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Dudášová J, Valenta Z, Sachs JR. Elucidating vaccine efficacy using a correlate of protection, demographics, and logistic regression. BMC Med Res Methodol 2024; 24:101. [PMID: 38689224 PMCID: PMC11059665 DOI: 10.1186/s12874-024-02197-3] [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: 05/26/2023] [Accepted: 03/04/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Vaccine efficacy (VE) assessed in a randomized controlled clinical trial can be affected by demographic, clinical, and other subject-specific characteristics evaluated as baseline covariates. Understanding the effect of covariates on efficacy is key to decisions by vaccine developers and public health authorities. METHODS This work evaluates the impact of including correlate of protection (CoP) data in logistic regression on its performance in identifying statistically and clinically significant covariates in settings typical for a vaccine phase 3 trial. The proposed approach uses CoP data and covariate data as predictors of clinical outcome (diseased versus non-diseased) and is compared to logistic regression (without CoP data) to relate vaccination status and covariate data to clinical outcome. RESULTS Clinical trial simulations, in which the true relationship between CoP data and clinical outcome probability is a sigmoid function, show that use of CoP data increases the positive predictive value for detection of a covariate effect. If the true relationship is characterized by a decreasing convex function, use of CoP data does not substantially change positive or negative predictive value. In either scenario, vaccine efficacy is estimated more precisely (i.e., confidence intervals are narrower) in covariate-defined subgroups if CoP data are used, implying that using CoP data increases the ability to determine clinical significance of baseline covariate effects on efficacy. CONCLUSIONS This study proposes and evaluates a novel approach for assessing baseline demographic covariates potentially affecting VE. Results show that the proposed approach can sensitively and specifically identify potentially important covariates and provides a method for evaluating their likely clinical significance in terms of predicted impact on vaccine efficacy. It shows further that inclusion of CoP data can enable more precise VE estimation, thus enhancing study power and/or efficiency and providing even better information to support health policy and development decisions.
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Affiliation(s)
- Julie Dudášová
- Quantitative Pharmacology and Pharmacometrics, MSD Czech Republic, Svornosti 3321/2, 150 00 Prague 5, Prague, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Zdeněk Valenta
- Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jeffrey R Sachs
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Rahway, NJ, USA
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Postma M, Fisman D, Giglio N, Márquez-Peláez S, Nguyen VH, Pugliese A, Ruiz-Aragón J, Urueña A, Mould-Quevedo J. Real-World Evidence in Cost-Effectiveness Analysis of Enhanced Influenza Vaccines in Adults ≥ 65 Years of Age: Literature Review and Expert Opinion. Vaccines (Basel) 2023; 11:1089. [PMID: 37376478 DOI: 10.3390/vaccines11061089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Influenza vaccination can benefit most populations, including adults ≥ 65 years of age, who are at greater risk of influenza-related complications. In many countries, enhanced vaccines, such as adjuvanted, high-dose, and recombinant trivalent/quadrivalent influenza vaccines (aTIV/aQIV, HD-TIV/HD-QIV, and QIVr, respectively), are recommended in older populations to provide higher immunogenicity and increased relative vaccine efficacy/effectiveness (rVE) than standard-dose vaccines. This review explores how efficacy and effectiveness data from randomized controlled trials and real-world evidence (RWE) are used in economic evaluations. Findings from published cost-effectiveness analyses (CEA) on enhanced influenza vaccines for older adults are summarized, and the assumptions and approaches used in these CEA are assessed alongside discussion of the importance of RWE in CEA. Results from many CEA showed that adjuvanted and high-dose enhanced vaccines were cost-effective compared with standard vaccines, and that differences in rVE estimates and acquisition price may drive differences in cost-effectiveness estimates between enhanced vaccines. Overall, RWE and CEA provide clinical and economic rationale for enhanced vaccine use in people ≥ 65 years of age, an at-risk population with substantial burden of disease. Countries that consider RWE when making vaccine recommendations have preferentially recommended aTIV/aQIV, as well as HD-TIV/HD-QIV and QIVr, to protect older individuals.
