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Carlock MA, Allen JD, Hanley HB, Ross TM. Longitudinal assessment of human antibody binding to hemagglutinin elicited by split-inactivated influenza vaccination over six consecutive seasons. PLoS One 2024; 19:e0301157. [PMID: 38917104 PMCID: PMC11198804 DOI: 10.1371/journal.pone.0301157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Participants between the ages of 10-86 years old were vaccinated with split-inactivated influenza vaccine (Fluzone®) in six consecutive influenza seasons from 2016-2017 to 2021-2022. Vaccine effectiveness varies from season to season as a result of both host immune responses as well as evolutionary changes in the influenza virus surface glycoproteins that provide challenges to vaccine manufacturers to produce more effective annual vaccines. Next generation influenza vaccines are in development and may provide protective immune responses against a broader number of influenza viruses and reduce the need for annual vaccination. An improved understanding how current influenza vaccines are influenced by human host immune responses in people of different ages and co-morbidities is necessary for designing the next-generation of 'universal' or broadly-protective influenza vaccines. Overall, pre-existing immune responses to previous influenza virus exposures, either by past infections or vaccinations, is a critical factor influencing host responses to seasonal influenza vaccination. Participants vaccinated in consecutive seasons had reduced serum hemagglutination-inhibition (HAI) activity against strains included in the vaccine compared to participants that had not been vaccinated in the preceding 1-2 years prior to entering this study. The magnitude and breadth of these antibody responses were also modulated by the age of the participant. Elderly participants over 65 years of age, in general, had lower pre-existing HAI titers each season prior to vaccination with lower post-vaccination titers compared to children or young adults under the age of 35. The administration of higher doses (HD) of the split-inactivated vaccine enhanced the antibody titers in the elderly. This report showcases 6 consecutive years of antibody HAI activity in human subjects receiving seasonal split-inactivated influenza vaccine.
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Affiliation(s)
- Michael A. Carlock
- Center for Vaccines and Immunology, Athens, GA, United States of America
- Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, FL, United States of America
| | - James D. Allen
- Center for Vaccines and Immunology, Athens, GA, United States of America
- Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, FL, United States of America
| | - Hannah B. Hanley
- Center for Vaccines and Immunology, Athens, GA, United States of America
- Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America
| | - Ted M. Ross
- Center for Vaccines and Immunology, Athens, GA, United States of America
- Department of Infectious Diseases, University of Georgia, Athens, GA, United States of America
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, FL, United States of America
- Department of Infection Biology, Lehner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America
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Yegorov S, Celeste DB, Gomes KB, Ang JC, Vandenhof C, Wang J, Rybkina K, Tsui V, Stacey HD, Loeb M, Miller MS. Inactivated and live-attenuated seasonal influenza vaccines boost broadly neutralizing antibodies in children. Cell Rep Med 2022; 3:100509. [PMID: 35243417 PMCID: PMC8861809 DOI: 10.1016/j.xcrm.2022.100509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/16/2021] [Accepted: 01/07/2022] [Indexed: 12/12/2022]
Abstract
The induction of broadly neutralizing antibodies (bNAbs) that target the hemagglutinin stalk domain is a promising strategy for the development of “universal” influenza virus vaccines. bNAbs can be boosted in adults by sequential exposure to heterosubtypic viruses through natural infection or vaccination. However, little is known about if or how bNAbs are induced by vaccination in more immunologically naive children. Here, we describe the impact of repeated seasonal influenza vaccination and vaccine type on induction of bNAbs against group 1 influenza viruses in a pediatric cohort enrolled in randomized controlled trials of seasonal influenza vaccination. Repeated seasonal vaccination results in significant boosting of a durable bNAb response. Boosting of serological bNAb titers is comparable within inactivated and live attenuated (LAIV) vaccinees and declines with age. These data provide insights into vaccine-elicited bNAb induction in children, which have important implications for the design of universal influenza vaccine modalities in this critical population. Repeated inactivated influenza vaccination boosts bNAbs Inactivated and live attenuated vaccines are similarly efficient at boosting bNAbs The magnitude of IIV and LAIV vaccine-elicited bNAb boosting declines with age
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Affiliation(s)
- Sergey Yegorov
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Daniel B. Celeste
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Kimberly Braz Gomes
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Jann C. Ang
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Colin Vandenhof
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Joanne Wang
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Ksenia Rybkina
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Vanessa Tsui
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Hannah D. Stacey
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- Michael G. DeGroote Institute for Infectious Disease Research, Health Research Methodology, Evidence, and Impact, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew S. Miller
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster Immunology Research Centre, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Corresponding author
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Luczo JM, Bousse T, Johnson SK, Jones CA, Pearce N, Neiswanger CA, Wang MX, Miller EA, Petrovsky N, Wentworth DE, Bronshtein V, Papania M, Tompkins SM. Intranasal powder live attenuated influenza vaccine is thermostable, immunogenic, and protective against homologous challenge in ferrets. NPJ Vaccines 2021; 6:59. [PMID: 33883559 PMCID: PMC8060263 DOI: 10.1038/s41541-021-00320-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Influenza viruses cause annual seasonal epidemics and sporadic pandemics; vaccination is the most effective countermeasure. Intranasal live attenuated influenza vaccines (LAIVs) are needle-free, mimic the natural route of infection, and elicit robust immunity. However, some LAIVs require reconstitution and cold-chain requirements restrict storage and distribution of all influenza vaccines. We generated a dry-powder, thermostable LAIV (T-LAIV) using Preservation by Vaporization technology and assessed the stability, immunogenicity, and efficacy of T-LAIV alone or combined with delta inulin adjuvant (Advax™) in ferrets. Stability assays demonstrated minimal loss of T-LAIV titer when stored at 25 °C for 1 year. Vaccination of ferrets with T-LAIV alone or with delta inulin adjuvant elicited mucosal antibody and robust serum HI responses in ferrets, and was protective against homologous challenge. These results suggest that the Preservation by Vaporization-generated dry-powder vaccines could be distributed without refrigeration and administered without reconstitution or injection. Given these significant advantages for vaccine distribution and delivery, further research is warranted.
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Affiliation(s)
- Jasmina M Luczo
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, USA
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, Georgia, 30602, USA
| | - Tatiana Bousse
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott K Johnson
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, USA
| | - Cheryl A Jones
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, USA
| | - Nicholas Pearce
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carlie A Neiswanger
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, USA
| | - Min-Xuan Wang
- Universal Stabilization Technologies, Inc., San Diego, California, USA
| | - Erin A Miller
- Universal Stabilization Technologies, Inc., San Diego, California, USA
| | - Nikolai Petrovsky
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Vaxine Pty Ltd, Warradale, South Australia, Australia
| | - David E Wentworth
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Victor Bronshtein
- Universal Stabilization Technologies, Inc., San Diego, California, USA
| | - Mark Papania
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen M Tompkins
- Center for Vaccines and Immunology, University of Georgia, Athens, Georgia, USA.
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, Georgia, 30602, USA.
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA.
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4
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Affiliation(s)
- John Treanor
- Department of Medicine, University of Rochester School of Medicine and Dentistry
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Busignies V, Simon G, Mollereau G, Bourry O, Mazel V, Rosa-Calatrava M, Tchoreloff P. Development and pre-clinical evaluation in the swine model of a mucosal vaccine tablet for human influenza viruses: A proof-of-concept study. Int J Pharm 2018; 538:87-96. [DOI: 10.1016/j.ijpharm.2018.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 01/09/2023]
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Dhere R, Yeolekar L, Kulkarni P, Menon R, Vaidya V, Ganguly M, Tyagi P, Barde P, Jadhav S. A pandemic influenza vaccine in India: from strain to sale within 12 months. Vaccine 2011; 29 Suppl 1:A16-21. [PMID: 21684421 DOI: 10.1016/j.vaccine.2011.04.119] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/28/2011] [Indexed: 11/30/2022]
Abstract
In the event of a highly pathogenic influenza pandemic, the Indian subcontinent would need 1.2 billion doses of vaccine to immunize its entire population, double if two doses were required to assure immunity. Serum Institute of India Limited (SII) thus became one of six initial grantees of the World Health Organization (WHO) technology transfer initiative to create capacity in developing countries to manufacture H5N1 pandemic influenza vaccine. At the outbreak of the A(H1N1) 2009 influenza pandemic, experience gained from the H5N1 project was used to develop a live attenuated influenza vaccine (LAIV), since this was the only option for the level of surge capacity required for a large-scale immunization campaign in India. SII took <12 months to develop and market its LAIV intranasal vaccine from receipt of the seed strain from WHO. As of November 2010, over 2.5 million persons have been vaccinated with Nasovac(®) with no serious adverse reactions or vaccine failure after 3 months' post-marketing surveillance. The product has been submitted for prequalification by WHO for purchase by United Nations agencies. In parallel, SII also developed an inactivated influenza vaccine, and is currently looking to ensure the sustainability of its influenza vaccine manufacturing capacity.
