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Ørbo HS, Bjørlykke KH, Sexton J, Jyssum I, Tveter AT, Christensen IE, Mjaaland S, Kvien TK, Grødeland G, Kro GB, Jahnsen J, Haavardsholm EA, Munthe LA, Provan SA, Vaage JT, Goll GL, Jørgensen KK, Syversen SW. Incidence and outcome of COVID-19 following vaccine and hybrid immunity in patients on immunosuppressive therapy: identification of protective post-immunisation anti-RBD antibody levels in a prospective cohort study. RMD Open 2024; 10:e003545. [PMID: 38599653 PMCID: PMC11015197 DOI: 10.1136/rmdopen-2023-003545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/15/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To assess incidence, severity and predictors of COVID-19, including protective post-vaccination levels of antibodies to the receptor-binding domain of SARS-CoV-2 spike protein (anti-RBD), informing further vaccine strategies for patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressive medication. METHODS IMIDs on immunosuppressives and healthy controls (HC) receiving SARS-CoV-2 vaccines were included in this prospective observational study. COVID-19 and outcome were registered and anti-RBD antibodies measured 2-5 weeks post-immunisation. RESULTS Between 15 February 2021 and 15 February 2023, 1729 IMIDs and 350 HC provided blood samples and self-reported COVID-19. The incidence of COVID-19 was 66% in patients and 67% in HC, with re-infection occurring in 12% of patients. Severe COVID-19 was recorded in 22 (2%) patients and no HC. No COVID-19-related deaths occurred. Vaccine-induced immunity gave higher risk of COVID-19 (HR 5.89 (95% CI 4.45 to 7.80)) than hybrid immunity. Post-immunisation anti-RBD levels <6000 binding antibody units/mL were associated with an increased risk of COVID-19 following three (HR 1.37 (95% CI 1.08 to 1.74)) and four doses (HR 1.28 (95% CI 1.02 to 1.62)), and of COVID-19 re-infection (HR 4.47 (95% CI 1.87 to 10.67)). CONCLUSION Vaccinated patients with IMID have a low risk of severe COVID-19. Hybrid immunity lowers the risk of infection. High post-immunisation anti-RBD levels protect against COVID-19. These results suggest that knowledge on COVID-19 history, and assessment of antibody levels post-immunisation can help individualise vaccination programme series in high-risk individuals. TRIAL REGISTRATION NUMBER NCT04798625.
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Affiliation(s)
- Hilde S Ørbo
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristin H Bjørlykke
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Joseph Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Jyssum
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne T Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid E Christensen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Siri Mjaaland
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Tore K Kvien
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gunnveig Grødeland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Grete B Kro
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Espen A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ludvig A Munthe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for B cell Malignancies, University of Oslo, Oslo, Norway
| | - Sella A Provan
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Section for Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - John T Vaage
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Guro Løvik Goll
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Silje Watterdal Syversen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Blix K, Laake I, Juvet L, Robertson AH, Caspersen IH, Mjaaland S, Skodvin SN, Magnus P, Feiring B, Trogstad L. Unexpected vaginal bleeding and COVID-19 vaccination in nonmenstruating women. Sci Adv 2023; 9:eadg1391. [PMID: 37738335 PMCID: PMC10516485 DOI: 10.1126/sciadv.adg1391] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/16/2023] [Indexed: 09/24/2023]
Abstract
The association between coronavirus disease 2019 (COVID-19) vaccination and vaginal bleeding among nonmenstruating women is not well studied. The Norwegian Institute of Public Health followed several cohorts throughout the pandemic and early performed a systematic data collection of self-reported unexpected vaginal bleeding in nonmenstruating women. Among 7725 postmenopausal women, 7148 perimenopausal women, and 7052 premenopausal women, 3.3, 14.1, and 13.1% experienced unexpected vaginal bleeding during a period of 8 to 9 months, respectively. In postmenopausal women, the risk of unexpected vaginal bleeding (i.e., postmenopausal bleeding) in the 4 weeks after COVID-19 vaccination was increased two- to threefold, compared to a prevaccination period. The corresponding risk of unexpected vaginal bleeding after vaccination was increased three- to fivefold in both nonmenstruating peri- and premenopausal women. In the premenopausal women, Spikevax was associated with at 32% increased risk as compared to Comirnaty. Our results must be confirmed in future studies.
