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Chatterjee A, Ambrose K, Canaday DH, Delair S, Ezike N, Huber VC, Jhaveri R, Nyquist AC, Sporer A, Varman M, Vivekanandan R, Wojcik R, Jandhyala R. The association between influenza vaccine effectiveness and egg-based manufacturing technology: literature review and US expert consensus. Curr Med Res Opin 2024; 40:335-343. [PMID: 38054898 DOI: 10.1080/03007995.2023.2284386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Influenza is associated with significant disease burden in the US and is currently best controlled by vaccination programs. Influenza vaccine effectiveness (VE) is low and may be reduced by several factors, including egg adaptations. Although non-egg-based influenza vaccines reportedly have greater VE in egg-adapted seasons, evidence for egg adaptations' reduction of VE is indirect and dissociated, apart from two previous European consensuses. METHODS This study replicated the methodology used in a 2020 literature review and European consensus, providing an updated review and consensus opinion of 10 US experts on the evidence for a mechanistic basis for reduction of VE due to egg-based manufacturing methods. A mechanistic basis was assumed if sufficient evidence was found for underlying principles proposed to give rise to such an effect. Evidence for each principle was brought forward from the 2020 review and identified here by structured literature review and expert panel. Experts rated the strength of support for each principle and a mechanistic basis for reduction of VE due to egg-based influenza vaccine manufacture in a consensus method (consensus for strong/very strong evidence = ≥ 3.5 on 5-point Likert scale). RESULTS Experts assessed 251 references (from previous study: 185; this study: 66). The majority of references for all underlying principles were rated as strong or very strong supporting evidence (52-86%). Global surveillance, WHO candidate vaccine virus selection, and manufacturing stages involving eggs were identified as most likely to impact influenza VE. CONCLUSION After review of extensive evidence for reduction of VE due to egg-based influenza vaccine manufacture, influenza experts in the US joined those in Europe in unanimous agreement for a mechanistic basis for the effect. Vaccine providers and administrators should consider use of non-egg-based influenza vaccine manufacture to reduce the risk of egg adaptations and likely impact on VE.
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Affiliation(s)
- Archana Chatterjee
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | | | | | | | | | - Ravi Jhaveri
- Feinberg School of Medicine, Northwestern, IL, USA
| | | | | | | | | | | | - Ravi Jandhyala
- Medialis Ltd, Milton Keynes, UK
- King's College London, London, UK
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2
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Al Farroukh M, Kiseleva I, Stepanova E, Bazhenova E, Krutikova E, Tkachev A, Chistyakova A, Rekstin A, Puchkova L, Rudenko L. The Effect of Mice Adaptation Process on the Pathogenicity of Influenza A/South Africa/3626/2013 (H1N1)pdm09 Model Strain. Int J Mol Sci 2023; 24:17386. [PMID: 38139214 PMCID: PMC10743444 DOI: 10.3390/ijms242417386] [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: 11/02/2023] [Revised: 11/24/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
Influenza virus strain A/South Africa/3626/2013 (H1N1)pdm09 (SA-WT) is a non-mouse-adapted model strain that has naturally high pathogenic properties in mice. It has been suggested that the high pathogenicity of this strain for mice could be due to the three strain-specific substitutions in the polymerase complex (Q687R in PB1, N102T in PB2, and E358E/K heterogeneity in PB2). To evaluate the role of these replacements, SA-WT was passaged five times in mouse lungs, and the genome of the mouse-adapted version of the SA-WT strain (SA-M5) was sequenced. SA-M5 lost E358E/K heterogeneity and retained E358, which is the prevalent amino acid at this position among H1N1pdm09 strains. In addition, in the hemagglutinin of SA-M5, two heterogeneous substitutions (G155G/E and S190S/R) were identified. Both viruses, SA-M5 and SA-WT, were compared for their toxicity, ability to replicate, pathogenicity, and immunogenicity in mice. In mice infected with SA-M5 or SA-WT strains, toxicity, virus titer in pulmonary homogenates, and mouse survival did not differ significantly. In contrast, an increase in the immunogenicity of SA-M5 compared to SA-WT was observed. This increase could be due to the substitutions G155G/E and S190S/R in the HA of SA-M5. The prospects for using SA-M5 in studying the immunogenicity mechanisms were also discussed.
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Affiliation(s)
- Mohammad Al Farroukh
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
- Institute of Biomedical Systems and Biotechnology, Peter the Great St. Petersburg Polytechnic University, St. Petersburg 194021, Russia;
| | - Irina Kiseleva
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
| | - Ekaterina Stepanova
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
| | - Ekaterina Bazhenova
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
| | - Elena Krutikova
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
| | - Artem Tkachev
- Institute of Biomedical Systems and Biotechnology, Peter the Great St. Petersburg Polytechnic University, St. Petersburg 194021, Russia;
| | - Anna Chistyakova
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
| | - Andrey Rekstin
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
| | - Ludmila Puchkova
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
| | - Larisa Rudenko
- Federal State Budgetary Scientific Institution “Institute of Experimental Medicine”, St. Petersburg 197022, Russia; (E.S.); (E.B.); (E.K.); (A.C.); (A.R.); (L.P.); (L.R.)
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Capodici A, Montalti M, Soldà G, Salussolia A, La Fauci G, Di Valerio Z, Scognamiglio F, Fantini MP, Odone A, Costantino C, Larson HJ, Leask J, Lenzi J, Gori D. Influenza vaccination landscape in Italy: A comprehensive study through the OBVIOUS project lens. Hum Vaccin Immunother 2023; 19:2252250. [PMID: 37846766 PMCID: PMC11253712 DOI: 10.1080/21645515.2023.2252250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/22/2023] [Indexed: 10/18/2023] Open
Abstract
Influenza annually claims an estimated 8,000 lives in Italy. Despite no-cost vaccinations for high-risk groups, hesitancy persists. This study aims to pinpoint social and behavioral vaccination determinants, forming strategies to bolster vaccine uptake. From April 11 to May 29, 2022, we surveyed a demographic-stratified sample of 10,000 Italian adults, employing the WHO's Behavioral and Social Drivers of Vaccination (BesD) framework. Of those, 4,613 (46.1%) were eligible for the influenza vaccine and included in the analysis. Roughly a third remained unvaccinated and unwilling. Central Italy showed the highest resistance, with significant percentages of seniors and professionals like teachers, law enforcement, and healthcare workers expressing noncompliance. A lack of awareness of being in a target group correlated significantly with vaccine refusal or delayed acceptance. Other refusal factors included female gender, being aged 45-54, rural residency, absence of higher education, perceived vaccine unsafety, and having vaccine-opposed acquaintances. Thus, addressing these perceptions and enhancing awareness can potentially increase vaccination rates and lessen disease impact.
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Affiliation(s)
- Angelo Capodici
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Marco Montalti
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giorgia Soldà
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Aurelia Salussolia
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giusy La Fauci
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Zeno Di Valerio
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Francesca Scognamiglio
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Heidi J. Larson
- Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine Institute of Health Metrics & Evaluation, University of Washington, Seattle, WA, USA
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Sydney Infectious Diseases Institute, Westmead, Australia
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Zhong W, Wu Y, Yue W, Fang J, Xie B, Xu N, Lin M, Zhu X, Su Z, Chen Y, Li H, Li H. Distinguishing COVID-19 from seasonal influenza in patients under age 65 years-a retrospective observational cohort study comparing the 2009 influenza A (H1N1) and 2022 SARS-CoV-2 pandemics. Front Cell Infect Microbiol 2023; 13:1179552. [PMID: 37533930 PMCID: PMC10393466 DOI: 10.3389/fcimb.2023.1179552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction This study explored the differences in clinical characteristics between the 2009 pandemic influenza A (H1N1) and SARS-CoV-2 BA.2 variant (Omicron) infections in patients younger than age 65 years, to improve identification of these diseases and better respond to the current epidemic. Methods Data from 127 patients with the 2009 pandemic influenza A (H1N1) diagnosed between May and July of 2009 and 3,265 patients with Omicron diagnosed between March and May of 2022 were collected. Using a 1:2 match based on age (difference <2 years), sex, and underlying diseases, data from 115 patients with the 2009 pandemic influenza A (H1N1) infection (H1N1 group) and 230 patients with SARS-CoV-2 Omicron BA.2 infection (Omicron group) were analyzed. The clinical manifestations were compared between the groups, logistic regression was performed to identify possible independent risk factors for each group, and multiple linear regression was used to analyze the factors predicting time for nucleic acid negativization (NAN). Results The median [interquartile range] age of the two groups was 21 [11, 26] years. Compared with the H1N1 group, the Omicron group had: lower white blood cell counts and C-reactive protein levels; less fever, nasal congestion, sore throat, cough, sputum, and headache; and more olfactory loss, muscle soreness, and lactate dehydrogenase (LDH) abnormalities. Patients in the Omicron group used fewer antibiotics and antiviral drugs, and the time for NAN was longer (17 [14,20] VS 4 [3,5] days, P<0.001). Logistic regression showed that fever, cough, headache, and increased white blood cell count were more strongly correlated with the H1N1 group, while muscle soreness and LDH abnormalities were more strongly correlated with the Omicron group. Fever (B 1.529, 95% confidence interval [0.149,2.909], P=0.030) significantly predicted a longer time for NAN in patients with Omicron. Discussion There are significant differences in clinical characteristics between SARS-CoV-2 Omicron infection and the 2009 pandemic influenza A (H1N1) infection. Recognition of these differences has important implications for clinical practice.
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Affiliation(s)
- Wen Zhong
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yisong Wu
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Wenxiang Yue
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jiabin Fang
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Baosong Xie
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Nengluan Xu
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ming Lin
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiongpeng Zhu
- Department of Hematology, Quanzhou First Hospital, Quanzhou, China
| | - Zhijun Su
- Department of Infectious Diseases, Quanzhou First Hospital, Fuzhou, China
| | - Yusheng Chen
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Hongru Li
- Department of Respiratory and Critical Care Medicine, Fujian Shengli Medical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Big Data Engineering, Fujian Provincial Hospital, Fuzhou, China
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CpG 1018 Is an Effective Adjuvant for Influenza Nucleoprotein. Vaccines (Basel) 2023; 11:vaccines11030649. [PMID: 36992232 PMCID: PMC10055716 DOI: 10.3390/vaccines11030649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
Current influenza vaccines mainly induce neutralizing antibodies against the highly variable surface antigen hemagglutinin and require annual manufacturing and immunization. Different from surface antigens, intracellular nucleoprotein (NP) is highly conserved and has been an attractive target to develop universal T cell vaccines against influenza. Yet, influenza NP protein mainly induces humoral immune responses and lacks the ability to induce potent cytotoxic T lymphocyte (CTL) responses, key for the success of universal T cell vaccines. This study compared CpG 1018 and AddaVax to enhance recombinant NP-induced CTL responses and protection in murine models. CpG 1018 was explored to boost intradermal NP immunization, while AddaVax was explored to boost intramuscular NP immunization due to the high risk of AddaVax adjuvant to induce significant local reactions following intradermal delivery. We found CpG 1018 was highly effective to enhance NP-induced humoral and cellular immune responses superior to AddaVax adjuvant. Furthermore, CpG 1018 potentiated Th1-biased antibody responses, while AddaVax enhanced Th1/Th2-balanced antibody responses. CpG 1018 significantly enhanced IFNγ-secreting Th1 cells, while AddaVax adjuvant significantly increased IL4-secreting Th2 cells. Influenza NP immunization in the presence of CpG 1018 induced significant protection against lethal viral challenges, while influenza NP immunization in the presence of AddaVax failed to elicit significant protection. Our data validated CpG 1018 as an effective adjuvant to enhance influenza NP-induced CTL responses and protection.