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MESH Headings
- Humans
- India/epidemiology
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza Vaccines/supply & distribution
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Pandemics/prevention & control
- Technology, Pharmaceutical/methods
- Technology, Pharmaceutical/organization & administration
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/immunology
- Vaccines, Attenuated/supply & distribution
- Vaccines, Inactivated/administration & dosage
- Vaccines, Inactivated/immunology
- Vaccines, Inactivated/supply & distribution
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Affiliation(s)
- Rajeev Dhere
- Serum Institute of India Limited, 212/2 Off Soli Poonawalla Road, Hadapsar, Pune 411028, Maharashtra, India.
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Schüpbach J, Bisset LR, Regenass S, Bürgisser P, Gorgievski M, Steffen I, Andreutti C, Martinetti G, Shah C, Yerly S, Klimkait T, Gebhardt M, Schöni-Affolter F, Rickenbach M, Barth J, Battegay M, Bernascon E, Böni J, Bucher HC, Bürgisser P, Burton-Jeangros C, Calmy A, Cavassini M, Dubs R, Egger M, Elzi L, Fehr J, Fischer M, Flepp M, Francioli P, Furrer H, Fux CA, Gorgievski M, Günthard H, Hasse B, Hirsch HH, Hirschel B, Hösli I, Kahlert C, Kaiser L, Keiser O, Kind C, Klimkait T, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Müller N, Nadal D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schmid P, Schultze D, Schöni-Affolter F, Schüpbach J, Speck R, Taffé P, Telenti A, Trkola A, Vernazza P, von Wyl V, Weber R, Yerly S. High specificity of line-immunoassay based algorithms for recent HIV-1 infection independent of viral subtype and stage of disease. BMC Infect Dis 2011; 11:254. [PMID: 21943091 PMCID: PMC3190377 DOI: 10.1186/1471-2334-11-254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 09/26/2011] [Indexed: 11/29/2022] Open
Abstract
Background Serologic testing algorithms for recent HIV seroconversion (STARHS) provide important information for HIV surveillance. We have shown that a patient's antibody reaction in a confirmatory line immunoassay (INNO-LIATM HIV I/II Score, Innogenetics) provides information on the duration of infection. Here, we sought to further investigate the diagnostic specificity of various Inno-Lia algorithms and to identify factors affecting it. Methods Plasma samples of 714 selected patients of the Swiss HIV Cohort Study infected for longer than 12 months and representing all viral clades and stages of chronic HIV-1 infection were tested blindly by Inno-Lia and classified as either incident (up to 12 m) or older infection by 24 different algorithms. Of the total, 524 patients received HAART, 308 had HIV-1 RNA below 50 copies/mL, and 620 were infected by a HIV-1 non-B clade. Using logistic regression analysis we evaluated factors that might affect the specificity of these algorithms. Results HIV-1 RNA <50 copies/mL was associated with significantly lower reactivity to all five HIV-1 antigens of the Inno-Lia and impaired specificity of most algorithms. Among 412 patients either untreated or with HIV-1 RNA ≥50 copies/mL despite HAART, the median specificity of the algorithms was 96.5% (range 92.0-100%). The only factor that significantly promoted false-incident results in this group was age, with false-incident results increasing by a few percent per additional year. HIV-1 clade, HIV-1 RNA, CD4 percentage, sex, disease stage, and testing modalities exhibited no significance. Results were similar among 190 untreated patients. Conclusions The specificity of most Inno-Lia algorithms was high and not affected by HIV-1 variability, advanced disease and other factors promoting false-recent results in other STARHS. Specificity should be good in any group of untreated HIV-1 patients.
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Affiliation(s)
- Jörg Schüpbach
- University of Zurich, Institute of Medical Virology, Swiss National Center for Retroviruses, Zurich, Switzerland.
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Suguitan AL, Cheng X, Wang W, Wang S, Jin H, Lu S. Influenza H5 hemagglutinin DNA primes the antibody response elicited by the live attenuated influenza A/Vietnam/1203/2004 vaccine in ferrets. PLoS One 2011; 6:e21942. [PMID: 21760928 PMCID: PMC3132217 DOI: 10.1371/journal.pone.0021942] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 06/13/2011] [Indexed: 01/27/2023] Open
Abstract
Priming immunization plays a key role in protecting individuals or populations to influenza viruses that are novel to humans. To identify the most promising vaccine priming strategy, we have evaluated different prime-boost regimens using inactivated, DNA and live attenuated vaccines in ferrets. Live attenuated influenza A/Vietnam/1203/2004 (H5N1) candidate vaccine (LAIV, VN04 ca) primed ferrets efficiently while inactivated H5N1 vaccine could not prime the immune response in seronegative ferrets unless an adjuvant was used. However, the H5 HA DNA vaccine alone was as successful as an adjuvanted inactivated VN04 vaccine in priming the immune response to VN04 ca virus. The serum antibody titers of ferrets primed with H5 HA DNA followed by intranasal vaccination of VN04 ca virus were comparable to that induced by two doses of VN04 ca virus. Both LAIV-LAIV and DNA-LAIV vaccine regimens could induce antibody responses that cross-neutralized antigenically distinct H5N1 virus isolates including A/HongKong/213/2003 (HK03) and prevented nasal infection of HK03 vaccine virus. Thus, H5 HA DNA vaccination may offer an alternative option for pandemic preparedness.
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Affiliation(s)
| | - Xing Cheng
- MedImmune, Mountain View, California, United States of America
| | - Weijia Wang
- MedImmune, Mountain View, California, United States of America
| | - Shixia Wang
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Hong Jin
- MedImmune, Mountain View, California, United States of America
- * E-mail:
| | - Shan Lu
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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Wang L, Green FHY, Smiley-Jewell SM, Pinkerton KE. Susceptibility of the aging lung to environmental injury. Semin Respir Crit Care Med 2010; 31:539-53. [PMID: 20941655 DOI: 10.1055/s-0030-1265895] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
With an ever-increasing number of elderly individuals in the world, a better understanding of the issues associated with aging and the environment is needed. The respiratory system is one of the primary interfaces between the body and the external environment. An expanding number of studies suggest that the aging pulmonary system (>65 years) is at increased risk for adverse health effects from environmental insult, such as by air pollutants, infection, and climate change. However, the mechanism(s) for increased susceptibility in this subpopulation are not well understood. In this review, we provide a limited but comprehensive overview of how the lung ages, examples of environmental exposures associated with injury to the aging lung, and potential mechanisms underlying the increased vulnerability of the aging lung to injury from environmental factors.
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Affiliation(s)
- Lei Wang
- Center for Health and the Environment, University of California at Davis, One Shields Ave., Davis, CA 95616, USA
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12
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Treanor JJ. Viral infections of the respiratory tract: prevention and treatment. Int J Antimicrob Agents 2010; 4:1-22. [PMID: 18611586 DOI: 10.1016/0924-8579(94)90060-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/1993] [Indexed: 10/27/2022]
Abstract
The rapid discovery of specific viral agents as the cause of many acute respiratory diseases was accompanied by considerable optimism that vaccines or other control measures could be developed quickly. Subsequent experience has demonstrated that effective control of these important public health problems has been an elusive goal. However, recent exciting developments in our understanding of the molecular biology and immunology of these viruses may provide the basis for more effective strategies in the future.