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Affiliation(s)
- Maarten Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, P.O. Box 72, 9700 AB Groningen, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, 9713 AB Groningen, The Netherlands
- Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, 40132 Bandung, Indonesia
| | - David Fisman
- Dalla Lana School of Public Health, Toronto, ON M5T 3M7, Canada
| | - Norberto Giglio
- Hospital de Niños Ricardo Gutièrrez, Buenos Aires 1425, Argentina
| | - Sergio Márquez-Peláez
- Department of Economics, Economic Analysis, Faculty of Business Pablo de Olavide University, 41013 Seville, Spain
| | | | - Andrea Pugliese
- Department of Mathematics, University of Trento, 38123 Trento, Italy
| | | | - Analia Urueña
- Centro de Estudios para la Prevención y Control de Enfermedades Transmisibles, Universidad Isalud, Buenos Aires C1095AAS, Argentina
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Loong D, Pham B, Amiri M, Saunders H, Mishra S, Radhakrishnan A, Rodrigues M, Yeung MW, Muller MP, Straus SE, Tricco AC, Isaranuwatchai W. Systematic Review on the Cost-Effectiveness of Seasonal Influenza Vaccines in Older Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1439-1458. [PMID: 35659487 DOI: 10.1016/j.jval.2022.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Older adults are at high risk of influenza-related complications or hospitalization. The purpose of this systematic review is to assess the relative cost-effectiveness of all influenza vaccine options for older adults. METHODS This systematic review identified economic evaluation studies assessing the cost-effectiveness of influenza vaccines in adults ≥65 years of age from 5 literature databases. Two reviewers independently selected, extracted, and appraised relevant studies using the JBI Critical Appraisal Checklist for Economic Evaluations and Heyland's generalizability checklist. Costs were converted to 2019 Canadian dollars and adjusted for inflation and purchasing power parity. RESULTS A total of 27 studies were included. There were 18 comparisons of quadrivalent inactivated vaccine (QIV) versus trivalent inactivated vaccine (TIV): 5 showed QIV dominated TIV (ie, lower costs and higher health benefit), and 13 showed the results depended on willingness to pay (WTP). There were 9 comparisons of high-dose TIV (TIV-HD) versus TIV: 5 showed TIV-HD dominated TIV, and 4 showed the results depended on WTP. There were 8 comparisons of adjuvanted TIV (TIV-ADJ) versus TIV: 4 showed TIV-ADJ dominated TIV, and 4 showed the results depended on WTP. There were few pairwise comparisons among QIV, TIV-HD, and TIV-ADJ. CONCLUSIONS The evidence suggests QIV, TIV-HD, and TIV-ADJ are cost-effective against TIV for a WTP threshold of $50 000 per quality-adjusted life-year. Future studies should include new and existing vaccine options for broad age ranges and use more robust methodologies-such as real-world evaluations or modeling studies accounting for methodological, structural, and parameter uncertainty.
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Affiliation(s)
- Desmond Loong
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ba' Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mohammadreza Amiri
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Hailey Saunders
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sujata Mishra
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Myanca Rodrigues
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Health Research Methodology Graduate Program, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Man Wah Yeung
- National Advisory Committee on Immunization Secretariat, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Matthew P Muller
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Infection Prevention and Control, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
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An epitope-optimized human H3N2 influenza vaccine induces broadly protective immunity in mice and ferrets. NPJ Vaccines 2022; 7:65. [PMID: 35739199 PMCID: PMC9226166 DOI: 10.1038/s41541-022-00492-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/16/2022] [Indexed: 12/03/2022] Open
Abstract
There is a crucial need for an improved H3N2 influenza virus vaccine due to low vaccine efficacy rates and increased morbidity and mortality associated with H3N2-dominated influenza seasons. Here, we utilize a computational design strategy to produce epitope-optimized, broadly cross-reactive H3 hemagglutinins in order to create a universal H3N2 influenza vaccine. The Epigraph immunogens are designed to maximize the viral population frequency of epitopes incorporated into the immunogen. We compared our Epigraph H3 vaccine to the traditional egg-based inactivated influenza vaccine from 2018-19, FluZone. Epigraph vaccination-induced stronger cross-reactive antibody responses than FluZone against 18 H3N2 viruses isolated from 1968 to 2019 in both mice and ferrets, with protective hemagglutination inhibition titers against 93-100% of the contemporary H3N2 strains compared to only 27% protection measured from FluZone. In addition, Epigraph vaccination-induced strong cross-reactive T-cell immunity which significantly contributes to protection against lethal influenza virus infection. Finally, Epigraph vaccination protected ferrets from influenza disease after challenge with two H3N2 viruses. The superior cross-reactive immunity induced by these Epigraph immunogens supports their development as a universal H3N2 influenza vaccine.
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Kompier R, Neels P, Beyer W, Hardman T, Lioznov D, Kharit S, Kostinov M. Analysis of the safety and immunogenicity profile of an azoximer bromide polymer-adjuvanted subunit influenza vaccine. F1000Res 2022; 11:259. [PMID: 36176546 PMCID: PMC9493399 DOI: 10.12688/f1000research.75869.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
A systematic review of clinical trials conducted with a low-dose inactivated influenza vaccine adjuvanted by azoximer bromide (AZB, Polyoxidonium), was performed to compare vaccine reactogenicity against non-adjuvant vaccines. We also assessed whether lower amounts of antigen per viral strain in AZB-adjuvanted vaccines affected antibody responses. A robust search strategy identified scientific publications reporting 30 clinical trials, comprising data on 11,736 participants and 86 trial arms, for inclusion in the analysis. Local reaction rates (R lr) appeared to be lower in AZB-adjuvanted vaccine treatment arms versus comparator vaccine treatment arms. Meta‑regression analysis revealed that AZB did not contribute to vaccine reactogenicity. Post-vaccination geometric mean titres in those exposed to AZB-adjuvanted vaccine and comparator vaccine treatment arms were similar in both children and adults aged 18-60 years, implying an antigen-sparing effect by AZB.