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6
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Influenza Viruses and Vaccines: The Role of Vaccine Effectiveness Studies for Evaluation of the Benefits of Influenza Vaccines. Vaccines (Basel) 2022; 10:vaccines10050714. [PMID: 35632470 PMCID: PMC9143275 DOI: 10.3390/vaccines10050714] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Influenza is a vaccine preventable disease and vaccination remains the most effective method of controlling the morbidity and mortality of seasonal influenza, especially with respect to risk groups. To date, three types of influenza vaccines have been licensed: inactivated, live-attenuated, and recombinant haemagglutinin vaccines. Effectiveness studies allow an assessment of the positive effects of influenza vaccines in the field. The effectiveness of current influenza is suboptimal, being estimated as 40% to 60% when the vaccines strains are antigenically well-matched with the circulating viruses. This review focuses on influenza viruses and vaccines and the role of vaccine effectiveness studies for evaluating the benefits of influenza vaccines. Overall, influenza vaccines are effective against morbidity and mortality in all age and risk groups, especially in young children and older adults. However, the effectiveness is dependent on several factors such as the age of vaccinees, the match between the strain included in the vaccine composition and the circulating virus, egg-adaptations occurring during the production process, and the subject’s history of previous vaccination.
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Lee K, Jalal H, Raviotta JM, Krauland MG, Zimmerman RK, Burke DS, Roberts MS. Estimating the Impact of Low Influenza Activity in 2020 on Population Immunity and Future Influenza Seasons in the United States. Open Forum Infect Dis 2022; 9:ofab607. [PMID: 35024374 PMCID: PMC8743127 DOI: 10.1093/ofid/ofab607] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Influenza activity in the 2020-2021 season was remarkably low, likely due to implementation of public health preventive measures such as social distancing, mask wearing, and school closure. With waning immunity, the impact of low influenza activity in the 2020-2021 season on the following season is unknown. METHODS We built a multistrain compartmental model that captures immunity over multiple influenza seasons in the United States. Compared with the counterfactual case, where influenza activity remained at the normal level in 2020-2021, we estimated the change in the number of hospitalizations when the transmission rate was decreased by 20% in 2020-2021. We varied the level of vaccine uptake and effectiveness in 2021-2022. We measured the change in population immunity over time by varying the number of seasons with lowered influenza activity. RESULTS With the lowered influenza activity in 2020-2021, the model estimated 102 000 (95% CI, 57 000-152 000) additional hospitalizations in 2021-2022, without changes in vaccine uptake and effectiveness. The estimated changes in hospitalizations varied depending on the level of vaccine uptake and effectiveness in the following year. Achieving a 50% increase in vaccine coverage was necessary to avert the expected increase in hospitalization in the next influenza season. If the low influenza activity were to continue over several seasons, population immunity would remain low during those seasons, with 48% of the population susceptible to influenza infection. CONCLUSIONS Our study projected a large compensatory influenza season in 2021-2022 due to a light season in 2020-2021. However, higher influenza vaccine uptake would reduce this projected increase in influenza.
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Affiliation(s)
- Kyueun Lee
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Public Health Dynamics Laboratory, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Hawre Jalal
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Public Health Dynamics Laboratory, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jonathan M Raviotta
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary G Krauland
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Public Health Dynamics Laboratory, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Richard K Zimmerman
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Donald S Burke
- Public Health Dynamics Laboratory, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark S Roberts
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Public Health Dynamics Laboratory, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Koesnoe S, Masjkuri N, Adisasmita A, Djauzi S, Kartasasmita C, Sundoro J, Nadjib M, Korib M, Muthia AN, Muzellina VN, Habibah U, Nursyirwan SA, Djaya KH, Bachtiar NS, Sari RM. A randomized controlled trial to evaluate the effect of influenza vaccination and probiotic supplementation on immune response and incidence of influenza-like illness in an elderly population in Indonesia. PLoS One 2021; 16:e0250234. [PMID: 34914726 PMCID: PMC8675694 DOI: 10.1371/journal.pone.0250234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/27/2021] [Indexed: 11/19/2022] Open
Abstract
AIM To investigate the effect of influenza vaccination with or without probiotic supplementation on the immune response and incidence of influenza-like illness (ILI) in the elderly. METHODS A randomized double-blind, placebo-controlled trial with a modified factorial design was conducted in 554 healthy elderly subjects aged 67 ± 5.6 (ranging from 60-90) years old in the Primary Health Care Center (Puskesmas area) of the Pulo Gadung District East Jakarta. Subjects received either a trivalent influenza vaccine or placebo at the start of the study, and a probiotic supplement (Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011) or a placebo for 6 months. Subjects were randomly assigned into four intervention groups: influenza vaccine and probiotics (n = 141), influenza vaccine and placebo (n = 136), placebo and probiotics (n = 140), and both placebo (n = 137). The primary outcome was ILI incidence within 6 months. The secondary outcomes were seroprotection and seroconversion rates at 1, 4, and 6 months after administering the interventions. RESULTS This study showed that the trivalent influenza vaccine increased seroprotection (RR 3.6 [95%CI 2.92-4.47]; p<0.010) and seroconversion (RR 29.8 [95%CI 11.1-79.5]; p<0.010) rates 1 month after vaccination in elderly people while the probiotic supplement did not alter influenza antibody titers (p = 1.000 and p = 0.210). The relative ILI incidence risk was similar between vaccinated and non-vaccinated groups, as well as in the probiotic group compared to the non-probiotic group. CONCLUSION The tested trivalent influenza vaccine significantly induced seroprotection and seroconversion in the vaccinated subjects, while probiotics administration did not influence these parameters. Vaccinated individuals displayed a similarly low ILI incidence as those in the Control Group. However, the observed trend towards a reduction of ILI incidence with probiotics supplementation warrants further assessments in a larger, at-risk population. CLINICAL TRIAL REGISTRY NUMBER NCT03695432.
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Affiliation(s)
- Sukamto Koesnoe
- Division of Allergy and Immunology, Department of Internal Medicine, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
- * E-mail:
| | - Nuning Masjkuri
- Department of Epidemiology, Faculty of Public Health University of Indonesia Jakarta, Jakarta, Indonesia
| | - Asri Adisasmita
- Department of Epidemiology, Faculty of Public Health University of Indonesia Jakarta, Jakarta, Indonesia
| | - Samsuridjal Djauzi
- Division of Allergy and Immunology, Department of Internal Medicine, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Cissy Kartasasmita
- Department of Child Health, Faculty of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | - Mardiati Nadjib
- Department of Health Policy and Administration, Faculty of Public Health University of Indonesia, Jakarta, Indonesia
| | - Mondastri Korib
- Department of Epidemiology, Faculty of Public Health University of Indonesia Jakarta, Jakarta, Indonesia
| | | | - Virly Nanda Muzellina
- Division of Gastroenterology, Depertment of Internal Medicine, dr. Cipto Mangunkusomo Hospital, Jakarta, Indonesia
- Division of Gastroenterology, Depertment of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Ummu Habibah
- Indonesian Society of Internal Medicine, Jakarta, Indonesia
| | - Saskia Aziza Nursyirwan
- Division of Gastroenterology, Depertment of Internal Medicine, dr. Cipto Mangunkusomo Hospital, Jakarta, Indonesia
- Division of Gastroenterology, Depertment of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
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Redondo E, Rivero-Calle I, Mascarós E, Yuste JE, Fernández-Prada M, Ocaña D, Jimeno I, Gil A, Molina J, Díaz-Maroto JL, Linares M, Martinón-Torres F. [Vaccination against community acquired pneumonia in adults. Update 2021 of the position paper by Neumoexpertos en Prevención Group]. Semergen 2021; 47:411-425. [PMID: 34332864 DOI: 10.1016/j.semerg.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022]
Abstract
Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the practical prevention guide for CAP through vaccination in Spain developed in 2016 and updated in 2018, based on available vaccines and evidence through bibliographic review and expert opinion. The arrival of COVID-19 as a new cause of CAP and the recent availability of safe and effective vaccines constitutes the most significant change. Vaccines against pneumococcus, influenza, pertussis and COVID-19 can help to reduce the burden of disease from CAP and its associated complications. The available evidence supports the priority indications established in this guide, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.