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Affiliation(s)
- J J Treanor
- Infectious Diseases Unit, Department of Medicine, University of Rochester School of Medicine, Rochester, NY 14642, USA
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Toapanta FR, Ross TM. Impaired immune responses in the lungs of aged mice following influenza infection. Respir Res 2009; 10:112. [PMID: 19922665 PMCID: PMC2785782 DOI: 10.1186/1465-9921-10-112] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 11/18/2009] [Indexed: 12/20/2022] Open
Abstract
Background Each year, influenza virus infection causes severe morbidity and mortality, particularly in the most susceptible groups including children, the elderly (>65 years-old) and people with chronic respiratory diseases. Among the several factors that contribute to the increased susceptibility in elderly populations are the higher prevalence of chronic diseases (e.g. diabetes) and the senescence of the immune system. Methods In this study, aged and adult mice were infected with sublethal doses of influenza virus (A/Puerto Rico/8/1934). Differences in weight loss, morbidity, virus titer and the kinetics of lung infiltration with cells of the innate and adaptive immune responses were analyzed. Additionally, the main cytokines and chemokines produced by these cells were also assayed. Results Compared to adult mice, aged mice had higher morbidity, lost weight more rapidly, and recovered more slowly from infection. There was a delay in the accumulation of granulocytic cells and conventional dendritic cells (cDCs), but not macrophages in the lungs of aged mice compared to adult animals. The delayed infiltration kinetics of APCs in aged animals correlated with alteration in their activation (CD40 expression), which also correlated with a delayed detection of cytokines and chemokines in lung homogenates. This was associated with retarded lung infiltration by natural killer (NK), CD4+ and CD8+ T-cells. Furthermore, the percentage of activated (CD69+) influenza-specific and IL-2 producer CD8+ T-cells was higher in adult mice compared to aged ones. Additionally, activation (CD69+) of adult B-cells was earlier and correlated with a quicker development of neutralizing antibodies in adult animals. Conclusion Overall, alterations in APC priming and activation lead to delayed production of cytokines and chemokines in the lungs that ultimately affected the infiltration of immune cells following influenza infection. This resulted in delayed activation of the adaptive immune response and subsequent delay in clearance of virus and prolonged illness in aged animals. Since the elderly are the fastest growing segment of the population in developed countries, a better understanding of the changes that occur in the immune system during the aging process is a priority for the development of new vaccines and adjuvants to improve the immune responses in this population.
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14
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Intranasal administration of a live non-pathogenic avian H5N1 influenza virus from a virus library confers protective immunity against H5N1 highly pathogenic avian influenza virus infection in mice: comparison of formulations and administration routes of vaccines. Vaccine 2009; 27:7402-8. [PMID: 19747993 DOI: 10.1016/j.vaccine.2009.08.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 08/04/2009] [Accepted: 08/24/2009] [Indexed: 01/09/2023]
Abstract
Outbreaks of highly pathogenic avian influenza viruses (HPAIVs) would cause disasters worldwide. Various strategies against HPAIVs are required to control damage. It is thought that the use of non-pathogenic avian influenza viruses as live vaccines will be effective in an emergency, even though there might be some adverse effects, because small amounts of live vaccines will confer immunity to protect against HPAIV infection. Therefore, live vaccines have the advantage of being able to be distributed worldwide soon after an outbreak. In the present study, we found that intranasal administration of a live H5N1 subtype non-pathogenic virus induced antibody and cytotoxic T lymphocyte responses and protected mice against H5N1 HPAIV infection. In addition, it was found that a small amount (100 PFU) of the live vaccine was as effective as 100 microg (approximately 10(10-11) PFU of virus particles) of the inactivated whole particle vaccine in mice. Consequently, the use of live virus vaccines might be one strategy for preventing pandemics of HPAIVs in an emergency.
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Abstract
Respiratory syncytial virus (RSV) is the leading cause of severe respiratory disease in infants and is an important source of morbidity and mortality in the elderly and immunocompromised. This review will discuss the humoral and cellular adaptive immune responses to RSV infection and how these responses are shaped in the immature immune system of the infant and the aged environment of the elderly. Furthermore, we will provide an overview of our current understanding of the role the various arms of the adaptive immune response play in mediating the delicate balance between the successful elimination of the virus from the host and the induction of immunopathology. Efficacious immunization against RSV remains a high priority within the field and we will highlight recent advances made in vaccine design.
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Affiliation(s)
- Matthew R Olson
- Department of Microbiology, 51 Newton Road, 3−532 Bowen Science Building, University of Iowa, Iowa City, IA 52242, USA Tel.: +1 319 335 8433 Fax: +1 319 335 9006
| | - Steven M Varga
- Department of Microbiology, Interdisciplinary Graduate Program in Immunology, 51 Newton Road, 3−532 Bowen Science Building, University of Iowa, Iowa City, IA 52242, USA Tel.: +1 319 335 7784 Fax: +1 319 335 9006
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16
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Jones SC, Clise-Dwyer K, Huston G, Dibble J, Eaton S, Haynes L, Swain SL. Impact of post-thymic cellular longevity on the development of age-associated CD4+ T cell defects. THE JOURNAL OF IMMUNOLOGY 2008; 180:4465-75. [PMID: 18354168 DOI: 10.4049/jimmunol.180.7.4465] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Elderly people are at higher risk for infections due to declining cellular and humoral immune responses. Central to this dysfunction is the reduced responsiveness of the naive CD4(+) T cell compartment. Previous data from our laboratory suggest that although defects in the aged naive CD4(+) T cell response are apparent in recent thymic emigrant populations, additional defects develop during extended post-thymic longevity in the periphery. To further investigate the factors that lead to aging defects, we took advantage of the OT-II TCR-transgenic (Tg) mouse model. We show that because of an apparent superantigen-mediated loss of naive Vbeta5(+) Tg CD4(+) T cells from the periphery of aging OT-II mice, this compartment becomes enriched for cells of reduced post-thymic longevity, resulting in a frequency of recent thymic emigrants in aged mice that is similar to that of young mice. Purification and functional analysis of aged OT-II cells with reduced post-thymic longevity reveal that they have an age-associated decrease in expansion and IL-2 production in response to Ag in vitro. However, the in vivo expansion, IL-2 production, and cognate B cell helper ability of these cells are similar to those of cells from young mice. In contrast, T cells from aged HNT Tg mice demonstrate extended post-thymic longevity and exhibit severe defects in the same in vitro and in vivo models. These data support a correlation between the requirement for increased post-thymic longevity and the development of the most severe naive CD4(+) T cell-aging defects.
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Tosh PK, Boyce TG, Poland GA. Flu myths: dispelling the myths associated with live attenuated influenza vaccine. Mayo Clin Proc 2008; 83:77-84. [PMID: 18174020 DOI: 10.4065/83.1.77] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Live attenuated influenza vaccine (LAIV), commercially available since 2003, has not gained widespread acceptance among prescribers. This underuse can be traced to several misperceptions and fears regarding LAIV. This review examines both the facts (safety, immunogenicity, and effectiveness) and the most pervasive myths about LAIV. Live attenuated influenza vaccine is a safe, highly immunogenic, and effective vaccine. It is well tolerated; only mild and transient upper respiratory infection symptoms occur with LAIV vs placebo, even in higher-risk patients with asthma or the early stages of human immunodeficiency virus. It is immunogenic, especially in induction of mucosal immunity. In certain populations, LAIV is as effective as, and in some cases more effective than, inactivated influenza in preventing influenza infection. It appears to be more effective in preventing influenza infection than trivalent inactivated influenza vaccine when the vaccine virus strain does not closely match that of the circulating wild-type virus. Many myths and misperceptions about the vaccine exist, foremost among them the myth of genetic reversion. Independent mutation in 4 gene segments would be required for reversion of the vaccine strain of influenza virus to a wild type, an unlikely and as yet unobserved event. Although shedding of vaccine virus is common, transmission of vaccine virus has been documented only in a single person, who remained asymptomatic. In the age groups for which it is indicated, LAIV is a safe and effective vaccine to prevent influenza infection.
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Affiliation(s)
- Pritish K Tosh
- Vaccine Research Group, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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18
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Abstract
There is very little change in the quantity of antibodies people produce, of any isotype, with age. However, there is a change in the quality of the antibody response. Older people produce fewer antibodies that are specific for the activating pathogen or vaccine. At the same time, the number of nonspecific antibodies increases. Quite often these antibodies have self-reactivity (e.g., anti-dsDNA). The appearance of these antibodies is not associated with pathogenic autoimmune disease, although it is true that the incidence of some autoimmune diseases increases with age. The authors postulate that the process of antibody affinity maturation is compromised in old age. No evidence was found that the process of hypermutation is compromised with age. However, using graph theory to study the dynamics of a germinal center selection process, a decrease in the extent of selection occurring in the germinal centers of mucosal tissue was observed with age. This is a tissue-specific phenomenon because the decrease was not seen in the germinal centers of spleen. Because selection of highly specific cells in the germinal center depends on a number of factors (number and quality of founder cells, help from T cells, and follicular dendritic cells) these need to be investigated further to determine what is needed to improve the affinity mutation process.
