue to demonstrate that the current influenza vaccine formulation remains highly effective in reducing morbidity and mortality when well matched to circulating strains.
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Affiliation(s)
- Jan Smetana
- University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic
| | - Roman Chlibek
- University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic
| | - Jana Shaw
- University of Hradec Kralove, Faculty of Science, Hradec Kralove, Czech Republic
- SUNY Upstate Medical University, Department of Pediatrics, Division of Pediatric Infectious Diseases, Syracuse, NY, USA
| | - Miroslav Splino
- University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic
| | - Roman Prymula
- University of Hradec Kralove, Faculty of Science, Hradec Kralove, Czech Republic
- Charles University, Faculty of Medicine in Hradec Kralove, Department of Social Medicine, Hradec Kralove, Czech Republic
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Weinberger B. Vaccines for the elderly: current use and future challenges. IMMUNITY & AGEING 2018; 15:3. [PMID: 29387135 PMCID: PMC5778733 DOI: 10.1186/s12979-017-0107-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/28/2017] [Indexed: 12/30/2022]
Abstract
Age-related changes of the immune system contribute to increased incidence and severity of infections in the elderly. Vaccination is the most effective measure to prevent infections and vaccination recommendations in most countries include specific guidelines for the elderly. Vaccination against influenza and Streptococcus pneumoniae is usually recommended for persons with underlying diseases and for the elderly with heterogeneous age limits between ≥ 50 years and ≥ 65 years. Some countries also recommend vaccination against herpes zoster. Several vaccines are recommended for all adults, such as regular booster shots against tetanus/diphtheria/pertussis/polio, or for specific groups, e.g. vaccination against tick-borne encephalitis in endemic areas or travel vaccines. These are also relevant for the elderly. Most currently used vaccines are less immunogenic and effective in the elderly compared to younger adults. Potential strategies to improve their immunogenicity include higher antigen dose, alternative routes of administration, and the use of adjuvants, which were all implemented for influenza vaccines, and induce moderately higher antibody concentrations. Research on universal vaccines against influenza and S. pneumoniae is ongoing in order to overcome the limitations of the current strain-specific vaccines. Respiratory syncytial virus causes significant morbidity in the elderly. Novel vaccines against this and other pathogens, for instance bacterial nosocomial infections, have tremendous potential impact on health in old age and are intensively studied by many academic and commercial organizations. In addition to novel vaccine developments, it is crucial to increase awareness for the importance of vaccination beyond the pediatric setting, as vaccination coverage is still far from optimal for the older population.
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Affiliation(s)
- Birgit Weinberger
- Universität Innsbruck, Institute for Biomedical Aging Research, Rennweg 10, 6020 Innsbruck, Austria
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Microneedles as the technique of drug delivery enhancement in diverse organs and tissues. J Control Release 2018; 270:184-202. [DOI: 10.1016/j.jconrel.2017.11.048] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 11/24/2022]
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BARBIERI M, CAPRI S, WAURE CDE, BOCCALINI S, PANATTO D. Age- and risk-related appropriateness of the use of available influenza vaccines in the Italian elderly population is advantageous: results from a budget impact analysis. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2017; 58:E279-E287. [PMID: 29707658 PMCID: PMC5912787 DOI: 10.15167/2421-4248/jpmh2017.58.4.867] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Nowadays, four different types of influenza vaccines are available in Italy: trivalent (TIV), quadrivalent (QIV), MF59-adjuvanted (aTIV) and intradermal TIV (idTIV) inactivated vaccines. Recently, a concept of the appropriateness (i.e. according to the age and risk factors) of the use of different vaccines has been established in Italy. We conducted a budget impact analysis of switching to a policy, in which the Italian elderly (who carry the major disease burden) received the available vaccines according to their age and risk profile. METHODS A novel budget impact model was constructed with a time horizon of one influenza season. In the reference scenario the cohort of Italian elderly individuals could receive either available vaccine according to 2017/18 season market share. The alternative scenario envisaged the administration of TIV/QIV to people aged 65-74 years and at low risk of developing influenza-related complications, while aTIV/idTIV were allocated to high-risk 65-74-year-olds and all subjects aged ≥ 75 years. RESULTS Switching to the alternative scenario would result in both significant health benefits and net budget savings. Particularly, it would be possible to prevent an additional 8201 cases of laboratory-confirmed influenza, 988 complications, 355 hospitalizations and 14 deaths. Despite the alternative strategy being associated with slightly higher vaccination costs, the total savings derived from fewer influenza events completely resets this increase with net budget savings of € 0.13 million. CONCLUSIONS An immunization policy in which influenza vaccines are administered according to the age and risk profile of Italian elderly individuals is advisable.
