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Sanchez PL, Andre G, Antipov A, Petrovsky N, Ross TM. Advax-SM™-Adjuvanted COBRA (H1/H3) Hemagglutinin Influenza Vaccines. Vaccines (Basel) 2024; 12:455. [PMID: 38793706 PMCID: PMC11125990 DOI: 10.3390/vaccines12050455] [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: 02/08/2024] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Adjuvants enhance immune responses stimulated by vaccines. To date, many seasonal influenza vaccines are not formulated with an adjuvant. In the present study, the adjuvant Advax-SM™ was combined with next generation, broadly reactive influenza hemagglutinin (HA) vaccines that were designed using a computationally optimized broadly reactive antigen (COBRA) methodology. Advax-SM™ is a novel adjuvant comprising inulin polysaccharide and CpG55.2, a TLR9 agonist. COBRA HA vaccines were combined with Advax-SM™ or a comparator squalene emulsion (SE) adjuvant and administered to mice intramuscularly. Mice vaccinated with Advax-SM™ adjuvanted COBRA HA vaccines had increased serum levels of anti-influenza IgG and IgA, high hemagglutination inhibition activity against a panel of H1N1 and H3N2 influenza viruses, and increased anti-influenza antibody secreting cells isolated from spleens. COBRA HA plus Advax-SM™ immunized mice were protected against both morbidity and mortality following viral challenge and, at postmortem, had no detectable lung viral titers or lung inflammation. Overall, the Advax-SM™-adjuvanted COBRA HA formulation provided effective protection against drifted H1N1 and H3N2 influenza viruses.
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Affiliation(s)
- Pedro L. Sanchez
- Center for Vaccines and Immunology, University of Georgia, Athens, GA 30602, USA;
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, FL 34987, USA
| | - Greiciely Andre
- Vaxine Pty Ltd., Adelaide, SA 5046, Australia; (G.A.); (A.A.); (N.P.)
| | - Anna Antipov
- Vaxine Pty Ltd., Adelaide, SA 5046, Australia; (G.A.); (A.A.); (N.P.)
| | - Nikolai Petrovsky
- Vaxine Pty Ltd., Adelaide, SA 5046, Australia; (G.A.); (A.A.); (N.P.)
| | - Ted M. Ross
- Center for Vaccines and Immunology, University of Georgia, Athens, GA 30602, USA;
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, FL 34987, USA
- Department of Infection Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Who Cares? A Pilot Study of Pandemic Influenza Risk Perception in an Urban Population. Disaster Med Public Health Prep 2021; 16:1982-1989. [PMID: 34470693 DOI: 10.1017/dmp.2021.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The association of urban population sociodemographic factors and components of pandemic influenza risk perception were studied. METHODS A prospective questionnaire-based study was undertaken between March 14, 2019 and October 18, 2019. A total of 464 questionnaires were distributed to 4 primary medical centers in 2 cities in England and Wales. Persons aged over 16 years presenting to the medical centers were asked to participate. RESULTS A total of 222 questionnaires were completed (return rate 47.8%). Participants were aged 16-84 years, with a median age of 45.5 years. Prevalence of 1 or more chronic diseases was 29.1%. Seasonal flu vaccination within 5 years was reported by 58.9%. Bivariate analyses of chronic disease and influenza vaccination observed a statistically significant association with influenza personal susceptibility expression (OR = 0.45; 95% CI: 0.22 - 0.94) and (OR = 0.50; 95% CI: 0.25 - 0.99) respectively. Multivariate analysis observed a statistically significant association between the presence of chronic disease and low comparative risk expression (OR = 0.33; 95% CI: 0.15 - 0.74) (P = 0.007). CONCLUSIONS Respondents identifying as 'healthy' are more likely to express lower risk perception of pandemic influenza. Importantly, this target group is not the usual focus of influenza campaigns and are perhaps more likely to disregard health advice. Factors influencing perceptions of this target group could be an important focus of future pandemic risk perception research.
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Ferdinands JM, Thompson MG, Blanton L, Spencer S, Grant L, Fry AM. Does influenza vaccination attenuate the severity of breakthrough infections? A narrative review and recommendations for further research. Vaccine 2021; 39:3678-3695. [PMID: 34090700 DOI: 10.1016/j.vaccine.2021.05.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 01/05/2023]
Abstract
The effect of influenza vaccination on influenza severity remains uncertain. We reviewed the literature for evidence to inform the question of whether influenza illness is less severe among individuals who received influenza vaccination compared with individuals with influenza illness who were unvaccinated prior to their illnesses. We conducted a narrative review to identify published findings comparing severity of influenza outcomes by vaccination status among community-dwelling adults and children ≥ 6 months of age with laboratory-confirmed influenza illness. When at least four effect estimates of the same type (e.g., odds ratio) were available for a specific outcome and age category (children versus adults), data were pooled with meta-analysis to generate a summary effect estimate. We identified 38 published articles reporting ≥ 1 association between influenza vaccination status and one of 21 indicators of severity of influenza illness among individuals with laboratory-confirmed influenza. Study methodologies and effect estimates were highly heterogenous, with only five severity indicators meeting criteria for calculating a combined effect. Among eight studies, influenza vaccination was associated with 26% reduction in odds of ICU admission among adults with influenza-associated hospitalization (OR = 0.74, 95% CI 0.58, 0.93). Among five studies of adults with influenza-associated hospitalization, vaccinated patients had 31% reduced risk of death compared with unvaccinated patients (OR = 0.69, 95% CI 0.52, 0.92). Among four studies of children with influenza virus infection, vaccination was associated with an estimated 45% reduction in the odds of manifesting fever (OR = 0.55, 95% CI 0.42, 0.71). Vaccination was not significantly associated with receiving a clinical diagnosis of pneumonia among adults hospitalized with influenza (OR = 0.92, 95% CI 0.82, 1.04) or with risk of hospitalization following outpatient influenza illness among adults (OR = 0.60, 95% CI 0.28, 1.28). Overall, our findings support the hypothesis that influenza vaccination may attenuate the course of disease among individuals with breakthrough influenza virus infection.
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Affiliation(s)
- Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Spencer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lauren Grant
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Lee RU, Phillips CJ, Faix DJ. Seasonal Influenza Vaccine Impact on Pandemic H1N1 Vaccine Efficacy. Clin Infect Dis 2020; 68:1839-1846. [PMID: 30239636 PMCID: PMC7314138 DOI: 10.1093/cid/ciy812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/17/2018] [Indexed: 01/06/2023] Open
Abstract
Background In 2009, a novel influenza A (pH1N1) was identified, resulting in a pandemic with significant morbidity and mortality. A monovalent pH1N1 vaccine was separately produced in addition to the seasonal trivalent influenza vaccine. Formulation of the seasonal influenza vaccine (injectable trivalent inactivated influenza vaccine [TIV] vs. intranasal live, attenuated influenza vaccine [LAIV]) was postulated to have impacted the efficacy of the pH1N1 vaccination. Methods We reviewed electronic health and databases, which included vaccination records, and healthcare encounters for influenza-like illness (ILI), influenza, and pneumonia among US military members. We examined rates by vaccination type to identify factors associated with the risk for study outcomes. Results Compared with those receiving the seasonal influenza vaccine alone, subjects receiving the pH1N1 vaccine, either alone (RR, 0.49) or in addition to the seasonal vaccine (RR, 0.51), had an approximately 50% reduction in ILI, 88% reduction in influenza (RR, 0.11 and 0.12, respectively), and 63% reduction in pneumonia (RR, 0.37 and 0.35, respectively). There was no clinically significant difference in ILI, influenza, or pneumonia attack rates among those receiving the pH1N1 vaccine with or without presence of the seasonal vaccine. Similarly, there was no clinically relevant difference in pH1N1 effectiveness between seasonal TIV and LAIV recipients. Conclusions During the 2009–2010 pandemic, the pH1N1 vaccination was effective in reducing rates of ILI, influenza, and pneumonia. Administration of the seasonal vaccine should continue without concern of potential interference with a novel pandemic vaccine, though more studies are needed to determine if this is applicable to other influenza seasons.
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Affiliation(s)
- Rachel U Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Naval Medical Center, San Diego, California
| | - Christopher J Phillips
- Military Population Health Directorate, Deployment Health Department, Naval Health Research Center, San Diego, California
| | - Dennis J Faix
- Military Population Health Directorate, Deployment Health Department, Naval Health Research Center, San Diego, California
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Barrett JP, Rosen IM, Stout LR, Rosen SE. Influenza Vaccination, Self-reported Illness, and Obstacles for Vaccination Among the 2010 ROTC Warrior Forge Cadet Cohort. Mil Med 2020; 185:610-616. [PMID: 32074350 DOI: 10.1093/milmed/usz257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION This study evaluates a large cohort of college students after the 2009-2010 pandemic H1N1 influenza season. The objective was to assess influenza vaccination status, influenzalike illnesses (ILIs), and other characteristics associated with attaining immunizations. METHODS This study was conducted during the summer 2010 the Reserve Officer Training Corps Leadership Development and Assessment Course involving 6272 college students. A voluntary, anonymous questionnaire was administered to assess study objectives. RESULTS Vaccination rates were 39.9% for pandemic H1N1, 40.6% for seasonal influenza, and 32.6% for receiving both vaccinations. Age less than 25 and having a Reserve Officer Training Corps scholarship were associated with lower odds of receiving vaccinations, whereas entering the nursing field and simultaneous membership in the Army reserve forces were associated with higher odds of vaccination. There are 11.2% of respondents reported having an ILI, including 4.3% with severe ILI. There were 4184 reasons indicated for not attaining influenza vaccinations, which are listed in categorical groupings. CONCLUSIONS A historical anchor for vaccination rates and ILI is provided in a large cohort of college students following the 2009 H1N1 influenza pandemic. Influenza immunization locations were determined, as was self-reported obstacles to receiving vaccinations. These are important results for public health leaders seeking to increase vaccination rates during future influenza seasons.
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Affiliation(s)
- John P Barrett
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Irene M Rosen
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431
| | - Louis R Stout
- Landstuhl Regional Medical Center, Unit 33100, APO-AE 09180, Germany
| | - Stephanie E Rosen
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431
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Chuah CXP, Lim RL, Chen MIC. Investigating the Legacy of the 1918 Influenza Pandemic in Age-Related Seroepidemiology and Immune Responses to Subsequent Influenza A(H1N1) Viruses Through a Structural Equation Model. Am J Epidemiol 2018; 187:2530-2540. [PMID: 30165573 PMCID: PMC6269251 DOI: 10.1093/aje/kwy192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/21/2018] [Indexed: 01/08/2023] Open
Abstract
A(H1N1) strains of Influenzavirus were responsible for 2 pandemics in the last 100 years. Because infections experienced early in life may have a long-lasting influence on future immune response against other influenza strains, we drew on previously collected seroincidence data from Singapore (n = 2,554; June-October 2009) to investigate whether the 1918 pandemic influenza virus and its early descendants produced an age-related signature in immune responses against the A/California/7/2009(H1N1)pdm09 virus of 2009. Hemagglutination inhibition assays revealed a J-shaped relationship; the oldest birth cohort (born in 1911-1926) had the highest titers, followed by the youngest (born in 1987-1992). Differential response by vaccination history was also observed, with seasonal influenza vaccine being associated with higher titers mainly in the oldest birth cohort. On the assumption that antibody titers are a correlate of protection, structural equation modeling predicted that a titer-mediated effect by the vaccine could, on its own, account for a negative association with seroconversion equivalent to a risk reduction of 23% (relative risk = 0.77, 95% confidence interval: 0.60, 0.99) in the oldest birth cohort. A subset of 503 samples tested against the A/Brisbane/59/2007(H1N1) and A/Puerto Rico/8/1934(H1N1) strains also revealed different age-related antibody profiles. The effectiveness of seasonal influenza vaccines against future pandemic strains could thus be age-dependent and related to early-life exposures.