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Affiliation(s)
- Wendy A Howard
- Department of Immunobiology, King's College London School of Medicine, Guy's Campus, London, United Kingdom
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19
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Hara M, Tanaka K, Hirota Y. Immune response to influenza vaccine in healthy adults and the elderly: association with nutritional status. Vaccine 2005; 23:1457-63. [PMID: 15670881 DOI: 10.1016/j.vaccine.2004.09.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Revised: 09/02/2004] [Accepted: 09/14/2004] [Indexed: 11/21/2022]
Abstract
The immune response and serum nutritional status of 153 elderly residents of nursing homes (mean age 84.4 years) and 95 health care workers (mean age 36.8 years) were assessed before and after immunization with trivalent split-virus influenza vaccine. Postvaccination titers of hemagglutination inhibition (HAI) antibody to A/H1N1 and B among the elderly were lower than those among workers, but the seroconversion rates (greater than or equal to a four-fold rise) for A/H1N1 and A/H3N2 were unexpectedly higher among the elderly than among workers. However, the difference in the seroconversion rate for either strain between workers and the elderly disappeared after adjusting for the prevaccination HAI titer. Among all subjects, lower age and higher serum concentrations of total protein, albumin, Vitamin E and folate were associated with an intact immune response (postvaccination HAI titers >/=40 for at least one strain). In an age-adjusted analysis limited to the elderly, however, only Vitamin E showed a significant association with the immune response. These results suggested that Vitamin E may play an important role in maintaining the immune response, especially among the elderly.
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Affiliation(s)
- Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga city, Saga 849-8501, Japan.
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20
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Abstract
Aging is associated with an increased morbidity to virus infections as well as a delay in clearance of symptoms after infection. Studies of sublethal virus infections of aged mice closely mirror the human situation: there is a delay in clearance of virus. The delay in virus clearance is accompanied by a delay and a decrease in T-cell response, particularly of CD8(+) T cells. Intrinsic alterations of T cells of aged mice contribute to this decrease in virus-specific T-cell response; however, evidence suggests that environmental or innate components of the aged host also influence this age-associated decline in clearance of virus. While the changes in the adaptive immune response have been carefully described, the early events in the generation of the T-cell response after virus infection have received limited attention. Importantly, age-associated changes in the innate response to virus infection, particularly production of and response to interferon (IFN)-alpha/beta, cytotoxicity and IFN-gamma production by natural killer cells, interleukin-12 induction, and depletion of non-specific T cells early during virus infection need further evaluation.
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Affiliation(s)
- Donna M Murasko
- Department of Bioscience and Biotechnology, College of Arts and Sciences, Drexel University, Philadelphia, PA 19104, USA.
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21
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Zanvit P, Havlícková M, Tácner J, Jirkovská M, Petrásková P, Novotná O, Cechová D, Julák J, Sterzl I, Prokesová L. Immune response after adjuvant mucosal immunization of mice with inactivated influenza virus. Immunol Lett 2005; 97:251-9. [PMID: 15752565 DOI: 10.1016/j.imlet.2004.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 10/15/2004] [Indexed: 10/26/2022]
Abstract
Satisfactory mucosal immunity in the respiratory tract is very important for protection against influenza. It can be achieved only by mucosal immunization. Mucosal vaccination with inactivated influenza virus may not be sufficiently effective and suitable adjuvants are therefore sought. We tested intratracheal immunization of mice with inactivate B type influenza virus in a mixture with formolized G+ bacterium Bacillus firmus, whose adjuvant effects have previously been documented in another system. The treatment resulted in a marked increase of both systemic and mucosal antibody response in IgG and IgA classes. Stimulation of T lymphocytes after adjuvant immunization was very mild, no proliferation taking place after specific stimulation with antigen in vitro. However, slightly increased systemic (spleen) and local (lungs) production of cytokines without perceptible Th1/Th2 polarization was determined. B. firmus is an efficient adjuvant in respiratory tract immunization while with subcutaneous immunization it lowers the antibody response.
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Affiliation(s)
- P Zanvit
- Charles University, 1st Faculty of Medicine, Institute of Immunology and Microbiology, Studnickova 7, 12800 Prague 2, Czech Republic.
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22
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Affiliation(s)
- William B Ershler
- Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, DC, USA
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Greenbaum E, Engelhard D, Levy R, Schlezinger M, Morag A, Zakay-Rones Z. Mucosal (SIgA) and serum (IgG) immunologic responses in young adults following intranasal administration of one or two doses of inactivated, trivalent anti-influenza vaccine. Vaccine 2004; 22:2566-77. [PMID: 15193382 DOI: 10.1016/j.vaccine.2003.12.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2003] [Accepted: 12/15/2003] [Indexed: 11/20/2022]
Abstract
Influenza morbidity affects the entire population and has an enormous impact upon the economic burden and the health care systems. Available vaccines are often unsatisfactory and many individuals are reluctant to receive injections. Intranasal immunization is painless, side effect free and may encourage a large number of individuals to participate in the vaccination programs. Ninety-two students were immunized intranasally once or twice, 21 days apart, with a trivalent inactivated whole influenza vaccine during three separate seasons (1996/1997, 1997/1998 and 1998/1999) with the recommended seasonal strains. The vaccine was well tolerated, without adverse effect and morbidity in the vaccinees during the winter season was low. Serum antibody response was determined by the hemagglutination inhibition (HI) test and nasal response by the enzyme-linked immunoadsorbant assay (ELISA). Following the second dose, mucosal antibody response was detected in 48.1-73.3% of immunized subjects. Serum and mucosal antibody levels (GMT) increased significantly to all the strains, with the exception of A/H3N2 in the mucosal response in 1997/1998. At the end of the trial, the percentage of immune subjects was over 93% to A/H1N1 strains, 60-71% to A/H3N2 and 64-66% to B/Harbin in 1996/1997 and 1997/1998, and 75-91% following one dose in 1998/1999. When serum and mucosal responses were combined, a higher percentage of responders was found (60-86%). Repeated vaccination does not seem to interfere with serum or mucosal response. The double barrier of mucosal and serum antibody may inhibit infection and decrease morbidity when infection occurs, thus limiting the spread of influenza in the community.
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MESH Headings
- Administration, Intranasal
- Adult
- Antibodies, Viral/analysis
- Antibodies, Viral/blood
- Female
- Humans
- Immunity, Mucosal
- Immunoglobulin A, Secretory/analysis
- Immunoglobulin A, Secretory/biosynthesis
- Immunoglobulin G/blood
- Influenza A virus/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Male
- Nasal Mucosa/immunology
- Vaccination
- Vaccines, Inactivated/administration & dosage
- Vaccines, Inactivated/immunology
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Affiliation(s)
- Evgenia Greenbaum
- Department of Virology, Faculty of Medicine, The Hebrew University Hadassah-Medical School, Hebrew University of Jerusalem, P O Box 12272, Jerusalem, Israel
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Cox RJ, Brokstad KA, Ogra P. Influenza virus: immunity and vaccination strategies. Comparison of the immune response to inactivated and live, attenuated influenza vaccines. Scand J Immunol 2004; 59:1-15. [PMID: 14723616 DOI: 10.1111/j.0300-9475.2004.01382.x] [Citation(s) in RCA: 397] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Influenza virus is a globally important respiratory pathogen which causes a high degree of morbidity and mortality annually. The virus is continuously undergoing antigenic change and thus bypasses the host's acquired immunity to influenza. Despite the improvement in antiviral therapy during the last decade, vaccination is still the most effective method of prophylaxis. Vaccination induces a good degree of protection (60-90% efficacy) and is well tolerated by the recipient. For those at risk of complications from influenza, annual vaccination is recommended due to the antigenic changes in circulating strains. However, there is still room for improvement in vaccine efficacy, long-lasting effect, ease of administration and compliance rates. The mucosal tissues of the respiratory tract are the main portal entry of influenza, and the mucosal immune system provides the first line of defence against infection. Secretory immunoglobulin A (SIgA) and IgM are the major neutralizing antibodies directed against mucosal pathogens. These antibodies work to prevent pathogen entry and can function intracellularly to inhibit replication of virus. This review describes influenza virus infection, epidemiology, clinical presentation and immune system response, particularly as it pertains to mucosal immunity and vaccine use. Specifically, this review provides an update of the current status on influenza vaccination and concentrates on the two main types of influenza vaccines currently in use, namely the cold-adapted vaccine (CAV) given intranasally/orally, and the inactivated vaccine (IV) delivered subcutanously or intramuscularly. The commercially available trivalent IV (TIV) elicits good serum antibody responses but induces poorly mucosal IgA antibody and cell-mediated immunity. In contrast, the CAV may elicit a long-lasting, broader immune (humoral and cellular) response, which more closely resembles natural immunity. The immune response induced by these two vaccines will be compared in this review.
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Affiliation(s)
- R J Cox
- Influenza Research Centre; Broegelmann Research Laboratory, The Gade Institute, University of Bergen, Bergen, Norway.