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Affiliation(s)
- M. BARBIERI
- Centre for Health Economics, University of York, York, UK
| | - S. CAPRI
- School of Economics and Management, Cattaneo University-LIUC, Castellanza, Italy
| | - C. DE WAURE
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - S. BOCCALINI
- Department of Health Sciences, University of Florence, Italy
| | - D. PANATTO
- Department of Health Sciences, University of Genoa, Italy
- Inter-University Centre for Research on Influenza and Other Transmitted Diseases (CIRI-IT), Genoa, Italy
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Nguyen TT, Park JH. Human studies with microneedles for evaluation of their efficacy and safety. Expert Opin Drug Deliv 2017; 15:235-245. [PMID: 29169288 DOI: 10.1080/17425247.2018.1410138] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION During the past two decades, many studies have documented the development of microneedles (MNs) as a feasible technique for the effective administration of drugs. More and more human studies have been done with MNs to bridge the gap between research and market applications that provide efficacious techniques for clinical implementation. AREAS COVERED The aim of this review is provide a brief description of the status of human study with MNs and to demonstrate progress for the right use of microneedle arrays in clinical settings. It also describes the considerations for clinical application with each type of MNs. EXPERT OPINION Microneedle systems were introduced to overcome the limitations of conventional methods of drug administration. Lots of microneedle systems have undergone clinical evaluation to determine their efficacy and safety, and many studies have demonstrated positive results. The successful clinical use of the microneedle in vaccine therapy is remarkable and supports the importance of conducting further tests in a wide range of medical applications. Self-administered MNs appeared to be an attractive alternative method that needs further research to become a reality in the near future.
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Affiliation(s)
- Thuy Trang Nguyen
- a Department of BioNano Technology , Gachon University , Gyeonggi-Do , South of Korea
| | - Jung Hwan Park
- a Department of BioNano Technology , Gachon University , Gyeonggi-Do , South of Korea
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Boonnak K, Dhitavat J, Thantamnu N, Kosoltanapiwat N, Auayporn M, Jiang L, Puthavathana P, Pitisuttithum P. Immune responses to intradermal and intramuscular inactivated influenza vaccine among older age group. Vaccine 2017; 35:7339-7346. [PMID: 29157960 DOI: 10.1016/j.vaccine.2017.10.106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/25/2017] [Accepted: 10/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUD Influenza viruses cause substantial morbidity, especially in older age groups. Thus, they are amongst high priority groups for routine vaccination. However, vaccine-induced immune responses and effectiveness were reported as relatively low. This study aims to systemically compare the immune responses elicited by intramuscular (IM) and intradermal (ID) injections with inactivated seasonal influenza vaccine among the older age group. METHODS A prospective, open-label, randomized study with a total of 221 adults (>60 years) were enrolled and randomized into 2 groups. Group I (n = 111) received an IM inactivated seasonal influenza vaccine while Group II (n = 110) received the same vaccine ID. Demographics and co-morbidity were collected at baseline. Safety data was collected 3 days post-vaccination using diary card. HAI, NAb and NAI titers were assessed prior to vaccination and at 30, 45, and 60 days post-vaccination. Data was analyzed using SPSS 11.5. RESULTS Both groups had similar BMI and co-morbidity. For ID and IM groups, significant differences were observed for seroconversion rate measured using HAI against H1N1 and H3N2 (58/111 vs 44/110 and 68/111 vs 54/110, respectively) being higher for those aged 60-65 years. However, no differences in HI antibody against B/Phuket were seen. For ID route, history of hyperlipidemia and hypertension were factors associated with high seroconversion rate towards influenza A (p = .001). The seroconversion rate risk ratio were 1.31 and 1.25 (p < .05) against A/California/07/09(H1N1) and A/Songkha/308/13 (H3N2), respectively. Interestingly, the GMT (95% CI) of baseline NAI antibodies among both groups were high (56.57 and 54.01 in the ID and IM groups, respectively). A 4-fold increase measured by NAI against A/California/07/09 (H1N1) were detected in 16.67% and 20% of participants who received ID or IM vaccination, respectively. CONCLUSIONS The seroconversion rates of HAI, NAb and NAI were modest, especially in those >65 years of age. However, it was higher in the ID group as compared to the IM group. CLINICAL TRIAL REGISTRATION NCT02101749.