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Affiliation(s)
- Kristine Blix
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Lene Juvet
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Hayman Robertson
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Siri Mjaaland
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri N. Skodvin
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Berit Feiring
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Lill Trogstad
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
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Trogstad L, Laake I, Robertson AH, Mjaaland S, Caspersen IH, Juvet LK, Magnus P, Blix K, Feiring B. Heavy bleeding and other menstrual disturbances in young women after COVID-19 vaccination. Vaccine 2023; 41:5271-5282. [PMID: 37451876 DOI: 10.1016/j.vaccine.2023.06.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Many signals of menstrual disturbances as possible side effects of vaccination against COVID-19 have been reported. Our objective was to compare the risk of menstrual disturbances before and after vaccination among women aged 18-30 years in Oslo, Norway. METHODS We used electronic questionnaires to collect reports of menstrual disturbances from 3972 women aged 18-30 years, participating in the population-based Norwegian Young Adult Cohort. We examined the occurrence of menstrual disturbances (heavier bleeding than usual, prolonged bleeding, shorter interval between menstruations, longer interval between menstruations, spot bleedings, stronger pain during menstruation, period pain without bleeding) before and after the first and second dose of COVID-19 vaccine. Relative risks (RR) according to vaccination were estimated using a self-controlled case-series design. We performed additional analyses stratified by vaccine brand, contraception/hormone use, and presence of gynecological condition(s). RESULTS The prevalence of any menstrual disturbance was 36.7 % in the last menstrual cycle prior the first vaccine dose. The RR for heavier bleeding than usual was 1.90 (95 % CI: 1.69-2.13) after the first vaccine dose and 1.84 (95 % CI 1.66-2.03) after the second dose. Increased risks of prolonged bleeding, shorter interval between menstruations, and stronger pain during menstruation were also observed after both doses. The RRs did not differ with vaccine brand, contraception/hormone use, or presence of gynecological condition(s) for any of the menstrual disturbances. CONCLUSION Menstrual disturbances were common regardless of vaccination. We found increased risk of menstrual disturbances after vaccination, particularly for heavier bleeding than usual, prolonged bleeding, shorter interval between menstruations, and stronger period pain. In the future, menstrual characteristics should be included in vaccine trials.
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Affiliation(s)
- Lill Trogstad
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway.
| | - Anna H Robertson
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida H Caspersen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lene K Juvet
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristine Blix
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Berit Feiring
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
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Che X, Roy A, Bresnahan M, Mjaaland S, Reichborn-Kjennerud T, Magnus P, Stoltenberg C, Shang Y, Zhang K, Susser E, Fiehn O, Lipkin WI. Metabolomic analysis of maternal mid-gestation plasma and cord blood in autism spectrum disorders. Mol Psychiatry 2023; 28:2355-2369. [PMID: 37037873 DOI: 10.1038/s41380-023-02051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
The discovery of prenatal and neonatal molecular biomarkers has the potential to yield insights into autism spectrum disorder (ASD) and facilitate early diagnosis. We characterized metabolomic profiles in ASD using plasma samples collected in the Norwegian Autism Birth Cohort from mothers at weeks 17-21 gestation (maternal mid-gestation, MMG, n = 408) and from children on the day of birth (cord blood, CB, n = 418). We analyzed associations using sex-stratified adjusted logistic regression models with Bayesian analyses. Chemical enrichment analyses (ChemRICH) were performed to determine altered chemical clusters. We also employed machine learning algorithms to assess the utility of metabolomics as ASD biomarkers. We identified ASD associations with a variety of chemical compounds including arachidonic acid, glutamate, and glutamine, and metabolite clusters including hydroxy eicospentaenoic acids, phosphatidylcholines, and ceramides in MMG and CB plasma that are consistent with inflammation, disruption of membrane integrity, and impaired neurotransmission and neurotoxicity. Girls with ASD have disruption of ether/non-ether phospholipid balance in the MMG plasma that is similar to that found in other neurodevelopmental disorders. ASD boys in the CB analyses had the highest number of dysregulated chemical clusters. Machine learning classifiers distinguished ASD cases from controls with area under the receiver operating characteristic (AUROC) values ranging from 0.710 to 0.853. Predictive performance was better in CB analyses than in MMG. These findings may provide new insights into the sex-specific differences in ASD and have implications for discovery of biomarkers that may enable early detection and intervention.