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25
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Targonski PV, Poland GA. Intranasal Cold-Adapted Influenza Virus Vaccine Combined with Inactivated Influenza Virus Vaccines. Drugs Aging 2004; 21:349-59. [PMID: 15084138 DOI: 10.2165/00002512-200421060-00001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Although influenza vaccine delivery strategies have improved coverage rates to unprecedented levels nationally among persons aged 65 years and older, influenza remains one of the greatest vaccine-preventable threats to public health among elderly in the US. A new, intranasal live attenuated influenza vaccine (LAIV) was recently approved by the US FDA for use in persons aged 5-49 years, which excludes the elderly population. Limitations of immune response to inactivated influenza vaccine (IAIV) and effectiveness of current influenza vaccination strategies among the elderly suggest that a combined approach using LAIV and/or the IAIV in various permutations might benefit this group. We explore characteristics of the LAIV, data regarding its utility in protecting against influenza in the elderly, and challenges and opportunities regarding potential combined inactivated/live attenuated vaccination strategies for the elderly. Although LAIV appears to hold promise either alone or in combination with IAIV, large well conducted randomised trials are necessary to define further the role of LAIV in preventing influenza morbidity and mortality among the elderly. We also suggest that innovative vaccine coverage strategies designed to optimise prevention and control of influenza and minimise viral transmission in the community must accompany, in parallel, the acquisition of clinical trials data to best combat morbidity and mortality from influenza.
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Affiliation(s)
- Paul V Targonski
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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26
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Muszkat M, Greenbaum E, Ben-Yehuda A, Oster M, Yeu'l E, Heimann S, Levy R, Friedman G, Zakay-Rones Z. Local and systemic immune response in nursing-home elderly following intranasal or intramuscular immunization with inactivated influenza vaccine. Vaccine 2003; 21:1180-6. [PMID: 12559796 DOI: 10.1016/s0264-410x(02)00481-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Intramuscular (IM) influenza vaccines are only 30-40% effective in preventing clinical illness among the elderly, and their effectiveness in eliciting mucosal response may be even lower. The aim of the present study was to evaluate the immunological effect of a novel inactivated intranasal (IN) trivalent whole influenza virus vaccine among nursing-home elderly. Twenty-one institutionalized elderly subjects were vaccinated IN with an inactivated novel vaccine, twice, 21 days apart, and with no adverse effects. Twenty-two subjects were vaccinated once with a commercial IM vaccine. Viral strains used in the 1998/9 vaccine (20 microg of each per dose) were A/Beijing/262/95, A/Sydney/5/97 and B/Harbin/7/94. Serum antibodies (IgG and IgM) and nasal IgA were determined by the hemagglutination inhibition (HI) test and enzyme-linked immunosorbent assay (ELISA), respectively. Mucosal antibody response to the three vaccine strains was detected in 47.6-71.4% and 18.1-31.8% of IN and IM immunized subjects, respectively. Serum antibody response to the three antigens tested was detected in 20.0-61.9% and 18.2-72.7% of IN and IM immunized subjects, respectively. Seroconversion was not significantly different after IN or IM vaccination for both A/Sydney and B/Harbin, but higher for A/Beijing following IM vaccination. On study completion, 57.1, 65.0 and 50.0% of IN vaccinees were seroprotected to A/Beijing, A/Sydney and B/Harbin, respectively. Similarly, 68.1, 77.2 and 54.5% were immune after IM vaccination. The IN vaccine tested was significantly more effective than the IM vaccine in inducing mucosal IgA response. This may prevent influenza at its early stages and thus contribute to the reduction of morbidity and complications in nursing-home elderly.
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Affiliation(s)
- Mordechai Muszkat
- Geriatric Unit, Department of Medicine, Hadassah University Hospital, Jerusalem, Israel
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27
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Murphy BR, Coelingh K. Principles underlying the development and use of live attenuated cold-adapted influenza A and B virus vaccines. Viral Immunol 2003; 15:295-323. [PMID: 12081014 DOI: 10.1089/08828240260066242] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brian R Murphy
- Respiratory Viruses Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-8007, USA.
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28
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Beyer WEP, Palache AM, de Jong JC, Osterhaus ADME. Cold-adapted live influenza vaccine versus inactivated vaccine: systemic vaccine reactions, local and systemic antibody response, and vaccine efficacy. A meta-analysis. Vaccine 2002; 20:1340-53. [PMID: 11818152 DOI: 10.1016/s0264-410x(01)00471-6] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Since the 1940s, influenza vaccines are inactivated and purified virus or virus subunit preparations (IIV) administered by the intramuscular route. Since decades, attempts have been made to construct, as an alternative, attenuated live influenza vaccines (LIV) for intranasal administration. Presently, the most successful LIV is derived from the cold-adapted master strains A/Ann Arbor/6/60 (H2N2) and B/Ann Arbor/1/66 (AA-LIV, for Ann-Arbor-derived live influenza vaccine). It has been claimed that AA-LIV is more efficacious than IIV. In order to assess differences between the two vaccines with respect to systemic reactogenicity, antibody response, and efficacy, we performed a meta-analysis on eighteen randomised comparative clinical trials involving a total of 5000 vaccinees of all ages. Pooled odds ratios (AA-LIV versus IIV) were calculated according to the random effects model. The two vaccines were associated with similarly low frequencies of systemic vaccine reactions (pooled odds ratio: 0.96, 95% confidence interval: 0.74-1.24). AA-LIV induced significantly lower levels of serum haemagglutination inhibiting antibody and significantly greater levels of local IgA antibody (influenza virus-specific respiratory IgA assayed by ELISA in nasal wash specimens) than IIV. Yet, although they predominantly stimulate different antibody compartments, the two vaccines were similarly efficacious in preventing culture-positive influenza illness. In all trials assessing clinical efficacy, the odds ratios were not significantly different from one (point of equivalence). The pooled odds ratio for influenza A-H3N2 was 1.50 (95% CI: 0.80-2.82), and for A-H1N1, 1.03 (95% CI: 0.58-1.82). The choice between the two vaccine types should be based on weighing the advantage of the attractive non-invasive mode of administration of AA-LIV, against serious concerns about the biological risks inherent to large-scale use of infectious influenza virus, in particular the hazard of gene reassortment with non-human influenza virus strains.
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Affiliation(s)
- W E P Beyer
- WHO National Influenza Centre, Institute of Virology, Erasmus University Rotterdam, P.O. Box 1738, NL-3000 DR, Rotterdam, The Netherlands
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29
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Greenbaum E, Furst A, Kiderman A, Stewart B, Levy R, Schlesinger M, Morag A, Zakay-Rones Z. Mucosal [SIgA] and serum [IgG] immunologic responses in the community after a single intra-nasal immunization with a new inactivated trivalent influenza vaccine. Vaccine 2002; 20:1232-9. [PMID: 11803086 DOI: 10.1016/s0264-410x(01)00396-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Influenza morbidity affects entire populations, imposing an enormous burden in economic terms from working days lost. Protection afforded by current vaccines is often unsatisfactory and many individuals remain averse to injections. To counter these drawbacks, we tested an inactive intra-nasal trivalent influenza vaccine on 182 vaccinated and 92 placebo subjects in the community. On study completion 73 and 66% of the subjects were immune to the vaccine's two A strains, 40% (> or=1:40) and 65% (> or=1:20) to its B strain; 30-40% demonstrated a 4x hemagglutination inhibition (HAI) titer increase; GMT titers increased 2.2-2.5x. About 50% of those initially non-immune became immune. A local antibody response to the three vaccine strains was recorded in 31-44% of vaccinees in which 57, 68 and 54% exhibited a mucosal and/or serum antibody response to the A/Johannesburg, A/Nanchang and B/Harbin strains, respectively. A higher dose (40mg) of A/Johannesburg in the vaccine did not influence response. The new vaccine was safe, without side-effects, and offered reasonable protection after one dose. It could thus play an important role in increasing enrollment into immunization programs.