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Affiliation(s)
- Kobporn Boonnak
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Thailand; Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Jittima Dhitavat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Thailand; Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Narumon Thantamnu
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Nathamon Kosoltanapiwat
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Thailand; Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Montida Auayporn
- Center of Excellence for Biomedical and Public Health Informatics, Mahidol University, Bangkok, Thailand
| | - Li Jiang
- Department of Microbiology, Siriraj Hospital, Mahidol University, Thailand
| | | | - Punnee Pitisuttithum
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Thailand; Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Thailand.
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Schipper P, van der Maaden K, Groeneveld V, Ruigrok M, Romeijn S, Uleman S, Oomens C, Kersten G, Jiskoot W, Bouwstra J. Diphtheria toxoid and N -trimethyl chitosan layer-by-layer coated pH-sensitive microneedles induce potent immune responses upon dermal vaccination in mice. J Control Release 2017; 262:28-36. [DOI: 10.1016/j.jconrel.2017.07.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/02/2017] [Accepted: 07/10/2017] [Indexed: 01/18/2023]
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Bhatnagar S, Dave K, Venuganti VVK. Microneedles in the clinic. J Control Release 2017; 260:164-182. [DOI: 10.1016/j.jconrel.2017.05.029] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 12/16/2022]
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Delgado-Arce JC, García-Lara JMA, Pérez-Zepeda MU, Avila-Funes JA. La fragilidad no se asocia con una baja frecuencia de vacunación en adultos mayores. SALUD PUBLICA DE MEXICO 2017; 59:493. [DOI: 10.21149/8394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Señor editor: Los adultos mayores son particularmente susceptibles a infecciones respiratorias, por lo que la prevención de éstas es fundamental para disminuir complicaciones. Por otra parte, en geriatría, “fragilidad”describe un estado de gran vulnerabilidad y pobre resiliencia, el cual no debería excluir a las personas frágiles del beneficio de intervenciones tales como la vacunación, bajo el argumento infundado de que ésta es inútil.
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Abstract
Annual administration of the seasonal influenza vaccine is strongly recommended to reduce the burden of disease, particularly for persons at the highest risk for the viral infection. Even during years when there is a good match between the vaccine and circulating strains, host-related factors such as age, preexisting immunity, genetic polymorphisms, and the presence of chronic underlying conditions may compromise influenza vaccine responsiveness. The application of new methodologies and large-scale profiling technologies are improving the ability to measure vaccine immunogenicity and our understanding of the immune mechanisms by which vaccines induce protective immunity. This review attempts to summarize the general concepts of how host factors can contribute to the heterogeneity of immune responses induced by influenza vaccines.