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Affiliation(s)
- Xiaoyu Che
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ayan Roy
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michaeline Bresnahan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | | | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health, University of Bergen, Bergen, Norway
| | - Yimeng Shang
- Department of Public Health Sciences, College of Medicine, Penn State University, State College, PA, 16801, USA
| | - Keming Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Oliver Fiehn
- UC Davis Genome Center-Metabolomics, University of California, Davis, CA, USA
| | - W Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Wolf AS, Ravussin A, König M, Øverås MH, Solum G, Kjønstad IF, Chopra A, Holmøy T, Harbo HF, Syversen SW, Jørgensen KK, Høgestøl EA, Vaage JT, Celius EG, Lund-Johansen F, Munthe LA, Nygaard GO, Mjaaland S. T cell responses to SARS-CoV-2 vaccination differ by disease-modifying therapy for multiple sclerosis. JCI Insight 2023:165111. [PMID: 37159281 PMCID: PMC10371236 DOI: 10.1172/jci.insight.165111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Immune responses in people with multiple sclerosis (pwMS) on disease-modifying therapies (DMTs) have been of significant interest throughout the COVID-19 pandemic. Lymphocyte-targeting immunotherapies including anti-CD20 treatments and sphingosine-1-phosphate receptor (S1PR) modulators attenuate antibody responses after vaccination. Evaluation of cellular responses after vaccination is therefore of particular importance in these populations. In this study, we analysed CD4 and CD8 T cell functional responses to SARS-CoV-2 spike peptides in healthy controls and pwMS on five different DMTs by flow cytometry. Although pwMS on rituximab and fingolimod therapies had low antibody responses after both two and three vaccine doses, T cell responses in pwMS on rituximab were preserved after a third vaccination, even when an additional dose of rituximab was administered between vaccine doses two and three. PwMS taking fingolimod had low detectable T cell responses in peripheral blood. CD4 and CD8 T cell responses to SARS-CoV-2 variants of concern Delta and Omicron were lower than to the ancestral Wuhan-Hu-1 variant. Our results indicate the importance of assessing both cellular and humoral responses after vaccination and suggest that even in the absence of robust antibody responses vaccination can generate immune responses in pwMS.
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Affiliation(s)
- Asia-Sophia Wolf
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Anthony Ravussin
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Marton König
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Guri Solum
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingrid Fadum Kjønstad
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Adity Chopra
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Trygve Holmøy
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Hanne F Harbo
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Silje Watterdal Syversen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - John T Vaage
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Ludvig A Munthe
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | | | - Siri Mjaaland
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
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Ravussin A, Robertson AH, Wolf AS, Blix K, Kjønstad IF, Solum G, Feiring B, Strand BH, Lund-Johansen F, Munthe LA, Magnus P, Trogstad L, Mjaaland S. Determinants of humoral and cellular immune responses to three doses of mRNA SARS-CoV-2 vaccines in older adults: a longitudinal cohort study. Lancet Healthy Longev 2023; 4:e188-e199. [PMID: 37148891 PMCID: PMC10156136 DOI: 10.1016/s2666-7568(23)00055-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Older age is associated with poorer outcomes to COVID-19 infection. The Norwegian Institute of Public Health established a longitudinal cohort of adults aged 65-80 years to study the effects of the COVID-19 pandemic. Here we describe the characteristics of the cohort in general, and specifically the immune responses at baseline and after primary and booster vaccination in a subset of longitudinal blood samples, and the epidemiological factors affecting these responses. METHODS 4551 participants were recruited, with humoral (n=299) and cellular (n=90) responses measured before vaccination and after two and three vaccine doses. Information on general health, infections, and vaccinations were obtained from questionnaires and national health registries. FINDINGS Half of the participants had a chronic condition. 849 (18·7%) of 4551 were prefrail and 184 (4%) of 4551 were frail. 