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Affiliation(s)
- Cheryl X P Chuah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Rachel L Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
| | - Mark I C Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore
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Rockman S, Lowther S, Camuglia S, Vandenberg K, Taylor S, Fabri L, Miescher S, Pearse M, Middleton D, Kent SJ, Maher D. Intravenous Immunoglobulin Protects Against Severe Pandemic Influenza Infection. EBioMedicine 2017; 19:119-127. [PMID: 28408242 PMCID: PMC5440604 DOI: 10.1016/j.ebiom.2017.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 12/09/2022] Open
Abstract
Influenza is a highly contagious, acute, febrile respiratory infection that can have fatal consequences particularly in individuals with chronic illnesses. Sporadic reports suggest that intravenous immunoglobulin (IVIg) may be efficacious in the influenza setting. We investigated the potential of human IVIg to ameliorate influenza infection in ferrets exposed to either the pandemic H1N1/09 virus (pH1N1) or highly pathogenic avian influenza (H5N1). IVIg administered at the time of influenza virus exposure led to a significant reduction in lung viral load following pH1N1 challenge. In the lethal H5N1 model, the majority of animals given IVIg survived challenge in a dose dependent manner. Protection was also afforded by purified F(ab′)2 but not Fc fragments derived from IVIg, supporting a specific antibody-mediated mechanism of protection. We conclude that pre-pandemic IVIg can modulate serious influenza infection-associated mortality and morbidity. IVIg could be useful prophylactically in the event of a pandemic to protect vulnerable population groups and in the critical care setting as a first stage intervention. Intravenous immunoglobulin (IVIg), prepared prior to a pandemic, prevents pandemic influenza disease in ferrets. IVIg effectively reduced viral levels of pandemic H1N1 influenza and prevented disease due to avian influenza H5N1. This work has implications for preventing and treating pandemic influenza infections with IVIg before a vaccine is available.
Influenza pandemics cause large numbers of infections and deaths. There is a lag between the identification of a pandemic and the development of vaccines. Future pandemics may be caused by influenza strains resistant to current anti-influenza drugs. New treatments are needed for future pandemic influenza outbreaks. We show that a readily available product (intravenous immunoglobuling – pooled antibodies from human donors) can prevent viral replication and disease caused by 2 strains of pandemic influenza viruses (“swine-flu” and “bird-flu”) in an appropriate animal model of influenza. This could form the basis of future treatments for severe influenza caused by pandemic strains.
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Affiliation(s)
- Steven Rockman
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, Australia; Seqirus, Parkville, Victoria, Australia.
| | - Sue Lowther
- CSIRO Australian Animal Health Laboratory, Geelong, Victoria, Australia
| | | | | | | | - Lou Fabri
- CSL Limited, Parkville, Victoria, Australia
| | | | | | - Deborah Middleton
- CSIRO Australian Animal Health Laboratory, Geelong, Victoria, Australia
| | - Stephen J Kent
- Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Victoria, Australia.
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Galson JD, Trück J, Kelly DF, van der Most R. Investigating the effect of AS03 adjuvant on the plasma cell repertoire following pH1N1 influenza vaccination. Sci Rep 2016; 6:37229. [PMID: 27849037 PMCID: PMC5110968 DOI: 10.1038/srep37229] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/26/2016] [Indexed: 12/24/2022] Open
Abstract
Influenza pandemics require rapid deployment of effective vaccines for control. Adjuvants such as AS03 improve vaccine immunogenicity, but this mechanism is poorly understood. We used high-throughput B cell receptor sequencing of plasma cells produced following AS03-adjuvanted and non-adjuvanted 2009 pandemic H1N1 vaccination, as well as pre-pandemic seasonal influenza vaccination to elucidate the effect of the adjuvant on the humoral immune response. By analyzing mutation levels, it was possible to distinguish sequences from cells that were recently activated from naïve B cells from those that were activated by memory recall. We show that the adjuvant functions through two mechanisms. First, the adjuvant stimulates increased activation of naïve B cells, thus reducing immune interference with previous vaccine responses. Second, the adjuvant is able to increase the adaptability of the recalled cells to give improved specificity to the new vaccine antigen. We thus show how AS03 enhances pH1N1 immune responses, and reduces immune interference.
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Affiliation(s)
- J. D. Galson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, United Kingdom
| | - J. Trück
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, United Kingdom
- Paediatric Immunology, University Children’s Hospital Zürich, Switzerland
| | - D. F. Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Center, Oxford, United Kingdom
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Park MS, Kim JI, Park S, Lee I, Park MS. Original Antigenic Sin Response to RNA Viruses and Antiviral Immunity. Immune Netw 2016; 16:261-270. [PMID: 27799871 PMCID: PMC5086450 DOI: 10.4110/in.2016.16.5.261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/13/2016] [Accepted: 08/15/2016] [Indexed: 12/25/2022] Open
Abstract
The human immune system has evolved to fight against foreign pathogens. It plays a central role in the body's defense mechanism. However, the immune memory geared to fight off a previously recognized pathogen, tends to remember an original form of the pathogen when a variant form subsequently invades. This has been termed 'original antigenic sin'. This adverse immunological effect can alter vaccine effectiveness and sometimes cause enhanced pathogenicity or additional inflammatory responses, according to the type of pathogen and the circumstances of infection. Here we aim to give a simplified conceptual understanding of virus infection and original antigenic sin by comparing and contrasting the two examples of recurring infections such as influenza and dengue viruses in humans.
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Affiliation(s)
- Mee Sook Park
- Department of Microbiology, The Institute of Viral Diseases, College of Medicine, Korea University, Seoul 02841, Korea
| | - Jin Il Kim
- Department of Microbiology, The Institute of Viral Diseases, College of Medicine, Korea University, Seoul 02841, Korea
| | - Sehee Park
- Department of Microbiology, The Institute of Viral Diseases, College of Medicine, Korea University, Seoul 02841, Korea
| | - Ilseob Lee
- Department of Microbiology, The Institute of Viral Diseases, College of Medicine, Korea University, Seoul 02841, Korea
| | - Man-Seong Park
- Department of Microbiology, The Institute of Viral Diseases, College of Medicine, Korea University, Seoul 02841, Korea
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Mcbride WJH, Abhayaratna WP, Barr I, Booy R, Carapetis J, Carson S, De Looze F, Ellis-Pegler R, Heron L, Karrasch J, Marshall H, Mcvernon J, Nolan T, Rawlinson W, Reid J, Richmond P, Shakib S, Basser RL, Hartel GF, Lai MH, Rockman S, Greenberg ME. Efficacy of a trivalent influenza vaccine against seasonal strains and against 2009 pandemic H1N1: A randomized, placebo-controlled trial. Vaccine 2016; 34:4991-4997. [PMID: 27595443 DOI: 10.1016/j.vaccine.2016.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/31/2016] [Accepted: 08/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Before pandemic H1N1 vaccines were available, the potential benefit of existing seasonal trivalent inactivated influenza vaccines (IIV3s) against influenza due to the 2009 pandemic H1N1 influenza strain was investigated, with conflicting results. This study assessed the efficacy of seasonal IIV3s against influenza due to 2008 and 2009 seasonal influenza strains and against the 2009 pandemic H1N1 strain. METHODS This observer-blind, randomized, placebo-controlled study enrolled adults aged 18-64years during 2008 and 2009 in Australia and New Zealand. Participants were randomized 2:1 to receive IIV3 or placebo. The primary objective was to demonstrate the efficacy of IIV3 against laboratory-confirmed influenza. Participants reporting an influenza-like illness during the period from 14days after vaccination until 30 November of each study year were tested for influenza by real-time reverse transcription polymerase chain reaction. RESULTS Over a study period of 2years, 15,044 participants were enrolled (mean age±standard deviation: 35.5±14.7years; 54.4% female). Vaccine efficacy of the 2008 and 2009 IIV3s against influenza due to any strain was 42% (95% confidence interval [CI]: 30%, 52%), whereas vaccine efficacy against influenza due to the vaccine-matched strains was 60% (95% CI: 44%, 72%). Vaccine efficacy of the 2009 IIV3 against influenza due to the 2009 pandemic H1N1 strain was 38% (95% CI: 19%, 53%). No vaccine-related deaths or serious adverse events were reported. Solicited local and systemic adverse events were more frequent in IIV3 recipients than placebo recipients (local: IIV3 74.6% vs placebo 20.4%, p<0.001; systemic: IIV3 46.6% vs placebo 39.1%, p<0.001). CONCLUSIONS The 2008 and 2009 IIV3s were efficacious against influenza due to seasonal influenza strains and the 2009 IIV3 demonstrated moderate efficacy against influenza due to the 2009 pandemic H1N1 strain. Funded by CSL Limited, ClinicalTrials.gov identifier NCT00562484.
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Affiliation(s)
- William J H Mcbride
- James Cook University, Cairns Hospital Clinical School, Cairns, Queensland 4870, Australia.
| | - Walter P Abhayaratna
- Academic Unit of Internal Medicine, Canberra Hospital, Woden, Australian Capital Territory 2606, Australia; ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory 0200, Australia.
| | - Ian Barr
- World Health Organization Collaborating Centre for Reference and Research on Influenza, North Melbourne, Victoria 3051, Australia.
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The University of Sydney and The Children's Hospital at Westmead, Westmead, New South Wales 2145, Australia.
| | - Jonathan Carapetis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0810, Australia.
| | - Simon Carson
- Southern Clinical Trials Ltd, Christchurch 8013, New Zealand.
| | - Ferdinandus De Looze
- Trialworks Clinical Research Pty Ltd and Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Queensland 4067, Australia.
| | | | - Leon Heron
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The University of Sydney and The Children's Hospital at Westmead, Westmead, New South Wales 2145, Australia.
| | - Jeff Karrasch
- Redcliffe Hospital, Redcliffe, Queensland 4020, Australia.
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, Robinson Research Institute and School of Medicine, University of Adelaide, Adelaide, South Australia 5006, Australia.
| | - Jodie Mcvernon
- Vaccine and Immunization Research Group, Melbourne School of Population and Global Health, University of Melbourne, and Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
| | - Terry Nolan
- Vaccine and Immunization Research Group, Melbourne School of Population and Global Health, University of Melbourne, and Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
| | - William Rawlinson
- South Eastern Sydney and Illawarra Area Health Service and University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Jim Reid
- Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand.
| | - Peter Richmond
- University of Western Australia, School of Paediatrics and Child Health, Princess Margaret Hospital for Children, Perth, Western Australia 6872, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, South Australia 5001, Australia.
| | - Russell L Basser
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Gunter F Hartel
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Michael H Lai
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Steven Rockman
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
| | - Michael E Greenberg
- Clinical Research and Development, CSL Limited, Parkville, Victoria 3052, Australia.