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Affiliation(s)
- E Redondo
- Medicina de Familia, Grupo de Actividades Preventivas y Salud Pública SEMERGEN, Centro de Salud Internacional, Ayuntamiento de Madrid, Madrid, España.
| | - I Rivero-Calle
- Servicio de Pediatría, Sección de Pediatría Clínica, Infectológica y Traslacional, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, España; Genética Vacunas e Infecciones Pediátricas (GENVIP), Instituto de Investigación de Santiago, Santiago de Compostela, A Coruña, España
| | - E Mascarós
- Medicina de Familia, Departamento de Salud Hospital la Fe, Consultorio Auxiliar Arquitecto Tolsá, Valencia, España
| | - J E Yuste
- Centro Nacional de Microbiología, Instituto de Salud Carlos III y CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - M Fernández-Prada
- Unidad de Vacunas, Servicio Medicina Preventiva y Salud Pública, Hospital Vital Álvarez Buylla, Mieres, Asturias, España
| | - D Ocaña
- Medicina de Familia, Centro de Atención Primaria Algeciras-Norte, Algeciras, Cádiz, España
| | - I Jimeno
- Medicina de Familia, Centro de Salud Isla de Oza, Madrid, España
| | - A Gil
- Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
| | - J Molina
- Medicina de Familia, Centro de Atención Primaria Francia, Fuenlabrada, Madrid, España
| | - J L Díaz-Maroto
- Medicina de Familia, Centro de Atención Primaria de Guadalajara, Guadalajara, España
| | - M Linares
- Medicina de Familia, Microbiología clínica, Miembro del Grupo de Enfermedades Infecciosas de SEMERGEN. Fundación iO, España
| | - F Martinón-Torres
- Servicio de Pediatría, Sección de Pediatría Clínica, Infectológica y Traslacional, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, España; Genética Vacunas e Infecciones Pediátricas (GENVIP), Instituto de Investigación de Santiago, Santiago de Compostela, A Coruña, España
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10
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Li Z, Zhao Y, Li Y, Chen X. Adjuvantation of Influenza Vaccines to Induce Cross-Protective Immunity. Vaccines (Basel) 2021; 9:75. [PMID: 33494477 PMCID: PMC7911902 DOI: 10.3390/vaccines9020075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/22/2022] Open
Abstract
Influenza poses a huge threat to global public health. Influenza vaccines are the most effective and cost-effective means to control influenza. Current influenza vaccines mainly induce neutralizing antibodies against highly variable globular head of hemagglutinin and lack cross-protection. Vaccine adjuvants have been approved to enhance seasonal influenza vaccine efficacy in the elderly and spare influenza vaccine doses. Clinical studies found that MF59 and AS03-adjuvanted influenza vaccines could induce cross-protective immunity against non-vaccine viral strains. In addition to MF59 and AS03 adjuvants, experimental adjuvants, such as Toll-like receptor agonists, saponin-based adjuvants, cholera toxin and heat-labile enterotoxin-based mucosal adjuvants, and physical adjuvants, are also able to broaden influenza vaccine-induced immune responses against non-vaccine strains. This review focuses on introducing the various types of adjuvants capable of assisting current influenza vaccines to induce cross-protective immunity in preclinical and clinical studies. Mechanisms of licensed MF59 and AS03 adjuvants to induce cross-protective immunity are also introduced. Vaccine adjuvants hold a great promise to adjuvant influenza vaccines to induce cross-protective immunity.
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Affiliation(s)
| | | | | | - Xinyuan Chen
- Biomedical & Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Avedisian Hall, Room 480, Kingston, RI 02881, USA; (Z.L.); (Y.Z.); (Y.L.)
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11
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Kim DI, Cho YB, Lim Y, Hong SH, Hahm B, Lee SM, Kang SC, Seo YJ. Chios mastic gum inhibits influenza A virus replication and viral pathogenicity. J Gen Virol 2021; 102. [PMID: 33416468 DOI: 10.1099/jgv.0.001550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chios mastic gum (CMG), a resin of the mastic tree (Pistacia lentiscus var. chia), has been used to treat multiple disorders caused by gastrointestinal malfunctions and bacterial infections for more than 2500 years. However, little is known about CMG's antiviral activity. CMG is known to influence multiple cellular processes such as cell proliferation, differentiation and apoptosis. As virus replication is largely dependent on the host cellular metabolism, it is conceivable that CMG regulates virus infectivity. Therefore, in this study, we evaluated CMG's potential as an antiviral drug to treat influenza A virus (IAV) infection. CMG treatment dramatically reduced the cytopathogenic effect and production of RNAs, proteins and infectious particles of IAV. Interestingly, CMG interfered with the early stage of the virus life cycle after viral attachment. Importantly, the administration of CMG greatly ameliorated morbidity and mortality in IAV-infected mice. The results suggest that CMG displays a potent anti-IAV activity by blocking the early stage of viral replication. Thus, mastic gum could be exploited as a novel therapeutic agent against IAV infection.
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Affiliation(s)
- Dong-In Kim
- Department of Life Science, Chung-Ang University, Seoul, Republic of Korea
| | - Yong-Bin Cho
- Department of Life Science, Chung-Ang University, Seoul, Republic of Korea
| | - Younghyun Lim
- Department of Life Science, Chung-Ang University, Seoul, Republic of Korea
| | - So-Hee Hong
- Department of Biotechnology, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Bumsuk Hahm
- Departments of Surgery and Molecular Microbiology and Immunology, University of Missouri, Columbia, MO 65212, USA
| | - Sang-Myeong Lee
- College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Division of Biotechnology, College of Environmental and Bioresources, Jeonbuk National University, Iksan, Republic of Korea
| | - Se Chan Kang
- Department of Oriental Medicine Biotechnology, College of Life Sciences, Kyung Hee University, Yongin, 17104, Republic of Korea
| | - Young-Jin Seo
- Department of Life Science, Chung-Ang University, Seoul, Republic of Korea
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12
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Hollingsworth R, El Guerche-Séblain C, Tsai T, Vasiliev Y, Lee S, Bright H, Barbosa P. Assessment of the benefits of seasonal influenza vaccination: Elements of a framework to interpret estimates of vaccine effectiveness and support robust decision-making and communication. Influenza Other Respir Viruses 2020; 15:164-174. [PMID: 32885610 PMCID: PMC7767949 DOI: 10.1111/irv.12786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/03/2022] Open
Abstract
Systematic reviews and meta‐analyses confirm that influenza vaccination reduces the risk of influenza illness by between about 40% and 60% in seasons when circulating influenza stains are well matched to vaccine strains. Influenza vaccine effectiveness (IVE) estimates, however, are often discordant and a source of confusion for decision makers. IVE assessments are increasingly publicized and are often used by policy makers to make decisions about the value of seasonal influenza vaccination. But there is limited guidance on how IVE should be interpreted or used to inform policy. There are several limitations to the use of IVE for decision‐making: (a) IVE studies have methodological issues that often complicate the interpretation of their value; and (b) the full impact of vaccination will almost always be greater than the impact assessed by a point estimate of IVE in specific populations or settings. Understanding the strengths and weaknesses of study methodologies and the fundamental limitations of IVE estimates is important for the accuracy of interpretations and support of policy makers’ decisions. Here, we review a comprehensive set of issues that need to be considered when interpreting IVE and determining the full benefits of influenza vaccination. We propose that published IVE values should be assessed using an evaluative framework that includes influenza‐specific outcomes, types of VE study design, and confounders, among other factors. Better interpretation of IVE will improve the broader assessment of the value of influenza vaccination and ultimately optimize the public health benefits in seasonal influenza vaccination.
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Affiliation(s)
| | | | | | - Yuri Vasiliev
- St. Petersburg Research Institute of Vaccines and Sera, Krasnoe Selo, Russian Federation
| | - Sam Lee
- Sanofi Pasteur, Swiftwater, PA, USA
| | | | - Paula Barbosa
- International Federation of Pharmaceutical Manufacturers and Associations, Geneva, Switzerland
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13
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Paton DJ, Reeve R, Capozzo AV, Ludi A. Estimating the protection afforded by foot-and-mouth disease vaccines in the laboratory. Vaccine 2019; 37:5515-5524. [PMID: 31405637 DOI: 10.1016/j.vaccine.2019.07.102] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
Foot-and-mouth disease (FMD) vaccines must be carefully selected and their application closely monitored to optimise their effectiveness. This review covers serological techniques for FMD vaccine quality control, including potency testing, vaccine matching and post-vaccination monitoring. It also discusses alternative laboratory procedures, such as antigen quantification and nucleotide sequencing, and briefly compares the approaches for FMD with those for measuring protection against influenza virus, where humoral immunity is also important. Serology is widely used to predict the protection afforded by vaccines and has great practical utility but also limitations. Animals differ in their responses to vaccines and in the protective mechanisms that they develop. Antibodies have a variety of properties and tests differ in what they measure. Antibody-virus interactions may vary between virus serotypes and strains and protection may be affected by the vaccination regime and the nature and timing of field virus challenge. Finally, tests employing biological reagents are difficult to standardise, whilst cross-protection data needed for test calibration and validation are scarce. All of this is difficult to reconcile with the desire for simple and universal criteria and thresholds for evaluating vaccines and vaccination responses and means that oversimplification of test procedures and their interpretation can lead to poor predictions. A holistic approach is therefore recommended, considering multiple sources of field, experimental and laboratory data. New antibody avidity and isotype tests seem promising alternatives to evaluate cross-protective, post-vaccination serological responses, taking account of vaccine potency as well as match. After choosing appropriate serological tests or test combinations and cut-offs, results should be interpreted cautiously and in context. Since opportunities for experimental challenge studies of cross-protection are limited and the approaches incompletely reflect real life, more field studies are needed to quantify cross-protection and its correlation to in vitro measurements.
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Affiliation(s)
- D J Paton
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK.
| | - R Reeve
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - A V Capozzo
- Instituto de Virología, CICVyA, INTA, N Repetto y De Los Reseros s/n, Hurlingham (1686), Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Tecnológicas, CONICET, Godoy Cruz 2290 (C1454FQB), Buenos Aires, Argentina
| | - A Ludi
- The Pirbright Institute, Ash Road, Pirbright, Surrey GU24 0NF, UK
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14
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Navarro-Torné A, Hanrahan F, Kerstiëns B, Aguar P, Matthiessen L. Public Health-Driven Research and Innovation for Next-Generation Influenza Vaccines, European Union. Emerg Infect Dis 2019; 25. [PMID: 30666948 PMCID: PMC6346458 DOI: 10.3201/eid2502.180359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Influenza virus infections are a major public health threat. Vaccination is available, but unpredictable antigenic changes in circulating strains require annual modification of seasonal influenza vaccines. Vaccine effectiveness has proven limited, particularly in certain groups, such as the elderly. Moreover, preparedness for upcoming pandemics is challenging because we can predict neither the strain that will cause the next pandemic nor the severity of the pandemic. The European Union fosters research and innovation to develop novel vaccines that evoke broadly protective and long-lasting immune responses against both seasonal and pandemic influenza, underpinned by a political commitment to global public health.
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15
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Mo PKH, Wong CHW, Lam EHK. Can the Health Belief Model and moral responsibility explain influenza vaccination uptake among nurses? J Adv Nurs 2019; 75:1188-1206. [PMID: 30375040 DOI: 10.1111/jan.13894] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 07/24/2018] [Accepted: 10/02/2018] [Indexed: 01/26/2023]
Abstract
AIMS The aim of this study was to examine the prevalence and the factors associated with influenza vaccination among nurses in Hong Kong based on the Health Belief Model. The role of moral responsibility was also examined. BACKGROUND Influenza vaccination is the most effective way to prevent influenza infection. Nurses are recommended to receive influenza vaccination annually. However, the rate of vaccination among nurses in Hong Kong is low. DESIGN A cross-sectional study. METHOD A survey was conducted among 214 nurses between January - March 2017. RESULT The prevalence of having ever received influenza vaccination, having received influenza vaccination in the last influenza season and having intention to receive influenza vaccination in the coming influenza season were 64.5%, 29.0% and 23.3% respectively. Results from multiple stepwise logistic regressions showed that perceived benefits of influenza vaccination and having received recommendations from colleagues were associated with higher chances of having ever received influenza vaccination. Perceived susceptibility of influenza, perceived benefits of influenza vaccination and perceived moral responsibility were associated with higher chances of having received influenza vaccination in the last influenza season, whereas perceived barriers of influenza vaccination were associated with lower chances. Furthermore, perceived susceptibility of influenza and perceived benefits of influenza vaccination were associated with higher chances of having the intention to receive influenza vaccination in the coming influenza season, whereas perceived barriers were associated with lower chances. The moderating effect of perceived moral responsibility was not significant. CONCLUSION Health promotion should make use of the Health Belief Model and increase moral responsibility to increase influenza vaccination rate among nurses.