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Affiliation(s)
- Ronald Kompier
- Ruijgenhoeck 6, 2201 EW Noordwijk, Vaccine Consultancy, The Netherlands, Netherlands Antilles
| | | | - Walter Beyer
- Ruijgenhoeck 6, 2201 EW Noordwijk, Vaccine Consultancy, The Netherlands, Netherlands Antilles,Niche Science and Technology Ltd., Unit 26, Falstaff House, Bardolph Road, Niche Science and Technology, London, UK
| | - Tim Hardman
- Niche Science and Technology Ltd., Unit 26, Falstaff House, Bardolph Road, Niche Science and Technology, London, UK,
| | - Dmitry Lioznov
- Smorodintsev Research Institute of Influenza, Saint Petersburg, Russian Federation,First Pavlov State Medical University, Saint Petersburg, Russian Federation
| | - Susanna Kharit
- Scientific Research Institute of Children’s Infections of the Russian Federal Biomedical Agency, St. Petersburg, Russian Federation
| | - Michail Kostinov
- Department of Allergology, I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russian Federation,Moscow State Medical University, Department of Epidemiology and Modern Vaccination Technologies, Sechenov First, Moscow, Russian Federation
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A method to estimate probability of disease and vaccine efficacy from clinical trial immunogenicity data. NPJ Vaccines 2021; 6:133. [PMID: 34737322 PMCID: PMC8568947 DOI: 10.1038/s41541-021-00377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/11/2021] [Indexed: 12/02/2022] Open
Abstract
Vaccine efficacy is often assessed by counting disease cases in a clinical trial. A new quantitative framework proposed here ("PoDBAY," Probability of Disease Bayesian Analysis), estimates vaccine efficacy (and confidence interval) using immune response biomarker data collected shortly after vaccination. Given a biomarker associated with protection, PoDBAY describes the relationship between biomarker and probability of disease as a sigmoid probability of disease ("PoD") curve. The PoDBAY framework is illustrated using clinical trial simulations and with data for influenza, zoster, and dengue virus vaccines. The simulations demonstrate that PoDBAY efficacy estimation (which integrates the PoD and biomarker data), can be accurate and more precise than the standard (case-count) estimation, contributing to more sensitive and specific decisions than threshold-based correlate of protection or case-count-based methods. For all three vaccine examples, the PoD fit indicates a substantial association between the biomarkers and protection, and efficacy estimated by PoDBAY from relatively little immunogenicity data is predictive of the standard estimate of efficacy, demonstrating how PoDBAY can provide early assessments of vaccine efficacy. Methods like PoDBAY can help accelerate and economize vaccine development using an immunological predictor of protection. For example, in the current effort against the COVID-19 pandemic it might provide information to help prioritize (rank) candidates both earlier in a trial and earlier in development.
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Plotkin SA. Updates on immunologic correlates of vaccine-induced protection. Vaccine 2019; 38:2250-2257. [PMID: 31767462 DOI: 10.1016/j.vaccine.2019.10.046] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023]
Abstract
Correlates of protection (CoPs) are increasingly important in the development and licensure of vaccines. Although the study of CoPs was initially directed at identifying a single immune function that could explain vaccine efficacy, it has become increasingly clear that there are often multiple functions responsible for efficacy. This review is meant to supplement prior articles on the subject, illustrating both simple and complex CoPs.
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Affiliation(s)
- Stanley A Plotkin
- Emeritus Professor of Pediatrics, University of Pennsylvania, Vaxconsult, 4650 Wismer Rd., Doylestown, PA 18902, United States.
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Gilbert PB, Fong Y, Juraska M, Carpp LN, Monto AS, Martin ET, Petrie JG. HAI and NAI titer correlates of inactivated and live attenuated influenza vaccine efficacy. BMC Infect Dis 2019; 19:453. [PMID: 31117986 PMCID: PMC6530189 DOI: 10.1186/s12879-019-4049-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High hemagglutination inhibition (HAI) and neuraminidase inhibition (NAI) titers are generally associated with reduced influenza risk. While repeated influenza vaccination reduces seroresponse, vaccine effectiveness is not always reduced. METHODS During the 2007-2008 influenza season, a randomized, placebo-controlled trial (FLUVACS) evaluated the efficacies of live-attenuated (LAIV) and inactivated influenza vaccines (IIV) among healthy adults aged 18-49 in Michigan; IIV vaccine efficacy (VE) and LAIV VE against influenza disease were estimated at 68% and 36%. Using the principal stratification/VE moderation framework, we analyzed data from this trial to assess how each VE varied by HAI or NAI responses to vaccination observed for vaccinated individuals and predicted counterfactually for placebo recipients. We also assessed how each VE varied with pre-vaccination/baseline variables including HAI titer, NAI titer, and vaccination history. RESULTS IIV VE appeared to increase with Day 30 post-vaccination HAI titer, albeit not significantly (p=0.20 and estimated VE 14.4%, 70.5%, and 85.5% at titer below the assay lower quantification limit, 512, and 4096 (maximum)). Moreover, IIV VE increased significantly with Day 30 post-vaccination NAI titer (p=0.040), with estimated VE zero at titer 10 and 92.2% at highest titer 640. There was no evidence that fold-change in post-vaccination HAI or NAI titer associated with IIV VE (p=0.76, 0.38). For LAIV, there was no evidence that VE associated with post-vaccination or fold-rise HAI or NAI titers (p-values >0.40). For IIV, VE increased with increasing baseline NAI titer in those previously vaccinated, but VE decreased with increasing baseline NAI titer in those previously unvaccinated. In contrast, for LAIV, VE did not depend on previous vaccination or baseline HAI or NAI titer. CONCLUSIONS Future efficacy trials should measure baseline and post-vaccination antibody titers in both vaccine and control/placebo recipients, enabling analyses to better elucidate correlates of vaccine- and natural-protection. TRIAL REGISTRATION ClinicalTrials.gov NCT00538512. October 1, 2007.