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Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev 2015; 28:743-800. [PMID: 26085551 PMCID: PMC4475643 DOI: 10.1128/cmr.00039-14] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | | | - James F Cummings
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, Rochester, Minnesota, USA
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA Oak Ridge Institute for Science and Education, Postgraduate Research Participation Program, U.S. Army Public Health Command, Aberdeen Proving Ground, Aberdeen, Maryland, USA
| | - Charlotte A Gaydos
- International STD, Respiratory, and Biothreat Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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Chen CH, Chiu PJ, Chih YC, Yeh GL. Determinants of influenza vaccination among young Taiwanese children. Vaccine 2015; 33:1993-8. [PMID: 25613722 DOI: 10.1016/j.vaccine.2015.01.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE According to the Health Belief Model (HBM), individual perceptions of susceptibility, severity, benefit, barrier, self-efficacy, and cues to action are associated with health actions. In this study, we investigated the perceptions and social factors that influence the intention to vaccinate children against influenza among parents of young Taiwanese children. METHODS A nationwide survey was performed using stratified random sampling to explore the beliefs, attitudes, and intentions of parents/main caregivers with regard to vaccinating children aged 6 months to 3 years against influenza. A questionnaire was developed based on the HBM and multivariate logistic regression analyses of 1300 eligible participants were used to identify significant predictors of the intention to vaccinate. RESULTS Greater perceived benefit, cues to action, and self-efficacy of childhood vaccination against influenza were positively associated with the intention to vaccinate. Children's experience of influenza vaccinations in the past year was also a positive predictor. However, perceived susceptibility, perceived severity regarding influenza and perceived barriers to vaccination were not predictive of the intention to vaccinate. CONCLUSION In addition to perceived benefits and cues to action, self-efficacy of parents/main caregivers was significantly predictive of their intention to accept influenza vaccination for their young children. These components of the HBM could be used in formulating strategies aimed at promoting the use of influenza vaccine.
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Affiliation(s)
- Chang-Hsun Chen
- Centers for Disease Control, R.O.C. (Taiwan); Department of Health Promotion and Health Education, National Taiwan Normal University (Taiwan)
| | - Po-Ju Chiu
- Centers for Disease Control, R.O.C. (Taiwan)
| | | | - Gwo-Liang Yeh
- Department of Health Promotion and Health Education, National Taiwan Normal University (Taiwan)
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Li ZY, Chen JY, Zhang YL, Fu WM. Partial protection against 2009 pandemic influenza A (H1N1) of seasonal influenza vaccination and related regional factors: Updated systematic review and meta-analyses. Hum Vaccin Immunother 2015; 11:1337-44. [PMID: 25692308 PMCID: PMC4514212 DOI: 10.4161/21645515.2014.985495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 01/02/2023] Open
Abstract
This updated systematic review and meta-analyses aims to systematically evaluate the cross-protection of seasonal influenza vaccines against the 2009 pandemic A (H1N1) influenza infection, and investigate the potential effect of the influenza strains circulating previous to the pandemic on the association between vaccine receipt and pandemic infection. In addition, subgroup analysis was performed based on the study locations and previous circulating influenza viruses. Relevant articles in English and Chinese from 2009 to October 2013 were systematically searched, and 21 eligible studies were included. For case-control studies, an insignificant 20% reduced risk for pandemic influenza infection based on combined national data (OR = 0.80; 95%CI: 0.60, 1.05) was calculated for people receiving seasonal influenza vaccination. However, for RCTs, an insignificant increase in the risk of seasonal influenza vaccines was observed (RR = 1.27; 95% CI: 0.46, 3.53). For the subgroup analysis, a significant 35% cross-protection was observed in the subgroup where influenza A outbreaks were detected before the 2009 pandemic. Moreover, the results indicated that seasonal influenza vaccination may reduce the risk of influenza-like illnesses (ILIs) (RR = 0.91; 95% CI: 0.84, 0.99). Our findings partially support the hypothesis that seasonal vaccines may offer moderate cross-protection for adults against laboratory-confirmed pandemic influenza A (H1N1) infection and ILIs. Further immunological studies are needed to understand the mechanism underlying these findings.
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Affiliation(s)
- Zhi-Yuan Li
- Guangzhou Institute of Advanced Technology; Chinese Academy of Sciences; Guangzhou, PR China
| | | | - Yan-Ling Zhang
- School of Medical Technology and Nursing; Shenzhen Polytechnic; Shenzhen, PR China
| | - Wei-Ming Fu
- Guangzhou Institute of Advanced Technology; Chinese Academy of Sciences; Guangzhou, PR China
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Zhang XS, Pebody R, De Angelis D, White PJ, Charlett A, McCauley JW. The Possible Impact of Vaccination for Seasonal Influenza on Emergence of Pandemic Influenza via Reassortment. PLoS One 2014; 9:e114637. [PMID: 25494180 PMCID: PMC4262424 DOI: 10.1371/journal.pone.0114637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 11/12/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND One pathway through which pandemic influenza strains might emerge is reassortment from coinfection of different influenza A viruses. Seasonal influenza vaccines are designed to target the circulating strains, which intuitively decreases the prevalence of coinfection and the chance of pandemic emergence due to reassortment. However, individual-based analyses on 2009 pandemic influenza show that the previous seasonal vaccination may increase the risk of pandemic A(H1N1) pdm09 infection. In view of pandemic influenza preparedness, it is essential to understand the overall effect of seasonal vaccination on pandemic emergence via reassortment. METHODS AND FINDINGS In a previous study we applied a population dynamics approach to investigate the effect of infection-induced cross-immunity on reducing such a pandemic risk. Here the model was extended by incorporating vaccination for seasonal influenza to assess its potential role on the pandemic emergence via reassortment and its effect in protecting humans if a pandemic does emerge. The vaccination is assumed to protect against the target strains but only partially against other strains. We find that a universal seasonal vaccine that provides full-spectrum cross-immunity substantially reduces the opportunity of pandemic emergence. However, our results show that such effectiveness depends on the strength of infection-induced cross-immunity against any novel reassortant strain. If it is weak, the vaccine that induces cross-immunity strongly against non-target resident strains but weakly against novel reassortant strains, can further depress the pandemic emergence; if it is very strong, the same kind of vaccine increases the probability of pandemic emergence. CONCLUSIONS Two types of vaccines are available: inactivated and live attenuated, only live attenuated vaccines can induce heterosubtypic immunity. Current vaccines are effective in controlling circulating strains; they cannot always help restrain pandemic emergence because of the uncertainty of the oncoming reassortant strains, however. This urges the development of universal vaccines for prevention of pandemic influenza.
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Affiliation(s)
- Xu-Sheng Zhang
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
- * E-mail:
| | - Richard Pebody
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - Daniela De Angelis
- Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Medical Research Council Biostatistics Unit, University Forvie Site, Cambridge, United Kingdom
| | - Peter J. White
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
- NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Andre Charlett
- Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - John W. McCauley
- Medical Research Council National Institute for Medical Research, Mill Hill, London, United Kingdom
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15
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Animal models for influenza viruses: implications for universal vaccine development. Pathogens 2014; 3:845-74. [PMID: 25436508 PMCID: PMC4282889 DOI: 10.3390/pathogens3040845] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 01/22/2023] Open
Abstract
Influenza virus infections are a significant cause of morbidity and mortality in the human population. Depending on the virulence of the influenza virus strain, as well as the immunological status of the infected individual, the severity of the respiratory disease may range from sub-clinical or mild symptoms to severe pneumonia that can sometimes lead to death. Vaccines remain the primary public health measure in reducing the influenza burden. Though the first influenza vaccine preparation was licensed more than 60 years ago, current research efforts seek to develop novel vaccination strategies with improved immunogenicity, effectiveness, and breadth of protection. Animal models of influenza have been essential in facilitating studies aimed at understanding viral factors that affect pathogenesis and contribute to disease or transmission. Among others, mice, ferrets, pigs, and nonhuman primates have been used to study influenza virus infection in vivo, as well as to do pre-clinical testing of novel vaccine approaches. Here we discuss and compare the unique advantages and limitations of each model.
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Jang YH, Seong BL. Options and obstacles for designing a universal influenza vaccine. Viruses 2014; 6:3159-80. [PMID: 25196381 PMCID: PMC4147691 DOI: 10.3390/v6083159] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/31/2014] [Accepted: 08/05/2014] [Indexed: 12/13/2022] Open
Abstract
Since the discovery of antibodies specific to a highly conserved stalk region of the influenza virus hemagglutinin (HA), eliciting such antibodies has been considered the key to developing a universal influenza vaccine that confers broad-spectrum protection against various influenza subtypes. To achieve this goal, a prime/boost immunization strategy has been heralded to redirect host immune responses from the variable globular head domain to the conserved stalk domain of HA. While this approach has been successful in eliciting cross-reactive antibodies against the HA stalk domain, protective efficacy remains relatively poor due to the low immunogenicity of the domain, and the cross-reactivity was only within the same group, rather than among different groups. Additionally, concerns are raised on the possibility of vaccine-associated enhancement of viral infection and whether multiple boost immunization protocols would be considered practical from a clinical standpoint. Live attenuated vaccine hitherto remains unexplored, but is expected to serve as an alternative approach, considering its superior cross-reactivity. This review summarizes recent advancements in the HA stalk-based universal influenza vaccines, discusses the pros and cons of these approaches with respect to the potentially beneficial and harmful effects of neutralizing and non-neutralizing antibodies, and suggests future guidelines towards the design of a truly protective universal influenza vaccine.
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Affiliation(s)
- Yo Han Jang
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, South Korea.
| | - Baik Lin Seong
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, South Korea.