483 (10·6%) of 4551 had general activity limitations (scored with the Global Activity Limitation Index). After dose two, 295 (98·7%) of 299 participants were seropositive for anti-receptor binding domain IgG, and 210 (100%) of 210 participants after dose three. Spike-specific CD4 and CD8 T cell responses showed high heterogeneity after vaccination and responded to the alpha (B.1.1.7), delta (B.1.617.2), and omicron (B.1.1.529 or BA.1) variants of concern. Cellular responses to seasonal coronaviruses increased after SARS-CoV-2 vaccination. Heterologous prime boosting with mRNA vaccines was associated with the highest antibody (p=0·019) and CD4 T cell responses (p=0·003), and hypertension with lower antibody levels after three doses (p=0·04). INTERPRETATION Most older adults, including those with comorbidities, generated good serological and cellular responses after two vaccine doses. Responses further improved after three doses, particularly after heterologous boosting. Vaccination also generated cross-reactive T cells against variants of concern and seasonal coronaviruses. Frailty was not associated with impaired immune responses, but hypertension might indicate reduced responsiveness to vaccines even after three doses. Individual differences identified through longitudinal sampling enables better prediction of the variability of vaccine responses, which can help guide future policy on the need for subsequent doses and their timing. FUNDING Norwegian Institute of Public Health, Norwegian Ministry of Health, Research Council of Norway, and Coalition for Epidemic Preparedness Innovations.
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Affiliation(s)
- Anthony Ravussin
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Hayman Robertson
- Division of Infection Control, Section for Vaccine Epidemiology and Population Studies, Norwegian Institute of Public Health, Oslo, Norway.
| | - Asia-Sophia Wolf
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristine Blix
- Division of Infection Control, Section for Vaccine Epidemiology and Population Studies, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingrid Fadum Kjønstad
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Guri Solum
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Berit Feiring
- Division of Infection Control, Section for Vaccine Epidemiology and Population Studies, Norwegian Institute of Public Health, Oslo, Norway
| | - Bjørn Heine Strand
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Fridtjof Lund-Johansen
- Department of Immunology, Oslo University Hospital, Oslo, Norway; ImmunoLingo Convergence Center, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ludvig A Munthe
- Department of Immunology, Oslo University Hospital, Oslo, Norway; KG Jebsen Centre for B cell Malignancies, University of Oslo, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lill Trogstad
- Division of Infection Control, Section for Vaccine Epidemiology and Population Studies, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
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7
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Bjørlykke KH, Ørbo HS, Tveter AT, Jyssum I, Sexton J, Tran TT, Christensen IE, Kro GB, Kvien TK, Jahnsen J, Munthe LA, Chopra A, Warren DJ, Mjaaland S, Haavardsholm EA, Grødeland G, Provan SA, Vaage JT, Syversen SW, Goll GL, Jørgensen KK. Four SARS-CoV-2 vaccine doses or hybrid immunity in patients on immunosuppressive therapies: a Norwegian cohort study. Lancet Rheumatol 2023; 5:e36-e46. [PMID: 36415604 PMCID: PMC9671616 DOI: 10.1016/s2665-9913(22)00330-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Data on response and safety of repeated vaccinations and hybrid immunity in patients with immune-mediated inflammatory diseases on immunosuppressive therapy is needed to further develop vaccination strategies in this vulnerable population. This study aimed to evaluate hybrid immunity and humoral immune response and safety of four SARS-CoV-2 vaccine doses in patients with immune-mediated inflammatory diseases on immunosuppressive therapy. Methods This prospective observational Norwegian study of vaccine response to COVID-19 (Nor-vaC) included adult patients aged 18 years and older with immune-mediated inflammatory diseases (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, Crohn's disease, or ulcerative colitis) on immunosuppressive therapy, who had received four SARS-CoV-2 vaccine doses (vaccine group) or three vaccine doses followed by COVID-19 (hybrid group), and healthy controls receiving three vaccine doses (control group). Patients were recruited from the Division of Rheumatology at Diakonhjemmet Hospital, Oslo, and the Department of Gastroenterology at Akershus University Hospital, Lørenskog. Patients who had