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Affiliation(s)
- Peter B Gilbert
- Department of Biostatistics, Bioinformatics, and Epidemiology, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, 98109, USA. .,Department of Biostatistics, University of Washington, 1705 NE Pacific St., Seattle, 98195, USA.
| | - Youyi Fong
- Department of Biostatistics, Bioinformatics, and Epidemiology, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, 98109, USA.,Department of Biostatistics, University of Washington, 1705 NE Pacific St., Seattle, 98195, USA
| | - Michal Juraska
- Department of Biostatistics, Bioinformatics, and Epidemiology, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, 98109, USA
| | - Lindsay N Carpp
- Department of Biostatistics, Bioinformatics, and Epidemiology, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, 98109, USA
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, 48109, USA
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, 48109, USA
| | - Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, 48109, USA
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Loperto I, Simonetti A, Nardone A, Triassi M. Use of adjuvanted trivalent influenza vaccine in older-age adults: a systematic review of economic evidence. Hum Vaccin Immunother 2019; 15:1035-1047. [PMID: 30735465 DOI: 10.1080/21645515.2019.1578597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Seasonal influenza is a very common disease. Yearly vaccination of at-risk population groups is a well-recognized cost-effective/cost-saving preventive measure. It is, however, unclear which available alternative has the most favorable economic profile. Some available options are: trivalent (TIV) and quadrivalent (QIV) inactivated vaccines, adjuvanted TIV (aTIV). Because of immunosenescence, aTIV has been specifically developed for elderly. The present study aimed at assessing the available evidence of aTIV use in elderly from the economic perspective. A systematic literature review targeting aTIV economic evaluations in adults aged ≥65 years was performed using Medline via Ovid, Embase, DARE and NHS/EED. Of a total of 3,654 papers screened, 18 studies (13 full papers, 5 conference abstracts) were included. It emerged that compared with both non-vaccination or non-adjuvanted vaccines, aTIV was cost-effective or cost-saving. The vaccinations strategies incorporating aTIV based on age and/or risk profile are associated with the most favorable economic outcomes.
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Affiliation(s)
- Ilaria Loperto
- a Department of Public Health , University of Naples "Federico II" , Naples , Italy
| | - Andrea Simonetti
- a Department of Public Health , University of Naples "Federico II" , Naples , Italy
| | - Antonio Nardone
- a Department of Public Health , University of Naples "Federico II" , Naples , Italy
| | - Maria Triassi
- a Department of Public Health , University of Naples "Federico II" , Naples , Italy
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Capri S, Barbieri M, de Waure C, Boccalini S, Panatto D. Cost-effectiveness analysis of different seasonal influenza vaccines in the elderly Italian population. Hum Vaccin Immunother 2018; 14:1331-1341. [PMID: 29425079 PMCID: PMC6037461 DOI: 10.1080/21645515.2018.1438792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In the perspective of reaching at least 75% influenza vaccination coverage in the elderly and substantial budget constraints, Italian decision makers are facing important challenges in determining an optimal immunization strategy for this growing and particularly vulnerable population. Four different influenza vaccines are currently available for Italian older adults aged 65 years or above, namely trivalent inactivated vaccines (TIVs), MF59-adjuvanted TIV (MF59-TIV), intradermal TIV (ID-TIV) and quadrivalent inactivated vaccines (QIVs). The present study is the first to compare the cost-effectiveness profiles of virtually all possible public health strategies, including the aforementioned four vaccine formulations as well non-vaccination. For this purpose, a decision tree model was built ex novo; the analysis was conducted from the third-payer perspective in the timeframe of one year. All available vaccines were cost-effective compared with non-vaccination. However, MF59-TIV had the most favorable economic profile in the Italian elderly population. Indeed, compared with non-vaccination, it was deemed highly cost-effective with an incremental cost-effectiveness ratio (ICER) of €10,750 per quality-adjusted life year (QALY). The ICER was much lower (€4,527/QALY) when MF59-TIV was directly compared with TIV. ID-TIV and QIV were dominated by MF59-TIV as the former comparators were associated with greater total costs and lower health benefits. Both deterministic and probabilistic sensitivity analyses confirmed robustness of the base case results. From the economic perspective, MF59-TIV should be considered as a preferential choice for Italian older adults aged 65 years or above.