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Prompetchara E, Ketloy C, Keelapang P, Sittisombut N, Ruxrungtham K. Induction of neutralizing antibody response against four dengue viruses in mice by intramuscular electroporation of tetravalent DNA vaccines. PLoS One 2014; 9:e92643. [PMID: 24887426 PMCID: PMC4041562 DOI: 10.1371/journal.pone.0092643] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/23/2014] [Indexed: 11/18/2022] Open
Abstract
DNA vaccine against dengue is an interesting strategy for a prime/boost approach. This study evaluated neutralizing antibody (NAb) induction of a dengue tetravalent DNA (TDNA) vaccine candidate administered by intramuscular-electroporation (IM-EP) and the benefit of homologous TDNA boosting in mice. Consensus humanized pre-membrane (prM) and envelope (E) of each serotypes, based on isolates from year 1962-2003, were separately cloned into a pCMVkan expression vector. ICR mice, five-six per group were immunized for three times (2-week interval) with TDNA at 100 µg (group I; 25 µg/monovalent) or 10 µg (group II; 2.5 µg/monovalent). In group I, mice received an additional TDNA boosting 13 weeks later. Plaque reduction neutralization tests (PRNT) were performed at 4 weeks post-last immunization. Both 100 µg and 10 µg doses of TDNA induced high NAb levels against all DENV serotypes. The median PRNT50 titers were comparable among four serotypes of DENV after TDNA immunization. Median PRNT50 titers ranged 240-320 in 100 µg and 160-240 in 10 µg groups (p = ns). A time course study of the 100 µg dose of TDNA showed detectable NAb at 2 weeks after the second injection. The NAb peaked at 4 weeks after the third injection then declined over time but remained detectable up to 13 weeks. An additional homologous TDNA boosting significantly enhanced the level of NAb from the nadir for at least ten-fold (p<0.05). Of interest, we have found that the use of more recent dengue viral strain for both vaccine immunogen design and neutralization assays is critical to avoid a mismatching outcome. In summary, this TDNA vaccine candidate induced good neutralizing antibody responses in mice; and the DNA/DNA prime/boost strategy is promising and warranted further evaluation in non-human primates.
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Affiliation(s)
- Eakachai Prompetchara
- Dengue Vaccine Research Unit, Chula Vaccine Research Center (ChulaVRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chutitorn Ketloy
- Dengue Vaccine Research Unit, Chula Vaccine Research Center (ChulaVRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Poonsook Keelapang
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nopporn Sittisombut
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Medical Biotechnology Unit, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Bangkok, Thailand
- * E-mail: (NS); (KR)
| | - Kiat Ruxrungtham
- Dengue Vaccine Research Unit, Chula Vaccine Research Center (ChulaVRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Vaccine and Cellular Immunology Laboratory, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail: (NS); (KR)
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Prior contacts with the 2000–2003 seasonal vaccines extends the 2009 pandemic A/H1N1 vaccine-specific immune protection to non-humoral compartments. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pandemic influenza A(H1N1)pdm09: risk of infection in primary healthcare workers. Br J Gen Pract 2014; 63:e416-22. [PMID: 23735413 DOI: 10.3399/bjgp13x668212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Healthcare workers in primary care are at risk of infection during an influenza pandemic. The 2009 influenza pandemic provided an opportunity to assess this risk. AIM To measure the prevalence of seropositivity to influenza A(H1N1)pdm09 among primary healthcare workers in Canterbury, New Zealand, following the 2009 influenza pandemic, and to examine associations between seropositivity and participants' sociodemographic characteristics, professional roles, work patterns, and seasonal influenza vaccination status. DESIGN AND SETTING An observational study involving a questionnaire and testing for influenza A(H1N1)pdm09 seropositivity in all primary healthcare workers in Canterbury, New Zealand between December 2009 and February 2010. Method Participants completed a questionnaire that recorded sociodemographic and professional data, symptoms of influenza-like illness, history of seasonal influenza vaccination, and work patterns. Serum samples were collected and haemagglutination inhibition antibody titres to influenza A(H1N1)pdm09 measured. RESULTS Questionnaires and serum samples were received from 1027 participants, from a workforce of 1476 (response rate 70%). Seropositivity was detected in 224 participants (22%). Receipt of seasonal influenza vaccine (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.2 to 3.3), recall of influenza (OR = 1.9, 95% CI = 1.3 to 2.8), and age ≤45 years (OR = 1.4, 95% CI = 1.0 to 1.9) were associated with seropositivity. CONCLUSION A total of 22% of primary care healthcare workers were seropositive. Younger participants, those who recalled having influenza, and those who had been vaccinated against seasonal influenza were more likely to be seropositive. Working in a dedicated influenza centre was not associated with an increased risk of seropositivity.
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Cosby MT, Pimentel G, Nevin RL, Fouad Ahmed S, Klena JD, Amir E, Younan M, Browning R, Sebeny PJ. Outbreak of H3N2 influenza at a US military base in Djibouti during the H1N1 pandemic of 2009. PLoS One 2013; 8:e82089. [PMID: 24339995 PMCID: PMC3855413 DOI: 10.1371/journal.pone.0082089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/29/2013] [Indexed: 12/11/2022] Open
Abstract
Background Influenza pandemics have significant operational impact on deployed military personnel working in areas throughout the world. The US Department of Defense global influenza-like illness (ILI) surveillance network serves an important role in establishing baseline trends and can be leveraged to respond to outbreaks of respiratory illness. Objective We identified and characterized an operationally unique outbreak of H3N2 influenza at Camp Lemonnier, Djibouti occurring simultaneously with the H1N1 pandemic of 2009 [A(H1N1)pdm09]. Methods Enhanced surveillance for ILI was conducted at Camp Lemonnier in response to local reports of a possible outbreak during the A(H1N1)pdm09 pandemic. Samples were collected from consenting patients presenting with ILI (utilizing a modified case definition) and who completed a case report form. Samples were cultured and analyzed using standard real-time reverse transcriptase PCR (rt-RT-PCR) methodology and sequenced genetic material was phylogenetically compared to other published strains. Results rt-RT-PCR and DNA sequencing revealed that 25 (78%) of the 32 clinical samples collected were seasonal H3N2 and only 2 (6%) were A(H1N1)pdm09 influenza. The highest incidence of H3N2 occurred during the month of May and 80% of these were active duty military personnel. Phylogenetic analysis revealed that sequenced H3N2 strains were genetically similar to 2009 strains from the United States of America, Australia, and South east Asia. Conclusions This outbreak highlights challenges in the investigation of influenza among deployed military populations and corroborates the public health importance of maintaining surveillance systems for ILI that can be enhanced locally when needed.
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Affiliation(s)
- Michael T. Cosby
- United States Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt
| | - Guillermo Pimentel
- Naval Medical Research Center (NMRC) – Frederick, Fort Detrick, Maryland, United States of America
| | - Remington L. Nevin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Salwa Fouad Ahmed
- United States Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt
| | - John D. Klena
- Emerging Infectious Diseases Program, China Office, United States Centers for Disease Control and Prevention, Beijing, China
| | - Ehab Amir
- United States Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt
| | - Mary Younan
- United States Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt
| | - Robert Browning
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Peter J. Sebeny
- Naval Medical Research Center (NMRC), Silver Spring, Maryland, United States of America
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Haneberg B, Mamelund SE, Mjaaland S. Influenza vaccine--for whom? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:2376-8. [PMID: 24287838 DOI: 10.4045/tidsskr.13.0857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Pichyangkul S, Krasaesub S, Jongkaewwattana A, Thitithanyanont A, Wiboon-Ut S, Yongvanitchit K, Limsalakpetch A, Kum-Arb U, Mongkolsirichaikul D, Khemnu N, Mahanonda R, Garcia JM, Mason CJ, Walsh DS, Saunders DL. Pre-existing cross-reactive antibodies to avian influenza H5N1 and 2009 pandemic H1N1 in US military personnel. Am J Trop Med Hyg 2013; 90:149-52. [PMID: 24277784 DOI: 10.4269/ajtmh.13-0151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We studied cross-reactive antibodies against avian influenza H5N1 and 2009 pandemic (p) H1N1 in 200 serum samples from US military personnel collected before the H1N1 pandemic. Assays used to measure antibodies against viral proteins involved in protection included a hemagglutination inhibition (HI) assay and a neuraminidase inhibition (NI) assay. Viral neutralization by antibodies against avian influenza H5N1 and 2009 pH1N1 was assessed by influenza (H5) pseudotyped lentiviral particle-based and H1N1 microneutralization assays. Some US military personnel had cross-neutralizing antibodies against H5N1 (14%) and 2009 pH1N1 (16.5%). The odds of having cross-neutralizing antibodies against 2009 pH1N1 were 4.4 times higher in subjects receiving more than five inactivated whole influenza virus vaccinations than those subjects with no record of vaccination. Although unclear if the result of prior vaccination or disease exposure, these pre-existing antibodies may prevent or reduce disease severity.
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Affiliation(s)
- Sathit Pichyangkul
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; National Center for Genetic Engineering and Biotechnology, Pathum Thani, Thailand; Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand; Department of Dentistry, Chulalongkorn University, Bangkok, Thailand; Hong Kong University-Pasteur Research Center, Hong Kong
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Fowler KB, Gupta V, Sullender W, Broor S, Widdowson MA, Lal RB, Krishnan A. Incidence of symptomatic A(H1N1)pdm09 influenza during the pandemic and post-pandemic periods in a rural Indian community. Int J Infect Dis 2013; 17:e1182-5. [PMID: 24103331 DOI: 10.1016/j.ijid.2013.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/07/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Data on influenza illness rates with population denominators are needed to quantify overall morbidity and to prioritize public health intervention strategies. METHODS The rates of influenza A(H1N1)pdm09 infection during pandemic phases were determined in a longitudinal community cohort study as part of an influenza vaccine study in a rural community of North India. RESULTS During the 711,731 person-weeks of surveillance, a total of 1410/7571 (19%) febrile acute respiratory illness cases were positive for influenza. Of these, 749 (53%) were influenza A(H1N1)pdm09, 643 (46%) influenza B, and 18 (1%) influenza A (H3N2). The overall incidence rate of influenza-associated febrile acute respiratory illness was 128/1000 person-years. The incidence rates of influenza A(H1N1)pdm09 were high during both the pandemic phase (179/1000 person-years; November 2009 to January 2010) and post-pandemic phase (156/1000 person-years; August to October 2010), with children<18 years of age being at the greatest risk of influenza infection in the community. CONCLUSIONS These findings provide important information for planning clinical and public health intervention strategies to mitigate the impact of influenza epidemics.
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Affiliation(s)
- Karen B Fowler
- Department of Pediatrics, 1600 7(th) Ave So CHB 304, University of Alabama at Birmingham, Birmingham, AL 35233-0011, USA.
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Sam IC, Shaw R, Chan YF, Hooi PS, Hurt AC, Barr IG. Seroprevalence of Seasonal and Pandemic Influenza A in Kuala Lumpur, Malaysia in 2008-2010. J Med Virol 2013; 85:1420-5. [DOI: 10.1002/jmv.23622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/07/2022]
Affiliation(s)
- I-Ching Sam
- Department of Medical Microbiology; Tropical Infectious Diseases Research and Education Centre, University Malaya; Kuala Lumpur Malaysia
| | - Robert Shaw
- WHO Collaborating Centre for Reference and Research on Influenza; Melbourne Australia
| | - Yoke-Fun Chan
- Department of Medical Microbiology; Tropical Infectious Diseases Research and Education Centre, University Malaya; Kuala Lumpur Malaysia
| | - Poh-Sim Hooi
- Diagnostic Virology Laboratory; University Malaya Medical Centre; Kuala Lumpur Malaysia
| | - Aeron C. Hurt
- WHO Collaborating Centre for Reference and Research on Influenza; Melbourne Australia
| | - Ian G. Barr
- WHO Collaborating Centre for Reference and Research on Influenza; Melbourne Australia
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Uno S, Kimachi K, Matsuo F, Miyazaki K, Oohama A, Kei J, Nishimura T, Odoh K, Kino Y. Cross-reactive antibody response to the pandemic A (H1N1) 2009 influenza virus induced by vaccination with a seasonal trivalent influenza vaccine: a longitudinal study of three influenza seasons in Japan. Microbiol Immunol 2013; 56:810-6. [PMID: 23009167 DOI: 10.1111/j.1348-0421.2012.00511.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The cross-reactivity of antibody to the swine-origin pandemic influenza A (H1N1) 2009 virus induced by vaccination with a seasonal trivalent influenza vaccine was studied. Paired sera from a cohort of adult volunteers vaccinated with a trivalent seasonal influenza vaccine every year from 2006 to 2008 were collected each year and tested by hemagglutination inhibition (HI) for antibody against the pandemic influenza A (H1N1) 2009 virus. There was little increase in the geometric mean titer overall; a slight increase was detected in the sera obtained in the 2007-2008 season but not in the other two seasons. The proportion of individuals with HI antibody titers ≥ 1:40 did not change significantly from year to year. These results indicate that cross-reactivity of the antibodies induced by a trivalent seasonal vaccine to the pandemic influenza A (H1N1) 2009 virus is marginal.