COVID-19 before the third vaccine dose, and patients with allergies or intolerances to elements of the vaccine were excluded. Antibodies to the receptor-binding domain of SARS-CoV-2 spike protein (anti-RBD antibodies) were assessed 2-4 weeks following vaccination or COVID-19. This study is registered at Clinialtrials.gov, NCT04798625. Findings Between Nov 12, 2021, and April 19, 2022, 1458 participants with immune-mediated inflammatory diseases provided post-vaccination samples at 2-4 weeks following a third vaccine dose. After 544 participants were excluded, 715 (78%) of the remaining 914 participants received the fourth dose of the vaccine, and of these, 536 (75%) provided post-vaccination samples 2-4 weeks after their fourth vaccination (vaccine group). 199 (22%) of the 914 had COVID-19 after their third dose of the vaccine and of these, 167 (84%) provided samples (hybrid group). 256 of the eligible 703 patients had rheumatoid arthritis, 107 had spondyloarthritis, 115 had psoriatic arthritis, 130 had Crohn's disease, and 95 had ulcerative colitis). Median age was 56 years [IQR 45-65], 398 (57%) were women, and 305 (43%) were men. Patients in the vaccine group had higher anti-RBD antibody concentrations following the fourth vaccine dose (median 6192 BAU/ml [IQR 2878-11 243]) than after the third dose (median 5087 BAU/ml [1250-9081]; p< 0·0001), but lower antibody concentrations than the control group following the third dose (median 7595 BAU/ml [5916-12 001]; p< 0·0001). Antibody concentrations were higher in the patients in the hybrid group (23 548 BAU/ml [IQR 11 440-35 935]) than in the vaccine group (p<0·0001). No difference was found in antibody concentrations between the fourth dose of BNT162b2 (full-dose) and mRNA-1273 (half-dose). Patients and controls had a comparable safety profile after both three and four vaccine doses. Interpretation Vaccine boosters improve humoral immune responses and are safe in patients with immune-mediated inflammatory diseases on immunosuppressive therapy, and administration should be considered regularly in this patient group. Hybrid immunity with omicron induces a strong humoral response suggesting longer intervals between booster doses in this patient group. Funding The South-Eastern Norway Regional Health Authority, The Coalition for Epidemic Preparedness Innovations, Akershus University Hospital.
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Affiliation(s)
- Kristin H Bjørlykke
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Correspondence to: Dr Kristin H Bjørlykke, Department of Gastroenterology, Akershus University Hospital, N-1478 Lørenskog, Norway
| | - Hilde S Ørbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Anne T Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Jyssum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Trung T Tran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Ingrid E Christensen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Tore K Kvien
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Jørgen Jahnsen
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ludvig A Munthe
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,KG Jebsen Centre for B cell Malignancies, University of Oslo, Oslo, Norway,Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Adity Chopra
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - David J Warren
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | - Espen A Haavardsholm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Gunnveig Grødeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Sella A Provan
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway,Section for Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - John T Vaage
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Silje Watterdal Syversen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Guro Løvik Goll
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Syversen SW, Jyssum I, Tveter AT, Sexton J, Christensen IE, Tran TT, Bjørlykke KH, Mjaaland S, Warren DJ, Kvien TK, Chopra A, Kro GB, Jahnsen J, Munthe LA, Haavardsholm EA, Grødeland G, Vaage JT, Provan SA, Jørgensen KK, Goll GL. Immunogenicity and safety of a three-dose SARS-CoV-2 vaccination strategy in patients with immune-mediated inflammatory diseases on immunosuppressive therapy. RMD Open 2022; 8:rmdopen-2022-002417. [PMID: 36328399 PMCID: PMC9638754 DOI: 10.1136/rmdopen-2022-002417] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Humoral vaccine responses to SARS-CoV-2 vaccines are impaired and short lasting in patients with immune-mediated inflammatory diseases (IMID) following two vaccine doses. To protect these vulnerable patients against severe COVID-19 disease, a three-dose primary vaccination strategy has been implemented in many countries. The