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Affiliation(s)
- Stefano Capri
- a School of Economics and Management , Cattaneo University-LIUC , Castellanza , Italy
| | - Marco Barbieri
- b Centre for Health Economics , University of York , York , UK
| | - Chiara de Waure
- c Institute of Public Health, Section of Hygiene , Catholic University of the Sacred Heart , Rome , Italy
| | - Sara Boccalini
- d Department of Health Sciences , University of Florence , Florence , Italy
| | - Donatella Panatto
- e Department of Health Sciences , University of Genoa , Genoa , Italy.,f Inter-University Centre for Research on Influenza and Other Transmitted Diseases (CIRI-IT) , Genoa , Italy
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BARBIERI M, CAPRI S, WAURE CDE, BOCCALINI S, PANATTO D. Age- and risk-related appropriateness of the use of available influenza vaccines in the Italian elderly population is advantageous: results from a budget impact analysis. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2017; 58:E279-E287. [PMID: 29707658 PMCID: PMC5912787 DOI: 10.15167/2421-4248/jpmh2017.58.4.867] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Nowadays, four different types of influenza vaccines are available in Italy: trivalent (TIV), quadrivalent (QIV), MF59-adjuvanted (aTIV) and intradermal TIV (idTIV) inactivated vaccines. Recently, a concept of the appropriateness (i.e. according to the age and risk factors) of the use of different vaccines has been established in Italy. We conducted a budget impact analysis of switching to a policy, in which the Italian elderly (who carry the major disease burden) received the available vaccines according to their age and risk profile. METHODS A novel budget impact model was constructed with a time horizon of one influenza season. In the reference scenario the cohort of Italian elderly individuals could receive either available vaccine according to 2017/18 season market share. The alternative scenario envisaged the administration of TIV/QIV to people aged 65-74 years and at low risk of developing influenza-related complications, while aTIV/idTIV were allocated to high-risk 65-74-year-olds and all subjects aged ≥ 75 years. RESULTS Switching to the alternative scenario would result in both significant health benefits and net budget savings. Particularly, it would be possible to prevent an additional 8201 cases of laboratory-confirmed influenza, 988 complications, 355 hospitalizations and 14 deaths. Despite the alternative strategy being associated with slightly higher vaccination costs, the total savings derived from fewer influenza events completely resets this increase with net budget savings of € 0.13 million. CONCLUSIONS An immunization policy in which influenza vaccines are administered according to the age and risk profile of Italian elderly individuals is advisable.
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Affiliation(s)
- M. BARBIERI
- Centre for Health Economics, University of York, York, UK
| | - S. CAPRI
- School of Economics and Management, Cattaneo University-LIUC, Castellanza, Italy
| | - C. DE WAURE
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - S. BOCCALINI
- Department of Health Sciences, University of Florence, Italy
| | - D. PANATTO
- Department of Health Sciences, University of Genoa, Italy
- Inter-University Centre for Research on Influenza and Other Transmitted Diseases (CIRI-IT), Genoa, Italy
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Beyer W, Palache A, Boulfich M, Osterhaus A. Rationale for two influenza B lineages in seasonal vaccines: A meta-regression study on immunogenicity and controlled field trials. Vaccine 2017; 35:4167-4176. [DOI: 10.1016/j.vaccine.2017.06.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 11/29/2022]
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Levin Y, Kochba E, Shukarev G, Rusch S, Herrera-Taracena G, van Damme P. A phase 1, open-label, randomized study to compare the immunogenicity and safety of different administration routes and doses of virosomal influenza vaccine in elderly. Vaccine 2016; 34:5262-5272. [PMID: 27667332 DOI: 10.1016/j.vaccine.2016.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/30/2016] [Accepted: 09/04/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Influenza remains a significant problem in elderly despite widespread vaccination coverage. This randomized, phase-I study in elderly compared different strategies of improving vaccine immunogenicity. METHODS A total of 370 healthy participants (⩾65years) were randomized equally 1:1:1:1:1:1 to six influenza vaccine treatments (approximately 60-63 participants per treatment arm) at day 1 that consisted of three investigational virosomal vaccine formulations at doses of 7.5, 15, and 45μg HA antigen/strain administered intradermally (ID) by MicronJet600™ microneedle device (NanoPass Technologies) or intramuscularly (IM), and three comparator registered seasonal vaccines; Inflexal V™ (Janssen) and MF59 adjuvanted Fluad™ (Novartis) administered IM and Intanza™ (Sanofi Pasteur) administered ID via Soluvia™ prefilled microinjection system (BD). Serological evaluations were performed at days 22 and 90 and safety followed-up for 6months. RESULTS Intradermal delivery of virosomal vaccine using MicronJet600™ resulted in significantly higher immunogenicity than the equivalent dose of virosomal Inflexal V™ administered intramuscularly across most of the parameters and strains, as well as in some of the readouts and strains as compared with the 45μg dose of virosomal vaccine formulation. Of 370 participants, 300 (81.1%) reported ⩾1 adverse event (AE); more participants reported solicited local AEs (72.2%) than solicited systemic AEs (12.2%). CONCLUSIONS Intradermal delivery significantly improved influenza vaccine immunogenicity compared with intramuscular delivery. Triple dose (45μg) virosomal vaccine did not demonstrate any benefit on vaccine's immunogenicity over 15μg commercial presentation. All treatments were generally safe and well-tolerated.
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MESH Headings
- Adjuvants, Immunologic
- Aged
- Aged, 80 and over
- Aging/immunology
- Antibodies, Viral/blood
- Dose-Response Relationship, Immunologic
- Drug Administration Routes
- Female
- Humans
- Immunogenicity, Vaccine
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/adverse effects
- Influenza Vaccines/immunology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Injections, Intradermal
- Injections, Intramuscular
- Male
- Vaccines, Virosome/administration & dosage
- Vaccines, Virosome/adverse effects
- Vaccines, Virosome/immunology
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Affiliation(s)
| | | | | | - Sarah Rusch
- Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Pierre van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Belgium
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14
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Bragazzi NL, Orsi A, Ansaldi F, Gasparini R, Icardi G. Fluzone® intra-dermal (Intanza®/Istivac® Intra-dermal): An updated overview. Hum Vaccin Immunother 2016; 12:2616-2627. [PMID: 27246556 DOI: 10.1080/21645515.2016.1187343] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Influenza is a highly contagious respiratory acute viral disease which imposes a very heavy burden both in terms of epidemiology and costs, in the developed countries as well as in the developing ones. It represents a serious public health concern and vaccination constitutes an important tool to reduce or at least mitigate its burden. Despite the existence of a broad armamentarium against influenza and despite all the efforts and recommendations of international organisms to broaden immunization, influenza vaccination coverage is still far from being optimal. This, taken together with logistic and technical difficulties that can result into vaccine shortage, makes intra-dermal (ID) vaccines, such as Fluzone® ID and Intanza®, particularly attractive. ID vaccines are comparable and, in some cases, superior to intra-muscular/sub-cutaneous vaccines in terms of immunogenicity, safety, reactogenicity, tolerability and cross-protection profiles, as well as in terms of patient preference, acceptance and vaccine selection. Further advances, such as Fluzone® ID with alternative B strains and Quadrivalent Fluzone® ID or the possibility of self-administering the vaccines, make influenza ID vaccines even more valuable.
