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Yang S, Wang Q, Li T, Long J, Xiong Y, Feng L, Wang Q, Zhao Y, Yang J, Tang W, Zhang H, Qi L. Effectiveness of influenza vaccine among the population in Chongqing, China, 2018-2022: A test negative design-based evaluation. Hum Vaccin Immunother 2024; 20:2376821. [PMID: 39025479 PMCID: PMC11259055 DOI: 10.1080/21645515.2024.2376821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
Influenza vaccination is the most cost-effective strategy for influenza prevention. Influenza vaccines have been found to be effective against symptomatic and medically attended outpatient influenza illnesses. However, there is currently a lack of data regarding the effectiveness of inactivated influenza vaccines in Chongqing, China. We conducted a prospective observational test-negative design study. Outpatient and emergency cases presenting with influenza-like illnesses (ILI) and available influenza reverse transcription polymerase chain reaction (RT-PCR) were selected and classified as cases (positive influenza RT-PCR) or controls (negative influenza RT-PCR). A total of 7,307 cases of influenza and 7,905 control subjects were included in this study. The overall adjusted influenza vaccine effectiveness (IVE) was 44.4% (95% confidence interval (CI): 32.5-54.2%). In the age groups of less than 6 years old, 6-18 years old, and 19-59 years old, the adjusted IVE were 32.2% (95% CI: 10.0-48.9%), 48.2% (95% CI: 30.6-61.4%), and 72.0% (95% CI: 43.6-86.1%). The adjusted IVE for H1N1, H3N2 and B (Victoria) were 71.1% (95% CI: 55.4-81.3%), 36.1% (95% CI: 14.6-52.2%) and 33.7% (95% CI: 14.6-48.5%). Influenza vaccination was effective in Chongqing from 2018 to 2022. Evaluating IVE in this area is feasible and should be conducted annually in the future.
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Affiliation(s)
- Shuang Yang
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qing Wang
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- 2023 Key Disciplines on Public Health Construction in Chongqing, Chongqing, China
| | - Tingting Li
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- 2023 Key Disciplines on Public Health Construction in Chongqing, Chongqing, China
| | - Jiang Long
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- 2023 Key Disciplines on Public Health Construction in Chongqing, Chongqing, China
| | - Yu Xiong
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- 2023 Key Disciplines on Public Health Construction in Chongqing, Chongqing, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Zhao
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Jule Yang
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- 2023 Key Disciplines on Public Health Construction in Chongqing, Chongqing, China
| | - Wenge Tang
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- 2023 Key Disciplines on Public Health Construction in Chongqing, Chongqing, China
| | - Huadong Zhang
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- 2023 Key Disciplines on Public Health Construction in Chongqing, Chongqing, China
| | - Li Qi
- Infectious Disease Prevention and Control, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
- 2023 Key Disciplines on Public Health Construction in Chongqing, Chongqing, China
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Akalu YT, Patel RS, Taft J, Canas-Arranz R, Richardson A, Buta S, Martin-Fernandez M, Sazeides C, Pearl RL, Mainkar G, Kurland AP, Geltman R, Rosberger H, Kang DD, Kurian AA, Kaur K, Altman J, Dong Y, Johnson JR, Zhangi L, Lim JK, Albrecht RA, García-Sastre A, Rosenberg BR, Bogunovic D. Broad-spectrum RNA antiviral inspired by ISG15 -/- deficiency. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.24.600468. [PMID: 38979204 PMCID: PMC11230275 DOI: 10.1101/2024.06.24.600468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Type I interferons (IFN-I) are cytokines with potent antiviral and inflammatory capacities. IFN-I signaling drives the expression of hundreds of IFN-I stimulated genes (ISGs), whose aggregate function results in the control of viral infection. A few of these ISGs are tasked with negatively regulating the IFN-I response to prevent overt inflammation. ISG15 is a negative regulator whose absence leads to persistent, low-grade elevation of ISG expression and concurrent, self-resolving mild autoinflammation. The limited breadth and low-grade persistence of ISGs expressed in ISG15 deficiency are sufficient to confer broad-spectrum antiviral resistance. Inspired by ISG15 deficiency, we have identified a nominal collection of 10 ISGs that recapitulate the broad antiviral potential of the IFN-I system. The expression of the 10 ISG collection in an IFN-I non-responsive cell line increased cellular resistance to Zika, Vesicular Stomatitis, Influenza A (IAV), and SARS-CoV-2 viruses. A deliverable prophylactic formulation of this syndicate of 10 ISGs significantly inhibited IAV PR8 replication in vivo in mice and protected hamsters against a lethal SARS-CoV-2 challenge, suggesting its potential as a broad-spectrum antiviral against many current and future emerging viral pathogens. One-Sentence Summary Human inborn error of immunity-guided discovery and development of a broad-spectrum RNA antiviral therapy.
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Bissett C, Belij-Rammerstorfer S, Ulaszewska M, Smith H, Kailath R, Morris S, Powers C, Sebastian S, Sharpe HR, Allen ER, Wang Z, Cunliffe RF, Sallah HJ, Spencer AJ, Gilbert S, Tregoning JS, Lambe T. Systemic prime mucosal boost significantly increases protective efficacy of bivalent RSV influenza viral vectored vaccine. NPJ Vaccines 2024; 9:118. [PMID: 38926455 PMCID: PMC11208422 DOI: 10.1038/s41541-024-00912-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Although licensed vaccines against influenza virus have been successful in reducing pathogen-mediated disease, they have been less effective at preventing viral infection of the airways and current seasonal updates to influenza vaccines do not always successfully accommodate viral drift. Most licensed influenza and recently licensed RSV vaccines are administered via the intramuscular route. Alternative immunisation strategies, such as intranasal vaccinations, and "prime-pull" regimens, may deliver a more sterilising form of protection against respiratory viruses. A bivalent ChAdOx1-based vaccine (ChAdOx1-NP + M1-RSVF) encoding conserved nucleoprotein and matrix 1 proteins from influenza A virus and a modified pre-fusion stabilised RSV A F protein, was designed, developed and tested in preclinical animal models. The aim was to induce broad, cross-protective tissue-resident T cells against heterotypic influenza viruses and neutralising antibodies against RSV in the respiratory mucosa and systemically. When administered via an intramuscular prime-intranasal boost (IM-IN) regimen in mice, superior protection was generated against challenge with either RSV A, Influenza A H3N2 or H1N1. These results support further clinical development of a pan influenza & RSV vaccine administered in a prime-pull regimen.
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Affiliation(s)
- Cameron Bissett
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | | | - Marta Ulaszewska
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Holly Smith
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Reshma Kailath
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Susan Morris
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Claire Powers
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Sebastian
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Hannah R Sharpe
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elizabeth R Allen
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ziyin Wang
- Department of Infectious Disease, Imperial College London, London, UK
| | - Robert F Cunliffe
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Alexandra J Spencer
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Sarah Gilbert
- Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John S Tregoning
- Department of Infectious Disease, Imperial College London, London, UK
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
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Hassan MZ, Biswas MAAJ, Rahman M, Shoshi HR, Pyash AS, Islam MA, Haque MA, Parvin SR, Hossen MT, Hussain M, Rahman M, Shirin T, Chowdhury F. Acceptability, cost-effectiveness, and capacity of a facility-based seasonal influenza vaccination among high-risk groups: a study protocol in selected tertiary care hospitals of Bangladesh. BMC Public Health 2024; 24:242. [PMID: 38245668 PMCID: PMC10800039 DOI: 10.1186/s12889-024-17724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND In Bangladesh, seasonal influenza imposes considerable disease and economic burden, especially for those at high-risk of severe disease. The most successful approach for influenza prevention is the administration of a vaccine. Many poor and middle-income nations, including Bangladesh, do not have a national strategy or program in place for seasonal influenza vaccines, despite the World Health Organization's (WHO) advice to prioritize high-risk populations. Additionally, there is a scarcity of substantial data on the cost-effectiveness of seasonal influenza vaccination in these countries. The aim of our study is to determine acceptability, health beliefs, barriers, and intention of receiving influenza vaccine among high-risk populations, assess the cost-effectiveness of implementing a facility-based seasonal influenza vaccination programme, and investigate the required capacity for a potential seasonal influenza vaccination programme. METHODS We will undertake this study following STROBE guidelines. We will conduct the study in inpatient and outpatient departments of three selected tertiary-level hospitals leveraging the ongoing hospital-based influenza surveillance (HBIS) platform. The study population will include the WHO-defined four high-risk groups excluding healthcare workers: children six months to eight years, pregnant women, elderly ≥ 60 years, and adults with chronic diseases. We will collect quantitative data on participants' acceptability, health beliefs, barriers, and vaccination intentions using the health belief model (HBM) from patients meeting the criteria for high-risk populations attending two public tertiary-level hospitals. In one of the two public tertiary-level hospitals, we will arrange an influenza vaccination campaign before the influenza season, where the vaccine will be offered free of cost to high-risk patients, and in the second hospital, vaccination will not be offered. Both the vaccinated and unvaccinated participants will then be followed-up once a month for one year to record any influenza-like illness, hospitalization, and death. Additional data for objective two will be collected from patients with symptoms of influenza-like illness (ILI) and severe acute respiratory infection (SARI) at one public and one private hospital to determine both direct and indirect costs associated with influenza illness. We will estimate the required number of influenza vaccines, safe injections, and total storage volume utilizing secondary data. We will use a deterministic Markov decision-analytic model to estimate the cost-effectiveness of facility-based influenza vaccination in Bangladesh. DISCUSSION The results of this study will enable the National Immunization Technical Advisory Group and the Ministry of Health & Family Welfare of Bangladesh to decide what steps to take to develop and implement an influenza vaccination strategy targeting high-risk populations. TRIAL REGISTRATION The Clinicaltrials.gov registration number is NCT05996549. The registration for the protocol version 2.0 took place in August 2023, with the initial participant being enrolled in March 2022.