aim of this study was to evaluate humoral response and safety of primary vaccination with three doses in patients with IMID. Methods Patients with IMID on immunosuppressive therapy and healthy controls receiving three-dose and two-dose primary SARS-CoV-2 vaccination, respectively, were included in this prospective observational cohort study. Anti-Spike antibodies were assessed 2–4 weeks, and 12 weeks following each dose. The main outcome was anti-Spike antibody levels 2–4 weeks following three doses in patients with IMID and two doses in controls. Additional outcomes were the antibody decline rate and adverse events. Results 1100 patients and 303 controls were included. Following three-dose vaccination, patients achieved median (IQR) antibody levels of 5720 BAU/mL (2138–8732) compared with 4495 (1591–6639) in controls receiving two doses, p=0.27. Anti-Spike antibody levels increased with median 1932 BAU/mL (IQR 150–4978) after the third dose. The interval between the vaccine doses and vaccination with mRNA-1273 or a combination of vaccines were associated with antibody levels following the third dose. Antibody levels had a slower decline-rate following the third than the second vaccine dose, p<0.001. Adverse events were reported by 464 (47%) patients and by 196 (78%) controls. Disease flares were reported by 70 (7%) patients. Conclusions This study shows that additional vaccine doses to patients with IMID contribute to strong and sustained immune-responses comparable to healthy persons vaccinated twice, and supports repeated vaccination of patients with IMID. Trial registration number NCT04798625.
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Affiliation(s)
- Silje Watterdal Syversen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Jyssum
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Joe Sexton
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Egeland Christensen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trung T Tran
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Kristin Hammersbøen Bjørlykke
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | | | - David J Warren
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Tore K Kvien
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Adity Chopra
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | | | - Jorgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Ludvig A Munthe
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre for B cell Malignancies, University of Oslo, Oslo, Norway
| | - Espen A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunnveig Grødeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - John Torgils Vaage
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Sella Aarrestad Provan
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Guro Løvik Goll
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Laake I, Skodvin SN, Blix K, Caspersen IH, Gjessing HK, Juvet LK, Magnus P, Mjaaland S, Robertson AH, Starrfelt J, Trogstad L, Feiring B. Effectiveness of mRNA Booster Vaccination Against Mild, Moderate, and Severe COVID-19 Caused by the Omicron Variant in a Large, Population-Based, Norwegian Cohort. J Infect Dis 2022; 226:1924-1933. [PMID: 36259543 PMCID: PMC9620770 DOI: 10.1093/infdis/jiac419] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/18/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding how booster vaccination can prevent moderate and severe illness without hospitalization is crucial to evaluate the full advantage of mRNA boosters. METHODS We followed 85 801 participants (aged 31-81 years) in 2 large population-based cohorts during the Omicron BA.1/2 wave. Information on home testing, PCR testing, and symptoms of coronavirus disease 2019 (COVID-19) was extracted from biweekly questionnaires covering the period 12 January 2022 to 7 April 2022. Vaccination status and data on previous SARS-CoV-2 infection were obtained from national registries. Cox regression was used to estimate the effectiveness of booster vaccination compared to receipt of 2-dose primary series >130 days previously. RESULTS The effectiveness of booster vaccination increased with increasing severity of COVID-19 and decreased with time since booster vaccination. The effectiveness against severe COVID-19 was reduced from 80.9% shortly after booster vaccination to 63.4% in the period >90 days after vaccination. There was hardly any effect against mild COVID-19. The effectiveness tended to be lower among subjects aged ≥60 years than those aged <50 years. CONCLUSIONS This is the first population-based study to evaluate booster effectiveness against self-reported mild, moderate, and severe COVID-19. Our findings contribute valuable information on duration of protection and thus timing of additional booster vaccinations.