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Affiliation(s)
- Phoenix K H Mo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Candice H W Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Eliz H K Lam
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
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16
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Egg-based influenza split virus vaccine with monoglycosylation induces cross-strain protection against influenza virus infections. Proc Natl Acad Sci U S A 2019; 116:4200-4205. [PMID: 30782805 DOI: 10.1073/pnas.1819197116] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Each year influenza virus infections cause hundreds of thousands of deaths worldwide and a significant level of morbidity with major economic burden. At the present time, vaccination with inactivated virus vaccine produced from embryonated chicken eggs is the most prevalent method to prevent the infections. However, current influenza vaccines are only effective against closely matched circulating strains and must be updated and administered yearly. Therefore, generating a vaccine that can provide broad protection is greatly needed for influenza vaccine development. We have previously shown that vaccination of the major surface glycoprotein hemagglutinin (HA) of influenza virus with a single N-acetylglucosamine at each of the N-glycosylation sites [monoglycosylated HA (HAmg)] can elicit better cross-protection compared with the fully glycosylated HA (HAfg). In the current study, we produced monoglycosylated inactivated split H1N1 virus vaccine from chicken eggs by the N-glycosylation process inhibitor kifunensine and the endoglycosidase Endo H, and intramuscularly immunized mice to examine its efficacy. Compared with vaccination of the traditional influenza vaccine with complex glycosylations from eggs, the monoglycosylated split virus vaccine provided better cross-strain protection against a lethal dose of virus challenge in mice. The enhanced antibody responses induced by the monoglycosylated vaccine immunization include higher neutralization activity, higher hemagglutination inhibition, and more HA stem selectivity, as well as, interestingly, higher antibody-dependent cellular cytotoxicity. This study provides a simple and practical procedure to enhance the cross-strain protection of influenza vaccine by removing the outer part of glycans from the virus surface through modifications of the current egg-based process.
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17
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Sambala EZ, Ndwandwe DE, Imaan LM, Wiysonge CS. Evaluation of influenza surveillance systems in sub-Saharan Africa: a systematic review protocol. BMJ Open 2019; 9:e023335. [PMID: 30782704 PMCID: PMC6352753 DOI: 10.1136/bmjopen-2018-023335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Influenza infrastructure systems are crucial for maintaining surveillance operations, and for mitigating and responding to the disease. The role of surveillance is to isolate and identify as rapidly as possible any new influenza strains and collate this information for the preparedness for, and response to, an impending influenza activity in humans. However, sources of surveillance information, particularly in Africa, are meagre. This systematic review will critically evaluate the existing influenza surveillance systems in sub-Saharan Africa. METHOD AND ANALYSIS We will build multiple electronic database search strategies for use in PubMed, Scopus, African Journal Online, Web of Science and Google scholar to identify as many studies as possible. The medical subject heading and keywords will include a wide range of synonyms, both in index terms and free-text words. Database search will be followed by hand searching of reference lists of all relevant studies. We will include eligible full-text studies published from 2002 in order to coincide with the establishment of the integrated disease surveillance and response system in Africa by WHO. We will examine the influenza surveillance performance systems using the US Centers for Disease Control and Prevention guidelines on evaluating public health surveillance systems. Our outcome measures will include surveillance system attributes such as timeliness, sensitivity, specificity, acceptability, representativeness, simplicity and usefulness. We will conduct a narrative synthesis of all studies. ETHICS AND DISSEMINATION This study does not require ethics approval because it uses publicly available data. Our findings will be published in a peer review journal and disseminated to policy makers. PROSPERO REGISTRATION NUMBER CRD42018103042.
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Affiliation(s)
- Evanson Zondani Sambala
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, Western Cape, South Africa
- Malawi Public Health Forum, Lilongwe, Malawi
| | - Duduzile Edith Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, Western Cape, South Africa
| | - Loveness M Imaan
- Malawi Public Health Forum, Lilongwe, Malawi
- Social Work Department, Catholic University of Malawi, Blantyre, Malawi
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, Western Cape, South Africa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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18
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Redondo E, Rivero-Calle I, Vargas DA, Mascarós E, Díaz-Maroto JL, Linares M, Gil A, Molina J, Jimeno I, Ocaña D, Yuste JE, Martinón-Torres F. [Adult community acquired pneumonia vaccination: 2018 Update of the positioning of the Pneumonia Prevention Expert Group]. Semergen 2018; 44:590-597. [PMID: 30318406 DOI: 10.1016/j.semerg.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/28/2018] [Indexed: 02/06/2023]
Abstract
Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the 2016 practical prevention guidelines for CAP through vaccination in Spain, based on the available vaccines, as well as the evidence using a literature review and expert opinion. Vaccines against pneumococcus and influenza continue to be the main prevention tools available against CAP, and can contribute to reduce the burden of disease due to CAP and its associated complications. The available evidence supports the priority indications established in these guidelines, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.
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Affiliation(s)
- E Redondo
- Grupo de Actividades Preventivas y Salud Pública SEMERGEN. Centro de Salud Internacional Ayuntamiento de Madrid, Madrid, España.
| | - I Rivero-Calle
- Sección de Pediatría Clínica, Infectológica y Traslacional, Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Genética, Vacunas e Infecciones Pediátricas (GENVIP), Instituto de Investigación de Santiago, Santiago de Compostela, La Coruña, España
| | - D A Vargas
- Unidad de Hospitalización Versátil, Hospital de Alta Resolución El Toyo. Agencia Pública Sanitaria, Hospital de Poniente, Almería, España
| | - E Mascarós
- Departamento de Salud Dr. Peset, Centro de Atención Primaria Fuente de San Luís, Valencia, España
| | - J L Díaz-Maroto
- Centro de Atención Primaria de Guadalajara, Guadalajara, España
| | - M Linares
- Grupo de Enfermedades Infecciosas de SEMERGEN, Fundación io, Madrid, España
| | - A Gil
- Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
| | - J Molina
- Centro de Atención Primaria Francia, Fuenlabrada, Madrid, España
| | - I Jimeno
- Centro de salud Isla de Oza, Madrid, España
| | - D Ocaña
- Centro de Atención Primaria Algeciras-Norte, Algeciras, Cádiz, España
| | - J E Yuste
- Centro Nacional de Microbiología, Instituto de Salud Carlos III y CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - F Martinón-Torres
- Sección de Pediatría Clínica, Infectológica y Traslacional, Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Genética, Vacunas e Infecciones Pediátricas (GENVIP), Instituto de Investigación de Santiago, Santiago de Compostela, La Coruña, España
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Chen WA, Zhang J, Hall KM, Martin CB, Kisselev S, Dasen EJ, Vahanian NN, Link CJ, Martin BK. Addition of αGal HyperAcute™ technology to recombinant avian influenza vaccines induces strong low-dose antibody responses. PLoS One 2017; 12:e0182683. [PMID: 28787006 PMCID: PMC5546595 DOI: 10.1371/journal.pone.0182683] [Citation(s) in RCA: 4] [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: 12/29/2016] [Accepted: 07/21/2017] [Indexed: 12/12/2022] Open
Abstract
Highly pathogenic avian influenza represents a severe public health threat. Over the last decade, the demand for highly efficacious vaccines against avian influenza viruses has grown, especially after the 2013 H7N9 outbreak in China that resulted in over 600 human cases with over 200 deaths. Currently, there are several H5N1 and H7N9 influenza vaccines in clinical trials, all of which employ traditional oil-in-water adjuvants due to the poor immunogenicity of avian influenza virus antigens. In this study, we developed potent recombinant avian influenza vaccine candidates using HyperAcute™ Technology, which takes advantage of naturally-acquired anti-αGal immunity in humans. We successfully generated αGal-positive recombinant protein and virus-like particle vaccine candidates of H5N1 and H7N9 influenza strains using either biological or our novel CarboLink chemical αGal modification techniques. Strikingly, two doses of 100 ng αGal-modified vaccine, with no traditional adjuvant, was able to induce a much stronger humoral response in αGT BALB/c knockout mice (the only experimental system readily available for testing αGal in vivo) than unmodified vaccines even at 10-fold higher dose (1000 ng/dose). Our data strongly suggest that αGal modification significantly enhances the humoral immunogenicity of the recombinant influenza vaccine candidates. Use of αGal HyperAcute™ technology allows significant dose-sparing while retaining desired immunogenicity. Our success in the development of highly potent H5N1 and H7N9 vaccine candidates demonstrated the potential of αGal HyperAcute™ technology for the development of vaccines against other infectious diseases.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Viral/immunology
- Epitopes/immunology
- Female
- Galactosyltransferases/deficiency
- Galactosyltransferases/genetics
- Gene Knockout Techniques
- Immunity, Humoral/immunology
- Influenza A Virus, H5N1 Subtype/immunology
- Influenza A Virus, H7N9 Subtype/immunology
- Influenza Vaccines/chemistry
- Influenza Vaccines/genetics
- Influenza Vaccines/immunology
- Mice
- Mice, Inbred BALB C
- Vaccines, Synthetic/chemistry
- Vaccines, Synthetic/genetics
- Vaccines, Synthetic/immunology
- Vaccines, Virus-Like Particle/genetics
- Vaccines, Virus-Like Particle/immunology
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Affiliation(s)
- Wenlan Alex Chen
- NewLink Genetics Corp., Ames, Iowa, United States of America
- * E-mail: (WAC); (BKM)
| | - Jinjin Zhang
- NewLink Genetics Corp., Ames, Iowa, United States of America
| | - Katie M. Hall
- NewLink Genetics Corp., Ames, Iowa, United States of America
| | - Carol B. Martin
- NewLink Genetics Corp., Ames, Iowa, United States of America
| | | | - Emily J. Dasen
- NewLink Genetics Corp., Ames, Iowa, United States of America
| | | | - Charles J. Link
- NewLink Genetics Corp., Ames, Iowa, United States of America
| | - Brian K. Martin
- NewLink Genetics Corp., Ames, Iowa, United States of America
- * E-mail: (WAC); (BKM)
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20
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Zhu W, Wang C, Wang BZ. From Variation of Influenza Viral Proteins to Vaccine Development. Int J Mol Sci 2017; 18:ijms18071554. [PMID: 28718801 PMCID: PMC5536042 DOI: 10.3390/ijms18071554] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 11/19/2022] Open
Abstract
Recurrent influenza epidemics and occasional pandemics are one of the most important global public health concerns and are major causes of human morbidity and mortality. Influenza viruses can evolve through antigen drift and shift to overcome the barriers of human immunity, leading to host adaption and transmission. Mechanisms underlying this viral evolution are gradually being elucidated. Vaccination is an effective method for the prevention of influenza virus infection. However, the emergence of novel viruses, including the 2009 pandemic influenza A (H1N1), the avian influenza A virus (H7N9), and the highly pathogenic avian influenza A virus (HPAI H5N1), that have infected human populations frequently in recent years reveals the tremendous challenges to the current influenza vaccine strategy. A better vaccine that provides protection against a wide spectrum of various influenza viruses and long-lasting immunity is urgently required. Here, we review the evolutionary changes of several important influenza proteins and the influence of these changes on viral antigenicity, host adaption, and viral pathogenicity. Furthermore, we discuss the development of a potent universal influenza vaccine based on this knowledge.