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Affiliation(s)
- Maria R Castrucci
- a Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy
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Pinti M, Appay V, Campisi J, Frasca D, Fülöp T, Sauce D, Larbi A, Weinberger B, Cossarizza A. Aging of the immune system: Focus on inflammation and vaccination. Eur J Immunol 2016; 46:2286-2301. [PMID: 27595500 PMCID: PMC5156481 DOI: 10.1002/eji.201546178] [Citation(s) in RCA: 288] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/20/2016] [Accepted: 08/30/2016] [Indexed: 12/21/2022]
Abstract
Major advances in preventing, delaying, or curing individual pathologies are responsible for an increasingly long life span in the developed parts of our planet, and indeed reaching eight to nine decades of life is nowadays extremely frequent. However, medical and sanitary advances have not prevented or delayed the underlying cause of the disparate pathologies occurring in the elderly: aging itself. The identification of the basis of the aging processes that drives the multiple pathologies and loss of function typical of older individuals is a major challenge in current aging research. Among the possible causes, an impairment of the immune system plays a major role, and indeed numerous studies have described immunological changes which occur with age. Far from the intention of being exhaustive, this review will focus on recent advances and views on the role that modifications of cell signalling and remodelling of the immune response play during human aging and longevity, paying particular attention to phenomena which are linked to the so called inflammaging process, such as dysregulation of innate immunity, altered T-cell or B-cell maturation and differentiation, as well as to the implications of immune aging for vaccination strategies in the elderly.
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Affiliation(s)
- Marcello Pinti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Victor Appay
- Sorbonne Universités, UPMC Univ. Paris 06, DHU FAST, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Judith Campisi
- USA and Lawrence Berkeley National Laboratory, Buck Institute for Research on Aging, Berkeley, CA, USA
| | - Daniela Frasca
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tamas Fülöp
- Division of Geriatrics, Department of Medicine, Research Center on Aging, University of Sherbrooke, Canada
| | - Delphine Sauce
- Sorbonne Universités, UPMC Univ. Paris 06, DHU FAST, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Aging and Immunity Program, A*STAR, Singapore
| | - Birgit Weinberger
- Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Andrea Cossarizza
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia School of Medicine, Modena, Italy.
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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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Robertson CA, Tsang P, Landolfi VA, Greenberg DP. Fluzone® Intradermal Quadrivalent Influenza Vaccine. Expert Rev Vaccines 2016; 15:1245-53. [PMID: 27457797 DOI: 10.1080/14760584.2016.1215246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION An intradermal version of Fluzone® split-virion inactivated trivalent influenza vaccine, containing 9 µg hemagglutinin per strain of A/H1N1, A/H3N2, and one B lineage virus (Fluzone Intradermal, Sanofi Pasteur), became available in the US during the 2011-2012 influenza season for adults 18-64 years of age. In advance of the 2015-2016 season, Fluzone Intradermal was replaced with Fluzone Intradermal Quadrivalent vaccine, which contains 9 µg hemagglutinin per strain of the two A-strain viruses and both B-strain lineage viruses (Victoria and Yamagata). AREAS COVERED This literature review summarizes the history and mechanism of intradermal vaccination, discusses the clinical trial results supporting the immunogenicity and safety of Fluzone Intradermal Quadrivalent vaccine, and describes the unique microinjection system used to deliver Fluzone Intradermal Quadrivalent. Expert commentary: Fluzone Intradermal Quadrivalent may boost confidence in influenza vaccination with the addition of a second B-lineage strain. By using an innovative microinjection system, the vaccine is also designed to address some of the logistic challenges faced by healthcare providers administering immunizations.
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Affiliation(s)
- Corwin A Robertson
- a Scientific and Medical Affairs Department , Sanofi Pasteur Inc ., Discovery Drive, Swiftwater , PA , USA
| | - Peter Tsang
- b Clinical Development Department , Sanofi Pasteur Inc ., Swiftwater , PA , USA
| | - Victoria A Landolfi
- c Late Development and Innovation Department , Sanofi Pasteur Inc ., Swiftwater , PA , USA
| | - David P Greenberg
- a Scientific and Medical Affairs Department , Sanofi Pasteur Inc ., Discovery Drive, Swiftwater , PA , USA.,d Department of Pediatrics , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
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