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Affiliation(s)
- Ida Laake
- Correspondence: Ida Laake, PhD, Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway ()
| | | | - Kristine Blix
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Håkon K Gjessing
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lene K Juvet
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna H Robertson
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Jostein Starrfelt
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Lill Trogstad
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
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Kared H, Wolf AS, Alirezaylavasani A, Ravussin A, Solum G, Tran TT, Lund-Johansen F, Vaage JT, Nissen-Meyer LS, Nygaard UC, Hungnes O, Robertson AH, Næss LM, Trogstad L, Magnus P, Munthe LA, Mjaaland S. Immune responses in Omicron SARS-CoV-2 breakthrough infection in vaccinated adults. Nat Commun 2022; 13:4165. [PMID: 35851055 PMCID: PMC9293966 DOI: 10.1038/s41467-022-31888-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/08/2022] [Indexed: 02/07/2023] Open
Abstract
The SARS-CoV-2 Omicron variant has more than 15 mutations in the receptor binding domain of the Spike protein enabling increased transmissibility and viral escape from antibodies in vaccinated individuals. It is unclear how vaccine immunity protects against Omicron infection. Here we show that vaccinated participants at a super-spreader event have robust recall response of humoral and pre-existing cellular immunity induced by the vaccines, and an emergent de novo T cell response to non-Spike antigens. Individuals with Omicron SARS-CoV-2 breakthrough infections have significantly increased activated SARS-CoV-2 wild type Spike-specific cytotoxic T cells, activated follicular helper (TFH) cells, functional T cell responses, boosted humoral responses, and rapid release of Spike and RBD-specific IgG+ B cell plasmablasts and memory B cells into circulation. Omicron breakthrough infection affords significantly increased de novo memory T cell responses to non-Spike viral antigens. Concerted T and B cell responses may provide durable and broad immunity. The SARS-CoV-2 Omicron variant possess many mutations within the receptor binding domain of the Spike protein, which confer increased transmissibility and higher antibody escape. Here, the authors carry out analysis of the serological and cellular immune responses of individuals with Omicron breakthrough infection.
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Affiliation(s)
- Hassen Kared
- KG Jebsen Centre for B cell malignancy, Institute of Clinical medicine, University of Oslo, Oslo, Norway. .,Department of Immunology, Oslo University Hospital, Oslo, Norway.
| | - Asia-Sophia Wolf
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Amin Alirezaylavasani
- KG Jebsen Centre for B cell malignancy, Institute of Clinical medicine, University of Oslo, Oslo, Norway
| | - Anthony Ravussin
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Guri Solum
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Trung The Tran
- Department of Immunology, Oslo University Hospital, Oslo, Norway.,ImmunoLingo Convergence Center, Institute of Clinical medicine, University of Oslo, Oslo, Norway
| | - Fridtjof Lund-Johansen
- Department of Immunology, Oslo University Hospital, Oslo, Norway.,ImmunoLingo Convergence Center, Institute of Clinical medicine, University of Oslo, Oslo, Norway
| | | | | | - Unni C Nygaard
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Olav Hungnes
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna H Robertson
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Lisbeth Meyer Næss
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Lill Trogstad
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Magnus
- Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ludvig A Munthe
- KG Jebsen Centre for B cell malignancy, Institute of Clinical medicine, University of Oslo, Oslo, Norway. .,Department of Immunology, Oslo University Hospital, Oslo, Norway.