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Affiliation(s)
- Wandi Zhu
- Center for Inflammation, Immunity & Infection, Georgia State University Institute for Biomedical Sciences, Atlanta, GA 30303, USA.
| | - Chao Wang
- Center for Inflammation, Immunity & Infection, Georgia State University Institute for Biomedical Sciences, Atlanta, GA 30303, USA.
| | - Bao-Zhong Wang
- Center for Inflammation, Immunity & Infection, Georgia State University Institute for Biomedical Sciences, Atlanta, GA 30303, USA.
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21
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Akand EH, Downard KM. Mutational analysis employing a phylogenetic mass tree approach in a study of the evolution of the influenza virus. Mol Phylogenet Evol 2017; 112:209-217. [DOI: 10.1016/j.ympev.2017.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/29/2017] [Accepted: 04/05/2017] [Indexed: 11/28/2022]
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22
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Wilson JR, Guo Z, Reber A, Kamal RP, Music N, Gansebom S, Bai Y, Levine M, Carney P, Tzeng WP, Stevens J, York IA. An influenza A virus (H7N9) anti-neuraminidase monoclonal antibody with prophylactic and therapeutic activity in vivo. Antiviral Res 2016; 135:48-55. [PMID: 27713074 DOI: 10.1016/j.antiviral.2016.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 12/09/2022]
Abstract
Zoonotic A(H7N9) avian influenza viruses emerged in China in 2013 and continue to be a threat to human public health, having infected over 800 individuals with a mortality rate approaching 40%. Treatment options for people infected with A(H7N9) include the use of neuraminidase (NA) inhibitors. However, like other influenza viruses, A(H7N9) can become resistant to these drugs. The use of monoclonal antibodies is a rapidly developing strategy for controlling influenza virus infection. Here we generated a murine monoclonal antibody (3c10-3) directed against the NA of A(H7N9) and show that prophylactic systemic administration of 3c10-3 fully protected mice from lethal challenge with wild-type A/Anhui/1/2013 (H7N9). Further, post-infection treatment with a single systemic dose of 3c10-3 at either 24, 48 or 72 h post A(H7N9) challenge resulted in both dose- and time-dependent protection of up to 100% of mice, demonstrating therapeutic potential for 3c10-3. Epitope mapping revealed that 3c10-3 binds near the enzyme active site of NA, and functional characterization showed that 3c10-3 inhibits the enzyme activity of NA and restricts the cell-to-cell spread of the virus in cultured cells. Affinity analysis also revealed that 3c10-3 binds equally well to recombinant NA of wild-type A/Anhui/1/2013 and to a variant NA carrying a R289K mutation known to infer NAI resistance. These results suggest that 3c10-3 has the potential to be used as a therapeutic to treat A(H7N9) infections either as an alternative to, or in combination with, current NA antiviral inhibitors.
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Affiliation(s)
- Jason R Wilson
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA; Carter Consulting, Inc., Atlanta, GA, USA
| | - Zhu Guo
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adrian Reber
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ram P Kamal
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA; Battelle Memorial Institute, Atlanta, GA, USA
| | - Nedzad Music
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA; Battelle Memorial Institute, Atlanta, GA, USA
| | - Shane Gansebom
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA; Carter Consulting, Inc., Atlanta, GA, USA
| | - Yaohui Bai
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Min Levine
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Carney
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wen-Pin Tzeng
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James Stevens
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ian A York
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Drews SJ. The Role of Clinical Virology Laboratory and the Clinical Virology Laboratorian in Ensuring Effective Surveillance for Influenza and Other Respiratory Viruses: Points to Consider and Pitfalls to Avoid. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016; 8:165-176. [PMID: 32226325 PMCID: PMC7100664 DOI: 10.1007/s40506-016-0081-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Influenza and respiratory viruses have a global impact on public health. Clinical virology laboratories and laboratorians play an important role in not only the diagnosis but also the surveillance of these pathogens. Surveillance for influenza and other respiratory pathogens is important, as it informs public health decision making in terms of influenza vaccine and antiviral effectiveness, informs clinicians and public health practitioners about the pathogenicity of specific viral strains, guides clinical practice, and supports laboratory panning activities. Key background issues include the following: the fact that the laboratory is only one of several data providers to a surveillance system, the biologic nature of influenza and respiratory viruses and the laboratory needs to keep up to date on the diagnosis of these agents, the need for laboratorians to be involved in case definition development, the impact of push and pull data flow models on laboratory resources, and the fact that laboratories may be asked to provide more than just test results to surveillance programs. This review also identifies some key issues or questions that arise during the pre-analytic, analytic, and post-analytic phases that could impact on the ability of the laboratory to link to surveillance programs. Finally, issues surrounding virus characterization programs and how they link to surveillance programs are identified and discussed.
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Affiliation(s)
- Steven J. Drews
- Provincial Laboratory for Public Health (ProvLab), 2B1.03 WMC, University of Alberta Hospital, Edmonton, Alberta T6G 2J2 Canada
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta Canada
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Järhult JD, Wahlgren J, Hasan B, Salaneck E, Lundkvist Å. Mallard or chicken? Comparing the isolation of avian influenza A viruses in embryonated Mallard and chicken eggs. Infect Ecol Epidemiol 2015; 5:28458. [PMID: 26356095 PMCID: PMC4565061 DOI: 10.3402/iee.v5.28458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/19/2015] [Accepted: 08/16/2015] [Indexed: 11/14/2022] Open
Abstract
Background To date, the most efficient and robust method for isolating avian influenza A viruses (IAVs) is using embryonated chicken eggs (ECEs). It is known that low-pathogenic avian IAVs undergo rapid genetic changes when introduced to poultry holdings, but the factors driving mutagenesis are not well understood. Despite this, there is limited data on the effects of the standard method of virus isolation of avian-derived viruses, that is, whether isolation in ECEs causes adaptive changes in avian IAVs. Eggs from a homologous species could potentially offer an isolation vessel less prone to induce adaptive changes. Methods We performed eight serial passages of two avian IAVs isolated from fecal samples of wild Mallards in both ECEs and embryonated Mallard eggs, and hemagglutination assay titers and hemagglutinin sequences were compared. Results There was no obvious difference in titers between ECEs and embryonated Mallard eggs. Sequence analyses of the isolates showed no apparent difference in the rate of introduction of amino acid substitutions in the hemagglutinin gene (three substitutions in total in embryonated Mallard eggs and two substitutions in ECEs). Conclusion Embryonated Mallard eggs seem to be good isolation vessels for avian IAVs but carry some practical problems such as limited availability and short egg-laying season of Mallards. Our study finds isolation of Mallard-derived avian IAVs in ECEs non-inferior to isolation in embryonated Mallard eggs, but more research in the area may be warranted as this is a small-scale study.
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Affiliation(s)
- Josef D Järhult
- Section for Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden;
| | - John Wahlgren
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Stockholm, Sweden.,The Public Health Agency of Sweden, Solna, Sweden
| | - Badrul Hasan
- Section for Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Erik Salaneck
- Section for Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Åke Lundkvist
- Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.,The Public Health Agency of Sweden, Solna, Sweden
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25
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Leentjens J, Kox M, Stokman R, Gerretsen J, Diavatopoulos DA, van Crevel R, Rimmelzwaan GF, Pickkers P, Netea MG. BCG Vaccination Enhances the Immunogenicity of Subsequent Influenza Vaccination in Healthy Volunteers: A Randomized, Placebo-Controlled Pilot Study. J Infect Dis 2015; 212:1930-8. [PMID: 26071565 DOI: 10.1093/infdis/jiv332] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/28/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Influenza-related morbidity and mortality remain high. Seasonal vaccination is the backbone of influenza management but does not always result in protective antibody titers. Nonspecific effects of BCG vaccination related to enhanced function of myeloid antigen-presenting cells have been reported. We hypothesized that BCG vaccination could also enhance immune responses to influenza vaccination. METHODS Healthy volunteers received either live attenuated BCG vaccine (n = 20) or placebo (n = 20) in a randomized fashion, followed by intramuscular injection of trivalent influenza vaccine 14 days later. Hemagglutination-inhibiting (HI) antibodies and cellular immunity measured by ex vivo leukocyte responses were assessed. RESULTS In BCG-vaccinated subjects, HI antibody responses against the 2009 pandemic influenza A(H1N1) vaccine strain were significantly enhanced, compared with the placebo group, and there was a trend toward more-rapid seroconversion. Additionally, apart from enhanced proinflammatory leukocyte responses following BCG vaccination, nonspecific effects of influenza vaccination were also observed, with modulation of cytokine responses against unrelated pathogens. CONCLUSIONS BCG vaccination prior to influenza vaccination results in a more pronounced increase and accelerated induction of functional antibody responses against the 2009 pandemic influenza A(H1N1) vaccine strain. These results may have implications for the design of vaccination strategies and could lead to improvement of vaccination efficacy.
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Affiliation(s)
- Jenneke Leentjens
- Department of Internal Medicine Department of Intensive Care Medicine, Radboud Institute for Health Sciences
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences
| | - Robin Stokman
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences
| | - Jelle Gerretsen
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences
| | - Dimitri A Diavatopoulos
- Laboratory of Pediatric Infectious Diseases, Radboud Institute for Molecular Life Sciences, Nijmegen
| | | | | | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences
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Yam KK, Gupta J, Winter K, Allen E, Brewer A, Beaulieu É, Mallett CP, Burt DS, Ward BJ. AS03-Adjuvanted, Very-Low-Dose Influenza Vaccines Induce Distinctive Immune Responses Compared to Unadjuvanted High-Dose Vaccines in BALB/c Mice. Front Immunol 2015; 6:207. [PMID: 25972874 PMCID: PMC4413846 DOI: 10.3389/fimmu.2015.00207] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/14/2015] [Indexed: 11/17/2022] Open
Abstract
During the 2009–2010 influenza pandemic, an adjuvanted, dose-sparing vaccine was recommended for most Canadians. We hypothesize that differences exist in the responses to AS03-adjuvanted, low antigen (Ag) dose versus unadjuvanted, full-dose vaccines. We investigated the relationship between Ag dose and the oil-in-water emulsion Adjuvant System AS03. BALB/c mice received two IM doses of AS03A or AS03B with exaggerated dilutions of A/Uruguay/716/2007 H3N2 split virion vaccine Ag. Immune responses were assessed 3 weeks after the booster. Unadjuvanted “high” (3 μg) and low-dose (0.03–0.003 μg) vaccines generated similar serum antibody titers and cytokine secretion patterns in restimulated splenocytes. Compared to unadjuvanted “high-dose” vaccination, both AS03A and AS03B-adjuvanted low-dose vaccines tended to elicit higher serum antibody titers, broader induction of cytokine secretion and generated more influenza-specific antibody secreting cells and cytokine-secreting CD4 and CD8 T cells in splenocytes. We show that varying Ag and/or AS03 dose in this influenza vaccination mouse model can strongly influence both the magnitude and pattern of the immune response elicited. These findings are highly relevant given the likelihood of expanded use of adjuvanted, dose-sparing vaccines and raise questions about the use of “standard” doses of vaccines in pre-clinical vaccine studies.
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Affiliation(s)
- Karen K Yam
- Department of Experimental Medicine, Research Institute of the McGill University Health Centre , Montreal, QC , Canada
| | - Jyotsana Gupta
- Department of Experimental Medicine, Research Institute of the McGill University Health Centre , Montreal, QC , Canada
| | - Kaitlin Winter
- Department of Experimental Medicine, Research Institute of the McGill University Health Centre , Montreal, QC , Canada
| | - Elizabeth Allen
- Department of Experimental Medicine, Research Institute of the McGill University Health Centre , Montreal, QC , Canada
| | - Angela Brewer
- Department of Experimental Medicine, Research Institute of the McGill University Health Centre , Montreal, QC , Canada
| | | | | | | | - Brian J Ward
- Department of Experimental Medicine, Research Institute of the McGill University Health Centre , Montreal, QC , Canada ; Vaccine Study Centre, Research Institute of the McGill University Health Centre , Montreal, QC , Canada
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MicroRNAs as potential biomarkers for VERO cell tumorigenicity. Vaccine 2014; 32:4799-805. [DOI: 10.1016/j.vaccine.2014.05.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/30/2014] [Accepted: 05/20/2014] [Indexed: 01/07/2023]
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28
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McMillan M, Kralik D, Porritt K, Marshall H. Influenza vaccination during pregnancy: a systematic review of effectiveness and safety. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Quinn E, Jit M, Newall AT. Key issues and challenges in estimating the impact and cost-effectiveness of quadrivalent influenza vaccination. Expert Rev Pharmacoecon Outcomes Res 2014; 14:425-35. [PMID: 24734967 DOI: 10.1586/14737167.2014.908713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Evidence has shown that quadrivalent influenza vaccines containing all four subtypes are safe and immunogenic. However, to date there have been few published studies exploring the population-level clinical and economic impact of quadrivalent compared to trivalent influenza vaccines. Economic evaluation studies need to be conducted in order to inform country-level decision making about whether (and how to) introduce and replace the current trivalent influenza vaccines with quadrivalent influenza vaccination programs. Several key issues associated with estimating the clinical and economic impact of the trivalent versus quadrivalent vaccines are discussed in this article, particularly the complexities involved in estimating the incremental preventable disease and economic burden. Other factors, such as the indirect (herd) protection from quadrivalent influenza vaccination and the timing of the replacement of trivalent influenza vaccination programs are also discussed.
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Affiliation(s)
- Emma Quinn
- NSW Ministry of Health , Sydney , Australia
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30
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Regev-Shoshani G, Vimalanathan S, Prema D, Church J, Reudink M, Nation N, Miller C. Safety, bioavailability and mechanism of action of nitric oxide to control Bovine Respiratory Disease Complex in calves entering a feedlot. Res Vet Sci 2014; 96:328-37. [DOI: 10.1016/j.rvsc.2013.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 12/06/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
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Leroux-Roels I, Weber F. Intanza (®) 9 µg intradermal seasonal influenza vaccine for adults 18 to 59 years of age. Hum Vaccin Immunother 2013; 9:115-21. [PMID: 23442585 DOI: 10.4161/hv.22342] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Seasonal influenza in healthy working-age adults accounts for a substantial part of the socioeconomic burden of this disease. Intanza® 9 µg (sanofi pasteur) is a microneedle-delivered intradermal trivalent inactivated influenza vaccine approved in 2009 for the prevention of seasonal influenza in adults 18 to 59 years of age. The microneedle system reliably and reproducibly delivers the vaccine to the dermis. Clinical studies show that Intanza 9 µg is as immunogenic and as well tolerated in working-age adults as a reference intramuscular trivalent inactivated vaccine. Local reactions to Intanza 9 µg, mainly erythema, are transient, mostly mild or moderate, and do not affect acceptability. Intanza 9 µg is considered satisfactory by at least 95% of both vaccinees and prescribers, especially because of the short needle and rapid administration. Because Intanza® 9 µg offers an alternative to intramuscular vaccines, it might help increase influenza vaccine coverage rates.
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Serological survey of the novel influenza A H1N1 in inner city Winnipeg, Manitoba, 2009. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2013; 23:65-70. [PMID: 23730311 DOI: 10.1155/2012/484693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Little is known about the determinants of pandemic H1N1 (pH1N1) infection in Canada among low-income, inner city populations. To inform future influenza planning, the seroprevalence of pH1N1 antibodies among inner city clinic attendees in Winnipeg (Manitoba) according to sociodemographic and risk factor characteristics were estimated and vaccination rates were explored. METHODS Adults presenting to three inner city community clinics in Winnipeg from October 2009 to December 2009 were recruited as study participants (n=458). A questionnaire was administered to collect demographic, risk factor and symptom information, and a venous blood sample was collected for hemagglutination inhibition assay testing to detect the presence of antibodies against pH1N1. RESULTS Approximately one-half (53%) of the study participants reported an annual household income of <$10,000/year, and 65% identified as Aboriginal. pH1N1 positivity was 5.7% among those enrolled early in the study and 15.5% among those enrolled later in the study. Positivity was higher among participants who were female, Aboriginal and in contact with children ≤5 years of age. The overall pH1N1 vaccination rate was 28%. DISCUSSION pH1N1 positivity was high among low-income adults accessing clinics in Winnipeg's inner city compared with the general population. Of further concern were the low rates of uptake of both seasonal and pH1N1 influenza vaccinations. When planning for future influenza outbreaks, it is important to incorporate strategies for the prevention, control, and care of influenza among low-income and inner city adults.
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Regev-Shoshani G, Vimalanathan S, McMullin B, Road J, Av-Gay Y, Miller C. Gaseous nitric oxide reduces influenza infectivity in vitro. Nitric Oxide 2013; 31:48-53. [PMID: 23562771 PMCID: PMC7110511 DOI: 10.1016/j.niox.2013.03.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 03/22/2013] [Accepted: 03/26/2013] [Indexed: 12/02/2022]
Abstract
Gaseous nitric oxide (gNO) is an approved vasodilator drug for inhalation up to a maximum dose of 80 ppm. While gNO has been shown, in vitro, to be an effective antibacterial agent (at 160 ppm), NO-donor compounds have been shown to inhibit a variety of viruses at varying stages of replication. This research was done in order to determine whether gNO at 80 or 160 ppm possesses an antiviral effect on influenza viruses. Three strains of influenza (A and B) were exposed to gNO for up to 180 min, before and after infection of MDCK cells. In search for possible mechanism of antiviral action, Neuraminidase (NA) inhibition assay of H1N1 that was exposed to gNO was performed. Results show that when virions were exposed to gNO prior to infection a complete inhibition of infectivity was achieved for all three strains. Post infection exposure of influenza with gNO resulted in about 30% inhibition of infectivity. Further testing showed that when eliminating the pH effect by exposing a dried virus to gNO, 90% inhibition was found after 2h exposure. NA activity, of whole dried H1N1 virus, was found to be inhibited by gNO (80%). These results suggest that 80 and 160 ppm gNO have a time dependent antiviral effect on influenza strains of viruses during various stages of cellular infection, which are not due to concomitant changes in pH in the surrounding milieu. Viral NA inhibition by gNO was shown and may be responsible for this antiviral effect.
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Affiliation(s)
- Gilly Regev-Shoshani
- Department of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Selvarani Vimalanathan
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bevin McMullin
- Department of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Respiratory Services, Vancouver Coastal Health – UBCH Site, Vancouver, British Columbia, Canada
| | - Jeremy Road
- Department of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yossef Av-Gay
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Microbiology and Infections Control, Vancouver Coastal Health at Vancouver General Hospital and at University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Miller
- Department of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Health care reform calls for the nursing profession, with a focus on disease prevention and health restoration, to innovate and create new models of care that are client-centric, evidence-based, and cost-effective. To do so, nurses must develop a fundamentally different paradigm and epistemology. New care models are required that focus on issues such as evidence-based prevention. Among the prevention foci for hospitals are hospital-acquired infections, including influenza, which kills 36,000 Americans annually. One crucial step in eliminating hospital-acquired influenza is to require influenza vaccination of all health care workers. This article challenges nursing leadership to seize opportunities to lead health care initiatives and encourage courageous innovative actions that depart from old paradigms; these actions must be based on scientific evidence, reduce costs, and promote patient safety and quality care and outcomes.
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Affiliation(s)
- Sharon Tucker
- University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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35
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Tucker S, Poland GA. Health Care Reform and Influenza Immunization. Workplace Health Saf 2013. [DOI: 10.3928/21650799-20130426-75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Velan B, Boyko V, Shenhar G, Lerner-Geva L, Kaplan G. Analysis of public responses to preparedness policies: the cases of H1N1 influenza vaccination and gas mask distribution. Isr J Health Policy Res 2013; 2:11. [PMID: 23537171 PMCID: PMC3621681 DOI: 10.1186/2045-4015-2-11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/28/2013] [Indexed: 01/26/2023] Open
Abstract
Background During several months in 2009–2010, the Israeli population was asked to take part in two preparedness programs: Acquisition of gas masks against a potential chemical-warfare attack, and vaccination against the A/H1N1 influenza pandemics. Compliance with the first request was moderate and did not attract much attention, whereas compliance with the second request was very low and was accompanied by significant controversy. The aims of this study are to compare the public’s attitudes towards these two preparedness campaigns, and to explore the roles of trust, reasoned assessment, and reflexive reactions in the public’s response to governmental preparedness policies. Methods The comparative analysis was based on a telephone survey of 2,018 respondents representing a cross-section of the adult Israeli population. Univariate analysis to describe associations of public response and attitude was performed by Chi-square tests. Findings A set of queries related to actual compliance, trust in credibility of authorities, personal opinions, reasons for non-compliance, and attitudes towards uncertainties was used to characterize the response to mask-acquisition and vaccination. In the case of mask-acquisition, the dominant response profile was of trusting compliance based on non-conditional belief in the need to adhere to the recommendation (35.6% of respondents). In the case of vaccination, the dominant response profile was of trusting non-compliance based on a reflective belief in the need for adherence (34.8% of respondents). Among the variables examined in the study, passivity was found to be the major reason for non-compliance with mask-acquisition, whereas reasoned assessment of risk played a major role in non-compliance with vaccination. Realization of the complexity in dealing with uncertainty related to developing epidemics and to newly-developed vaccines was identified in the public’s response to the H1N1 vaccination campaign. Conclusions The newly identified profile of “trusting-reflective-non-complier” individuals should be of concern to policy makers. The public is not accepting governmental recommendations in an unconditional manner. This is not driven by lack of trust in authorities, but rather by the perception of the responsibility of individuals in confronting forthcoming risks. Nevertheless, under certain conditions the public may respond in a non-reflective way and delegate this responsibly to authorities in an uncontested manner. This leaves the policy makers with the complex challenge of interacting with a passive non-involved public or alternatively with an opinionated, reflexive public.
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Affiliation(s)
- Baruch Velan
- Genetic Policy and Bioethics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer 52621, Israel.
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Erythropoietin treatment is associated with an augmented immune response to the influenza vaccine in hematologic patients. Exp Hematol 2013; 41:167-71. [DOI: 10.1016/j.exphem.2012.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 09/07/2012] [Accepted: 10/17/2012] [Indexed: 01/08/2023]
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Influenza vaccination among cancer survivors: disparities in prevalence between blacks and whites. J Cancer Surviv 2013; 7:183-90. [PMID: 23315210 DOI: 10.1007/s11764-012-0257-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/22/2012] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cancer survivors are at increased risk for influenza-related complications. Racial disparities in preventive health services have not been extensively studied among cancer survivors. Our objective is to compare influenza vaccination prevalence among black and white cancer survivors METHODS We performed a secondary data analysis of 41,346 white and black cancer survivors (excluding non-melanoma skin cancer) from the 2009 Behavioral Risk Factor Surveillance System survey. Respondents were asked whether they had received an influenza vaccination in the previous year. Multivariable logistic regression was used to estimate the odds of having influenza vaccine by race. RESULTS Sixty-five percent of whites reported receiving the vaccine in the last year compared to 50 % of blacks. Blacks had significantly lower odds of vaccination after controlling for covariates significantly associated with the odds of influenza vaccination. Higher education, having health insurance, having a primary care provider, and having a routine check-up in the last year increased the odds of receiving an influenza vaccine. CONCLUSIONS Our analysis supports that racial disparities in vaccine coverage persist among cancer survivors, a group strongly recommended to receive annual influenza vaccine, even when predictors significantly associated with increased vaccination are controlled for. IMPLICATIONS FOR CANCER SURVIVORS As a nationally representative survey with a large sample size, our study provides a picture of self-reported vaccine coverage among cancer survivors in the USA and the disparity that exists between blacks and whites in this population. Care teams can use these findings to better target follow-up care for cancer survivors.
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Margine I, Martinez-Gil L, Chou YY, Krammer F. Residual baculovirus in insect cell-derived influenza virus-like particle preparations enhances immunogenicity. PLoS One 2012; 7:e51559. [PMID: 23236516 PMCID: PMC3517492 DOI: 10.1371/journal.pone.0051559] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 11/05/2012] [Indexed: 12/22/2022] Open
Abstract
Influenza virus-like particles are currently evaluated in clinical trials as vaccine candidates for influenza viruses. Most commonly they are produced in baculovirus- or mammalian- expression systems. Here we used different vaccination schemes in order to systematically compare virus-like particle preparations generated in the two systems. Our work shows significant differences in immunogenicity between the two, and indicates superior and broader immune responses induced by the baculovirus-derived constructs. We demonstrate that these differences critically influence protection and survival in a mouse model of influenza virus infection. Finally, we show that the enhanced immunogenicity of the baculovirus-derived virus-like particles is caused by contamination with residual baculovirus which activates the innate immune response at the site of inoculation.
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Affiliation(s)
- Irina Margine
- Department of Microbiology, Mount Sinai School of Medicine, New York, New York, United States of America
- Graduate School of Biological Sciences, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Luis Martinez-Gil
- Department of Microbiology, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Yi-ying Chou
- Department of Microbiology, Mount Sinai School of Medicine, New York, New York, United States of America
- Graduate School of Biological Sciences, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Florian Krammer
- Department of Microbiology, Mount Sinai School of Medicine, New York, New York, United States of America
- * E-mail:
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Liu X, Guo J, Han S, Yao L, Chen A, Yang Q, Bo H, Xu P, Yin J, Zhang Z. Enhanced immune response induced by a potential influenza A vaccine based on branched M2e polypeptides linked to tuftsin. Vaccine 2012; 30:6527-33. [PMID: 22959982 DOI: 10.1016/j.vaccine.2012.08.054] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
Vaccination is the most effective means for preventing influenza-associated morbidity and mortality. Since the influenza virus mutates frequently, the virus strains for new vaccine production should be changed according to predicted epidemic strains. The extracellular domain of matrix protein 2 (M2e) is 24 amino acids long, which is highly conserved and therefore a good target for the development of a universal vaccine which may protect against a much wider range of influenza A virus strains. However its low antigenicity and immunogenicity, which are related to its small size, poses a big challenge for vaccine development. Multiple antigen peptide system (MAP) is based on an inert core molecule of radially branching lysine dendrites onto which a number of peptide antigens are anchored. Tuftsin is an immuno-stimulant molecule peptide. Here we developed a novel peptide vaccine by connecting a tuftsin to a branched, four-copy M2e. Not only did this increase the molecular mass, but also potentiate the immunogenicity. Two branched peptides, (M2e)4-tuftsin and (M2e)4-G4(tuftsin was replaced with four glycines), and a M2e monomer were synthesized using standard solid-phase methods. In vitro and in vivo studies were performed to compare their antigenicity and immunogenicity. Experiments in BALB/c mice demonstrated that the branched M2e could induce stronger humoral and cellular immune responses than the M2e monomer, and (M2e)4-tuftsin induced stronger humoral and cellular immune response than (M2e)4-G4. After lethal challenge with influenza virus PR8 strain, up to 80% of the animals in the (M2e)4-tuftsin vaccinated group still survived, in contrast to 44% in the (M2e)4-G4 group and 30% in the M2e monomer group. The combination of branched polypeptides and tuftsin in vaccine design is presented here for the first time, and the results show that the new construct is a promising candidate for a universal vaccine against the influenza A virus.
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Affiliation(s)
- Xiaoyu Liu
- Institute for Viral Disease Control and Prevention, China CDC, Changbai Road 155, Beijing, 102206, China
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Lau AYS, Sintchenko V, Crimmins J, Magrabi F, Gallego B, Coiera E. Protocol for a randomised controlled trial examining the impact of a web-based personally controlled health management system on the uptake of influenza vaccination rates. BMC Health Serv Res 2012; 12:86. [PMID: 22462549 PMCID: PMC3364146 DOI: 10.1186/1472-6963-12-86] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 04/02/2012] [Indexed: 12/04/2022] Open
Abstract
Background Online social networking and personally controlled health management systems (PCHMS) offer a new opportunity for developing innovative interventions to prevent diseases of public health concern (e.g., influenza) but there are few comparative studies about patterns of use and impact of these systems. Methods/Design A 2010 CONSORT-compliant randomised controlled trial with a two-group parallel design will assess the efficacy of a web-based PCHMS called Healthy.me in facilitating the uptake of influenza vaccine amongst university students and staff. Eligible participants are randomised either to obtain access to Healthy.me or a 6-month waitlist. Participants complete pre-study, post-study and monthly surveys about their health and utilisation of health services. A post-study clinical audit will be conducted to validate self-reports about influenza vaccination and visits to the university health service due to influenza-like illness (ILI) amongst a subset of participants. 600 participants older than 18 years with monthly access to the Internet and email will be recruited. Participants who (i) discontinue the online registration process; (ii) report obtaining an influenza vaccination in 2010 before the commencement of the study; or (iii) report being influenced by other participants to undertake influenza vaccination will be excluded from analysis. The primary outcome measure is the number of participants obtaining influenza vaccination during the study. Secondary outcome measures include: number of participants (i) experiencing ILI symptoms, (ii) absent from or experiencing impairment in work or study due to ILI symptoms, (iii) using health services or medications due to ILI symptoms; (iv) expressing positive or negative attitudes or experiences towards influenza vaccination, via their reasons of receiving (or not receiving) influenza vaccine; and (v) their patterns of usage of Healthy.me (e.g., frequency and timing of hits, duration of access, uptake of specific functions). Discussion This study will provide new insights about the utility of online social networking and PCHMS for public health and health promotion. It will help to assess whether a web-based PCHMS, with connectivity to a health service provider, containing information and self-management tools, can improve the uptake of preventive health services amongst university students and staff. Trial registration ACTRN12610000386033 (Australian New Zealand Clinical Trials Registry)
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Affiliation(s)
- Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia.
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Application of deglycosylation to SDS PAGE analysis improves calibration of influenza antigen standards. Biologicals 2012; 40:96-9. [DOI: 10.1016/j.biologicals.2011.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 11/21/2011] [Accepted: 12/20/2011] [Indexed: 11/19/2022] Open
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Kaminski DA, Lee FEH. Antibodies against conserved antigens provide opportunities for reform in influenza vaccine design. Front Immunol 2011; 2:76. [PMID: 22566865 PMCID: PMC3342000 DOI: 10.3389/fimmu.2011.00076] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 11/26/2011] [Indexed: 11/13/2022] Open
Abstract
High-performance neutralizing antibody against influenza virus typically recognizes the globular head region of its hemagglutinin (HA) envelope glycoprotein. To-date, approved human vaccination strategies have been designed to induce such antibodies as a sole means of preventing the consequences of this infection. However, frequent amino-acid changes in the HA globular head allow for efficient immune evasion. Consequently, vaccines inducing such neutralizing antibodies need to be annually re-designed and re-administered at a great expense. These vaccines furthermore provide little-to-no immunity against antigenic-shift strains, which arise from complete replacement of HA or of neuraminidase genes, and pose pandemic risks. To address these issues, laboratory research has focused on inducing immunity effective against all strains, regardless of changes in the HA globular head. Despite prior dogma that such cross-protection needs to be induced by cellular immunity alone, several advances in recent years demonstrate that antibodies of other specificities are capable of cross-strain protection in mice. This review discusses the reactivity, induction, efficacy, and mechanisms of antibodies that react with poorly accessible epitopes in the HA stalk, with the matrix 2 membrane ion channel, and even with the internal nucleoprotein. These advances warrant further investigation of the inducibility and efficacy of such revolutionary antibody strategies in humans.