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Affiliation(s)
- Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh.
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Md Abdullah Al Jubayer Biswas
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh
| | - Homayra Rahman Shoshi
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Ashrak Shad Pyash
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Md Ariful Islam
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Md Azizul Haque
- Department of Medicine, Rajshahi Medical College, Rajshahi, Bangladesh
| | | | - Md Tanvir Hossen
- The Expanded Programme on Immunization (EPI), Maternal Neonatal Child and Adolescent Health of the Ministry of Health & Family Welfare of Bangladesh, Dhaka, Bangladesh
| | - Mofakhar Hussain
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Mahmudur Rahman
- Global Health Development (GHD), The Eastern Mediterranean Public Health Network (EMPHNET), Abdallah Ben Abbas St, Building No. 42, Amman, Jordan
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Mohakhali, Dhaka, Bangladesh
| | - Fahmida Chowdhury
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
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Wunderlich B, Laskow T, Li H, Zhang L, Abrams E, Tian J, Yu J, Chen Y, Tavenier J, Huang Y, Talaat K, Bream JH, Xue QL, Pawelec G, Leng SX. Interseason waning of vaccine-induced hemagglutination inhibition antibody titers and contributing factors to pre-existing humoral immunity against influenza in community-dwelling older adults 75 years and older. Immun Ageing 2023; 20:38. [PMID: 37525151 PMCID: PMC10388475 DOI: 10.1186/s12979-023-00362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Seasonal influenza causes significant morbidity and mortality with a disproportionately high disease burden in older adults. Strain-specific hemagglutination-inhibition (HAI) antibody titer is a well-established measure of humoral immunity against influenza and pre-vaccination HAI titer is a valuable indicator of pre-existing humoral immunity at the beginning of each influenza season in highly vaccinated older adults. While vaccine-induced HAI antibody titers are known to wane over time, accurate assessment of their interseason waning has been challenging. This is because pre-vaccination HAI titers are routinely measured using current season vaccine strain antigens instead of the prior season vaccines with which individuals were immunized; as such, they do not accurately represent residual antibody titers from prior season vaccination. This study took advantage of available pre-vaccination HAI titers measured using both current and prior season vaccine strain antigens in a longitudinal influenza immunization study with participants enrolled for multiple consecutive influenza seasons from 2014 through 2017. Influenza A virus (IAV) H3N2 and influenza B virus (IBV) strains in the vaccine formula changed in 2015 and again in 2016 season. IAV H1N1 vaccine strain remained the same from 2014 through 2016 seasons, but changed in 2017. We also investigated factors contributing to pre-existing humoral immunity. RESULTS Interseason waning of HAI titers was evident, but rates of waning varied among vaccine strains and study seasons, from 18% (p = .43) to 61% (p < .01). Rates of waning were noticeably greater when pre-vaccination HAI titers were measured by the routine approach, i.e., using current season vaccine strain antigens, from 33% (p = .12) to 83% (p < .01), adjusting for age at prior study season, sex, race, and education. This was largely because the routinely measured pre-vaccination HAI titers underrepresented residual HAI titers from prior season vaccinations. Moreover, interseason antibody waning and prior season post-vaccination HAI titers had significant and independent associations with pre-vaccination HAI titers. CONCLUSIONS The routinely measured pre-vaccination HAI titer overestimates interseason HAI antibody waning as it underestimates residual antibody titers from prior season vaccination when virus strains in the vaccine formula change. Moreover, interseason antibody waning and prior season post-vaccination HAI titers independently contribute to pre-existing humoral immunity in this highly vaccinated, community-dwelling older adult population.
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Affiliation(s)
- Bettina Wunderlich
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas Laskow
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Huifen Li
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Li Zhang
- Department of Geriatrics, The First People's Hospital of Yunnan Province, Kunming, China
| | - Engle Abrams
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Jing Tian
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jun Yu
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Yiyin Chen
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | | | - Kawsar Talaat
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jay H Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Immunology Training Program, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Graham Pawelec
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins Center On Aging and Immune Remodeling, Johns Hopkins University School of Medicine and Bloomberg School of Public Health, JHAAC Room 1A.38A, 5501 Hopkins Bayview Circle, Baltimore, MD, 21224, USA.
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Antiviral activity of CAVAC-1901, a combination of 3 standardized medicinal plants, against highly pathogenic influenza A virus in chickens. Poult Sci 2022; 102:102315. [PMID: 36473384 PMCID: PMC9720341 DOI: 10.1016/j.psj.2022.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Three different medicinal plants that consisted of the formulated mixture (CAVAC-1901) have been traditionally used for distinct medicinal purposes in different areas. Angelica dahurica has been used as an important ingredient of a prescription, Gumiganghwal-tang, for the common cold and influenza. Curcuma longa has been utilized for the treatment of asthma, and jaundice. Pinus densiflora (Korean red pine) has been used to improve memory and brain function for the treatment of vascular. Industrial livestock, which are characterized by dense breeding, are vulnerable to influenza infection, causing severe economic loss and social problems. However, there are no viable alternatives due to the risk of the occurrence of variants. Therefore, the aim of this study was to discover anti-influenza combinations of different medicinal plants with the concept of a multicomponent and multitarget (MCMT) strategy in traditional Chinese medicine (TCM). As part of a continuous project, 3 medicinal plants whose inhibitory activity against influenza A was previously reported at the compound level, and the inhibition of cytopathic effects (CPEs) by these formulated mixtures was evaluated against influenza A virus H1N1. A selected combination with an optimal ratio exhibiting synergistic activity was assessed for its antiviral activity in chickens against the highly pathogenic avian influenza (HPAI) H5N6. The selected combination (CAVAC-1901) showed potent inhibitory effects on the expression of neuraminidase and nucleoprotein, by RT-qPCR, Western blot, and immunofluorescence assays. The antiviral activity was more evident in chickens infected with H5N6. The sample-treated group (50 mg/kg/d) decreased mortality and virus titers in various organs. Our results indirectly suggest synergistic inhibitory activity of the combination of 3 different medicinal plants with different modes of action. Taken together, an optimally formulated mixture (CAVAC-1901) could serve as an effective alternative to current measures to minimize damage caused by HPAIs.
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Calabrò GE, D’Ambrosio F, Fallani E, Ricciardi W. Influenza Vaccination Assessment according to a Value-Based Health Care Approach. Vaccines (Basel) 2022; 10:vaccines10101675. [PMID: 36298540 PMCID: PMC9612276 DOI: 10.3390/vaccines10101675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Seasonal influenza has a considerable public health impact, and vaccination is the key to preventing its consequences. Our aim was to describe how the value of influenza vaccination is addressed in the scientific literature considering a new value framework based on four pillars (personal, allocative, technical, and societal value). Methods: A systematic review was conducted by querying three databases. The analysis was performed on international studies focused on influenza vaccination value, and the four value pillars were taken into consideration for their description. Results: Overall, 40 studies were considered. Most of them focused on influenza vaccination in the general population (27.5%), emphasizing its value for all age groups. Most studies addressed technical value (70.4%), especially in terms of economic models and cost drivers to be considered for the economic evaluations of influenza vaccines, and societal value (63%), whereas few dealt with personal (37%) and allocative values (22.2%). Conclusions: The whole value of influenza vaccination is still not completely recognized. Knowledge and communication of the whole value of influenza vaccination is essential to guide value-based health policies. To achieve this goal, it is necessary to implement initiatives that involve all relevant stakeholders.