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Affiliation(s)
- Evgenia Greenbaum
- Department of Virology, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
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30
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Hodge LM, Marinaro M, Jones HP, McGhee JR, Kiyono H, Simecka JW. Immunoglobulin A (IgA) responses and IgE-associated inflammation along the respiratory tract after mucosal but not systemic immunization. Infect Immun 2001; 69:2328-38. [PMID: 11254590 PMCID: PMC98162 DOI: 10.1128/iai.69.4.2328-2338.2001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of the present study was to determine the extent of immunologic responses, particularly immunopathologic responses, within the upper and lower respiratory tracts after intranasal immunization using the mucosal adjuvant cholera toxin (CT). BALB/c mice were nasally immunized with influenza virus vaccine combined with CT. The inclusion of the mucosal adjuvant CT clearly enhanced generation of antibody responses in both the nasal passages and lungs. After nasal immunization, antigen-specific immunoglobulin A (IgA) antibody-forming cells dominated antibody responses throughout the respiratory tract. However, IgG responses were significant in lungs but not in nasal passages. Furthermore, parenteral immunization did not enhance humoral immunity in the upper respiratory tract even after a nasal challenge, whereas extrapulmonary lymphoid responses enhanced responses in the lung. After nasal immunization, inflammatory reactions, characterized by mononuclear cell infiltration, developed within the lungs of mice but not in nasal passages. Lowering dosages of CT reduced, but did not eliminate, these adverse reactions without compromising adjuvancy. Serum IgE responses were also enhanced in a dose-dependent manner by inclusion of CT. In summary, there are differences in the generation of humoral immunity between the upper respiratory tract and the lung. As the upper respiratory tract is in a separate compartment of the immune system from that stimulated by parenteral immunization, nasal immunization is an optimal approach to generate immunity throughout the respiratory tract. Despite the promise of nasal immunization, there is also the potential to develop adverse immunopathologic reactions characterized by pulmonary airway inflammation and IgE production.
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Affiliation(s)
- L M Hodge
- Department of Molecular Biology and Immunology, University of North Texas Health Science Center in Fort Worth, Fort Worth, Texas 76107, USA
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31
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Singh M, Briones M, O'Hagan DT. A novel bioadhesive intranasal delivery system for inactivated influenza vaccines. J Control Release 2001; 70:267-76. [PMID: 11182197 DOI: 10.1016/s0168-3659(00)00330-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of the current studies was to evaluate a bioadhesive delivery system for intranasal administration of a flu vaccine, in combination with a mucosal adjuvant (LTK63). A commercially available influenza vaccine, containing hemagglutinin (HA) from influenza/A Johannesberg H1N1 1996, and LTK63 or LTR72 adjuvants, which are genetically detoxified derivatives of heat labile enterotoxin from Escherichia coli, were administered IN in a bioadhesive delivery system, which comprised esterified hyaluronic acid (HYAFF) microspheres, to mice, rabbits and micro-pigs at days 0 and 28. For comparison, additional groups of animals were immunized intranasally with the HA vaccine alone, with soluble HA+LTK63, or IM with HA. In all three species, the groups of animals receiving IN immunization with the bioadhesive microsphere formulations, including LT mutants, showed significantly enhanced serum IgG responses (P<0.05) and higher hemagglutination inhibition (HI) titers in comparison to the other groups. In addition, the bioadhesive formulation also showed a significantly enhanced nasal wash IgA response (P<0.05). Most encouragingly, in pigs, the bioadhesive microsphere vaccine delivery system induced serum immune responses following IN immunization, which were significantly more potent than those induced by traditional IM immunization at the same vaccine dose (P<0.05).
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Affiliation(s)
- M Singh
- Chiron Technologies, Chiron Corporation, 4560 Horton Street, Emeryville, CA 94608, USA
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32
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Krakauer T, Russo C. Serum cytokine levels and antibody response to influenza vaccine in the elderly. Immunopharmacol Immunotoxicol 2001; 23:35-41. [PMID: 11322647 DOI: 10.1081/iph-100102565] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cytokines play critical roles in regulating the antibody response to vaccines. We sought to understand the role of endogenous cytokines in the determination of antibody production in the elderly, a group of subjects known to have a lower response rate to vaccination. We found that in a healthy elderly group, only 52% of whom responded to the influenza vaccine, endogenous levels of interleukin 6 (IL-6), IL-10 and gamma interferon (IFNgamma) did not differ statistically significantly between responders and non-responders (responders: n = 27, IL-6 = 293 +/- 101 pg/ml, IL-10 = 882 +/- 240 pg/ml; nonresponders: n = 26, IL-6 = 223 +/- 71 pg/ml, P = 0.57, IL-10 = 445 +/- 148 pg/ml, mean +/- SE, P = 0.14, respectively, and undetectable IFNgamma). Serum levels of these three cytokines were not changed significantly four weeks after vaccination (P < 0.05 for IL-6 and P < 0.01 for IL-10). In addition, there were also no age-dependent differences in serum IL-6 and IL-10 levels.
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Affiliation(s)
- T Krakauer
- Dept of Molecular Biology and Immunology, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
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33
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Rudenko LG, Arden NH, Grigorieva E, Naychin A, Rekstin A, Klimov AI, Donina S, Desheva J, Holman RC, DeGuzman A, Cox NJ, Katz JM. Immunogenicity and efficacy of Russian live attenuated and US inactivated influenza vaccines used alone and in combination in nursing home residents. Vaccine 2000; 19:308-18. [PMID: 10930686 DOI: 10.1016/s0264-410x(00)00153-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The immunogenicity and efficacy of Russian live attenuated and US inactivated trivalent influenza vaccines administered alone or in three different combinations were evaluated in a randomized, placebo-controlled, double-blinded study of 614 elderly or chronically ill nursing home residents in St. Petersburg, Russia during the 1996-97 influenza season. Postvaccination serum antibody responses were more frequent among individuals administered the combination vaccines than among those vaccinated with live or inactivated vaccine alone. Only individuals who received live vaccine, alone or in combination with inactivated vaccine, achieved significant postvaccination increases in virus-specific nasal IgA. Efficacy in preventing laboratory-confirmed influenza in vaccinated versus nonvaccinated individuals was 67% (95%CI, 36-81%) for recipients of a combination of the vaccines compared with 51% (95%CI, -17-79%) for recipients of live vaccine alone and 50% (95%CI, -26-80%) for recipients of inactivated vaccine alone. These results suggest that administration of a combination of influenza vaccines may provide a strategy for improved influenza vaccination of elderly people.
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Affiliation(s)
- L G Rudenko
- Department of Virology, Institute for Experimental Medicine, 12 Pavlov Street, St. Petersburg, Russia
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Muszkat M, Yehuda AB, Schein M, Friedlander Y, Naveh P, Greenbaum E, Schlesinger M, Levy R, Zakay-Rones Z, Friedman G. Local and systemic immune response in community-dwelling elderly after intranasal or intramuscular immunization with inactivated influenza vaccine. J Med Virol 2000. [DOI: 10.1002/(sici)1096-9071(200005)61:1<100::aid-jmv16>3.0.co;2-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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35
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Boyce TG, Poland GA. Promises and challenges of live-attenuated intranasal influenza vaccines across the age spectrum: a review. Biomed Pharmacother 2000; 54:210-8. [PMID: 10872719 DOI: 10.1016/s0753-3322(00)89027-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Despite the availability of inactivated influenza vaccines, influenza continues to cause considerable mortality in the elderly, and morbidity in all age groups. Cold-adapted, live-attenuated, intranasally administered influenza vaccines, first developed in the 1960s, have been tested in more than 10,000 volunteers and have been shown to be safe, well-tolerated, and immunogenic. Recent trials suggest that efficacy in children may be superior to that of inactivated vaccines, and efficacy in healthy adults may be similar to that of inactivated vaccines, although there are limited data comparing the two vaccines directly. Advantages of the live-attenuated vaccines include acceptability, ease of administration, and the potential for mass immunization. The possibility of substantially higher vaccination rates across all age groups brings promise for the development of herd immunity and greatly improved control of influenza in the future.
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Affiliation(s)
- T G Boyce
- Department of Pediatric and Adolescent Medicine, Mayo Medical School and Foundation, Rochester, MN 55905, USA
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36
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Muszkat M, Yehuda AB, Schein M, Friedlander Y, Naveh P, Greenbaum E, Schlesinger M, Levy R, Zakay-Rones Z, Friedman G. Local and systemic immune response in community-dwelling elderly after intranasal or intramuscular immunization with inactivated influenza vaccine. J Med Virol 2000. [DOI: 10.1002/(sici)1096-9071(200005)61:1%3c100::aid-jmv16%3e3.0.co;2-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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37
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Abstract
Viral respiratory infections represent a significant challenge for those interested in improving the health of the elderly. Influenza continues to result in a large burden of excess morbidity and mortality. Two effective measures, inactivated influenza vaccine, and the antiviral drugs rimantadine and amantadine, are currently available for control of this disease. Inactivated vaccine should be given yearly to all of those over the age of 65, as well as younger individuals with high-risk medical conditions and individuals delivering care to such persons. Live, intranasally administered attenuated influenza vaccines are also in development, and may be useful in combination with inactivated vaccine in the elderly. The antiviral drugs amantadine and rimantadine are effective in the treatment and prevention of influenza A, although rimantadine is associated with fewer side-effects. Recently, the inhaled neuraminidase inhibitor zanamivir, which is active against both influenza A and B viruses, was licensed for use in uncomplicated influenza. The role of this drug in treatment and prevention of influenza in the elderly remains to be determined. Additional neuraminidase inhibitors are also being developed. In addition, to influenza, respiratory infections with respiratory syncytial virus, parainfluenza virus, rhinovirus, and coronavirus have been identified as potential problems in the elderly. With increasing attention, it is probable that the impact of these infections in this age group will be more extensively documented. Understanding of the immunology and pathogenesis of these infections in elderly adults is in its infancy, and considerable additional work will need to be performed towards development of effective control measures.
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Affiliation(s)
- J Treanor
- Infectious Disease Unit, University of Rochester School of Medicine, NY 14642, USA.
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38
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Abstract
Immunization is the most feasible method for preventing influenza. Vaccination against influenza is recommended for everyone 65 years of age and older and for persons less than 65 years of age who are at risk for developing complications of influenza. Immune correlates of protection have been established, and a global network is in place to monitor the appearance and circulation of antigenic variants of influenza viruses, as well as the appearance of novel subtypes of influenza A. Antigenic and genetic analyses of circulating viruses and testing of serum from vaccine recipients guide vaccine composition updates. The efficacy of influenza vaccines depends in part on the closeness of the antigenic match between the vaccine strain and the epidemic strain. Currently licensed influenza vaccines are trivalent, formalin-inactivated, egg-derived vaccines; their efficacy ranges from 70 to 90% in young, healthy populations when there is a close antigenic match between vaccine strains and epidemic strains. Development of intranasally administered alternative vaccines and improvement of the existing vaccine are areas of active research. A trivalent, ca live vaccine is the most promising LAIV candidate. In a field trial, efficacy rates of LAIV in young children were 96% against influenza A (H3N2) and 91% against influenza B. However, few data are available to compare this formulation of the trivalent ca live vaccine with the trivalent, inactivated vaccine. Influenza vaccine recommendations will most likely be revised on licensure of LAIV; each vaccine may offer distinct advantages in specific populations.
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Affiliation(s)
- K Subbarao
- Influenza Branch, Center for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Abstract
Influenza infection is an acute respiratory disease with a high morbidity and significant mortality, particularly among the elderly and individuals with chronic diseases. The majority of countries now recommend annual influenza vaccination for all people aged 65 years or older, and for those with high risk conditions. Most commercially available influenza vaccines are administered systemically and while these are effective in children and young adults, efficacy levels in elderly individuals have been reported to be much lower. Mucosal vaccines may offer an improved vaccine strategy for protection of the elderly. As the influenza virus causes a respiratory infection, it is potentially more beneficial to administer a vaccine that will boost protection in the mucosal surfaces of the upper and lower respiratory tract. Mucosal influenza vaccines are aimed at stimulating protective immunity in the respiratory tract via oral or intranasal immunisation. This review examines our present knowledge of mucosal immunity and current strategies for mucosal vaccination. It also stresses that the use of serum antibody levels as a 'surrogate marker' for protection against influenza is potentially misleading; serum antibody, for example, may be a quite inappropriate marker to assess a mucosal vaccine. This marker does not reflect other immune responses to vaccination that are crucial for protection.
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Affiliation(s)
- E M Corrigan
- The Australian Institute of Mucosal Immunology, Royal Newcastle Hospital, New South Wales
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40
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Barackman JD, Ott G, O'Hagan DT. Intranasal immunization of mice with influenza vaccine in combination with the adjuvant LT-R72 induces potent mucosal and serum immunity which is stronger than that with traditional intramuscular immunization. Infect Immun 1999; 67:4276-9. [PMID: 10417205 PMCID: PMC96738 DOI: 10.1128/iai.67.8.4276-4279.1999] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Immunization of mice by the intranasal route with influenza virus hemagglutinin in combination with the mutant Escherichia coli heat-labile enterotoxin R72 (LT-R72) induced significantly enhanced serum and mucosal antibodies, surpassing, in most cases, responses achieved by traditional intramuscular immunization using inactivated split influenza vaccine. Furthermore, intranasal immunization with LT-R72 induced a potent serum immunoglobulin G2a response, indicating that this adjuvant has Th1 character.
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41
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Treanor JJ, Betts RF. Evaluation of live, cold-adapted influenza A and B virus vaccines in elderly and high-risk subjects. Vaccine 1998; 16:1756-60. [PMID: 9778752 DOI: 10.1016/s0264-410x(98)00136-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We have evaluated the use of live cold-adapted influenza A and B virus vaccines in the elderly. Cold-adapted influenza A and B virus vaccines are safe and modestly immunogenic in individuals over 65 years of age. However, our studies and those of other groups have shown that immune response to cold-adapted vaccines in this age group are modest. Administration of combined cold-adapted influenza A and inactivated influenza vaccine has resulted in slightly higher frequencies of local and systemic humoral immune responses than inactivated vaccine alone in some, but not all, studies. In a double-blind field trial conducted in nursing homes over a 3 year period, combined cold-adapted influenza A (H3N2) and trivalent inactivated influenza vaccine resulted in a 60% decrease (95% CI, 18-82%) in the rate of laboratory documented influenza A compared with inactivated vaccine alone. Further studies of multivalent cold-adapted influenza vaccines used in combination with inactivated vaccine should be performed.
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Affiliation(s)
- J J Treanor
- University of Rochester, Infectious Diseases Unit, NY 14642, USA.
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Belshe RB, Mendelman PM, Treanor J, King J, Gruber WC, Piedra P, Bernstein DI, Hayden FG, Kotloff K, Zangwill K, Iacuzio D, Wolff M. The efficacy of live attenuated, cold-adapted, trivalent, intranasal influenzavirus vaccine in children. N Engl J Med 1998; 338:1405-12. [PMID: 9580647 DOI: 10.1056/nejm199805143382002] [Citation(s) in RCA: 727] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Influenzavirus vaccine is used infrequently in healthy children, even though the rates of influenza in this group are high. We conducted a multicenter, double-blind, placebo-controlled trial of a live attenuated, cold-adapted, trivalent influenzavirus vaccine in children 15 to 71 months old. METHODS Two hundred eighty-eight children were assigned to receive one dose of vaccine or placebo given by intranasal spray, and 1314 were assigned to receive two doses approximately 60 days apart. The strains included in the vaccine were antigenically equivalent to those in the inactivated influenzavirus vaccine in use at the time. The subjects were monitored with viral cultures for influenza during the subsequent influenza season. A case of influenza was defined as an illness associated with the isolation of wild-type influenzavirus from respiratory secretions. RESULTS The intranasal vaccine was accepted and well tolerated. Among children who were initially seronegative, antibody titers increased by a factor of four in 61 to 96 percent, depending on the influenza strain. Culture-positive influenza was significantly less common in the vaccine group (14 cases among 1070 subjects) than the placebo group (95 cases among 532 subjects). The vaccine efficacy was 93 percent (95 percent confidence interval, 88 to 96 percent) against culture-confirmed influenza. Both the one-dose regimen (89 percent efficacy) and the two-dose regimen (94 percent efficacy) were efficacious, and the vaccine was efficacious against both strains of influenza circulating in 1996-1997, A(H3N2) and B. The vaccinated children had significantly fewer febrile illnesses, including 30 percent fewer episodes of febrile otitis media (95 percent confidence interval, 18 to 45 percent; P<0.001). CONCLUSIONS A live attenuated, cold-adapted influenzavirus vaccine was safe, immunogenic, and effective against influenza A(H3N2) and B in healthy children.
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Affiliation(s)
- R B Belshe
- Department of Medicine, Saint Louis University, MO 63110, USA
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43
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Abstract
The medical and economic burden associated with annual influenza activity is well known and well documented. Yearly updated influenza vaccines are available to combat the disease and its consequences. In many countries, less than half of the high risk patients are being vaccinated, despite recommendations to do so by national health authorities. Scientific evidence on the safety, tolerance, efficacy and effectiveness of currently existing inactivated influenza vaccines unambiguously demonstrates the favourable benefit/risk ratio of influenza immunisations for high risk patients and strongly suggests an economic benefit of influenza immunisation programmes. Because of both the successful world-wide efforts of the WHO to optimise the chance of an adequate antigenic match between vaccine and epidemic strains each year and the available scientific data about the inactivated influenza vaccines, influenza immunisations should be offered annually to high risk patients. On the basis of the available evidence, offering a vaccination to such patients should be considered an ethical obligation.