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Affiliation(s)
- Denise A Kaminski
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Rochester, NY, USA.
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Infection with seasonal influenza virus elicits CD4 T cells specific for genetically conserved epitopes that can be rapidly mobilized for protective immunity to pandemic H1N1 influenza virus. J Virol 2011; 85:13310-21. [PMID: 21976658 DOI: 10.1128/jvi.05728-11] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In recent years, influenza viruses with pandemic potential have been a major concern worldwide. One unresolved issue is how infection or vaccination with seasonal influenza virus strains influences the ability to mount a protective immune response to novel pandemic strains. In this study, we developed a mouse model of primary and secondary influenza infection by using a widely circulating seasonal H1N1 virus and the pandemic strain of H1N1 that emerged in Mexico in 2009, and we evaluated several key issues. First, using overlapping peptide libraries encompassing the entire translated sequences of 5 major influenza virus proteins, we assessed the specificity of CD4 T cell reactivity toward epitopes conserved among H1N1 viruses or unique to the seasonal or pandemic strain by enzyme-linked immunospot (ELISpot) assays. Our data show that CD4 T cells reactive to both virus-specific and genetically conserved epitopes are elicited, allowing separate tracking of these responses. Populations of cross-reactive CD4 T cells generated from seasonal influenza infection were found to expand earlier after secondary infection with the pandemic H1N1 virus than CD4 T cell populations specific for new epitopes. Coincident with this rapid CD4 T cell response was a potentiated neutralizing-antibody response to the pandemic strain and protection from the pathological effects of infection with the pandemic virus. This protection was not dependent on CD8 T cells. Together, our results indicate that exposure to seasonal vaccines and infection elicits CD4 T cells that promote the ability of the mammalian host to mount a protective immune response to pandemic strains of influenza virus.
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Acceptance of Intanza® 9 μg intradermal influenza vaccine in routine clinical practice in Australia and Argentina. Adv Ther 2011; 28:640-9. [PMID: 21751080 DOI: 10.1007/s12325-011-0042-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Intanza® 9 μg (Sanofi Pasteur SA, Lyon, France), a split virion trivalent influenza vaccine delivered by intradermal injection with a microinjection system, became available as a vaccination for adults aged 18 to 59 years old, as of the 2010 southern hemisphere influenza season. METHODS This study was designed to assess the acceptability of intradermal vaccination with Intanza 9 μg in routine clinical practice by adult vaccinees and their prescribers. Prescribers and healthy adults 18 to 59 years old in Australia and Argentina who had elected to be vaccinated with Intanza 9 μg during the 2010 southern hemisphere influenza season were recruited to complete surveys about their opinions of influenza vaccination and acceptance of the intradermal vaccination. RESULTS 1402 vaccinees and 30 prescribers in Australia, and 264 vaccinees and 16 prescribers in Argentina responded to surveys. In both countries, 98% of vaccinees were satisfied or very satisfied with Intanza 9 μg. The main reasons for satisfaction were that the injection was considered minimally painful and that the vaccination was quickly administered. Most (95%) vaccinees reported that they would prefer to receive the same vaccination next year. Furthermore, 85% of prescribers were satisfied or very satisfied with the intradermal vaccine. CONCLUSION Intradermal vaccination for seasonal influenza using Intanza 9 μg is well accepted both by adult vaccinees and prescribers. By providing an additional, well-accepted method, Intanza 9 μg might help increase seasonal influenza vaccination rates in adults.
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Eichelberger MC, Green MD. Animal models to assess the toxicity, immunogenicity and effectiveness of candidate influenza vaccines. Expert Opin Drug Metab Toxicol 2011; 7:1117-27. [PMID: 21749266 DOI: 10.1517/17425255.2011.602065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Every year, > 100 million doses of licensed influenza vaccine are administered worldwide, with relatively few serious adverse events reported. Initiatives to manufacture influenza vaccines on different platforms have come about to ensure timely production of strain-specific as well as universal vaccines. To prevent adverse events that may be associated with these new vaccines, it is important to evaluate the toxicity of new formulations in animal models. AREAS COVERED This review outlines preclinical studies that evaluate safety, immunogenicity and effectiveness of novel products to support further development and clinical trials. This has been done through a review of the latest literature describing vaccines under development. EXPERT OPINION The objective of preclinical safety tests is to demonstrate the absence of toxic contaminants and adventitious agents. Additional tests that characterize vaccine content more completely, or demonstrate the absence of exacerbated disease following virus challenge in vaccinated animals, may provide additional data to ensure the safety of new vaccine strategies.
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Affiliation(s)
- Maryna C Eichelberger
- Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD 20892, USA.
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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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LaMere MW, Moquin A, Lee FEH, Misra RS, Blair PJ, Haynes L, Randall TD, Lund FE, Kaminski DA. Regulation of antinucleoprotein IgG by systemic vaccination and its effect on influenza virus clearance. J Virol 2011; 85:5027-35. [PMID: 21367900 PMCID: PMC3126167 DOI: 10.1128/jvi.00150-11] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 02/22/2011] [Indexed: 11/20/2022] Open
Abstract
Seasonal influenza epidemics recur due to antigenic drift of envelope glycoprotein antigens and immune evasion of circulating viruses. Additionally, antigenic shift can lead to influenza pandemics. Thus, a universal vaccine that protects against multiple influenza virus strains could alleviate the continuing impact of this virus on human health. In mice, accelerated clearance of a new viral strain (cross-protection) can be elicited by prior infection (heterosubtypic immunity) or by immunization with the highly conserved internal nucleoprotein (NP). Both heterosubtypic immunity and NP-immune protection require antibody production. Here, we show that systemic immunization with NP readily accelerated clearance of a 2009 pandemic H1N1 influenza virus isolate in an antibody-dependent manner. However, human immunization with trivalent inactivated influenza virus vaccine (TIV) only rarely and modestly boosted existing levels of anti-NP IgG. Similar results were observed in mice, although the reaction could be enhanced with adjuvants, by adjusting the stoichiometry among NP and other vaccine components, and by increasing the interval between TIV prime and boost. Importantly, mouse heterosubtypic immunity that had waned over several months could be enhanced by injecting purified anti-NP IgG or by boosting with NP protein, correlating with a long-lived increase in anti-NP antibody titers. Thus, current immunization strategies poorly induce NP-immune antibody that is nonetheless capable of contributing to long-lived cross-protection. The high conservation of NP antigen and the known longevity of antibody responses suggest that the antiviral activity of anti-NP IgG may provide a critically needed component of a universal influenza vaccine.
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Affiliation(s)
- Mark W. LaMere
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York 14642
| | - Amy Moquin
- Trudeau Institute, Saranac Lake, New York 12983
| | - F. Eun-Hyung Lee
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York 14642
| | - Ravi S. Misra
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York 14642
| | - Patrick J. Blair
- Respiratory Diseases Research Department, Naval Health Research Center, San Diego, California 92106
| | | | - Troy D. Randall
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York 14642
| | - Frances E. Lund
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York 14642
| | - Denise A. Kaminski
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center, Rochester, New York 14642
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LaMere MW, Lam HT, Moquin A, Haynes L, Lund FE, Randall TD, Kaminski DA. Contributions of antinucleoprotein IgG to heterosubtypic immunity against influenza virus. THE JOURNAL OF IMMUNOLOGY 2011; 186:4331-9. [PMID: 21357542 DOI: 10.4049/jimmunol.1003057] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Influenza A virus causes recurring seasonal epidemics and occasional influenza pandemics. Because of changes in envelope glycoprotein Ags, neutralizing Abs induced by inactivated vaccines provide limited cross-protection against new viral serotypes. However, prior influenza infection induces heterosubtypic immunity that accelerates viral clearance of a second strain, even if the external proteins are distinct. In mice, cross-protection can also be elicited by systemic immunization with the highly conserved internal nucleoprotein (NP). Both T lymphocytes and Ab contribute to such cross-protection. In this paper, we demonstrate that anti-NP IgG specifically promoted influenza virus clearance in mice by using a mechanism involving both FcRs and CD8(+) cells. Furthermore, anti-NP IgG rescued poor heterosubtypic immunity in B cell-deficient mice, correlating with enhanced NP-specific CD8 T cell responses. Thus, Ab against this conserved Ag has potent antiviral activity both in naive and in influenza-immune subjects. Such antiviral activity was not seen when mice were vaccinated with another internal influenza protein, nonstructural 1. The high conservation of NP Ag and the known longevity of Ab responses suggest that anti-NP IgG may provide a critically needed component of a universal influenza vaccine.
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Affiliation(s)
- Mark W LaMere
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
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Benjamins MR, Ellison CG, Krause NM, Marcum JP. Religion and preventive service use: do congregational support and religious beliefs explain the relationship between attendance and utilization? J Behav Med 2011; 34:462-76. [PMID: 21286800 DOI: 10.1007/s10865-011-9318-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 01/14/2011] [Indexed: 11/27/2022]
Abstract
Religious individuals are more likely to engage in healthy practices, including using preventive services; however, the underlying mechanisms have not been adequately explored. To begin addressing this, the current study examines the association between religious attendance, four aspects of congregational support, two health-related religious beliefs, and the use of preventive services (cholesterol screening, flu shot, and colonoscopy) among a national sample of Presbyterian adults (n = 1,076). The findings show that two aspects of congregational support are relevant to these types of behavioral health. First, church-based health activities are significantly related to the use of cholesterol screenings and flu shots (OR = 1.13, P < .05; OR = 1.10, P < .05, respectively). Second, discussing health-related issues with fellow church members is also significantly associated with reporting a cholesterol screening (OR = 1.15, P < .05), as well as moderately predictive of colonoscopy use (OR = 1.10, P < .10). Neither of the religious beliefs related to health, such as the God locus of health control scale or beliefs about the sanctity of the body, are related to preventive service use in this population. Although attendance is predictive of service use in unadjusted models, the association appears to be explained by age rather than by the congregational or belief variables. These findings contribute to a more nuanced understanding of the various ways in which religion might impact health behaviors and may also help to shape and refine interventions designed to improve individual well-being.
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