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Affiliation(s)
- Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spinoff of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Floriana D’Ambrosio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Elettra Fallani
- Department of Life Sciences, University of Siena, 53100 Siena, Italy
- Seqirus S.R.L., Via del Pozzo 3/A, San Martino, 53035 Monteriggioni, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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CALABRÒ GIOVANNAELISA, ICARDI GIANCARLO, BONANNI PAOLO, GABUTTI GIOVANNI, VITALE FRANCESCO, RIZZO CATERINA, CICCHETTI AMERICO, STAIANO ANNAMARIA, ANSALDI FILIPPO, ORSI ANDREA, DE WAURE CHIARA, PANATTO DONATELLA, AMICIZIA DANIELA, BERT FABRIZIO, VILLANI ALBERTO, IERACI ROBERTO, CONVERSANO MICHELE, RUSSO CARMELA, RUMI FILIPPO, SCOTTI SILVESTRO, MAIO TOMMASA, RUSSO ROCCO, VACCARO CONCETTAMARIA, SILIQUINI ROBERTA, RICCIARDI WALTER. [Flu vaccination and value-based health care: operational solutions to safeguard public health]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E1-E85. [PMID: 36310765 PMCID: PMC9586154 DOI: 10.15167/2421-4248/jpmh2022.63.2s2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
- VIHTALI - Value In Health Technology and Academy for Leadership & Innovation, Spin-Off dell'Università Cattolica del Sacro Cuore, Roma
- Autore corrispondente: Giovanna Elisa Calabrò, Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia - E-mail:
| | - GIANCARLO ICARDI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
- U.O. Igiene, IRCCS Ospedale Policlinico San Martino, Genova
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute (DSS), Università di Firenze
| | - GIOVANNI GABUTTI
- Coordinatore Nazionale GdL Vaccini e Politiche Vaccinali della SItI
| | - FRANCESCO VITALE
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - CATERINA RIZZO
- Dipartimento di ricerca traslazionale e nuove tecnologie in medicina e chirurgia, Università degli Studi di Pisa
| | - AMERICO CICCHETTI
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Roma
| | - ANNAMARIA STAIANO
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi “Federico II”, Napoli
- Presidente Società Italiana di Pediatria (SIP)
| | - FILIPPO ANSALDI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
- A.Li.Sa. Azienda Ligure Sanitaria Regione Liguria
| | - ANDREA ORSI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
- U.O. Igiene, IRCCS Ospedale Policlinico San Martino, Genova
| | - CHIARA DE WAURE
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia
| | - DONATELLA PANATTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - DANIELA AMICIZIA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
- A.Li.Sa. Azienda Ligure Sanitaria Regione Liguria
| | - FABRIZIO BERT
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino
- SSDU Igiene Ospedaliera e Governo delle Infezioni Correlate all’Assistenza, ASL TO3
| | - ALBERTO VILLANI
- Dipartimento Emergenza Accettazione Ospedale Pediatrico Bambino Gesù, IRCCS, Roma
- Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata
| | - ROBERTO IERACI
- Strategie vaccinali, Regione Lazio
- Ricercatore associato CID Ethics-CNR
| | | | - CARMELA RUSSO
- U.O.S.V.D. Epidemiologia - Comunicazione e Formazione Coordinamento delle Attività di Promozione della Salute e di Educazione Sanitaria, ASL Taranto
| | - FILIPPO RUMI
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Roma
| | | | - TOMMASA MAIO
- Federazione Italiana Medici di Medicina Generale (FIMMG)
| | - ROCCO RUSSO
- Coordinatore tavolo tecnico vaccinazioni, Società Italiana di Pediatria (SIP)
| | | | - ROBERTA SILIQUINI
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino
- AOU Città della Salute e della Scienza di Torino
| | - WALTER RICCIARDI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma
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9
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Relative Vaccine Effectiveness of Adjuvanted Trivalent Influenza Vaccine over Three Consecutive Influenza Seasons in the United States. Vaccines (Basel) 2022; 10:vaccines10091456. [PMID: 36146534 PMCID: PMC9504704 DOI: 10.3390/vaccines10091456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022] Open
Abstract
Traditional influenza vaccines may be less immunogenic in adults ≥65 years of age due to immunosenescence. Two influenza vaccines—MF59®-adjuvanted trivalent inactivated influenza vaccine (aIIV3) and high-dose influenza vaccine (HD-IIV3)—were developed to overcome this problem. We summarize estimates of the relative vaccine effectiveness (rVE) of aIIV3 vs. HD-IIV3 and aIIV3 vs. standard, egg-based quadrivalent influenza vaccines (IIV4e) during the 2017–2018, 2018–2019, and 2019–2020 US influenza seasons using the same underlying electronic medical record and linked claims dataset for all three seasons. The primary outcome was influenza-related medical encounters (IRMEs), defined by diagnostic codes specific to influenza (ICD J09*-J11*). rVE was estimated using propensity score methods adjusting for demographics and health status. rVE estimates demonstrated consistent benefit for aIIV3 over IIV4e in the overall and at-risk populations. Relative to HD-IIV3, aIIV3 provided improved benefit in the overall study population and comparable benefit in the at-risk population across each season.
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10
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Epidemiology of repeat influenza infection in Queensland, Australia, 2005-2017. Epidemiol Infect 2022; 150:e144. [PMID: 35843721 PMCID: PMC9354477 DOI: 10.1017/s0950268822001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Natural infection with the influenza virus is believed to generate cross-protective immunity across both types and subtypes. However, less is known about the persistence of this immunity and thus the susceptibility of individuals to repeat infection. We used 13 years (2005–2017) of surveillance data from Queensland, Australia, to describe the incidence and distribution of repeat influenza infections. Consecutive infections that occurred within 14 days of prior infection were considered a mixed infection; those that occurred more than 14 days later were considered separate (repeat) infections. Kaplan-Meier plots were used to investigate the probability of reinfection over time and the Prentice, Williams and Peterson extension of the Cox proportional hazards model was used to assess the association of age and gender with reinfection. Among the 188 392 notifications received during 2005–2017, 6165 were consecutively notified for the same individual (3.3% of notifications), and 2958 were mixed infections (1.6%). Overall, the probability of reinfection was low: the cumulative incidence was <1% after one year, 4.6% after five years, and 9.6% after ten years. The majority of consecutive infections were the result of two type A infections (43%) and were most common among females (adjusted hazard ratio (aHR): 1.15, 95% confidence interval (CI) 1.09–1.21), children aged less than 5 years (relative to adults aged 18–64 years aHR: 1.58, 95% CI 1.47–1.70) and older adults aged at least 65 years (aHR: 1.35; 95% CI 1.24–1.47). Our study suggests consecutive infections are possible but rare. These findings have implications for our understanding of population immunity to influenza.
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11
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A Virion-Based Combination Vaccine Protects against Influenza and SARS-CoV-2 Disease in Mice. J Virol 2022; 96:e0068922. [PMID: 35862698 PMCID: PMC9364787 DOI: 10.1128/jvi.00689-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vaccines targeting SARS-CoV-2 have been shown to be highly effective; however, the breadth against emerging variants and the longevity of protection remains unclear. Postimmunization boosting has been shown to be beneficial for disease protection, and as new variants continue to emerge, periodic (and perhaps annual) vaccination will likely be recommended. New seasonal influenza virus vaccines currently need to be developed every year due to continual antigenic drift, an undertaking made possible by a robust global vaccine production and distribution infrastructure. To create a seasonal combination vaccine targeting both influenza viruses and SARS-CoV-2 that is also amenable to frequent reformulation, we have developed an influenza A virus (IAV) genetic platform that allows the incorporation of an immunogenic domain of the SARS-CoV-2 spike (S) protein onto IAV particles. Vaccination with this combination vaccine elicited neutralizing antibodies and provided protection from lethal challenge with both pathogens in mice. This approach may allow the leveraging of established influenza vaccine infrastructure to generate a cost-effective and scalable seasonal vaccine solution for both influenza and coronaviruses. IMPORTANCE The rapid emergence of SARS-CoV-2 variants since the onset of the pandemic has highlighted the need for both periodic vaccination “boosts” and a platform that can be rapidly reformulated to manufacture new vaccines. In this work, we report an approach that can utilize current influenza vaccine manufacturing infrastructure to generate combination vaccines capable of protecting from both influenza virus- and SARS-CoV-2-induced disease. The production of a combined influenza/SARS-CoV-2 vaccine may represent a practical solution to boost immunity to these important respiratory viruses without the increased cost and administration burden of multiple independent vaccines.
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12
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Review of Analyses Estimating Relative Vaccine Effectiveness of Cell-Based Quadrivalent Influenza Vaccine in Three Consecutive US Influenza Seasons. Vaccines (Basel) 2022; 10:vaccines10060896. [PMID: 35746504 PMCID: PMC9228909 DOI: 10.3390/vaccines10060896] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/13/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
The adaptation of influenza seed viruses in egg culture can result in a variable antigenic vaccine match each season. The cell-based quadrivalent inactivated influenza vaccine (IIV4c) contains viruses grown in mammalian cell lines rather than eggs. IIV4c is not subject to egg-adaptive changes and therefore may offer improved protection relative to egg-based vaccines, depending on the degree of match with circulating influenza viruses. We summarize the relative vaccine effectiveness (rVE) of IIV4c versus egg-based quadrivalent influenza vaccines (IIV4e) to prevent influenza-related medical encounters (IRMEs) from three retrospective observational cohort studies conducted during the 2017–2018, 2018–2019, and 2019–2020 US influenza seasons using the same underlying electronic medical record dataset for all three seasons—with the addition of linked medical claims for the latter two seasons. We identified IRMEs using diagnostic codes specific to influenza disease (ICD J09*-J11*) from the records of over 10 million people. We estimated rVE using propensity score methods adjusting for age, sex, race, ethnicity, geographic location, week of vaccination, and health status. Subgroup analyses included specific age groups. IIV4c consistently had higher relative effectiveness than IIV4e across all seasons assessed, which were characterized by different dominant circulating strains and variable antigenic drift or egg adaptation.
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13
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Integrating Electronic Medical Records and Claims Data for Influenza Vaccine Research. Vaccines (Basel) 2022; 10:vaccines10050727. [PMID: 35632483 PMCID: PMC9143116 DOI: 10.3390/vaccines10050727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 12/10/2022] Open
Abstract
Real-world evidence (RWE) increasingly informs public health and healthcare decisions worldwide. A large database has been created (“Integrated Dataset”) that integrates primary care electronic medical records with pharmacy and medical claims data on >123 million US patients since 2014. This article describes the components of the Integrated Dataset and evaluates its representativeness to the US population and its potential use in evaluating influenza vaccine effectiveness. Representativeness to the US population (2014−2019) was evaluated by comparison with demographic information from the 2019 US census and the National Ambulatory Medical Care Survey (NAMCS). Variables included in the Integrated Dataset were evaluated against World Health Organization (WHO) defined key and non-critical variables for evaluating influenza vaccine performance. The Integrated Dataset contains a variety of information, including demographic data, patient medical history, diagnoses, immunizations, and prescriptions. Distributions of most age categories and sex were comparable with the US Census and NAMCS populations. The Integrated Dataset was less diverse by race and ethnicity. Additionally, WHO key and non-critical variables for the estimation of influenza vaccine effectiveness are available in the Integrated Dataset. In summary, the Integrated Dataset is generally representative of the US population and contains key variables for the assessment of influenza vaccine effectiveness.