| | - Siri Mjaaland
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
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11
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Jyssum I, Tveter AT, Sexton J, Christensen IE, Tran TT, Mjaaland S, Warren DJ, Kvien TK, Bjørlykke KH, Kro GB, Jahnsen J, Munthe LA, Haavardsholm EA, Vaage JT, Grodeland G, Lund-Johansen F, Aarrestad Provan S, Jørgensen KK, Goll GL, Syversen SW. OP0192 SEROLOGICAL RESPONSE AND SAFETY OF A THREE-DOSE SARS-CoV-2 VACCINATION STRATEGY IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES ON IMMUNOSUPPRESSIVE THERAPY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressive therapy have an inadequate serologic response following two-dose SARS-CoV-2 vaccination, and a standard vaccination strategy of three doses for this patient group is currently under implementation in several countries. However, the serological response and safety of this strategy has not been evaluated.ObjectivesTo assess serological response and safety of a three-dose vaccination strategy in IMID patients on immunosuppressive therapy as compared to standard two-dose vaccination of healthy controls.MethodsThe prospective observational Nor-vaC study (NCT04798625) enrolled adult patients on immunosuppressive therapy for inflammatory joint- and bowel diseases. Healthy controls were health care workers from participating hospitals. All participants received standard vaccines according to the national vaccination program with three doses in patients and two doses in controls. The third dose was offered to IMID patients >4 weeks after the second dose. Analyses of antibodies binding the receptor-binding domain of the SARS-CoV-2 Spike protein were performed prior to, and 2-4 weeks after the second and third vaccine doses. Levels were compared across groups by Mann-Whitney U tests and multivariate linear regression was used to identify predictors of response.ResultsOverall, 961 patients (315 rheumatoid arthritis, 156 spondyloarthritis, 171 psoriatic arthritis, 132 ulcerative colitis and182 Crohn’s disease) (median age 54 years [IQR 43-64]; 56 % women) and 227 controls (median age 44 years [IQR 32-55]; 83 % women) were included in the present analyses. TNFi monotherapy was used by 399 patients, 229 used TNFi in combination with other immunomodulators, 189 methotrexate monotherapy, 39 vedolizumab, 32 JAKi and 73 patients used other drugs. Patients on rituximab were not included. Patients were vaccinated with Pfizer BNT162b2 (54% patients, 14% controls), Moderna mRNA-1273 (16% patients, 40% controls) or a combination of vaccines (30% patients, 46% controls). Patients received the third vaccine dose a median of 120 (IQR 102-143) days after the second dose. After two doses, median anti-Spike antibody levels were significantly lower in patients (861 BAU/ml (IQR 418-4275) than controls (6318 BAU/ml (IQR 2468-9857)), p<0.001 (Figure 1). Following the third dose, patients achieved antibody levels comparable to the two-dose vaccinated controls (median 5480 BAU/ml (IQR 1081-12069), p=0.28) (Figure 1). In the patients anti-Spike antibody levels increased by a median of 2685 BAU/ml (IQR 265-9129) from the second to the third dose. Main factors associated with increased antibody level after the third dose were younger age (β -87.7 (p=0.002)), and vaccine status (mRNA-1273 vaccine (β 5549 (p<0.001)) or a combination of vaccines (β 4367.3 (p<0.001)).Adverse events were reported by 438 (48%) of patients after the third dose as compared to 471 (54%) after the second dose and 193 (78 %) of controls. Disease flares were reported by 42 (5%) and 69 (8%) patients after the second and third dose, respectively.ConclusionThis study suggests that a third vaccine dose for immunosuppressed patients closes the gap in serological response between patients and the healthy population. Antibody levels following the three-dose regimen in IMID patients were comparable to healthy controls vaccinated twice, and no new safety issues emerged. This finding was consistent across all diagnoses and treatment groups, supporting the implementation of a three-dose vaccine regimen as standard in the IMID population.Disclosure of InterestsIngrid Jyssum: None declared, Anne Therese Tveter: None declared, Joe Sexton: None declared, Ingrid E. Christensen: None declared, Trung T. Tran: None declared, Siri Mjaaland: None declared, David J Warren: None declared, Tore K. Kvien Speakers bureau: Amgen,Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofi, Consultant of: Abbvie, Amgen, Biogen, Celltrion, Eli Lilly, Gilead, Mylan, Novartis, Pfizer, Sandoz, Sanofi, Grant/research support from: Grants to institution (Diakonhjemmet Hospital): Abbvie, Amgen, BMS, MSD, Novartis, Pfizer, UCB, Kristin Hammersbøen Bjørlykke: None declared, Grete B. Kro: None declared, Jørgen Jahnsen Speakers bureau: AbbVie, Astro Pharma, Boerhinger Ingelheim, BMS, Celltrion, Ferring, Gilead, Hikma, Janssen Cilag, Meda, MSD, NappPharma, Novartis, Orion Pharma Pfizer, Pharmacosmos, Roche, Takeda, Sandoz, