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Padykula I, Damodaran L, Young KT, Krunkosky M, Griffin EF, North JF, Neasham PJ, Pliasas VC, Siepker CL, Stanton JB, Howerth EW, Bahl J, Kyriakis CS, Tompkins SM. Pandemic Risk Assessment for Swine Influenza A Virus in Comparative In Vitro and In Vivo Models. Viruses 2024; 16:548. [PMID: 38675891 PMCID: PMC11053818 DOI: 10.3390/v16040548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
Swine influenza A viruses pose a public health concern as novel and circulating strains occasionally spill over into human hosts, with the potential to cause disease. Crucial to preempting these events is the use of a threat assessment framework for human populations. However, established guidelines do not specify which animal models or in vitro substrates should be used. We completed an assessment of a contemporary swine influenza isolate, A/swine/GA/A27480/2019 (H1N2), using animal models and human cell substrates. Infection studies in vivo revealed high replicative ability and a pathogenic phenotype in the swine host, with replication corresponding to a complementary study performed in swine primary respiratory epithelial cells. However, replication was limited in human primary cell substrates. This contrasted with our findings in the Calu-3 cell line, which demonstrated a replication profile on par with the 2009 pandemic H1N1 virus. These data suggest that the selection of models is important for meaningful risk assessment.
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Affiliation(s)
- Ian Padykula
- Center for Vaccines and Immunology, University of Georgia, Athens, GA 30602, USA
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
| | - Lambodhar Damodaran
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
| | - Kelsey T. Young
- Department of Pathology, University of Georgia, Athens, GA 30602, USA
| | - Madelyn Krunkosky
- Center for Vaccines and Immunology, University of Georgia, Athens, GA 30602, USA
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
| | - Emily F. Griffin
- Center for Vaccines and Immunology, University of Georgia, Athens, GA 30602, USA
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
| | - James F. North
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
- Department of Pathobiology, Auburn University, Auburn, AL 36849, USA
| | - Peter J. Neasham
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
- Department of Pathobiology, Auburn University, Auburn, AL 36849, USA
| | - Vasilis C. Pliasas
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
- Department of Pathobiology, Auburn University, Auburn, AL 36849, USA
| | - Chris L. Siepker
- Department of Pathology, University of Georgia, Athens, GA 30602, USA
| | - James B. Stanton
- Department of Pathology, University of Georgia, Athens, GA 30602, USA
| | | | - Justin Bahl
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
| | - Constantinos S. Kyriakis
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
- Department of Pathobiology, Auburn University, Auburn, AL 36849, USA
| | - Stephen Mark Tompkins
- Center for Vaccines and Immunology, University of Georgia, Athens, GA 30602, USA
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
- Emory-UGA Centers of Excellence for Influenza Research and Surveillance (CEIRS), Athens, GA 30602, USA
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Phase 3 Randomized, Multicenter, Placebo-Controlled Study to Evaluate Safety, Immunogenicity, and Lot-to-Lot Consistency of an Adjuvanted Cell Culture-Derived, H5N1 Subunit Influenza Virus Vaccine in Healthy Adult Subjects. Vaccines (Basel) 2022; 10:vaccines10040497. [PMID: 35455245 PMCID: PMC9027673 DOI: 10.3390/vaccines10040497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023] Open
Abstract
A cell-based process may be better suited for vaccine production during a highly pathogenic avian influenza (HPAI) pandemic. This was a phase 3, randomized, controlled, observer-blind, multicenter study evaluated safety, immunogenicity, and lot-to-lot consistency of two doses of a MF59-adjuvanted, H5N1 influenza pandemic vaccine manufactured on a cell culture platform (aH5N1c) in 3196 healthy adult subjects, stratified into two age groups: 18 to <65 and ≥65 years. Immunogenicity was measured using hemagglutination inhibition (HI) titers. HI antibody responses increased after the first aH5N1c vaccine dose, and 3 weeks after the second vaccination (Day 43), age-appropriate US Center for Biologics Evaluation and Research (CBER) and former European Medicines Authority Committee for Medicinal Products for Human Use (EMA CHMP) immunogenicity criteria were met. Six months after the first vaccination, HI titers were above baseline but no longer met CBER and CHMP criteria. No relevant changes over time were seen in placebo subjects. Solicited AEs were more frequent in the active treatment than the placebo group, primarily due to injection site pain. No serious adverse events (SAEs) related to aH5N1c- were reported. aH5N1c influenza vaccine elicited high levels of antibodies following two vaccinations administered 21 days apart and met both CBER and former CHMP immunogenicity criteria at Day 43 among both younger and older adults with a clinically acceptable safety profile. Consistency of the three consecutive aH5N1c vaccine lots was demonstrated (NCT02839330).