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14
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Villani L, D'Ambrosio F, Ricciardi R, Waure C, Calabrò GE. Seasonal influenza in children: Costs for the health system and society in Europe. Influenza Other Respir Viruses 2022; 16:820-831. [PMID: 35429133 PMCID: PMC9343336 DOI: 10.1111/irv.12991] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 12/29/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Leonardo Villani
- Section of Hygiene, University Department of Life Sciences and Public Health Università Cattolica del Sacro Cuore Rome Italy
| | - Floriana D'Ambrosio
- Section of Hygiene, University Department of Life Sciences and Public Health Università Cattolica del Sacro Cuore Rome Italy
| | - Roberto Ricciardi
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation) Spin‐Off of Università Cattolica del Sacro Cuore Rome Italy
| | - Chiara Waure
- Department of Medicine and Surgery University of Perugia Perugia Italy
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health Università Cattolica del Sacro Cuore Rome Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation) Spin‐Off of Università Cattolica del Sacro Cuore Rome Italy
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15
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Dwipa L, Usman SY, Rakhimullah AB, Mutyara K, Indrati AR, Atik N, Muliasari R, Kartasasmita C. The Immunogenicity and Safety of Influenza Vaccines among Indonesian Older adult. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Immunosenescence, frailty, sarcopenia, and Vitamin D deficiency were thought of having a negative influence on adequate immune response following vaccination. Epidemiological data related to influenza vaccination and its immunogenicity and safety in Indonesia are still scarce.
AIM: This study aimed to assess the immunogenicity and safety of the influenza vaccine in older adults in Indonesia and common related conditions.
METHODS: This study was a one-group, pre-test, post-test, quasi-experimental study. The vaccine used was a trivalent type. Immunogenicity was assessed according to rate of seropositivity and seroconversion based on hemagglutination inhibition antibody titer. Immunization safety was assessed according to adverse events following immunization (AEFI).
RESULTS: A total of 227 subjects were involved in this study. Antibody titers were significantly increased after 28-day influenza vaccination for all strains (p < 0.001). Seropositive rate in 28-day post-vaccination for A/H1N1, A/H3N2, and influenza B was 98.7%, 99.1%, and 97.4%, respectively. Meanwhile, the seroconversion rate for A/H1N1, A/H3N2, and influenza B strains was 54.2%, 66.1%, and 60.4%, respectively. The conditions of the frailty status, sarcopenia, and Vitamin D level were not associated with either seroconversion or seropositive status, both at baseline and endpoint. AEFI was occurred on seven subjects (3.08%) with pain at the injection site and one subject (0.44%) with arm tenderness.
CONCLUSION: Influenza vaccination showed adequate immune response and safety regardless of the frailty status, sarcopenia, or Vitamin D level. This result strengthened the importance of influenza vaccine administration in Indonesia older adults.
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16
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Esposito S, Nauta J, Lapini G, Montomoli E, van de Witte S. Efficacy and safety of a quadrivalent influenza vaccine in children aged 6–35 months: A global, multiseasonal, controlled, randomized Phase III study. Vaccine 2022; 40:2626-2634. [DOI: 10.1016/j.vaccine.2022.02.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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17
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Influenza Vaccine Effectiveness Estimates among US Department of Defense Adult Beneficiaries over Four Consecutive Influenza Seasons: A Test-Negative Design Study with Different Control Groups. Vaccines (Basel) 2021; 10:vaccines10010058. [PMID: 35062721 PMCID: PMC8781181 DOI: 10.3390/vaccines10010058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
A test-negative design study with different control groups (influenza test-negative controls, non-influenza virus positive controls, and pan-negative controls) was conducted to assess inactivated influenza vaccine effectiveness (VE) in adults aged ≥18 years, 2016-2017 through 2019-2020 influenza seasons. A database was developed from the US Department of Defense Global Respiratory Pathogen Surveillance Program. VE was estimated using a generalized linear mixed model with logit link and binomial distribution, adjusted for confounding effects. A total of 7114 adults including 2543 medically attended, laboratory-confirmed influenza-positive cases were identified. Using influenza test-negative controls, the adjusted VE in adults was 40% [95% confidence interval (CI): 33-46%] overall, including 46% (95% CI: 36-55%) for influenza A(H1N1)pdm09, 32% (95% CI: 19-42%) for influenza A(H3N2), and 54% (95% CI: 44-62%) for influenza B. The age-stratified analysis showed that VE estimates against influenza A(H1N1)pdm09 (34%; 95% CI: -29-66%) and influenza A(H3N2) (6%; 95% CI: -60-45%) were low and non-significant for elderly adults ≥65 years of age. Overall VE estimates against any influenza or by influenza (sub)types in adults were consistent when using influenza test-negative controls, non-influenza virus positive controls, and pan-negative controls. Inactivated influenza vaccination provided moderate protection against influenza virus infection, based on the analysis from a large number of adults aged ≥18 years over multiple influenza seasons.
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18
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Severance R, Schwartz H, Dagan R, Connor L, Li J, Pedley A, Hartzel J, Sterling TM, Nolan KM, Tamms GM, Musey LK, Buchwald UK. Safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, administered concomitantly with influenza vaccine in healthy adults aged ≥50 years: a randomized phase 3 trial (PNEU-FLU). Hum Vaccin Immunother 2021; 18:1-14. [PMID: 34726574 PMCID: PMC8920144 DOI: 10.1080/21645515.2021.1976581] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Streptococcus pneumoniae and influenza viruses are associated with significant morbidity and mortality in older adults. Concomitant vaccination against these agents reduces hospitalization and mortality rates. This phase 3 trial evaluated safety, tolerability, and immunogenicity of concomitant and non-concomitant administration of V114, a 15-valent pneumococcal conjugate vaccine containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19F, 19A, 22F, 23F, 33F, and quadrivalent inactivated influenza vaccine (QIV), in healthy adults aged ≥50 years. Participants (N = 1,200) were randomized 1:1 to receive either V114 administered concomitantly with QIV (concomitant group) or QIV plus placebo (non-concomitant group) on Day 1, followed by placebo (concomitant group) or V114 (non-concomitant group) 30 days later. Randomization was stratified by age and history of pneumococcal polysaccharide vaccine receipt. Overall, 426 (71.0%) and 438 (73.5%) participants in the concomitant and non-concomitant groups experienced solicited injection-site adverse events (AEs); 278 (46.3%) and 300 (50.3%) reported solicited systemic AEs. Most solicited AEs were mild or moderate in severity and of short duration. Non-inferiority for pneumococcal- and influenza-specific antibody responses (lower bound 95% confidence interval of opsonophagocytic activity [OPA] and hemagglutination inhibition geometric mean titers [GMTs] ratios ≥0.5) was demonstrated for concomitant versus non-concomitant administration for all 15 pneumococcal serotypes and all four influenza strains. Consistent with previous studies, a trend was observed toward lower pneumococcal OPA GMTs in the concomitant versus the non-concomitant group. V114 administered concomitantly with QIV is generally well tolerated and immunologically non-inferior to non-concomitant administration, supporting coadministration of both vaccines.
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Affiliation(s)
| | | | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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19
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Comparing the Clinical and Economic Outcomes Associated with Adjuvanted versus High-Dose Trivalent Influenza Vaccine among Adults Aged ≥ 65 Years in the US during the 2019-20 Influenza Season-A Retrospective Cohort Analysis. Vaccines (Basel) 2021; 9:vaccines9101146. [PMID: 34696254 PMCID: PMC8540032 DOI: 10.3390/vaccines9101146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
The burden of influenza is disproportionally higher among older adults. We evaluated the relative vaccine effectiveness (rVE) of adjuvanted trivalent (aIIV3) compared to high-dose trivalent influenza vaccine (HD-IIV3e) against influenza and cardio-respiratory disease (CRD)-related hospitalizations/ER visits among adults ≥65 years during the 2019-2020 influenza season. Economic outcomes were also compared. A retrospective cohort analysis was conducted using prescription, professional fee claims, and hospital data. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding. IPTW-adjusted Poisson regression was used to evaluate the adjusted rVE of aIIV3 versus HD-IIV3e. All-cause and influenza-related healthcare resource utilization (HCRU) and costs were examined post-IPTW. Recycled predictions from generalized linear models were used to estimate adjusted costs. Adjusted analysis showed that aIIV3 (n = 798,987) was similarly effective compared to HD-IIV3e (n = 1,655,979) in preventing influenza-related hospitalizations/ER visits (rVE 3.1%; 95% CI: -2.8%; 8.6%), hospitalizations due to any cause (-0.7%; 95% CI: -1.6%; 0.3%), and any CRD-related hospitalization/ER visit (0.9%; 95% CI: 0.01%; 1.7%). Adjusted HCRU and annualized costs were also statistically insignificant between the two cohorts. The adjusted clinical and economic outcomes evaluated in this study were comparable between aIIV3 and HD-IIV3e during the 2019-2020 influenza season.