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Affiliation(s)
- Shingo Uno
- Headquarters, Chemo-Sero-Therapeutic Research Institute Kaketsuken, Kumamoto 860-8568, Japan.
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Antibody-dependent cellular cytotoxicity is associated with control of pandemic H1N1 influenza virus infection of macaques. J Virol 2013; 87:5512-22. [PMID: 23468501 DOI: 10.1128/jvi.03030-12] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Emerging influenza viruses pose a serious risk to global human health. Recent studies in ferrets, macaques, and humans suggest that seasonal H1N1 (sH1N1) infection provides some cross-protection against 2009 pandemic influenza viruses (H1N1pdm), but the correlates of cross-protection are poorly understood. Here we show that seasonal infection of influenza-naïve Indian rhesus macaques (Macaca mulatta) with A/Kawasaki/173/2001 (sH1N1) virus induces antibodies capable of binding the hemagglutinin (HA) of both the homologous seasonal virus and the antigenically divergent A/California/04/2009 (H1N1pdm) strain in the absence of detectable H1N1pdm-specific neutralizing antibodies. These influenza virus-specific antibodies activated macaque NK cells to express both CD107a and gamma interferon (IFN-γ) in the presence of HA proteins from either sH1N1 or H1N1pdm viruses. Although influenza virus-specific antibody-dependent cellular cytotoxicity (ADCC)-mediated NK cell activation diminished in titer over time following sH1N1 infection, these cells expanded rapidly within 7 days following H1N1pdm exposure. Furthermore, we found that influenza virus-specific ADCC was present in bronchoalveolar lavage fluid and was able to activate lung NK cells. We concluded that infection with a seasonal influenza virus can induce antibodies that mediate ADCC capable of recognizing divergent influenza virus strains. Cross-reactive ADCC may provide a mechanism for reducing the severity of divergent influenza virus infections.
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MacIntosh VH, Tastad KJ, Eick-Cost AA. Mid-season influenza vaccine effectiveness 2011–2012: A Department of Defense Global, Laboratory-based, Influenza Surveillance System case–control study estimate. Vaccine 2013; 31:1651-5. [DOI: 10.1016/j.vaccine.2013.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 01/06/2013] [Accepted: 01/14/2013] [Indexed: 10/27/2022]
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Huijskens EGW, Reimerink J, Mulder PGH, van Beek J, Meijer A, de Bruin E, Friesema I, de Jong MD, Rimmelzwaan GF, Peeters MF, Rossen JWA, Koopmans M. Profiling of humoral response to influenza A(H1N1)pdm09 infection and vaccination measured by a protein microarray in persons with and without history of seasonal vaccination. PLoS One 2013; 8:e54890. [PMID: 23365683 PMCID: PMC3554683 DOI: 10.1371/journal.pone.0054890] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 12/18/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The influence of prior seasonal influenza vaccination on the antibody response produced by natural infection or vaccination is not well understood. METHODS We compared the profiles of antibody responses of 32 naturally infected subjects and 98 subjects vaccinated with a 2009 influenza A(H1N1) monovalent MF59-adjuvanted vaccine (Focetria, Novartis), with and without a history of seasonal influenza vaccination. Antibodies were measured by hemagglutination inhibition (HI) assay for influenza A(H1N1)pdm09 and by protein microarray (PA) using the HA1 subunit for seven recent and historic H1, H2 and H3 influenza viruses, and three avian influenza viruses. Serum samples for the infection group were taken at the moment of collection of the diagnostic sample, 10 days and 30 days after onset of influenza symptoms. For the vaccination group, samples were drawn at baseline, 3 weeks after the first vaccination and 5 weeks after the second vaccination. RESULTS We showed that subjects with a history of seasonal vaccination generally exhibited higher baseline titers for the various HA1 antigens than subjects without a seasonal vaccination history. Infection and pandemic influenza vaccination responses in persons with a history of seasonal vaccination were skewed towards historic antigens. CONCLUSIONS Seasonal vaccination is of significant influence on the antibody response to subsequent infection and vaccination, and further research is needed to understand the effect of annual vaccination on protective immunity.
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MESH Headings
- Adolescent
- Adult
- Aged
- Animals
- Antibodies, Viral/biosynthesis
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Birds
- Female
- Hemagglutination Inhibition Tests
- Hemagglutinin Glycoproteins, Influenza Virus/blood
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Humans
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza in Birds/immunology
- Influenza in Birds/virology
- Influenza, Human/blood
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Middle Aged
- Protein Array Analysis
- Vaccination/methods
- Vaccination/statistics & numerical data
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Affiliation(s)
- Elisabeth G W Huijskens
- Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, The Netherlands.
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Mahmud SM, Van Caeseele P, Hammond G, Kurbis C, Hilderman T, Elliott L. No association between 2008-09 influenza vaccine and influenza A(H1N1)pdm09 virus infection, Manitoba, Canada, 2009. Emerg Infect Dis 2013; 18:801-10. [PMID: 22516189 PMCID: PMC3358049 DOI: 10.3201/eid1805.111596] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Receipt of seasonal inactivated trivalent vaccine neither increased nor decreased the risk for pandemic influenza virus infection. We conducted a population-based study in Manitoba, Canada, to investigate whether use of inactivated trivalent influenza vaccine (TIV) during the 2008–09 influenza season was associated with subsequent infection with influenza A(H1N1)pdm09 virus during the first wave of the 2009 pandemic. Data were obtained from a provincewide population-based immunization registry and laboratory-based influenza surveillance system. The test-negative case–control study included 831 case-patients with confirmed influenza A(H1N1)pdm09 virus infection and 2,479 controls, participants with test results negative for influenza A and B viruses. For the association of TIV receipt with influenza A(H1N1)pdm09 virus infection, the fully adjusted odds ratio was 1.0 (95% CI 0.7–1.4). Among case-patients, receipt of 2008–09 TIV was associated with a statistically nonsignificant 49% reduction in risk for hospitalization. In agreement with study findings outside Canada, our study in Manitoba indicates that the 2008–09 TIV neither increased nor decreased the risk for infection with influenza A(H1N1)pdm09 virus.
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Broor S, Sullender W, Fowler K, Gupta V, Widdowson MA, Krishnan A, Lal RB. Demographic shift of influenza A(H1N1)pdm09 during and after pandemic, rural India. Emerg Infect Dis 2013; 18:1472-5. [PMID: 22932477 PMCID: PMC3437708 DOI: 10.3201/eid1809.111847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Population-based active surveillance in India showed higher incidence rates for influenza A(H1N1)pdm09 among children during pandemic versus postpandemic periods (345 vs. 199/1,000 person-years), whereas adults had higher rates during postpandemic versus pandemic periods (131 vs. 69/1,000 person-years). Demographic shifts as pandemics evolve should be considered in public health response planning.
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Affiliation(s)
- Shobha Broor
- Department of Microbiology, AIIMS, New Delhi-110029, India.
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Occurrence of AH1N1 viral infection and clinical features in symptomatic patients who received medical care during the 2009 influenza pandemic in Central Mexico. BMC Infect Dis 2012; 12:363. [PMID: 23256776 PMCID: PMC3553033 DOI: 10.1186/1471-2334-12-363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 12/18/2012] [Indexed: 01/21/2023] Open
Abstract
Background In 2009 a new influenza serotype (AH1N1) was identified in Mexico that spread rapidly generating worldwide alarm. San Luis Potosi (SLP) was the third state with more cases reported in that year. The clinical identification of this flu posed a challenge to medical staff. This study aimed at estimating the AH1N1 infection, hospitalization and mortality rates, and at identifying related clinical features in persons who received medical care during the influenza pandemic. Methods Retrospective study with persons with flu-like illness who received public or private medical care in SLP from 15.03.09 to 30.10.09. Physicians purposely recorded many clinical variables. Samples from pharyngeal exudate or bronchoalveolar lavage were taken to diagnose AH1N1 using real-time PCR. Clinical predictors were identified using multivariate logistic regression with infection as a dependent variable. Odds ratios (OR) with 95% confidence intervals (CI) were computed. Analyses were stratified by age group based on the distribution of positive cases. Results From the 6922 persons with flu symptoms 6158 had available laboratory results from which 44.9% turned out to be positive for AH1N1. From those, 5.8% were hospitalized and 0.7% died. Most positive cases were aged 5–14 years and, in this subgroup, older age was positively associated with A H1N1 infection (95% CI 1.05-1.1); conversely, in patients aged 15 years or more, older age was negatively associated with the infection (95% CI 0.97-0.98). Fever was related in those aged 15 years or more (95% CI 1.4-3.5), and headache (95% CI 1.2-2.2) only in the 0–14 years group. Clear rhinorrhea and cough were positively related in both groups (p < 0.05). Arthralgia, dyspnea and vaccination history were related to lesser risk in persons aged 15 years or more, just as dyspnea, purulent rhinorrhea and leukocytosis were in the 0–14 years group. Conclusion This study identified various signs and symptoms for the clinical diagnosis of AH1N1 influenza and revealed that some of them can be age-specific.
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Domínguez A, Castilla J, Godoy P, Delgado-Rodríguez M, Martín V, Saez M, Soldevila N, Quintana JM, Mayoral JM, Astray J, González-Candelas F, Cantón R, Tamames S, Castro A, Baricot M, Alonso J, Pumarola T. Effectiveness of pandemic and seasonal influenza vaccines in preventing pandemic influenza-associated hospitalization. Vaccine 2012; 30:5644-50. [DOI: 10.1016/j.vaccine.2012.06.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 06/14/2012] [Accepted: 06/29/2012] [Indexed: 12/27/2022]
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van Riet E, Ainai A, Suzuki T, Hasegawa H. Mucosal IgA responses in influenza virus infections; thoughts for vaccine design. Vaccine 2012; 30:5893-900. [DOI: 10.1016/j.vaccine.2012.04.109] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
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Eick-Cost AA, Tastad KJ, Guerrero AC, Johns MC, Lee SE, MacIntosh VH, Burke RL, Blazes DL, Russell KL, Sanchez JL. Effectiveness of seasonal influenza vaccines against influenza-associated illnesses among US military personnel in 2010-11: a case-control approach. PLoS One 2012; 7:e41435. [PMID: 22859985 PMCID: PMC3409214 DOI: 10.1371/journal.pone.0041435] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 06/22/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Following the 2009 influenza A/H1N1 (pH1N1) pandemic, both seasonal and pH1N1 viruses circulated in the US during the 2010-2011 influenza season; influenza vaccine effectiveness (VE) may vary between live attenuated (LAIV) and trivalent inactivated (TIV) vaccines as well as by virus subtype. MATERIALS AND METHODS Vaccine type and virus subtype-specific VE were determined for US military active component personnel for the period of September 1, 2010 through April 30, 2011. Laboratory-confirmed influenza-related medical encounters were compared to matched individuals with a non-respiratory illness (healthy controls), and unmatched individuals who experienced a non-influenza respiratory illness (test-negative controls). Odds ratios (OR) and VE estimates were calculated overall, by vaccine type and influenza subtype. RESULTS A total of 603 influenza cases were identified. Overall VE was relatively low and similar regardless of whether healthy controls (VE = 26%, 95% CI: -1 to 45) or test-negative controls (VE = 29%, 95% CI: -6 to 53) were used as comparison groups. Using test-negative controls, vaccine type-specific VE was found to be higher for TIV (53%, 95% CI: 25 to 71) than for LAIV (VE = -13%, 95% CI: -77 to 27). Influenza subtype-specific analyses revealed moderate protection against A/H3 (VE = 58%, 95% CI: 21 to 78), but not against A/H1 (VE = -38%, 95% CI: -211 to 39) or B (VE = 34%, 95% CI: -122 to 80). CONCLUSION Overall, a low level of protection against clinically-apparent, laboratory-confirmed, influenza was found for the 2010-11 seasonal influenza vaccines. TIV immunization was associated with higher protection than LAIV, however, no protection against A/H1 was noted, despite inclusion of a pandemic influenza strain as a vaccine component for two consecutive years. Vaccine virus mismatch or lower immunogenicity may have contributed to these findings and deserve further examination in controlled studies. Continued assessment of VE in military personnel is essential in order to better inform vaccination policy decisions.
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Affiliation(s)
- Angelia A. Eick-Cost
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
| | - Katie J. Tastad
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
| | - Alicia C. Guerrero
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
| | - Matthew C. Johns
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Seung-eun Lee
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Victor H. MacIntosh
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
| | - Ronald L. Burke
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - David L. Blazes
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Kevin L. Russell
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
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Schmidt T, Dirks J, Enders M, Gärtner BC, Uhlmann-Schiffler H, Sester U, Sester M. CD4+T-cell immunity after pandemic influenza vaccination cross-reacts with seasonal antigens and functionally differs from active influenza infection. Eur J Immunol 2012; 42:1755-66. [DOI: 10.1002/eji.201242393] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Tina Schmidt
- Department of Transplant and Infection Immunology; Saarland University; Homburg; Germany
| | - Jan Dirks
- Department of Transplant and Infection Immunology; Saarland University; Homburg; Germany
| | - Martin Enders
- Laboratory Prof. G. Enders and Partners & Institute of Virology; Infectious Diseases and Epidemiology e.V.; Stuttgart; Germany
| | - Barbara C. Gärtner
- Institute of Medical Microbiology and Hygiene; Saarland University; Homburg; Germany
| | | | - Urban Sester
- Department of Internal Medicine IV; Saarland University; Homburg; Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology; Saarland University; Homburg; Germany
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HI responses induced by seasonal influenza vaccination are associated with clinical protection and with seroprotection against non-homologous strains. Vaccine 2012; 30:5262-9. [PMID: 22691431 DOI: 10.1016/j.vaccine.2012.05.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 05/07/2012] [Accepted: 05/25/2012] [Indexed: 01/16/2023]
Abstract
Vaccination against influenza induces homologous as well as cross-specific hemagglutination inhibiting (HI) responses. Induction of cross-specific HI responses may be essential when the influenza strain does not match the vaccine strain, or even to confer a basic immune response against a pandemic influenza virus. We carried out a clinical study to evaluate the immunological responses after seasonal vaccination in healthy adults 18-60 years of age, receiving the yearly voluntary vaccination during the influenza season 2006/2007. Vaccinees of different age groups were followed for laboratory confirmed influenza (LCI) and homologous HI responses as well as cross-specific HI responses against the seasonal H1N1 strain of 2008 and pandemic H1N1 virus of 2009 (H1N1pdm09) were determined. Homologous HI titers that are generally associated with protection (i.e. seroprotective HI titers ≥40) were found in more than 70% of vaccinees. In contrast, low HI titers before and after vaccination were significantly associated with seasonal LCI. Cross-specific HI titers ≥40 against drifted seasonal H1N1 were found in 69% of vaccinees. Cross-specific HI titers ≥40 against H1N1pdm09 were also significantly induced, especially in the youngest age group. More specifically, cross-specific HI titers ≥40 against H1N1pdm09 were inversely correlated with age. We did not find a correlation between the subtype of influenza which was circulating at the age of birth of the vaccinees and cross-specific HI response against H1N1pdm09. These data indicate that the HI titers before and after vaccination determine the vaccination efficacy. In addition, in healthy adults between 18 and 60 years of age, young adults appear to be best able to mount a cross-protective HI response against H1N1pdm09 or drifted seasonal influenza after seasonal vaccination.
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Cheng VCC, To KKW, Tse H, Hung IFN, Yuen KY. Two years after pandemic influenza A/2009/H1N1: what have we learned? Clin Microbiol Rev 2012; 25:223-63. [PMID: 22491771 PMCID: PMC3346300 DOI: 10.1128/cmr.05012-11] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The world had been anticipating another influenza pandemic since the last one in 1968. The pandemic influenza A H1N1 2009 virus (A/2009/H1N1) finally arrived, causing the first pandemic influenza of the new millennium, which has affected over 214 countries and caused over 18,449 deaths. Because of the persistent threat from the A/H5N1 virus since 1997 and the outbreak of the severe acute respiratory syndrome (SARS) coronavirus in 2003, medical and scientific communities have been more prepared in mindset and infrastructure. This preparedness has allowed for rapid and effective research on the epidemiological, clinical, pathological, immunological, virological, and other basic scientific aspects of the disease, with impacts on its control. A PubMed search using the keywords "pandemic influenza virus H1N1 2009" yielded over 2,500 publications, which markedly exceeded the number published on previous pandemics. Only representative works with relevance to clinical microbiology and infectious diseases are reviewed in this article. A significant increase in the understanding of this virus and the disease within such a short amount of time has allowed for the timely development of diagnostic tests, treatments, and preventive measures. These findings could prove useful for future randomized controlled clinical trials and the epidemiological control of future pandemics.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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Impacts on influenza A(H1N1)pdm09 infection from cross-protection of seasonal trivalent influenza vaccines and A(H1N1)pdm09 vaccines: systematic review and meta-analyses. Vaccine 2012; 30:3209-22. [PMID: 22387221 DOI: 10.1016/j.vaccine.2012.02.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 02/04/2012] [Accepted: 02/20/2012] [Indexed: 01/07/2023]
Abstract
Cross-protection by seasonal trivalent influenza vaccines (TIVs) against pandemic influenza A H1N1 2009 (now known as A[H1N1]pdm09) infection is controversial; and the vaccine effectiveness (VE) of A(H1N1)pdm09 vaccines has important health-policy implications. Systematic reviews and meta-analyses are needed to assess the impacts of both seasonal TIVs and A(H1N1)pdm09 vaccines against A(H1N1)pdm09.We did a systematic literature search to identify observational and/or interventional studies reporting cross-protection of TIV and A(H1N1)pdm09 VE from when the pandemic started (2009) until July 2011. The studies fulfilling inclusion criteria were meta-analysed. For cross-protection and VE, respectively, we stratified by vaccine type, study design and endpoint. Seventeen studies (104,781 subjects) and 10 studies (2,906,860 subjects), respectively, reported cross-protection of seasonal TIV and VE of A(H1N1)pdm09 vaccines; six studies (17,229 subjects) reported on both. Thirteen studies (95,903 subjects) of cross-protection, eight studies (859,461 subjects) of VE, and five studies (9,643 subjects) of both were meta-analysed and revealed: (1) cross-protection for confirmed illness was 19% (95% confident interval=13-42%) based on 13 case-control studies with notable heterogeneity. A higher cross-protection of 34% (9-52%) was found in sensitivity analysis (excluding five studies with moderate/high risk of bias). Further exclusion of studies that recruited early in the pandemic (when non-recipients of TIV were more likely to have had non-pandemic influenza infection that may have been cross-protective) dramatically reduced heterogeneity. One RCT reported cross-protection of 38% (19-53%) for confirmed illness. One case-control study reported cross-protection of 50% (40-59%) against hospitalisation. (2) VE of A(H1N1)pdm09 for confirmed illness was 86% (73-93%) based on 11 case-control studies and 79% (22-94%) based on two cohort studies; VE against medically-attended ILI was 32% (8-50%) in one cohort study. TIVs provided moderate cross-protection against both laboratory-confirmed A(H1N1)pdm09 illness (based on eight case-control studies with low risk of bias and one RCT) and also hospitalisation. A finding of increased risk from seasonal vaccine was limited to cases recruited early in the pandemic. A(H1N1)pdm09 vaccines were highly effective against confirmed A(H1N1)pdm09 illness. Although cross-protection was less than the direct effect of strain-specific vaccination against A(H1N1)pdm09, TIV was generally beneficial before A(H1N1)pdm09 vaccine was available.
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Abstract
A clear understanding of immunity in individuals infected with influenza virus is critical for the design of effective vaccination and treatment strategies. Whereas myriad studies have teased apart innate and adaptive immune responses to influenza infection in murine models, much less is known about human immunity as a result of the ethical and technical constraints of human research. Still, these murine studies have provided important insights into the critical correlates of protection and pathogenicity in human infection and helped direct the human studies that have been conducted. Here, we examine and review the current literature on immunity in humans infected with influenza virus, noting evidence offered by select murine studies and suggesting directions in which future research is most warranted.
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Affiliation(s)
- Christine M Oshansky
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Iorio AM, Bistoni O, Galdiero M, Lepri E, Camilloni B, Russano AM, Neri M, Basileo M, Spinozzi F. Influenza viruses and cross-reactivity in healthy adults: humoral and cellular immunity induced by seasonal 2007/2008 influenza vaccination against vaccine antigens and 2009 A(H1N1) pandemic influenza virus. Vaccine 2012; 30:1617-23. [PMID: 22245606 DOI: 10.1016/j.vaccine.2011.12.107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/16/2011] [Accepted: 12/22/2011] [Indexed: 01/10/2023]
Abstract
We analyzed humoral and cellular immune responses against vaccine antigens and the new A(H1N1) virus in healthy adults before and after immunization with the 2007/2008 commercially available trivalent subunit MF59-adjuvanted influenza vaccine during the Fall 2007, prior to the emergence of the new virus. Antibody titers were significantly boosted only against the three vaccine antigens. Seasonal vaccination boosted pre-existing cellular responses upon stimulation of peripheral blood mononuclear cells not only with the homologous three vaccine antigens, but also with the heterologous new 2009 A(H1N1) and with a highly conserved peptide present in the stalk region of hemagglutinin (HA). These results show that cross-reactive cell responses against the new virus were present before the circulation of the virus and were boosted by seasonal vaccination. The cross-reactivity of cellular responses might, at least in part, explain the low pathogenicity of the new pandemic virus. The finding of cellular immunity, that can be increased by seasonal vaccination, against the conserved HA peptide, underline the potential use, in human vaccines, of conserved peptides of the stalk region of HA characterized by broad immunogenicity in experimental systems.