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Affiliation(s)
| | - Andrea Orsi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
| | - Filippo Ansaldi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
| | - Roberto Gasparini
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy
| | - Giancarlo Icardi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
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15
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Trombetta CM, Montomoli E. Influenza immunology evaluation and correlates of protection: a focus on vaccines. Expert Rev Vaccines 2016; 15:967-76. [PMID: 26954563 DOI: 10.1586/14760584.2016.1164046] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vaccination is the most effective method of controlling seasonal influenza infections and preventing possible pandemic events. Although influenza vaccines have been licensed and used for decades, the potential correlates of protection induced by these vaccines are still a matter of discussion. Currently, inactivated vaccines are the most common and the haemagglutination inhibition antibody titer is regarded as an immunological correlate of protection and the best available parameter for predicting protection from influenza infection. However, the assay shows some limitations, such as its low sensitivity to B and avian strains and inter-laboratory variability. Additional assays and next-generation vaccines have been evaluated to overcome the limitations of the traditional serological techniques and to elicit broad immune responses, underlining the need to revise the current correlates of protection. The aim of this review is to provide an overview of the current scenario regarding the immunological evaluation and correlates of protection of influenza vaccines.
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Affiliation(s)
| | - Emanuele Montomoli
- a Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy.,b VisMederi srl , Enterprise of services in Life Sciences , Siena , Italy
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16
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Mullikin M, Tan L, Jansen JP, Van Ranst M, Farkas N, Petri E. A Novel Dynamic Model for Health Economic Analysis of Influenza Vaccination in the Elderly. Infect Dis Ther 2015; 4:459-87. [PMID: 26350238 PMCID: PMC4675767 DOI: 10.1007/s40121-015-0076-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction New vaccines are being developed to improve the efficacy of seasonal influenza immunization in elderly persons aged ≥65 years. These products require clinical and economic evaluation to aid policy decisions. Methods To address this need, a two-part model has been developed, which we have applied to examine the potential clinical and economic impact of vaccinating elderly persons with adjuvanted trivalent inactivated influenza vaccine (aTIV) relative to conventional trivalent (TIV) and quadrivalent (QIV) vaccines. We compared outcomes in the US population for (1) aTIV in persons aged ≥65 years and QIV in all other age cohorts; (2) QIV in all cohorts; (3) TIV in all cohorts. Low, average, and high intensity seasons with low, average, and high vaccine match scenarios were compared. Probabilistic sensitivity analysis was conducted within each discrete scenario to explore the impact of variation in model inputs on potential outcomes. Results Assuming current vaccination coverage rates in the US population with (a) 25% better efficacy of adjuvanted versus non-adjuvanted vaccine against any strain and (b) 35% better efficacy of non-adjuvanted vaccine against matched B versus mismatched B strains, use of aTIV in persons aged ≥65 years and QIV in persons <65 years could reduce influenza cases by 11,166–1,329,200, hospitalizations by 1365–43,674, and deaths by 421–11,320 versus use of QIV in all cohorts. These outcomes are reflected in a corresponding increase in quality-adjusted life-years (QALYs) of 3003–94,084. If the prevalence of mismatched influenza B was >54.5% of all circulating strains, use of QIV in all cohorts would offset the clinical benefits of aTIV. Elderly aTIV or QIV vaccination was associated with improved outcomes over non-adjuvanted TIV in many of the scenarios, particularly in low match seasons of any intensity. Total cost savings (including direct and indirect healthcare costs plus productivity impacts) with aTIV in the elderly versus QIV in the whole population ranged from $27 million (low intensity, low match) to $934 million (high intensity, high match). Univariate sensitivity analysis of relative vaccine prices in the average intensity, average match scenario indicated that aTIV could be marginally cost saving relative to QIV at the currently published Medicare price for influenza vaccines offering enhanced efficacy in the elderly. Elderly vaccination with aTIV was associated with a higher overall cost compared with TIV in only two scenarios (low intensity with average or high match); the incremental cost/QALY relative to TIV was $9980 in the average match scenario and $28,800 in the high match scenario. Conclusions Vaccination of persons aged ≥65 years with aTIV has the potential to provide clinical and economic benefit relative to QIV and TIV. The new model allows the assessment of various alternative strategies for available influenza vaccines. Funding Novartis Vaccines. Electronic supplementary material The online version of this article (doi:10.1007/s40121-015-0076-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Litjen Tan
- Immunization Action Coalition, Saint Paul, MN, USA
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17
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Czako R, Subbarao K. Refining the approach to vaccines against influenza A viruses with pandemic potential. Future Virol 2015; 10:1033-1047. [PMID: 26587050 DOI: 10.2217/fvl.15.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vaccination is the most effective strategy for prevention and control of influenza. Timely production and deployment of seasonal influenza vaccines is based on an understanding of the epidemiology of influenza and on global disease and virologic surveillance. Experience with seasonal influenza vaccines guided the initial development of pandemic influenza vaccines. A large investment in pandemic influenza vaccines in the last decade has resulted in much progress and a body of information that can now be applied to refine the established paradigm. Critical and complementary considerations for pandemic influenza vaccines include improved assessment of the pandemic potential of animal influenza viruses, proactive development and deployment of pandemic influenza vaccines, and application of novel platforms and strategies for vaccine production and administration.