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20
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Bansal A, Trieu MC, Mohn KGI, Cox RJ. Safety, Immunogenicity, Efficacy and Effectiveness of Inactivated Influenza Vaccines in Healthy Pregnant Women and Children Under 5 Years: An Evidence-Based Clinical Review. Front Immunol 2021; 12:744774. [PMID: 34691051 PMCID: PMC8526930 DOI: 10.3389/fimmu.2021.744774] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023] Open
Abstract
Annual influenza vaccination is often recommended for pregnant women and young children to reduce the risk of severe influenza. However, most studies investigating the safety, immunogenicity, and efficacy or effectiveness of influenza vaccines are conducted in healthy adults. In this evidence-based clinical review, we provide an update on the safety profile, immunogenicity, and efficacy/effectiveness of inactivated influenza vaccines (IIVs) in healthy pregnant women and children <5 years old. Six electronic databases were searched until May 27, 2021. We identified 3,731 articles, of which 93 met the eligibility criteria and were included. The IIVs were generally well tolerated in pregnant women and young children, with low frequencies of adverse events following IIV administration; however, continuous vaccine safety monitoring systems are necessary to detect rare adverse events. IIVs generated good antibody responses, and the seroprotection rates after IIVs were moderate to high in pregnant women (range = 65%-96%) and young children (range = 50%-100%), varying between the different influenza types/subtypes and seasons. Studies show vaccine efficacy/effectiveness values of 50%-70% in pregnant women and 20%-90% in young children against lab-confirmed influenza, although the efficacy/effectiveness depended on the study design, host factors, vaccine type, manufacturing practices, and the antigenic match/mismatch between the influenza vaccine strains and the circulating strains. Current evidence suggests that the benefits of IIVs far outweigh the potential risks and that IIVs should be recommended for pregnant women and young children.
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Affiliation(s)
- Amit Bansal
- The Influenza Centre, Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mai-Chi Trieu
- The Influenza Centre, Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Kristin G I Mohn
- The Influenza Centre, Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Rebecca Jane Cox
- The Influenza Centre, Department of Clinical Sciences, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Microbiology, Haukeland University Hospital, Helse Bergen, Bergen, Norway
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21
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Adeyanju GC, Engel E, Koch L, Ranzinger T, Shahid IBM, Head MG, Eitze S, Betsch C. Determinants of influenza vaccine hesitancy among pregnant women in Europe: a systematic review. Eur J Med Res 2021; 26:116. [PMID: 34583779 PMCID: PMC8477621 DOI: 10.1186/s40001-021-00584-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pregnant women are at high risk for severe influenza. However, maternal influenza vaccination uptake in most World Health Organization (WHO) European Region countries remains low, despite the presence of widespread national recommendations. An influenza vaccination reduces influenza-associated morbidity and mortality in pregnancy, as well as providing newborns with protection in their first months. Potential determinants of vaccine hesitancy need to be identified to develop strategies that can increase vaccine acceptance and uptake among pregnant women. The primary objective of the systematic review is to identify the individual determinants of influenza vaccine hesitancy among pregnant women in Europe, and how to overcome the hesitancy. METHODS Databases were searched for peer-reviewed qualitative and quantitative studies published between 2009 and 2019 inclusive. Databases included PubMed via MEDLINE, Cochrane Central Register for Controlled Trials, PsycINFO, SAGE Journals, Taylor and Francis and Springer nature. These covered themes including psychology, medicine, and public health. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, 11 studies were eligible and analyzed for significant determinants of influenza vaccine hesitancy among pregnant women in Europe. RESULTS The most commonly reported factors were psychological aspects, for example concerns about safety and risks to mother and child, or general low risk perception of becoming ill from influenza. Doubts about the effectiveness of the vaccine and a lack of knowledge about this topic were further factors. There was also influence of contextual factors, such as healthcare workers not providing adequate knowledge about the influenza vaccine or the pregnant lady stating their antivaccine sentiment. CONCLUSION Health promotion that specifically increases knowledge among pregnant women about influenza and vaccination is important, supporting a valid risk judgment by the pregnant lady. The development of new information strategies for dialogue between healthcare providers and pregnant women should form part of this strategy.
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Affiliation(s)
- Gbadebo Collins Adeyanju
- Centre for Empirical Research in Economics and Behavioural Science (CEREB), University of Erfurt, Erfurt, Germany.
- Media and Communication Science, University of Erfurt, Erfurt, Germany.
| | - Elena Engel
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Laura Koch
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Tabea Ranzinger
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | | | - Micheal G Head
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sarah Eitze
- Centre for Empirical Research in Economics and Behavioural Science (CEREB), University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Cornelia Betsch
- Centre for Empirical Research in Economics and Behavioural Science (CEREB), University of Erfurt, Erfurt, Germany
- Media and Communication Science, University of Erfurt, Erfurt, Germany
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22
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Carre C, Wong G, Narang V, Tan C, Chong J, Chin HX, Xu W, Lu Y, Chua M, Poidinger M, Tambyah P, Nyunt M, Ng TP, Larocque D, Hessler C, Bosco N, Quemeneur L, Larbi A. Endoplasmic reticulum stress response and bile acid signatures associate with multi-strain seroresponsiveness during elderly influenza vaccination. iScience 2021; 24:102970. [PMID: 34471863 PMCID: PMC8387917 DOI: 10.1016/j.isci.2021.102970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/25/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
The elderly are an important target for influenza vaccination, and the determination of factors that underlie immune responsiveness is clinically valuable. We evaluated the immune and metabolic profiles of 205 elderly Singaporeans administered with Vaxigrip. Despite high seroprotection rates, we observed heterogeneity in the response. We stratified the cohort into complete (CR) or incomplete responders (IR), where IR exhibited signs of accelerated T cell aging. We found a higher upregulation of genes associated with the B-cell endoplasmic-reticulum stress response in CR, where XBP-1 acts as a key upstream regulator. B-cells from IR were incapable of matching the level of XBP-1 upregulation observed in CR after inducing ER stress with tunicamycin in vitro. Metabolic signatures also distinguished CR and IR - as CR presented with a greater diversity of bile acids. Our findings suggest that the ER-stress pathway activation could improve influenza vaccination in the elderly.
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Affiliation(s)
| | - Glenn Wong
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Vipin Narang
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Crystal Tan
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Joni Chong
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Hui Xian Chin
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Weili Xu
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Yanxia Lu
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Michelle Chua
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Michael Poidinger
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
| | - Paul Tambyah
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Ma Nyunt
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Tze Pin Ng
- Division of Infectious Diseases, National University Hospital, Singapore
| | | | | | - Nabil Bosco
- Nestlé Research, Nestlé Institute of Health Sciences, EPFL Innovation Park, 1015 Lausanne, Switzerland
| | | | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A∗STAR), Immunos, Singapore
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Nuwarda RF, Alharbi AA, Kayser V. An Overview of Influenza Viruses and Vaccines. Vaccines (Basel) 2021; 9:1032. [PMID: 34579269 PMCID: PMC8473132 DOI: 10.3390/vaccines9091032] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 01/12/2023] Open
Abstract
Influenza remains one of the major public health concerns because it causes annual epidemics and can potentially instigate a global pandemic. Numerous countermeasures, including vaccines and antiviral treatments, are in use against seasonal influenza infection; however, their effectiveness has always been discussed due to the ongoing resistance to antivirals and relatively low and unpredictable efficiency of influenza vaccines compared to other vaccines. The growing interest in vaccines as a promising approach to prevent and control influenza may provide alternative vaccine development options with potentially increased efficiency. In addition to currently available inactivated, live-attenuated, and recombinant influenza vaccines on the market, novel platforms such as virus-like particles (VLPs) and nanoparticles, and new vaccine formulations are presently being explored. These platforms provide the opportunity to design influenza vaccines with improved properties to maximize quality, efficacy, and safety. The influenza vaccine manufacturing process is also moving forward with advancements relating to egg- and cell-based production, purification processes, and studies into the physicochemical attributes and vaccine degradation pathways. These will contribute to the design of more stable, optimized vaccine formulations guided by contemporary analytical testing methods and via the implementation of the latest advances in the field.
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Affiliation(s)
| | | | - Veysel Kayser
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, NSW 2006, Australia; (R.F.N.); (A.A.A.)