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Affiliation(s)
- A M Palache
- Department of Virology, Erasmus University, Rotterdam, The Netherlands
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Gorse GJ, Otto EE, Daughaday CC, Newman FK, Eickhoff CS, Powers DC, Lusk RH. Influenza virus vaccination of patients with chronic lung disease. Chest 1997; 112:1221-33. [PMID: 9367461 DOI: 10.1378/chest.112.5.1221] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES To evaluate the safety of, and mucosal and systemic immune responses induced by two influenza virus vaccine regimens in subjects with COPD. DESIGN Single-center, blinded, randomized, prospective clinical trial evaluating two vaccine regimens. SETTING Outpatient clinics of St. Louis Department of Veterans Affairs Medical Center. PARTICIPANTS Volunteers (age range, 42 to 88 years) had preexisting COPD with severe obstruction to airflow on average, were male, and were not receiving immunosuppressive medication. INTERVENTIONS Twenty-nine volunteers were randomly assigned to receive either bivalent live attenuated influenza A virus vaccine (CAV) or saline solution placebo intranasally. All subjects also received an i.m. injection of trivalent inactivated influenza virus vaccine (TVV) simultaneously. MEASUREMENTS AND RESULTS Clinical status and pulmonary function measured by spirometry did not change significantly after vaccination. Using hemagglutinins (H1 and H3 HA) which more closely resembled those in CAV, mean levels of anti-HA immunoglobulin A (IgA) antibodies in nasal washings increased significantly after vaccination with CAV and TVV compared to prevaccination, but they did not increase significantly after TVV and intranasal placebo. Mean levels of influenza A virus-stimulated interleukin-2 and -4 produced by peripheral blood mononuclear cells in vitro increased significantly after administration of the combination vaccine regimen and to a lesser extent after TVV and intranasal placebo compared to respective prevaccination levels. The timing of the cytokine response appeared different following CAV and TVV compared to TVV and intranasal placebo. CONCLUSIONS Intranasally administered CAV was safe when given with i.m. administered TVV and there may be an immunologic advantage to administration of the combination vaccine regimen compared to TVV with intranasal placebo.
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MESH Headings
- Administration, Intranasal
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Viral/analysis
- Cytokines/biosynthesis
- Double-Blind Method
- Humans
- Immunoglobulin A/analysis
- Influenza A virus/immunology
- Influenza A virus/isolation & purification
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/adverse effects
- Influenza, Human/immunology
- Influenza, Human/physiopathology
- Influenza, Human/prevention & control
- Injections, Intramuscular
- Lung Diseases, Obstructive/complications
- Lung Diseases, Obstructive/immunology
- Lung Diseases, Obstructive/physiopathology
- Male
- Middle Aged
- Prospective Studies
- Respiratory Function Tests
- Safety
- Treatment Outcome
- Vaccination
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/adverse effects
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Affiliation(s)
- G J Gorse
- Section of Infectious Diseases, St. Louis Department of Veterans Affairs Medical Center, Saint Louis University School of Medicine, MO 63110, USA
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45
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Abstract
The majority of patients with cancer in the United States are more than 70 years old. Despite the increased understanding of the molecular bases for both oncogenesis and aging, the overlap of cancer and aging at that level remains a wide-open research domain. Similarly, at the clinical level, there is also an increased awareness of the need for more information about the influence of host age on the development of tumors, on the growth and spread of the disease, and on treatment expectations. In this review, we have attempted to frame questions regarding cancer and aging from the perspective of biogerontology and geriatric medicine. An increased effort to address the issues of aging is of paramount importance at all levels of cancer investigation.
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Affiliation(s)
- W B Ershler
- Glennan Center for Geriatrics and Gerontology, Eastern Virginia Medical School, Norfolk, USA
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46
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47
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Keitel WA, Cate TR, Atmar RL, Turner CS, Nino D, Dukes CM, Six HR, Couch RB. Increasing doses of purified influenza virus hemagglutinin and subvirion vaccines enhance antibody responses in the elderly. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1996; 3:507-10. [PMID: 8877126 PMCID: PMC170397 DOI: 10.1128/cdli.3.5.507-510.1996] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The reactogenicities and immunogenicities of two influenza virus vaccines were compared in a placebo-controlled clinical trial among healthy ambulatory persons > or = 65 years old (mean age, 72 years). Volunteers were assigned randomly to receive 15-, 45-, or 135-micrograms doses of monovalent influenza A/Taiwan (H1N1) hemagglutinin (HA) or subvirion (SV) vaccine intramuscularly or a placebo. Increasing doses of SV vaccine were associated with a higher rate of injection site discomfort (P < 0.05; chi-square test for linear trend), but all doses of both vaccines were well tolerated. Increasing the dose of the HA or the SV vaccine resulted in increasingly higher postimmunization levels of serum hemagglutination inhibition and neutralizing antibody levels (P < 0.001; multiple linear regression). Mean serum antibody titers at 1 month increased two- to threefold with a ninefold increase in dose; the frequencies of fourfold or greater rises in titer likewise increased. An increase in the dose of the HA or the SV vaccine also resulted in increased frequencies of rises in immunoglobulin A or G antibody titers in nasal wash specimens. The frequencies increased approximately twofold for each vaccine with a ninefold increase in the dose. These data suggest that increasing the HA vaccine dose is a promising approach to the development of improved influenza virus vaccines for use in elderly people.
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Affiliation(s)
- W A Keitel
- Department of Microbiology and Immunology, Baylor College of Medicine Houston, Texas 77030, USA
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48
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Abstract
There is overwhelming evidence for the clinical efficacy of the influenza vaccine, especially in the elderly with chronic disease, reducing mortality and hospital admissions. There is also evidence to suggest that the influenza vaccine may be beneficial in the healthy elderly. There is some evidence to suggest that the antibody response in the elderly to the vaccine may decrease with increasing age, although there are several confounding factors that have not been taken into account in many of these studies. That aside, even if antibody response is not as good as that in younger people, the evidence that vaccination saves lives and reduces morbidity in the elderly means that the vaccination should be offered to elderly patients at high risk and perhaps even to the elderly healthy population. Although vaccination of an elderly at-risk patient does not necessarily mean that that particular patient will mount an appropriate antibody response, a significant number of elderly patients will respond appropriately. Serious side-effects from vaccination are extremely rare and the more common side-effects are mild and self-limiting. Increasing the number of elderly people receiving the influenza vaccination will not only result in cost savings for the National Health Service in terms of reduced hospitalisation but, more significantly, the elderly will benefit in terms of reduced morbidity and mortality.
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Affiliation(s)
- R Morgan
- Geriatric Medicine, Withington Hospital, Manchester, UK
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49
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Affiliation(s)
- R L Clancy
- Department of Pathology, Faculty of Medicine, University of Newcastle, New South Wales, Australia
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50
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Glathe H, Lange W. Influenza vaccination in older patients. Immunogenicity, epidemiology and available agents. Drugs Aging 1995; 6:368-87. [PMID: 7647426 DOI: 10.2165/00002512-199506050-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Excess hospitalisation and deaths attributable to influenza virus infections often occur during epidemics and even in interepidemic periods. Influenza vaccines in current use are inactivated preparations that contain 15 micrograms each of the most recently circulating influenza A (H3N2 and H1N1) and B viruses. At present, 3 types of inactivated influenza virus vaccines are available: (a) whole virus vaccines; (b) split virus vaccines; and (c) subunit vaccines. All 3 types are similarly immunogenic in primed patients. Vaccine efficacy depends on a close antigenic match between the vaccine composition and the influenza strains circulating in the human population. The continuous antigenic drift of the viral membrane antigens (haemagglutinin and neuraminidase) necessitates an update of the vaccine composition each year according to the recommendations of the World Health Organization (WHO). Subunit and split virus vaccines cause fewer systemic reactions than whole virus vaccines. At present, live attenuated influenza virus vaccines are not licensed. In perspective, combined administration of live and inactivated vaccines seems to be advantageous. Influenza vaccine is approximately 75% effective in reducing deaths in elderly and high risk persons. Several studies have shown that the antiviral agent amantadine is a useful adjunct to vaccination for preventing influenza A in institutional settings. Currently, the proper use of inactivated vaccine according to the recommendations of public health authorities is the only way to reduce the annual influenza-associated medical and economic burden.
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Affiliation(s)
- H Glathe
- Robert-Koch-Institute, Berlin, Germany
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