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Affiliation(s)
- Rita Czako
- Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD, USA
| | - Kanta Subbarao
- Laboratory of Infectious Diseases, NIAID, NIH, Bethesda, MD, USA
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18
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Saggini R, Di Stefano A, Dodaj I, Scarcello L, Bellomo RG. Pes Anserine Bursitis in Symptomatic Osteoarthritis Patients: A Mesotherapy Treatment Study. J Altern Complement Med 2015; 21:480-4. [PMID: 26083769 PMCID: PMC4522948 DOI: 10.1089/acm.2015.0007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Pes anserine bursitis strongly affects quality of life in patients with osteoarthritis. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and injections of corticosteroid, with highly variable responses; recovery can take 10 days to 36 months. Mesotherapy is a minimally invasive technique consisting of subcutaneous injections of bioactive substances. The goal is to modulate the pharmacokinetics of the injected substance and prolong the effects at a local level. Objective: To evaluate the effects of mesotherapy with diclofenac for anserine bursitis associated with knee osteoarthritis. Methods: One hundred and seventeen patients with anserine bursitis associated with grade II Kellgren-Lawrence knee osteoarthritis, assessed by clinical, radiographic, and ultrasonographic examination, were evaluated and treated. They were randomly divided into two groups (A, mesotherapy; B, control). Group A completed nine sessions of mesotherapy with sodium diclofenac (25 mg/1 mL; Akis®, IBSA, Lugano, Switzerland), 1 mL for each session, three times per week. Group B received 21 oral administrations of sodium diclofenac (50 mg; Voltaren®, Novartis, Parsippany, NJ), once a day for 3 weeks. Primary outcome measures were pain intensity assessed by visual analogue scale (VAS), along with ability to perform activities of daily living, ability to participate in sports, level of pain, symptoms, and quality of life, as assessed by the Knee injury and Osteoarthritis Outcome Score. These measures were performed before and after the treatment period and at 30 and 90 days' follow up. Results: In both groups pain level decreased significantly after the treatment period. Ultrasonography showed a reduction of the hypoechoic area related to anserine bursitis only in group A. Conclusion: Administration of conventional NSAIDs (diclofenac) by mesotherapy is effective in managing anserine bursitis in knee osteoarthritis in the short term and mid-term. These observations could be of interest for efforts to reduce the adverse effects of oral administration of anti-inflammatory drugs.
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Affiliation(s)
- Raoul Saggini
- 1 Department of Medical Science Oral and Biotechnology, G. D'Annunzio University , Chieti, Italy
| | - Alexandra Di Stefano
- 2 School of Specialties in Physical Medicine and Rehabilitation, G. D'Annunzio University , Chieti, Italy
| | - Ira Dodaj
- 2 School of Specialties in Physical Medicine and Rehabilitation, G. D'Annunzio University , Chieti, Italy
| | - Laura Scarcello
- 2 School of Specialties in Physical Medicine and Rehabilitation, G. D'Annunzio University , Chieti, Italy
| | - Rosa Grazia Bellomo
- 3 Department of Medicine and Science of Aging, G. D'Annunzio University , Chieti, Italy
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19
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Pfleiderer M, Trouvin JH, Brasseur D, Gränstrom M, Shivji R, Mura M, Cavaleri M. Summary of knowledge gaps related to quality and efficacy of current influenza vaccines. Vaccine 2014; 32:4586-4591. [PMID: 24954696 DOI: 10.1016/j.vaccine.2014.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/09/2014] [Indexed: 02/05/2023]
Abstract
Influenza viruses are a public health threat, as they are pathogenic, highly transmissible and prone to genetic changes. For decades vaccination strategies have been based on trivalent inactivated vaccines, which are regulated by specific guidelines. The progress in scientific knowledge and the lessons learned from the A(H1N1)2009 pandemic have highlighted further the need to improve current guidelines, including the immunogenicity criteria set by the CHMP in 1997, and to promote the discussion on the shortcomings encountered, e.g. the evaluation of vaccine efficacy in the paediatric and elderly populations, the measurement of the naivety of a population, the impact of prior immunity on subsequent vaccinations, and the technical issues with the serological assays for detection of immunity and immunogenicity. The authors attempted to summarise and tackle key gaps in the existing evidence concerning quality and efficacy of influenza vaccines, aiming at favouring a common understanding and a coordinated approach across stakeholders.