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Burden of Seasonal Influenza A and B in Panama from 2011 to 2017: An Observational Retrospective Database Study. Infect Dis Ther 2021; 10:2465-2478. [PMID: 34424506 PMCID: PMC8381717 DOI: 10.1007/s40121-021-00501-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Influenza A and B viruses constantly evolve and cause seasonal epidemics and sporadic outbreaks. Therefore, epidemiological surveillance is critical for monitoring their circulation pattern. Trivalent and quadrivalent vaccine formulations are available in Panama (until and since 2016, respectively). Herein, we analysed influenza A and B epidemiological patterns in Panama. Methods This was a retrospective descriptive analysis of all laboratory-confirmed influenza nasopharyngeal samples recorded between 2011 and 2017 in the nationwide surveillance database of Gorgas Memorial Institute for Health Studies. The analysis involved data relative to demographic information, virus type, subtype and lineage, geographic region, treatment and outcomes. The percentage level of mismatch between circulating and vaccine-recommended B lineage was assessed for each May–October influenza season. Results Among 1839 influenza cases, 79.6% were type A and 20.4% were type B. Most of them were observed in Panama City (54.7%) followed by the West (23.2%) and Central (16.7%) regions; across all regions, influenza A and B cases were distributed in a 4:1 ratio. Overall, approximately half were hospitalized (52.0% for type A; 45.5% for type B) and 11 (0.6%) died. Treatment, usually antimicrobial, was administered in 15.1% of cases. Children less than 2 years old were the most affected by this disease. Influenza type A circulated every year, while influenza B only circulated in 2012, 2014 and 2017. In the 2012 May–October influenza B season, the predominant lineage was B/Victoria and a switch to B/Yamagata was observed in 2014. Both lineages co-circulated in 2017, leading to a 38.9% B-lineage-level vaccine mismatch. Conclusion Influenza A was predominant among all ages and children less than 2 years and inhabitants of Panama City reported the highest circulation rate. In 2017, co-circulation of both B lineages led to a vaccine mismatch. Continuous monitoring of seasonal influenza is critical to establish immunization recommendations. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00501-y. Influenza or “flu” is caused by influenza viruses A and B and its symptoms range from mild to severe. This virus is constantly evolving; thus, careful monitoring of influenza is important to update immunization and vaccine recommendations yearly. This study used data from surveillance centres in Panama from 2011 to 2017 and evaluated the number of flu cases by age, gender, region, virus type, symptoms, comorbidities, treatment, coinfections with other viruses, and the circulating influenza subtype and the vaccine recommended each year. We found several points: almost 80% of cases were influenza A; most of the positive samples were found in children less than 2 years old and the Panama city region; more than 50% of influenza cases needed hospitalization; and in 2017 a mismatch was detected between the circulating influenza subtype and the recommended vaccine. This study helped to better characterize influenza circulation patterns and the burden of the disease during 2011–2017. We concluded that continuous monitoring of the influenza cases is necessary to establish future vaccination recommendations.
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25
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Universal Live-Attenuated Influenza Vaccine Candidates Expressing Multiple M2e Epitopes Protect Ferrets against a High-Dose Heterologous Virus Challenge. Viruses 2021; 13:v13071280. [PMID: 34209093 PMCID: PMC8310119 DOI: 10.3390/v13071280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022] Open
Abstract
The development of an influenza vaccine with broad protection and durability remains an attractive idea due to the high mutation rate of the influenza virus. An extracellular domain of Matrix 2 protein (M2e) is among the most attractive target for the universal influenza vaccine owing to its high conservancy rate. Here, we generated two recombinant live attenuated influenza vaccine (LAIV) candidates encoding four M2e epitopes representing consensus sequences of human, avian and swine influenza viruses, and studied them in a preclinical ferret model. Both LAIV+4M2e viruses induced higher levels of M2e-specific antibodies compared to the control LAIV strain, with the LAIV/HA+4M2e candidate being significantly more immunogenic than the LAIV/NS+4M2e counterpart. A high-dose heterosubtypic influenza virus challenge revealed the highest degree of protection after immunization with LAIV/HA+4M2e strain, followed by the NS-modified LAIV and the classical LAIV virus. Furthermore, only the immune sera from the LAIV/HA+4M2e-immunized ferrets protected mice from a panel of lethal influenza viruses encoding M genes of various origins. These data suggest that the improved cross-protection of the LAIV/HA+4M2e universal influenza vaccine candidate was mediated by the M2e-targeted antibodies. Taking into account the safety profile and improved cross-protective potential, the LAIV/HA+4M2e vaccine warrants its further evaluation in a phase I clinical trial.
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26
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Cheong CW, Chen CL, Li CH, Seak CJ, Tseng HJ, Hsu KH, Ng CJ, Chien CY. Two-stage prediction model for in-hospital mortality of patients with influenza infection. BMC Infect Dis 2021; 21:451. [PMID: 34011298 PMCID: PMC8131882 DOI: 10.1186/s12879-021-06169-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infleunza is a challenging issue in public health. The mortality and morbidity associated with epidemic and pandemic influenza puts a heavy burden on health care system. Most patients with influenza can be treated on an outpatient basis but some required critical care. It is crucial for frontline physicians to stratify influenza patients by level of risk. Therefore, this study aimed to create a prediction model for critical care and in-hospital mortality. METHODS This retrospective cohort study extracted data from the Chang Gung Research Database. This study included the patients who were diagnosed with influenza between 2010 and 2016. The primary outcome of this study was critical illness. The secondary analysis was to predict in-hospital mortality. A two-stage-modeling method was developed to predict hospital mortality. We constructed a multiple logistic regression model to predict the outcome of critical illness in the first stage, then S1 score were calculated. In the second stage, we used the S1 score and other data to construct a backward multiple logistic regression model. The area under the receiver operating curve was used to assess the predictive value of the model. RESULTS In the present study, 1680 patients met the inclusion criteria. The overall ICU admission and in-hospital mortality was 10.36% (174 patients) and 4.29% (72 patients), respectively. In stage I analysis, hypothermia (OR = 1.92), tachypnea (OR = 4.94), lower systolic blood pressure (OR = 2.35), diabetes mellitus (OR = 1.87), leukocytosis (OR = 2.22), leukopenia (OR = 2.70), and a high percentage of segmented neutrophils (OR = 2.10) were associated with ICU admission. Bandemia had the highest odds ratio in the Stage I model (OR = 5.43). In stage II analysis, C-reactive protein (OR = 1.01), blood urea nitrogen (OR = 1.02) and stage I model's S1 score were assocaited with in-hospital mortality. The area under the curve for the stage I and II model was 0.889 and 0.766, respectively. CONCLUSIONS The two-stage model is a efficient risk-stratification tool for predicting critical illness and mortailty. The model may be an optional tool other than qSOFA and SIRS criteria.
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Affiliation(s)
- Chan-Wa Cheong
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Lin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chih-Huang Li
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Hsiao-Jung Tseng
- Biostatistical Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Laboratory for Epidemiology, Chang Gung University, Kwei-Shan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan. .,Graduate Institute of Business and Management, Chang Gung University, Kwei-Shan, Taiwan.
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Pelton SI, Divino V, Postma MJ, Shah D, Mould-Quevedo J, DeKoven M, Krishnarajah G. A retrospective cohort study assessing relative effectiveness of adjuvanted versus high-dose trivalent influenza vaccines among older adults in the United States during the 2018-19 influenza season. Vaccine 2021; 39:2396-2407. [PMID: 33810903 DOI: 10.1016/j.vaccine.2021.03.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the relative vaccine effectiveness (rVE) against influenza-related hospitalizations/emergency room (ER) visits, influenza-related office visits, and cardio-respiratory disease (CRD)-related hospitalizations/ER visits and compare all-cause and influenza-related costs associated with two vaccines specifically indicated for older adults (≥65 years), adjuvanted (aTIV) and high-dose trivalent influenza vaccine (TIV-HD), for the 2018-19 influenza season. METHODS A retrospective analysis of older adults was conducted using claims and hospital data in the United States. For clinical evaluations, adjusted analyses were conducted following inverse probability of treatment weighting (IPTW) to control for selection bias. Poisson regression was used to estimate the adjusted rVE against influenza-related hospitalizations/ER visits, influenza-related office visits, and any CRD-related hospitalizations/ER visits. For the economic evaluation, treatment selection bias was adjusted through 1:1 propensity score matching (PSM). All-cause and influenza-related costs associated with hospitalizations/ER, physician office and pharmacy visits were adjusted using generalized estimating equation (GEE) models. RESULTS After IPTW and Poisson regression, aTIV (n = 561,315) was slightly more effective in reducing influenza-related office visits compared to TIV-HD (n = 1,672,779) (6.6%; 95% CI: 2.8-10.3%). aTIV was statistically comparable to TIV-HD (2.0%; 95% CI: -3.7%-7.3%) in preventing influenza-related hospitalizations/ER visits but more effective in reducing hospitalizations/ER visits for any CRD (2.6%; 95% CI: 2.0-3.2%). In the PSM-adjusted cohorts (n = 561,243 pairs), following GEE adjustments, predicted mean annualized all-cause and influenza-related total costs per patient were statistically similar between aTIV and TIV-HD (US$9676 vs. US$9625 and US$18.74 vs. US$17.28, respectively; both p > 0.05). Finally, influenza-related pharmacy costs were slightly lower for aTIV as compared to TIV-HD ($1.75 vs $1.85; p < 0.0001). CONCLUSIONS During the 2018-19 influenza season, influenza-related hospitalization/ER visits and associated costs among people aged ≥ 65 were comparable between aTIV and TIV-HD. aTIV was slightly more effective in preventing influenza-related office visits and any CRD event as compared to TIV-HD in this population.