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Graf EH. Finding the Middle Ground with the Clinical Laboratory's Role in SARS-CoV-2 Genomic Surveillance. J Clin Microbiol 2021; 59:e0181621. [PMID: 34550811 PMCID: PMC8601223 DOI: 10.1128/jcm.01816-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Continued replacement of the dominant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineages, and associated surges, highlights the importance of genomic surveillance to identify the next possible threats. Despite concerted efforts between clinical laboratories and public health to generate sequence data, the United States has lagged in percentage of SARS-CoV-2 cases sequenced. A more simple and cost-effective option is needed to allow front-line clinical laboratories to perform high-throughput surveillance and refer important samples for slow and expensive next-generation sequencing (NGS). In this issue of the Journal of Clinical Microbiology, A. Babiker, K. Immergluck, S. D. Stampfer, A. Rao, et al. (J Clin Microbiol 59:e01446-21, 2021, https://doi.org/10.1128/JCM.01446-21) describe a rapid and flexible multiplex single-nucleotide polymorphism (SNP) assay targeting mutations associated with Alpha, Beta/Gamma, and, added later, Delta variants. They show 100% accuracy in characterized variant pools and clinical samples confirmed by NGS. Such an approach could be a happy medium in the role of front-line laboratories to assist with critically needed high-throughput genomic surveillance.
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Affiliation(s)
- Erin H. Graf
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Regional differences in vaccine uptake and serological responses to vaccine and circulating strains of H1N1 viruses among patients with confirmed influenza. JOURNAL OF CLINICAL VIROLOGY PLUS 2021. [DOI: 10.1016/j.jcvp.2021.100034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Boikos C, Fischer L, O'Brien D, Vasey J, Sylvester GC, Mansi JA. Relative Effectiveness of the Cell-derived Inactivated Quadrivalent Influenza Vaccine Versus Egg-derived Inactivated Quadrivalent Influenza Vaccines in Preventing Influenza-related Medical Encounters During the 2018-2019 Influenza Season in the United States. Clin Infect Dis 2021; 73:e692-e698. [PMID: 33400775 PMCID: PMC8326580 DOI: 10.1093/cid/ciaa1944] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background The cell-propagated inactivated quadrivalent influenza vaccine (ccIIV4) may offer improved protection in seasons where egg-derived influenza viruses undergo mutations that affect antigenicity. This study estimated the relative vaccine effectiveness (rVE) of ccIIV4 versus egg-derived inactivated quadrivalent influenza vaccine (eIIV4) in preventing influenza-related medical encounters in the 2018–2019 US season. Methods A dataset linking primary care electronic medical records with medical claims data was used to conduct a retrospective cohort study among individuals ≥ 4 years old vaccinated with ccIIV4 or eIIV4 during the 2018–2019 season. Adjusted odds ratios (ORs) were derived from a doubly robust inverse probability of treatment-weighted approach adjusting for age, sex, race, ethnicity, geographic region, vaccination week, and health status. rVE was estimated by (1 – OR) × 100 and presented with 95% confidence intervals (CI). Results Following the application of inclusion/exclusion criteria, the study cohort included 2 125 430 ccIIV4 and 8 000 903 eIIV4 recipients. Adjusted analyses demonstrated a greater reduction in influenza-related medical encounters with ccIIV4 versus eIIV4, with the following rVE: overall, 7.6% (95% CI, 6.5–8.6); age 4–17 years, 3.9% (95% CI, .9–7.0); 18–64 years, 6.5% (95% CI, 5.2–7.9); 18–49 years, 7.5% (95% CI, 5.7–9.3); 50–64 years, 5.6% (95% CI, 3.6–7.6); and ≥65 years, –2.2% (95% CI, –5.4 to .9). Conclusions Adjusted analyses demonstrated statistically significantly greater reduction in influenza-related medical encounters in individuals vaccinated with ccIIV4 versus eIIV4 in the 2018–2019 US influenza season. These results support ccIIV4 as a potentially more effective public health measure against influenza than an egg-based equivalent.
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Affiliation(s)
| | | | | | - Joe Vasey
- Veradigm, San Francisco, California, USA
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Boikos C, Sylvester GC, Sampalis JS, Mansi JA. Relative Effectiveness of the Cell-Cultured Quadrivalent Influenza Vaccine Compared to Standard, Egg-derived Quadrivalent Influenza Vaccines in Preventing Influenza-like Illness in 2017-2018. Clin Infect Dis 2021; 71:e665-e671. [PMID: 32253431 PMCID: PMC7745007 DOI: 10.1093/cid/ciaa371] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 04/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background Influenza antigens may undergo adaptive mutations during egg-based vaccine production. In the 2017–2018 influenza season, quadrivalent, inactivated cell-derived influenza vaccine (ccIIV4) vaccine was produced using A(H3N2) seed virus propagated exclusively in cell culture, thus lacking egg adaptive changes. This United States study estimated relative vaccine effectiveness (rVE) of ccIIV4 vs egg-derived quadrivalent vaccines (egg-derived IIV4) for that season. Methods Vaccination, outcome, and covariate data were ascertained retrospectively from a electronic medical record (EMR) dataset and analyzed. The study cohort included patients ≥ 4 years of age. rVE was estimated against influenza-like illness (ILI) using diagnostic International Classification of Diseases, Ninth or Tenth Revision codes. The adjusted odds ratios used to derive rVE estimates were estimated from multivariable logistic regression models adjusted for age, sex, race/ethnicity, geographic region, and health status. Results Overall, 92 187 individuals had a primary care EMR record of ccIIV4 and 1 261 675 had a record of egg-derived IIV4. In the ccIIV4 group, 1705 narrowly defined ILI events occurred, and 25 645 occurred in the standard egg-derived IIV4 group. Crude rVE was 9.2% (95% confidence interval [CI], 4.6%–13.6%). When adjusted for age, sex, health status, comorbidities, and geographic region, the estimated rVE changed to 36.2% (95% CI, 26.1%–44.9%). Conclusions ccIIV4, derived from A(H3N2) seed virus propagated exclusively in cell culture, was more effective than egg-derived IIV4 in preventing ILI during the 2017–2018 influenza season. This result suggests that cell-derived influenza vaccines may have greater effectiveness than standard egg-derived vaccines.
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Affiliation(s)
| | | | - John S Sampalis
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
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Boikos C, Imran M, Nguyen VH, Ducruet T, Sylvester GC, Mansi JA. Effectiveness of the Cell-Derived Inactivated Quadrivalent Influenza Vaccine in Individuals at High Risk of Influenza Complications in the 2018-2019 United States Influenza Season. Open Forum Infect Dis 2021; 8:ofab167. [PMID: 34327253 PMCID: PMC8314952 DOI: 10.1093/ofid/ofab167] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background Higher rates of influenza-related morbidity and mortality occur in individuals with underlying medical conditions. To improve vaccine effectiveness, cell-based technology for influenza vaccine manufacturing has been developed. Cell-derived inactivated quadrivalent influenza vaccines (cIIV4) may improve protection in seasons in which egg-propagated influenza viruses undergo mutations that affect antigenicity. This study aimed to estimate the relative vaccine effectiveness (rVE) of cIIV4 versus egg-derived inactivated quadrivalent influenza vaccines (eIIV4) in preventing influenza-related medical encounters in individuals with underlying medical conditions putting them at high risk of influenza complications during the 2018-2019 US influenza season. Methods An integrated dataset, linking primary care electronic medical records with claims data, was used to conduct a retrospective cohort study among individuals aged ≥4 years, with ≥1 health condition, vaccinated with cIIV4 or eIIV4 during the 2018-2019 season. Adjusted odds ratios (ORs) were derived using a doubly robust inverse probability of treatment-weighting (IPTW) model, adjusting for age, sex, race, ethnicity, geographic region, vaccination week, and health status. Relative vaccine effectiveness was estimated by (1 - OR) × 100 and presented with 95% confidence intervals (CIs). Results The study cohort included 471 301 cIIV4 and 1 641 915 eIIV4 recipients. Compared with eIIV4, cIIV4 prevented significantly more influenza-related medical encounters among individuals with ≥1 health condition (rVE, 13.4% [95% CI, 11.4%-15.4%]), chronic pulmonary disease (rVE, 18.7% [95% CI, 16.0%-21.3%]), and rheumatic disease (rVE, 11.8% [95% CI, 3.6%-19.3%]). Conclusions Our findings support the use of cIIV4 in individuals ≥4 years of age at high risk of influenza complications and provide further evidence supporting improved effectiveness of cIIV4 compared with eIIV4.
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A Heterogeneous Swine Show Circuit Drives Zoonotic Transmission of Influenza A Viruses in the United States. J Virol 2020; 94:JVI.01453-20. [PMID: 32999022 DOI: 10.1128/jvi.01453-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
Influenza pandemics are associated with severe morbidity, mortality, and social and economic disruption. Every summer in the United States, youths attending agricultural fairs are exposed to genetically diverse influenza A viruses (IAVs) circulating in exhibition swine, resulting in over 450 lab-confirmed zoonotic infections since 2010. Exhibition swine represent a small, defined population (∼1.5% of the U.S. herd), presenting a realistic opportunity to mitigate a pandemic threat by reducing IAV transmission in the animals themselves. Through intensive surveillance and genetic sequencing of IAVs in exhibition swine in six U.S. states in 2018 (n = 212), we characterized how a heterogeneous circuit of swine shows, comprising fairs with different sizes and geographic coverage, facilitates IAV transmission among exhibition swine and into humans. Specifically, we identified the role of an early-season national show in the propagation and spatial dissemination of a specific virus (H1δ-2) that becomes dominant among exhibition swine and is associated with the majority of zoonotic infections in 2018. These findings suggest that a highly targeted mitigation strategy, such as postponing swine shows for 1 to 2 weeks following the early-season national show, could potentially reduce IAV transmission in exhibition swine and spillover into humans, and this merits further study.IMPORTANCE The varying influenza A virus (IAV) exposure and infection status of individual swine facilitates introduction, transmission, and dissemination of diverse IAVs. Since agricultural fairs bring people into intimate contact with swine, they provide a unique interface for zoonotic transmission of IAV. Understanding the dynamics of IAV transmission through exhibition swine is critical to mitigating the high incidence of variant IAV cases reported in association with agricultural fairs. We used genomic sequences from our exhibition swine surveillance to characterize the hemagglutinin and full genotypic diversity of IAV at early-season shows and the subsequent dissemination through later-season agricultural fairs. We were able to identify a critical time point with important implications for downstream IAV and zoonotic transmission. With improved understanding of evolutionary origins of zoonotic IAV, we can inform public health mitigation strategies to ultimately reduce zoonotic IAV transmission and risk of pandemic IAV emergence.
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Ruiz-Aragón J, Gani R, Márquez S, Alvarez P. Estimated cost-effectiveness and burden of disease associated with quadrivalent cell-based and egg-based influenza vaccines in Spain. Hum Vaccin Immunother 2020; 16:2238-2244. [PMID: 32040379 PMCID: PMC7553711 DOI: 10.1080/21645515.2020.1712935] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 01/04/2020] [Indexed: 01/03/2023] Open
Abstract
Influenza is a viral respiratory disease that causes significant clinical and economic burden globally. Quadrivalent influenza vaccine (QIV) is frequently used to protect people who have a high-risk of developing influenza complications due to comorbidities. QIV offers protection against influenza A (A/H1N1 and H3N2) and B (B/Victoria, and B/Yamagata) strains. The European Medicines Agency has recently approved a cell-based QIV (QIVc) in people aged over 9 years old. QIVc has been shown to be more effective at preventing influenza than traditional egg-based QIV (QIVe). In this study, we use a health economic model adapted to Spain to assess the costs and outcomes associated with using QIVc instead of QIVe in people aged 9-64 at high-risk of complications. Observed vaccine coverage of 32% in the 9-17 age group, 17% in those aged 18-59, and 22% for ages 60-64 was used in the analysis. In total, 2.5 million people were vaccinated in the simulations. Using QIVc instead of QIVe was associated with 16,221fewer symptomatic cases, 4,522 fewer primary care visits, 1,015 fewer emergency room visits and 88 fewer hospitalizations. From a societal perspective, QIVc was more effective and less expensive compared to QIVe, leading to a cost-saving of €3.4 million. From a public payer perspective, the incremental cost-effectiveness ratio for QIVc vs QIVe was €12,852 per QALY gained. In conclusion, QIVc offers a cost-effective alternative to QIVe and should be considered as an alternative vaccine to QIVe for people aged 9-64 at high-risk of influenza complications in Spain.
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Affiliation(s)
- Jesús Ruiz-Aragón
- FEA de Microbiología Clínica, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Ray Gani
- Modeling and Simulation, Evidera, London, UK
| | - Sergio Márquez
- Department of Economics, Pablo Olavide University, Sevilla, Spain
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Baseline Levels of Influenza-Specific B Cells and T Cell Responses Modulate Human Immune Responses to Swine Variant Influenza A/H3N2 Vaccine. Vaccines (Basel) 2020; 8:vaccines8010126. [PMID: 32183105 PMCID: PMC7157591 DOI: 10.3390/vaccines8010126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 11/16/2022] Open
Abstract
The cellular immune responses elicited by an investigational vaccine against an emergent variant of influenza (H3N2v) are not fully understood. Twenty-five subjects, enrolled in an investigational influenza A/H3N2v vaccine study, who received two doses of vaccine 21 days apart, were included in a sub-study of cellular immune responses. H3N2v-specific plasmablasts were determined by ELISpot 8 days after each vaccine dose and H3N2v specific CD4+ T cells were quantified by intracellular cytokine and CD154 (CD40 ligand) staining before vaccination, 8 and 21 days after each vaccine dose. Results: 95% (19/20) and 96% (24/25) subjects had pre-existing H3N2v specific memory B, and T cell responses, respectively. Plasmablast responses at Day 8 after the first vaccine administration were detected against contemporary H3N2 strains and correlated with hemagglutination inhibition HAI (IgG: p = 0.018; IgA: p < 0.001) and Neut (IgG: p = 0.038; IgA: p = 0.021) titers and with memory B cell frequency at baseline (IgA: r = 0.76, p < 0.001; IgG: r = 0.74, p = 0.0001). The CD4+ T cells at Days 8 and 21 expanded after prime vaccination and this expansion correlated strongly with early post-vaccination HAI and Neut titers (p ≤ 0.002). In an adult population, the rapid serological response observed after initial H3N2v vaccination correlates with post-vaccination plasmablasts and CD4+ T cell responses.
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Munoz FM, Anderson EJ, Bernstein DI, Harrison CJ, Pahud B, Anderson E, Creech CB, Berry AA, Kotloff KL, Walter EB, Atmar RL, Bellamy AR, Chang S, Keitel WA. Safety and immunogenicity of unadjuvanted subvirion monovalent inactivated influenza H3N2 variant (H3N2v) vaccine in children and adolescents. Vaccine 2019; 37:5161-5170. [PMID: 31375440 PMCID: PMC10494964 DOI: 10.1016/j.vaccine.2019.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In response to the emergence of influenza viruses with pandemic potential, we evaluated a swine-origin influenza A/H3N2 variant (H3N2v) vaccine in children. STUDY DESIGN This multicenter phase II open-label study assessed the safety and immunogenicity of two doses, 21 days apart, of investigational unadjuvanted subvirion monovalent inactivated H3N2v vaccine administered via intramuscular injection. Children 6-35 months of age received 7.5mcg or 15mcg of hemagglutinin (HA)/dose; children 3-17 years of age received 15mcg HA/dose. Safety and reactogenicity were assessed by measuring the occurrence of solicited injection site and systemic reactions in the 7 days after each vaccination; adverse events were assessed for 42 days and serious adverse events for 7 months after the first vaccination. Immunogenicity was evaluated by measuring hemagglutination inhibition (HAI) and neutralizing (Neut) antibodies to H3N2v prior to and 21 days after each vaccination. Cross-reactivity against seasonal H3N2 strains was evaluated. RESULTS The H3N2v vaccine was well tolerated. Transient mild to moderate injection site tenderness, pain and erythema was observed, with the most commonly reported systemic reactogenicity being irritability in children 6-35 months, and headache and fatigue in children 9-17 years old. Children 6-35 months old, whether they received 7.5mcg or 15mcg/dose, had low HAI and Neut antibody responses after two doses compared to older children. Children under 9 years of age required two doses of vaccine to demonstrate a response, while 9-17 year olds responded well after one dose. Previous influenza vaccination and older age were associated with higher immune responses to H3N2v vaccine. Children 9-17 years of age also developed cross-reactive antibodies against recent seasonal H3N2 influenza viruses. CONCLUSION The H3N2v vaccine was safe and immunogenic in children and adolescents. Age-related increases in immunogenicity against H3N2v and seasonal H3N2 viruses were observed, suggesting prior priming via infection and/or immunization. Clinical trial registry: The trial is registered with clinicaltrial.gov: NCT02100436.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Viral/immunology
- Antibodies, Viral/metabolism
- Child
- Child, Preschool
- Female
- Hemagglutination Inhibition Tests
- Humans
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/pathogenicity
- Influenza Vaccines/adverse effects
- Influenza Vaccines/immunology
- Influenza Vaccines/therapeutic use
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Male
- Vaccines, Inactivated/adverse effects
- Vaccines, Inactivated/immunology
- Vaccines, Inactivated/therapeutic use
- Young Adult
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Affiliation(s)
- Flor M Munoz
- Departments of Pediatrics, Baylor College of Medicine, Houston, TX, United States; Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States.
| | - Evan J Anderson
- Department of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - David I Bernstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Christopher J Harrison
- Department of Pediatrics, Children's Mercy Hospital Kansas City, Kansas City, MO, United States
| | - Barbara Pahud
- Department of Pediatrics, Children's Mercy Hospital Kansas City, Kansas City, MO, United States
| | - Edwin Anderson
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Andrea A Berry
- Department of Pediatrics and Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Karen L Kotloff
- Department of Pediatrics and Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Emmanuel B Walter
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Robert L Atmar
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States; Medicine, Baylor College of Medicine, Houston, TX, United States
| | | | - Soju Chang
- National Institute of Allergy and Infectious Diseases, Rockville, MD, United States
| | - Wendy A Keitel
- Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States; Medicine, Baylor College of Medicine, Houston, TX, United States
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Ofori-Amoah J, Anokye R, Mensah A, Esinam FA, Yeboah JB, Kontor IK. Influenza A (H1N1) outbreak in the Asokore Mampong Sub – Municipal, Ghana: A case report. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1648196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - Reindolf Anokye
- Centre for Disability and Rehabilitation Studies, Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
| | - Alfred Mensah
- Ghana Health Services, Asokore Mampong Sub Municipal, Accra, Ghana
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Hodges EN, Mishin VP, De la Cruz J, Guo Z, Nguyen HT, Fallows E, Stevens J, Wentworth DE, Davis CT, Gubareva LV. Detection of oseltamivir-resistant zoonotic and animal influenza A viruses using the rapid influenza antiviral resistance test. Influenza Other Respir Viruses 2019; 13:522-527. [PMID: 31187572 PMCID: PMC6692545 DOI: 10.1111/irv.12661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/28/2022] Open
Abstract
Mutations in the influenza virus neuraminidase (NA) that cause reduced susceptibility to the NA inhibitor (NAI) oseltamivir may occur naturally or following antiviral treatment. Currently, detection uses either a traditional NA inhibition assay or gene sequencing to identify known markers associated with reduced inhibition by oseltamivir. Both methods are laborious and require trained personnel. The influenza antiviral resistance test (iART), a prototype system developed by Becton, Dickinson and Company for research use only, offers a rapid and simple method to identify such viruses. This study investigated application of iART to influenza A viruses isolated from non-human hosts with a variety of NA subtypes (N1-N9).
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Affiliation(s)
- Erin N. Hodges
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
- CNI AdvantageAtlantaGeorgia
| | - Vasiliy P. Mishin
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
| | - Juan De la Cruz
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
- Battelle Memorial InstituteAtlantaGeorgia
| | - Zhu Guo
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
| | - Ha T. Nguyen
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
- Battelle Memorial InstituteAtlantaGeorgia
| | - Eric Fallows
- Becton, Dickinson and CompanyResearch Triangle ParkNorth Carolina
| | - James Stevens
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
| | - David E. Wentworth
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
| | - Charles Todd Davis
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
| | - Larisa V. Gubareva
- Influenza DivisionCenters for Disease Control and Prevention (CDC)AtlantaGeorgia
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14
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Genetic characterization of hemagglutinin (HA) gene of influenza A viruses circulating in Southwest India during 2017 season. Virus Genes 2019; 55:458-464. [PMID: 31129786 DOI: 10.1007/s11262-019-01675-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
Molecular surveillance of influenza viruses is essential for early detection of novel variants. The aim of the present study was to analyze the hemagglutinin gene of influenza A(H1N1)pdm09 and A(H3N2) viruses circulating during the 2017 season. To investigate the genetic diversity of hemagglutinin gene of influenza A(H1N1)pdm09 and A(H3N2) viruses from 2017 season, ten samples from each subtype were sequenced and analyzed. The season was predominated by influenza A(H1N1)pdm09 viruses. Ten samples were sequenced from each subtype and all sequenced influenza A(H1N1)pdm09 and A(H3N2) viruses belonged to clades 6B.1 and 3C.2a, respectively. Sequence analysis of H1 gene in comparison to 2010-2016 vaccine strain showed mutations K166Q and S188T (K180Q and S202T here) that most likely resulted in antigenic drift and emergence of variant viruses. H3 gene substitutions N137K, N187K, I422V, and G500E that define clade 3C.2a1 were detected during analysis of sequences in comparison to 2017-2018 vaccine strain of northern hemisphere. These substitutions contributed to the change of WHO's recommendation of the 2018-2019 vaccine strain for northern hemisphere. The results of this study provide insights about the continuous genetic variability of the HA gene.
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15
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Bromley C, Reynard C. BET 1: Oseltamivir use for quicker alleviation of symptoms, fewer hospital admissions and lower mortality in adult patients with influenza B. Emerg Med J 2019; 36:55-56. [DOI: 10.1136/emermed-2018-208381.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
A short cut review was carried out to establish whether Oseltamivir leads to faster alleviation of symptoms, fewer hospital admissions and lower mortality in adult patients with confirmed influenza B presenting to the Emergency Department. Two studies were directly relevant to the question using the described search methodology on Ovid Medline and Embase. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line: there is no good evidence that oseltamivir results in quicker alleviation of symptoms, fewer hospital admissions or lower mortality in adult patients with influenza B.
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16
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Duwell MM, Blythe D, Radebaugh MW, Kough EM, Bachaus B, Crum DA, Perkins KA, Blanton L, Davis CT, Jang Y, Vincent A, Chang J, Abney DE, Gudmundson L, Brewster MG, Polsky L, Rose DC, Feldman KA. Influenza A(H3N2) Variant Virus Outbreak at Three Fairs - Maryland, 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:1169-1173. [PMID: 30359341 PMCID: PMC6290816 DOI: 10.15585/mmwr.mm6742a1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Clinical and demographic characteristics of influenza b outbreak in Erzincan province of Turkey. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.437319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Budd AP, Wentworth DE, Blanton L, Elal AIA, Alabi N, Barnes J, Brammer L, Burns E, Cummings CN, Davis T, Flannery B, Fry AM, Garg S, Garten R, Gubareva L, Jang Y, Kniss K, Kramer N, Lindstrom S, Mustaquim D, O'Halloran A, Olsen SJ, Sessions W, Taylor C, Xu X, Dugan VG, Katz J, Jernigan D. Update: Influenza Activity - United States, October 1, 2017-February 3, 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:169-179. [PMID: 29447145 PMCID: PMC5815487 DOI: 10.15585/mmwr.mm6706a1] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Alicia P Budd
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - David E Wentworth
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Lenee Blanton
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Anwar Isa Abd Elal
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Noreen Alabi
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - John Barnes
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Lynnette Brammer
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Erin Burns
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Charisse N Cummings
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Todd Davis
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Rebecca Garten
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Larisa Gubareva
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Yunho Jang
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Krista Kniss
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Natalie Kramer
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Stephen Lindstrom
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Desiree Mustaquim
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Alissa O'Halloran
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Sonja J Olsen
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Wendy Sessions
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Calli Taylor
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Xiyan Xu
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Vivien G Dugan
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Jacqueline Katz
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Daniel Jernigan
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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19
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Du X, Pascual M. Incidence Prediction for the 2017-2018 Influenza Season in the United States with an Evolution-informed Model. PLOS CURRENTS 2018; 10. [PMID: 29588875 PMCID: PMC5843489 DOI: 10.1371/currents.outbreaks.6f03b36587ae74b11353c1127cbe7d0e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Seasonal influenza is responsible for a high disease burden in the United States and worldwide. Predicting outbreak size in advance can contribute to the timely control of seasonal influenza by informing health care and vaccination planning. Methods: Recently, a process-based model was developed for forecasting incidence dynamics ahead of the season, with the approach validated by several statistical criteria, including an accurate real-time prediction for the past 2016-2017 influenza season before it started. Results: Based on this model and data up to June 2017, a forecast for the upcoming 2017-2018 influenza season is presented here, indicating an above-average, moderately severe, outbreak dominated by the H3N2 subtype. Discussion: The prediction is consistent with surveillance data so far, which already indicate the predominance of H3N2. The forecast for the upcoming 2017-2018 influenza season reinforces the importance of the on-going vaccination campaign.
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Affiliation(s)
- Xiangjun Du
- Ecology and Evolution, University of Chicago, Chicago, Illinois, USA
| | - Mercedes Pascual
- Ecology and Evolution, University of Chicago, Chicago, Illinois, USA
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20
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Dugan VG, Blanton L, Elal AIA, Alabi N, Barnes J, Brammer L, Burns E, Cummings CN, Davis T, Flannery B, Fry AM, Garg S, Garten R, Gubareva L, Jang Y, Kniss K, Kramer N, Lindstrom S, Mustaquim D, O'Halloran A, Olsen SJ, Sessions W, Taylor C, Trock S, Xu X, Wentworth DE, Katz J, Jernigan D. Update: Influenza Activity - United States, October 1-November 25, 2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:1318-1326. [PMID: 29216030 PMCID: PMC5757637 DOI: 10.15585/mmwr.mm6648a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Vivien G Dugan
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Lenee Blanton
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Anwar Isa Abd Elal
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Noreen Alabi
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - John Barnes
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Lynnette Brammer
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Erin Burns
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Charisse N Cummings
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Todd Davis
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Rebecca Garten
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Larisa Gubareva
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Yunho Jang
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Krista Kniss
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Natalie Kramer
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Stephen Lindstrom
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Desiree Mustaquim
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Alissa O'Halloran
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Sonja J Olsen
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Wendy Sessions
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Calli Taylor
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Susan Trock
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Xiyan Xu
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - David E Wentworth
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Jacqueline Katz
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | - Daniel Jernigan
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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