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Affiliation(s)
- Michael Pfleiderer
- Vaccine Working Party of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA); Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Straße 51-59, 63225 Langen, Germany
| | - Jean-Hugues Trouvin
- Paris Descartes University, School of Pharmacy, Health Safety and Public Health Department, Paris, France
| | - Daniel Brasseur
- Vaccine Working Party of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA); Agence Fédérale des Médicaments et des Produits de Santé, Batiment EUROSTATION, bloc 2, place Victor Horta, 40/40, B-1060 Brussels, Belgium; Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA)
| | - Marta Gränstrom
- Vaccine Working Party of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA); MTC, Karolinska Institutet, Stockholm, Sweden; Paediatric Committee of the European Medicines Agency (EMA)
| | - Ragini Shivji
- European Medicines Agency (EMA), 7 Westferry Circus, Canary Wharf, London E14 4HB, United Kingdom
| | - Manuela Mura
- European Medicines Agency (EMA), 7 Westferry Circus, Canary Wharf, London E14 4HB, United Kingdom.
| | - Marco Cavaleri
- European Medicines Agency (EMA), 7 Westferry Circus, Canary Wharf, London E14 4HB, United Kingdom
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20
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Garcia AB, Bahrndorff S, Hald B, Hoorfar J, Madsen M, Vigre H. Design and data analysis of experimental trials to test vaccine candidates against zoonotic pathogens in animals: the case of a clinical trial against campylobacter in broilers. Expert Rev Vaccines 2014; 11:1179-88. [DOI: 10.1586/erv.12.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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López-Medrano F, Cordero E, Gavaldá J, Cruzado JM, Marcos MÁ, Pérez-Romero P, Sabé N, Gómez-Bravo MÁ, Delgado JF, Cabral E, Carratalá J. Management of influenza infection in solid-organ transplant recipients: consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2013; 31:526.e1-526.e20. [PMID: 23528341 DOI: 10.1016/j.eimc.2013.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at greater risk than the general population for complications and mortality from influenza infection. METHODS Researchers and clinicians with experience in SOT infections have developed this consensus document in collaboration with several Spanish scientific societies and study networks related to transplant management. We conducted a systematic review to assess the management and prevention of influenza infection in SOT recipients. Evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS Recommendations are provided on the procurement of organs from donors with suspected or confirmed influenza infection. We highlight the importance of the possibility of influenza infection in any SOT recipient presenting upper or lower respiratory symptoms, including pneumonia. The importance of early antiviral treatment of SOT recipients with suspected or confirmed influenza infection and the necessity of annual influenza vaccination are emphasized. The microbiological techniques for diagnosis of influenza infection are reviewed. Guidelines for the use of antiviral prophylaxis in inpatients and outpatients are provided. Recommendations for household contacts of SOT recipients with influenza infection and health care workers in close contact with transplant patients are also included. Finally antiviral dose adjustment guidelines are presented for cases of impaired renal function and for pediatric populations. CONCLUSIONS The latest scientific information available regarding influenza infection in the context of SOT is incorporated into this document.
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Affiliation(s)
- Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre (i+12), Departamento de Medicina, Universidad Complutense, Madrid, Spain.
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22
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Kang SM, Song JM, Kim YC. Microneedle and mucosal delivery of influenza vaccines. Expert Rev Vaccines 2012; 11:547-60. [PMID: 22697052 DOI: 10.1586/erv.12.25] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In recent years with the threat of pandemic influenza and other public health needs, alternative vaccination methods other than intramuscular immunization have received great attention. The skin and mucosal surfaces are attractive sites probably because of both noninvasive access to the vaccine delivery and unique immunological responses. Intradermal vaccines using a microinjection system (BD Soluvia(TM)) and intranasal vaccines (FluMist®) are licensed. As a new vaccination method, solid microneedles have been developed using a simple device that may be suitable for self-administration. Because coated microneedle influenza vaccines are administered in the solid state, developing formulations maintaining the stability of influenza vaccines is an important issue to be considered. Marketable microneedle devices and clinical trials remain to be developed. Other alternative mucosal routes such as oral and intranasal delivery systems are also attractive for inducing cross-protective mucosal immunity, but effective non-live mucosal vaccines remain to be developed.
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Affiliation(s)
- Sang-Moo Kang
- Center for Inflammation, Immunity and Infection, and Department of Biology, Georgia State University, Atlanta, GA 30303, USA.
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23
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Role of mesotherapy in musculoskeletal pain: opinions from the italian society of mesotherapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:436959. [PMID: 22654954 PMCID: PMC3359685 DOI: 10.1155/2012/436959] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/05/2012] [Accepted: 02/24/2012] [Indexed: 01/15/2023]
Abstract
Mesotherapy is the injection of active substances into the surface layer of the skin. This method allows a slower spread, higher levels, and longer lasting effects of drugs in the tissues underlying the site of injection (skin, muscle, and joint) compared with those following intramuscular injection. This technique is useful when a local pharmacological effect is required and relatively high doses of drug in the systemic circulation are not. Mesotherapy should only be undertaken following a complete clinical workup and subsequent diagnosis. Encouraging results have been reported in randomized, controlled clinical trials and in observational studies involving patients with various forms of musculoskeletal pain. Recommendations by experts from the Italian Society of Mesotherapy for appropriate use of mesotherapy in musculoskeletal pain and an algorithm for treating localized painful conditions are provided.
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