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Affiliation(s)
- Stephen I Pelton
- Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, MA, USA; Maxwell Finland Laboratories, Boston Medical Center, Boston, MA, USA
| | | | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands; Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands; Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands
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Wang X, Kulkarni D, Dozier M, Hartnup K, Paget J, Campbell H, Nair H. Influenza vaccination strategies for 2020-21 in the context of COVID-19. J Glob Health 2020; 10:021102. [PMID: 33312512 PMCID: PMC7719353 DOI: 10.7189/jogh.10.021102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Influenza vaccination prevents people from influenza-related diseases and thereby mitigates the burden on national health systems when COVID-19 circulates and public health measures controlling respiratory viral infections are relaxed. However, it is challenging to maintain influenza vaccine services as the COVID-19 pandemic has the potential to disrupt vaccination programmes in many countries during the 2020/21 winter. We summarise available recommendations and strategies on influenza vaccination, specifically the changes in the context of the COVID-19 pandemic. METHODS We searched websites and databases of national and international public health agencies (focusing on Europe, North and South America, Australia, New Zealand, and South Africa). We also contacted key influenza immunization focal points and experts in respective countries and organizations including WHO and ECDC. RESULTS Available global and regional guidance emphasises the control of COVID-19 infection in immunisation settings by implementing multiple measures, such as physical distancing, hand hygiene practice, appropriate use of personal protective equipment by health care workers and establishing separate vaccination sessions for medically vulnerable people. The guidance also emphasises using alternative models or settings (eg, outdoor areas and pharmacies) for vaccine delivery, communication strategies and developing registry and catch-up programmes to achieve high coverage. Several novel national strategies have been adopted, such as combining influenza vaccination with other medical visits and setting up outdoor and drive through vaccination clinics. Several Southern Hemisphere countries have increased influenza vaccine coverage substantially for the 2020 influenza season. Most of the countries included in our review have planned a universal or near universal influenza vaccination for health care workers, or have made influenza vaccination for health care workers mandatory. Australia has requested that all workers and visitors in long term care facilities receive influenza vaccine. The UK has planned to expand the influenza programme to provide free influenza vaccine for the first time to all adults 50-64 years of age, people on the shielded patient list and their household members and children in the first year of secondary school. South Africa has additionally prioritised people with hypertension for influenza vaccination. CONCLUSIONS This review of influenza vaccination guidance and strategies should support strategy development on influenza vaccination in the context of COVID-19.
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Affiliation(s)
- Xin Wang
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Durga Kulkarni
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Marshall Dozier
- Information Services, University of Edinburgh, Edinburgh, UK
| | - Karen Hartnup
- Information Services, University of Edinburgh, Edinburgh, UK
| | - John Paget
- Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Harry Campbell
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
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Evaluating the Relative Vaccine Effectiveness of Adjuvanted Trivalent Influenza Vaccine Compared to High-Dose Trivalent and Other Egg-Based Influenza Vaccines among Older Adults in the US during the 2017-2018 Influenza Season. Vaccines (Basel) 2020; 8:vaccines8030446. [PMID: 32784684 PMCID: PMC7563546 DOI: 10.3390/vaccines8030446] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
The influenza-related disease burden is highest among the elderly. We evaluated the relative vaccine effectiveness (rVE) of adjuvanted trivalent influenza vaccine (aTIV) compared to other egg-based influenza vaccines (high-dose trivalent (TIV-HD), quadrivalent (QIVe-SD), and standard-dose trivalent (TIVe-SD)) against influenza-related and cardio-respiratory events among subjects aged ≥65 years for the 2017–2018 influenza season. This retrospective cohort analysis used prescription claims, professional fee claims, and hospital charge master data. Influenza-related hospitalizations/ER visits and office visits and cardio-respiratory events were assessed post-vaccination. Inverse probability of treatment weighting (IPTW) and Poisson regression were used to evaluate the adjusted rVE of aTIV compared to other vaccines. In an economic analysis, annualized follow-up costs were compared between aTIV and TIV-HD. The study was composed of 234,313 aTIV, 1,269,855 TIV-HD, 212,287 QIVe-SD, and 106,491 TIVe-SD recipients. aTIV was more effective in reducing influenza-related office visits and other respiratory-related hospitalizations/ER visits compared to the other vaccines. For influenza-related hospitalizations/ER visits, aTIV was associated with a significantly higher rVE compared to QIVe-SD and TIVe-SD and was comparable to TIV-HD. aTIV was also associated with a significantly higher rVE compared to TIVe-SD against hospitalizations/ER visits related to pneumonia and asthma/COPD/bronchial events. aTIV and TIV-HD were associated with comparable annualized all-cause and influenza-related costs. Adjusted analyses demonstrated a significant benefit of aTIV against influenza- and respiratory-related events compared to the other egg-based vaccines.
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Glatman-Freedman A, Pando R, Sefty H, Omer I, Rosenberg A, Drori Y, Nemet I, Mendelson E, Keinan-Boker L, Mandelboim M. Predominance of a Drifted Influenza A (H3N2) Clade and its Association with Age-specific Influenza Vaccine Effectiveness Variations, Influenza Season 2018-2019. Vaccines (Basel) 2020; 8:vaccines8010078. [PMID: 32050460 PMCID: PMC7157661 DOI: 10.3390/vaccines8010078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Influenza A (H3N2) clade 3C.3a was the predominant influenza virus in Israel throughout the 2018-2019 season, constituting a drift from the influenza A (H3N2) vaccine. We estimated the end-of season vaccine effectiveness (VE) by age, among community patients with influenza-like illness (ILI), considering the hemagglutinin (HA) gene mutations and amino acid substitutions of influenza A (H3N2) viruses detected. Methods: Nose-throat samples were analyzed for the presence of influenza virus, type/subtype, and HA gene sequence. HA gene sequences and amino acid substitutions were compared to the influenza A/Singapore/INFIMH-16-0019/2016 (H3N2)-like 2018-2019 vaccine virus, and a phylogenetic tree was generated. Influenza VE against influenza A (H3N2) was estimated using the test-negative design. VE was estimated by age group and by 15 year moving age intervals. Results: In total, 90% of the influenza A (H3N2) viruses belonged to the 3C.3a clade, constituting a unique situation in the northern hemisphere. Adjusted all-age influenza A (H3N2) VE was −3.5% (95% CI: −51.2 to 29.1). Although adjusted VEs were very low among infants, children, and young adults, a VE of 45% (95% CI: −19.2 to 74.6) was estimated among adults aged ≥45 years old. Conclusions: The higher VE point estimates among older adults may be related to previous exposure to similar influenza viruses.
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Affiliation(s)
- Aharona Glatman-Freedman
- Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
- School of Public Health, Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
| | - Rakefet Pando
- Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
- Central Virology Laboratory, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
| | - Hanna Sefty
- Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
| | - Itay Omer
- School of Public Health, Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Alina Rosenberg
- Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
| | - Yaron Drori
- School of Public Health, Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Central Virology Laboratory, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
| | - Ital Nemet
- Central Virology Laboratory, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
| | - Ella Mendelson
- School of Public Health, Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Central Virology Laboratory, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
- School of Public Health, University of Haifa, Haifa 3498838, Israel
| | - Michal Mandelboim
- School of Public Health, Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Central Virology Laboratory, Sheba Medical Center, Israel Ministry of Health, Tel Hashomer, Ramat Gan 5265601, Israel
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Maertens K, Orije MRP, Van Damme P, Leuridan E. Vaccination during pregnancy: current and possible future recommendations. Eur J Pediatr 2020; 179:235-242. [PMID: 31912233 PMCID: PMC7222942 DOI: 10.1007/s00431-019-03563-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/15/2019] [Accepted: 12/23/2019] [Indexed: 11/15/2022]
Abstract
Immunizing pregnant women to protect the mother, fetus and infant from infection has increasingly been used over the last decade. Protection against infectious diseases in neonates is mainly provided by maternal antibodies transferred from mother to infant during pregnancy through transplacental transport or after delivery via breastfeeding. Both the transplacental- and breast milk-derived maternal antibodies function as the primary source of protection against infectious diseases in neonates during the first vulnerable weeks of life. During recent infectious disease outbreaks (influenza, pertussis, Zika…) and for other infectious diseases (CMV, GBS…), pregnant women are increasingly identified as an important target for vaccination. For some of these diseases, vaccines are already on the market, and recommended during pregnancy. For others, vaccines are currently under development; furthermore, some are even specifically designed to be administered during pregnancy.Conclusion: This review article provides an overview on the rationale and main mechanism of the maternal vaccination strategy and gives a summary about the current and possible future recommendations for maternal vaccination.What is Known:• Maternal vaccination has a far-reaching potential in the protection of both women and offspring.• Currently, tetanus, pertussis and influenza vaccination during pregnancy is recommended in some countries. Several new vaccines specifically designed for use in pregnancy are currently under development.What is New:• Review providing a timely overview of the rationale and main mechanisms of the maternal vaccination strategy• Up-to-date summary of the current and possible future recommendations for maternal vaccination.
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Affiliation(s)
- Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Marjolein Rozemarie Paulien Orije
- grid.5284.b0000 0001 0790 3681Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Pierre Van Damme
- grid.5284.b0000 0001 0790 3681Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Elke Leuridan
- grid.5284.b0000 0001 0790 3681Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Vassilieva EV, Taylor DW, Compans RW. Combination of STING Pathway Agonist With Saponin Is an Effective Adjuvant in Immunosenescent Mice. Front Immunol 2019; 10:3006. [PMID: 31921219 PMCID: PMC6935580 DOI: 10.3389/fimmu.2019.03006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022] Open
Abstract
There is an urgent need to improve protective responses to influenza vaccination in the elderly population, which is at especially high risk for adverse outcomes from influenza infection. Currently available inactivated vaccines provide limited protection, even when a 4-fold higher dose of the vaccine is administered. Adjuvants are often added to vaccines to boost protective efficacy. Here we describe a novel combination of an activator of the STING pathway, 2′,3′-cyclic guanosine monophosphate–adenosine monophosphate (cGAMP) with a saponin adjuvant, that we found to be highly effective in boosting protective immunity from vaccination in an aged mouse model. Using this combination with a subunit influenza vaccine, we observed that survival of vaccinated 20 month-old mice after lethal challenge increased from 0 to 20% with unadjuvanted vaccine to 80–100%, depending on the vaccination route. Compared to unadjuvanted vaccine, the levels of vaccine-specific IgG and IgG2a increased by almost two orders of magnitude as early as 2 weeks after a single immunization with the adjuvanted formulation. By analyzing phosphorylation of interferon regulatory factor 3 (IRF3) in cell culture, we provide evidence that the saponin component increases access of exogenous cGAMP to the intracellular STING pathway. Our findings suggest that combining a STING activator with a saponin-based adjuvant increases the effectiveness of influenza vaccine in aged hosts, without having to increase dose or perform additional vaccinations. This study reports a novel adjuvant combination that (a) is more effective than current methods of boosting vaccine efficacy, (b) can be used to enhance efficacy of licensed influenza vaccines, and (c) results in effective protection using a single vaccine dose.