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Affiliation(s)
- Anna M Iorio
- Department of Medical and Surgical Specialties and Public Health, University of Perugia, Via del Giochetto, 06123 Perugia, Italy.
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Dellagi K, Rollot O, Temmam S, Salez N, Guernier V, Pascalis H, Gérardin P, Fianu A, Lapidus N, Naty N, Tortosa P, Boussaïd K, Jaffar-Banjee MC, Filleul L, Flahault A, Carrat F, Favier F, de Lamballerie X. Pandemic influenza due to pH1N1/2009 virus: estimation of infection burden in Reunion Island through a prospective serosurvey, austral winter 2009. PLoS One 2011; 6:e25738. [PMID: 21980532 PMCID: PMC3183080 DOI: 10.1371/journal.pone.0025738] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 09/11/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, there is little information that reflects the true extent of spread of the pH1N1/2009v influenza pandemic at the community level as infection often results in mild or no clinical symptoms. This study aimed at assessing through a prospective study, the attack rate of pH1N1/2009 virus in Reunion Island and risk factors of infection, during the 2009 season. METHODOLOGY/PRINCIPAL FINDINGS A serosurvey was conducted during the 2009 austral winter, in the frame of a prospective population study. Pairs of sera were collected from 1687 individuals belonging to 772 households, during and after passage of the pandemic wave. Antibodies to pH1N1/2009v were titered using the hemagglutination inhibition assay (HIA) with titers ≥ 1/40 being considered positive. Seroprevalence during the first two weeks of detection of pH1N1/2009v in Reunion Island was 29.8% in people under 20 years of age, 35.6% in adults (20-59 years) and 73.3% in the elderly (≥ 60 years) (P<0.0001). Baseline corrected cumulative incidence rates, were 42.9%, 13.9% and 0% in these age groups respectively (P<0.0001). A significant decline in antibody titers occurred soon after the passage of the epidemic wave. Seroconversion rates to pH1N1/2009 correlated negatively with age: 63.2%, 39.4% and 16.7%, in each age group respectively (P<0.0001). Seroconversion occurred in 65.2% of individuals who were seronegative at inclusion compared to 6.8% in those who were initially seropositive. CONCLUSIONS Seroincidence of pH1N1/2009v infection was three times that estimated from clinical surveillance, indicating that almost two thirds of infections occurring at the community level have escaped medical detection. People under 20 years of age were the most affected group. Pre-epidemic titers ≥ 1/40 prevented seroconversion and are likely protective against infection. A concern was raised about the long term stability of the antibody responses.
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Affiliation(s)
- Koussay Dellagi
- GIS CRVOI, Centre de Recherche et de Veille sur les Maladies Emergentes dans l'Océan Indien, Saint-Denis, La Réunion.
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Chen CJ, Lee PI, Chang SC, Huang YC, Chiu CH, Hsieh YC, Chang SC, Chang FY, Lee JJ, Su SC, Shen GH, Chuang YC, Chen YS, Liu JW, Lin TY. Seroprevalence and severity of 2009 pandemic influenza A H1N1 in Taiwan. PLoS One 2011; 6:e24440. [PMID: 21909433 PMCID: PMC3164718 DOI: 10.1371/journal.pone.0024440] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 08/10/2011] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study is to determine the seroprevalence of the pandemic influenza A H1N1 virus (pH1N1) in Taiwan before and after the 2009 pandemic, and to estimate the relative severity of pH1N1 infections among different age groups. METHODOLOGY/PRINCIPAL FINDINGS A total of 1544 and 1558 random serum samples were collected from the general population in Taiwan in 2007 and 2010, respectively. Seropositivity was defined by a hemagglutination inhibition titer to pH1N1 (A/Taiwan/126/09) ≥1:40. The seropositivity rate of pH1N1 among the unvaccinated subjects and national surveillance data were used to compare the proportion of infections that led to severe diseases and fatalities among different age groups. The overall seroprevalence of pH1N1 was 0.91% (95% confidence interval [CI] 0.43-1.38) in 2007 and significantly increased to 29.9% (95% CI 27.6-32.2) in 2010 (p<0.0001), with the peak attack rate (55.4%) in 10-17 year-old adolescents, the lowest in elderly ≥65 years (14.1%). The overall attack rates were 20.6% (188/912) in unvaccinated subjects. Among the unvaccinated but infected populations, the estimated attack rates of severe cases per 100,000 infections were significantly higher in children aged 0-5 years (54.9 cases, odds ratio [OR] 4.23, 95% CI 3.04-5.90) and elderly ≥ 65 years (22.4 cases, OR 2.76, 95% CI 1.99-3.83) compared to adolescents aged 10-17 years (13.0 cases). The overall case-fatality rate was 0.98 per 100,000 infections without a significant difference in different age groups. CONCLUSIONS/SIGNIFICANCE Pre-existing immunity against pH1N1 was rarely identified in Taiwanese at any age in 2007. Young children and elderly--the two most lower seroprotection groups showed the greatest vulnerability to clinical severity after the pH1N1 infections. These results imply that both age groups should have higher priority for immunization in the coming flu season.
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Affiliation(s)
- Chih-Jung Chen
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Cheng Chang
- Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chia Hsieh
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Jen-Jyh Lee
- Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien and Tzu Chi University, Hualien, Taiwan
| | - Shey-Chiang Su
- Division of Infectious Disease, Department of Internal Medicine, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Gwan-Han Shen
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yin-Ching Chuang
- Division of Infectious Diseases, Department of Internal Medicine, Chi-Mei Medical Center, Tainan and Liouying, Taiwan
| | - Yao-Shen Chen
- Division of Infectious Diseases and Clinical Microbiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jien-Wei Liu
- Division of Infectious Disease, Department of Internal Medicine, Chang Gung University-Kaohsiung, Chang Gung University Medical College, Kaohsiung, Taiwan
| | - Tzou-Yien Lin
- Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Kelly HA, Grant KA, Fielding JE, Carville KS, Looker CO, Tran T, Jacoby P. Pandemic influenza H1N1 2009 infection in Victoria, Australia: No evidence for harm or benefit following receipt of seasonal influenza vaccine in 2009. Vaccine 2011; 29:6419-26. [DOI: 10.1016/j.vaccine.2011.03.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 03/07/2011] [Accepted: 03/17/2011] [Indexed: 11/27/2022]
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Seasonal influenza vaccination status among children with laboratory evidence of pandemic H1N1 infection. Pediatr Infect Dis J 2011; 30:562-5. [PMID: 21248657 DOI: 10.1097/inf.0b013e31820bb482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The 2009 pandemic H1N1 influenza virus emerged in March 2009 and spread rapidly, causing many thousands of deaths worldwide. A case-control study of 60 Mexican adults with H1N1 suggested that the seasonal influenza vaccine protected against H1N1 infection (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.11-0.66), but subsequent studies have had varied results and few have addressed this question in children. The objective of this study was to evaluate the effect of 2008-2009 seasonal influenza vaccination on pandemic H1N1 infection in children. METHODS Cases (n = 165) were Kaiser Permanente Colorado inpatients and outpatients aged between 18 months and 18 years, with laboratory-confirmed pandemic H1N1 infection from May to November 2009. Controls (n = 660) were pediatric Kaiser Permanente members without documented H1N1 infection who were matched by age and gender. Seasonal influenza vaccination status was recorded for all cases and controls; conditional logistic regression analyses were used to calculate matched odds ratios. RESULTS Cases were more likely than controls to have underlying chronic health conditions (45% vs. 21%, P < 0.0001). Pandemic H1N1 cases were neither more nor less likely to have received the 2008-2009 seasonal influenza vaccine (OR, 1.31; 95% CI, 0.92-1.88). After adjustment for chronic medical conditions and health-seeking behavior, H1N1 cases were as likely as controls to have received the 2008-2009 seasonal influenza vaccine (OR, 1.08; 95% CI, 0.75-1.57). CONCLUSIONS There was no overall association--either protection or risk--between seasonal influenza vaccination and medically attended pandemic H1N1 infection in children. These results have important implications for understanding influenza immunity and future public health efforts to prevent pandemic influenza.
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Wang W, Anderson CM, De Feo CJ, Zhuang M, Yang H, Vassell R, Xie H, Ye Z, Scott D, Weiss CD. Cross-neutralizing antibodies to pandemic 2009 H1N1 and recent seasonal H1N1 influenza A strains influenced by a mutation in hemagglutinin subunit 2. PLoS Pathog 2011; 7:e1002081. [PMID: 21695241 PMCID: PMC3111540 DOI: 10.1371/journal.ppat.1002081] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 04/08/2011] [Indexed: 11/25/2022] Open
Abstract
Pandemic 2009 H1N1 influenza A virus (2009 H1N1) differs from H1N1 strains that circulated in the past 50 years, but resembles the A/New Jersey/1976 H1N1 strain used in the 1976 swine influenza vaccine. We investigated whether sera from persons immunized with the 1976 swine influenza or recent seasonal influenza vaccines, or both, neutralize 2009 H1N1. Using retroviral pseudovirions bearing hemagglutinins on their surface (HA-pseudotypes), we found that 77% of the sera collected in 1976 after immunization with the A/New Jersey/1976 H1N1 swine influenza vaccine neutralized 2009 H1N1. Forty five percent also neutralized A/New Caledonia/20/1999 H1N1, a strain used in seasonal influenza vaccines during the 2000/01–2006/07 seasons. Among adults aged 48–64 who received the swine influenza vaccine in 1976 and recent seasonal influenza vaccines during the 2004/05–2008/09 seasons, 83% had sera that neutralized 2009 H1N1. However, 68% of age-matched subjects who received the same seasonal influenza vaccines, but did not receive the 1976 swine influenza vaccine, also had sera that neutralized 2009 H1N1. Sera from both 1976 and contemporary cohorts frequently had cross-neutralizing antibodies to 2009 H1N1 and A/New Caledonia/20/1999 that mapped to hemagglutinin subunit 2 (HA2). A conservative mutation in HA2 corresponding to a residue in the A/Solomon Islands/3/2006 and A/Brisbane/59/2007 H1N1 strains that circulated in the 2006/07 and 2007/08 influenza seasons, respectively, abrogated this neutralization. These findings highlight a cross-neutralization determinant influenced by a point mutation in HA2 and suggest that HA2 may be evolving under direct or indirect immune pressure. Influenza A viruses mutate to escape neutralization by antibodies. These mutations predominantly occur in the globular head of the hemagglutinin protein, while the stalk is more conserved. Pandemic 2009 H1N1 influenza virus differs from seasonal H1N1 strains that circulated in the past 50 years and resembles a strain that did not circulate but was used in the 1976 swine influenza vaccine. We investigated whether persons immunized with either the 1976 swine influenza or recent seasonal influenza vaccines, or both, have antibodies that cross-neutralize pandemic 2009 H1N1. Sera from 1976 swine influenza vaccine trials cross-neutralized pandemic 2009 H1N1 and to a lesser extent the A/New Caledonia/20/1999 H1N1 strain that was used in vaccines during the 2000/01–2006/07 influenza seasons. Sera from persons who received several seasonal influenza vaccines containing A/New Caledonia/20/1999 H1N1 cross-neutralized pandemic 2009 H1N1, regardless of whether they received the 1976 swine influenza vaccine. We found that cross-neutralization between 2009 H1N1 and A/New Caledonia/20/1999 frequently mapped to the hemagglutinin stalk. A mutation in the stalk of strains circulating during the 2007/08–2008/09 seasons abrogates this neutralization. These findings highlight a cross-neutralization determinant influenced by a point mutation in the hemagglutinin stalk and suggest that the stalk may be evolving under direct or indirect immune pressure.