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Affiliation(s)
- Elena V Vassilieva
- Department of Microbiology and Immunology, Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Dahnide W Taylor
- Department of Microbiology and Immunology, Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Richard W Compans
- Department of Microbiology and Immunology, Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, United States
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Dhakal S, Klein SL. Host Factors Impact Vaccine Efficacy: Implications for Seasonal and Universal Influenza Vaccine Programs. J Virol 2019; 93:e00797-19. [PMID: 31391269 PMCID: PMC6803252 DOI: 10.1128/jvi.00797-19] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Influenza is a global public health problem. Current seasonal influenza vaccines have highly variable efficacy, and thus attempts to develop broadly protective universal influenza vaccines with durable protection are under way. While much attention is given to the virus-related factors contributing to inconsistent vaccine responses, host-associated factors are often neglected. Growing evidences suggest that host factors including age, biological sex, pregnancy, and immune history play important roles as modifiers of influenza virus vaccine efficacy. We hypothesize that host genetics, the hormonal milieu, and gut microbiota contribute to host-related differences in influenza virus vaccine efficacy. This review highlights the current insights and future perspectives into host-specific factors that impact influenza vaccine-induced immunity and protection. Consideration of the host factors that affect influenza vaccine-induced immunity might improve influenza vaccines by providing empirical evidence for optimizing or even personalizing vaccine type, dose, and use of adjuvants for current seasonal and future universal influenza vaccines.
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Affiliation(s)
- Santosh Dhakal
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L Klein
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Host Factors Impact Vaccine Efficacy: Implications for Seasonal and Universal Influenza Vaccine Programs. J Virol 2019. [PMID: 31391269 DOI: 10.1128/jvi.00797‐19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Influenza is a global public health problem. Current seasonal influenza vaccines have highly variable efficacy, and thus attempts to develop broadly protective universal influenza vaccines with durable protection are under way. While much attention is given to the virus-related factors contributing to inconsistent vaccine responses, host-associated factors are often neglected. Growing evidences suggest that host factors including age, biological sex, pregnancy, and immune history play important roles as modifiers of influenza virus vaccine efficacy. We hypothesize that host genetics, the hormonal milieu, and gut microbiota contribute to host-related differences in influenza virus vaccine efficacy. This review highlights the current insights and future perspectives into host-specific factors that impact influenza vaccine-induced immunity and protection. Consideration of the host factors that affect influenza vaccine-induced immunity might improve influenza vaccines by providing empirical evidence for optimizing or even personalizing vaccine type, dose, and use of adjuvants for current seasonal and future universal influenza vaccines.
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De Oliveira Bernardo C, González-Chica DA, Stocks N. Impact of funding influenza vaccination on coverage among Australian children: a national study using MedicineInsight, a large general practice database. Hum Vaccin Immunother 2019; 16:630-635. [PMID: 31526224 PMCID: PMC7227683 DOI: 10.1080/21645515.2019.1664866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Influenza contributes to morbidity and mortality worldwide. Children are at a higher risk of influenza-related complications and vaccination promotes direct protection and limits transmission. This study aimed to explore influenza vaccination coverage among children in Australian general practice from 2015 to 2018, and patterns in coverage before and after the implementation of state-funded immunization programs. Data from 196,520 'active' patients (3+ consultations in two consecutive years) aged <5 years from 542 Australian general practices were included (MedicineInsight database). Logistic regression models were used to identify associations between vaccination with patient and practice characteristics. The overall vaccination coverage increased more than five times from 2015 (3.9%) to 2018 (19.6%) and varied among states. Children attending practices located in the wealthiest areas were more likely to receive the vaccine and appeared to benefit most from the funding, as the increase in coverage from 2017 to 2018 was greater among them than those attending practices in the least advantaged areas (17 vs. 11 percentage points, respectively). This relationship was not evident when analyzing the patient's socioeconomic level. In conclusion, free influenza vaccinations increase coverage in at-risk populations. Promotional campaigns may be required to maintain higher coverage and target practices located in low-income areas.
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Affiliation(s)
- Carla De Oliveira Bernardo
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - David Alejandro González-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE) Centre of Research Excellence, NHMRC, Adelaide, Australia.,EMPOWER: Health Systems, Adversity and Child Well Being Centre of Research Excellence, NHMRC, Adelaide, Australia
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Affanni P, Colucci ME, Bracchi MT, Capobianco E, Zoni R, Caruso L, Castrucci MR, Puzelli S, Cantarelli A, Veronesi L. Virological Surveillance of Influenza in the eight epidemic seasons after the 2009 pandemic in Emilia-Romagna (Northern Italy). ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:35-44. [PMID: 31517888 PMCID: PMC7233653 DOI: 10.23750/abm.v90i9-s.8722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Influenza virological surveillance is essential for monitoring the evolution of influenza viruses (IVs) as well as for annual updating of the vaccine composition. The aim of this study is to analyse IVs circulation in Emilia-Romagna during the eight epidemic seasons after the 2009 pandemic and to evaluate their match with seasonal vaccine strains. METHODS A total of 7882 respiratory specimens from patients with influenza-like illness (ILI), were collected by regional sentinel practitioners and hospital physicians. Viral investigations were conducted by rRT-PCR assay. Genetic characterization was performed for a spatial-temporal representative number of influenza laboratory-confirmed specimens. RESULTS Influenza-positive samples per season ranged between 28.9% (2013-2014) and 66.8% (2012-2013). Co-circulation of IVs type A and type B was observed in all seasons, although with a different intensity. In all seasons, the highest number of positive samples was recorded in younger patients aged 5-14 years with relative frequencies ranging from 40% in the 2013-2014 season and 78% in the 2012-2013 season. Since the 2009 pandemic, A/H1N1pdm09 IVs circulating were closely related to the vaccine strain A/California/7/2009. Antigenic mismatch between vaccine strain and A/H3N2 IVs was observed in the 2011-2012 and 2014-2015 seasons. During 2015-2016, 2016-2017 and 2017-2018 seasons a complete or nearly complete mismatch between the predominant influenza B lineage of IVs type B circulating and vaccine B lineage occurred. CONCLUSIONS This analysis confirms the importance of the virological surveillance and highlights the need of a continuous monitoring of IVs circulation, to improve the most appropriate vaccination strategies. (www.actabiomedica.it).
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Affiliation(s)
- Paola Affanni
- Department of Medicine and Surgery, University of Parma, Italy.
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Ainslie KEC, Haber M, Orenstein WA. Challenges in estimating influenza vaccine effectiveness. Expert Rev Vaccines 2019; 18:615-628. [PMID: 31116070 PMCID: PMC6594904 DOI: 10.1080/14760584.2019.1622419] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/20/2019] [Indexed: 12/25/2022]
Abstract
Introduction: Influenza vaccination is regarded as the most effective way to prevent influenza infection. Due to the rapid genetic changes that influenza viruses undergo, seasonal influenza vaccines must be reformulated and re-administered annually necessitating the evaluation of influenza vaccine effectiveness (VE) each year. The estimation of influenza VE presents numerous challenges. Areas Covered: This review aims to identify, discuss, and, where possible, offer suggestions for dealing with the following challenges in estimating influenza VE: different outcomes of interest against which VE is estimated, study designs used to assess VE, sources of bias and confounding, repeat vaccination, waning immunity, population level effects of vaccination, and VE in at-risk populations. Expert Opinion: The estimation of influenza VE has improved with surveillance networks, better understanding of sources of bias and confounding, and the implementation of advanced statistical methods. Future research should focus on better estimates of the indirect effects of vaccination, the biological effects of vaccination, and how vaccines interact with the immune system. Specifically, little is known about how influenza vaccination impacts an individual's infectiousness, how vaccines wane over time, and the impact of repeated vaccination.
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Affiliation(s)
- Kylie E. C. Ainslie
- Research Associate in Influenza Disease Dynamics, MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Michael Haber
- Professor, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Walt A. Orenstein
- Professor, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 1462 Clifton Rd NE, Atlanta, GA 30322, USA
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Beard FH, Hendry AJ, Macartney K. Early success with room for improvement: influenza vaccination of young Australian children. Med J Aust 2019; 210:484-486.e1. [DOI: 10.5694/mja2.50141] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Frank H Beard
- National Centre for Immunisation Research and SurveillanceChildren's Hospital at Westmead Sydney NSW
- University of Sydney Sydney NSW
| | - Alexandra J Hendry
- National Centre for Immunisation Research and SurveillanceChildren's Hospital at Westmead Sydney NSW
| | - Kristine Macartney
- National Centre for Immunisation Research and SurveillanceChildren's Hospital at Westmead Sydney NSW
- University of Sydney Sydney NSW
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