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Affiliation(s)
- Wei Wang
- Laboratory of Immunoregulation, Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Christine M. Anderson
- Division of Hematology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Christopher J. De Feo
- Laboratory of Immunoregulation, Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Min Zhuang
- Laboratory of Immunoregulation, Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Hong Yang
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Russell Vassell
- Laboratory of Immunoregulation, Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Hang Xie
- Laboratory of Pediatric and Respiratory Diseases, Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Zhiping Ye
- Laboratory of Pediatric and Respiratory Diseases, Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Dorothy Scott
- Division of Hematology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
| | - Carol D. Weiss
- Laboratory of Immunoregulation, Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Bethesda, Maryland, United States of America
- * E-mail:
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Myers ER, Misurski DA, Swamy GK. Influence of timing of seasonal influenza vaccination on effectiveness and cost-effectiveness in pregnancy. Am J Obstet Gynecol 2011; 204:S128-40. [PMID: 21640230 DOI: 10.1016/j.ajog.2011.04.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 03/14/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
Abstract
The purpose of this review was to estimate the impact of timing of seasonal influenza vaccination during pregnancy on health and economic outcomes. Cost-effectiveness analysis with a dynamic model of the US population of pregnant women and infants who were <6 months incorporated seasonal variation in influenza incidence. Compared with no vaccination, seasonal influenza vaccination in pregnancy costs $70,089 per quality-adjusted life year. Most of the benefit for infants was limited to those whose mothers were vaccinated within the first 4 weeks of vaccine availability. Once all women who were pregnant at the time of vaccine availability were vaccinated, vaccination of newly pregnant women had benefits for mothers but not infants. Delay of vaccination beyond November reduced both effectiveness and cost-effectiveness. The greatest population benefit from seasonal influenza vaccination in pregnancy was realized if pregnant women were vaccinated as soon as possible after trivalent inactivated influenza vaccine became available. Efforts to increase vaccine rates should be concentrated early in the influenza season.
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Pelat C, Falchi A, Carrat F, Mosnier A, Bonmarin I, Turbelin C, Vaux S, van der Werf S, Cohen JM, Lina B, Blanchon T, Hanslik T. Field effectiveness of pandemic and 2009-2010 seasonal vaccines against 2009-2010 A(H1N1) influenza: estimations from surveillance data in France. PLoS One 2011; 6:e19621. [PMID: 21573005 PMCID: PMC3091864 DOI: 10.1371/journal.pone.0019621] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 04/08/2011] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In this study, we assess how effective pandemic and trivalent 2009-2010 seasonal vaccines were in preventing influenza-like illness (ILI) during the 2009 A(H1N1) pandemic in France. We also compare vaccine effectiveness against ILI versus laboratory-confirmed pandemic A(H1N1) influenza, and assess the possible bias caused by using non-specific endpoints and observational data. METHODOLOGY AND PRINCIPAL FINDINGS We estimated vaccine effectiveness by using the following formula: VE = (PPV-PCV)/(PPV(1-PCV)) × 100%, where PPV is the proportion vaccinated in the population and PCV the proportion of vaccinated influenza cases. People were considered vaccinated three weeks after receiving a dose of vaccine. ILI and pandemic A(H1N1) laboratory-confirmed cases were obtained from two surveillance networks of general practitioners. During the epidemic, 99.7% of influenza isolates were pandemic A(H1N1). Pandemic and seasonal vaccine uptakes in the population were obtained from the National Health Insurance database and by telephonic surveys, respectively. Effectiveness estimates were adjusted by age and week. The presence of residual biases was explored by calculating vaccine effectiveness after the influenza period. The effectiveness of pandemic vaccines in preventing ILI was 52% (95% confidence interval: 30-69) during the pandemic and 33% (4-55) after. It was 86% (56-98) against confirmed influenza. The effectiveness of seasonal vaccines against ILI was 61% (56-66) during the pandemic and 19% (-10-41) after. It was 60% (41-74) against confirmed influenza. CONCLUSIONS The effectiveness of pandemic vaccines in preventing confirmed pandemic A(H1N1) influenza on the field was high, consistently with published findings. It was significantly lower against ILI. This is unsurprising since not all ILI cases are caused by influenza. Trivalent 2009-2010 seasonal vaccines had a statistically significant effectiveness in preventing ILI and confirmed pandemic influenza, but were not better in preventing confirmed pandemic influenza than in preventing ILI. This lack of difference might be indicative of selection bias.
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49
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Abstract
The mechanisms responsible for heterosubtypic immunity to influenza virus are not well understood but might hold the key for new vaccine strategies capable of providing lasting protection against both seasonal and pandemic strains. Memory CD4 T cells are capable of providing substantial protection against influenza both through direct effector mechanisms and indirectly through regulatory and helper functions. Here, we discuss the broad impact of memory CD4 T cells on heterosubtypic immunity against influenza and the prospects of translating findings from animal models into improved human influenza vaccines.
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Affiliation(s)
- K K McKinstry
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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50
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Burke RL, Vest KG, Eick AA, Sanchez JL, Johns MC, Pavlin JA, Jarman RG, Mothershead JL, Quintana M, Palys T, Cooper MJ, Guan J, Schnabel D, Waitumbi J, Wilma A, Daniels C, Brown ML, Tobias S, Kasper MR, Williams M, Tjaden JA, Oyofo B, Styles T, Blair PJ, Hawksworth A, Montgomery JM, Razuri H, Laguna-Torres A, Schoepp RJ, Norwood DA, MacIntosh VH, Gibbons T, Gray GC, Blazes DL, Russell KL. Department of Defense influenza and other respiratory disease surveillance during the 2009 pandemic. BMC Public Health 2011; 11 Suppl 2:S6. [PMID: 21388566 PMCID: PMC3092416 DOI: 10.1186/1471-2458-11-s2-s6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Armed Forces Health Surveillance Center's Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supports and oversees surveillance for emerging infectious diseases, including respiratory diseases, of importance to the U.S. Department of Defense (DoD). AFHSC-GEIS accomplishes this mission by providing funding and oversight to a global network of partners for respiratory disease surveillance. This report details the system's surveillance activities during 2009, with a focus on efforts in responding to the novel H1N1 Influenza A (A/H1N1) pandemic and contributions to global public health. Active surveillance networks established by AFHSC-GEIS partners resulted in the initial detection of novel A/H1N1 influenza in the U.S. and several other countries, and viruses isolated from these activities were used as seed strains for the 2009 pandemic influenza vaccine. Partners also provided diagnostic laboratory training and capacity building to host nations to assist with the novel A/H1N1 pandemic global response, adapted a Food and Drug Administration-approved assay for use on a ruggedized polymerase chain reaction platform for diagnosing novel A/H1N1 in remote settings, and provided estimates of seasonal vaccine effectiveness against novel A/H1N1 illness. Regular reporting of the system's worldwide surveillance findings to the global public health community enabled leaders to make informed decisions on disease mitigation measures and controls for the 2009 A/H1N1 influenza pandemic. AFHSC-GEIS's support of a global network contributes to DoD's force health protection, while supporting global public health.
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Affiliation(s)
- Ronald L Burke
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Angelia A Eick
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Jose L Sanchez
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Matthew C Johns
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Julie A Pavlin
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Richard G Jarman
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Jerry L Mothershead
- Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Miguel Quintana
- Public Health Region-South, Building 2472, Schofield Road, Fort Sam Houston, TX 78234, USA
| | - Thomas Palys
- Landstuhl Regional Medical Center, Department of Pathology and Area Laboratory Services, CMR 402, APO AE 09180, USA
| | | | - Jian Guan
- Public Health Region-Pacific, Unit 45006, APO AE 96343, USA
| | - David Schnabel
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
| | - John Waitumbi
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
| | - Alisa Wilma
- Department of Defense Veterinary Food Analysis & Diagnostic Laboratory, 2472 Schofield Road, Suite 2630, Fort Sam Houston, TX 78234, USA
| | - Candelaria Daniels
- Department of Defense Veterinary Food Analysis & Diagnostic Laboratory, 2472 Schofield Road, Suite 2630, Fort Sam Houston, TX 78234, USA
| | - Matthew L Brown
- USAMEDDAC-Korea, Microbiology Section, Unit 15244, Box 459, APO AP 96205, USA
| | - Steven Tobias
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Matthew R Kasper
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Maya Williams
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Jeffrey A Tjaden
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Buhari Oyofo
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Timothy Styles
- U.S. Navy Environmental Preventive Medicine Unit No. 2, 1887 Powhatan Street, Norfolk, VA 23511, USA
| | - Patrick J Blair
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Anthony Hawksworth
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Joel M Montgomery
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Hugo Razuri
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Alberto Laguna-Torres
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Randal J Schoepp
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - David A Norwood
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Victor H MacIntosh
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
| | - Thomas Gibbons
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
| | - Gregory C Gray
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Post Office Box 100188, Gainesville, FL 32610, USA
| | - David L Blazes
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - AFHSC-GEIS Influenza Surveillance Writing Group
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
- Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Landstuhl Regional Medical Center, Department of Pathology and Area Laboratory Services, CMR 402, APO AE 09180, USA
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
- U.S. Navy Environmental Preventive Medicine Unit No. 2, 1887 Powhatan Street, Norfolk, VA 23511, USA
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
- Walter Reed Army Institute of Research, Emerging Infectious Diseases Research Unit, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Australian Army Malaria Institute, Gallipoli Barracks, Enoggera, QLD 4051, Australia
- Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD 20723, USA
- U.S. Navy and Marine Corps Public Health Center, 620 John Paul Jones Circle, Suite 1100, Portsmouth, VA 23708, USA
- Laboratory for Emerging Infectious Diseases, University of Buea, Post Office Box 63, Buea, Cameroon
- Global Viral Forecasting Initiative, 1 Sutter, Suite 600, San Francisco, CA 94104, USA
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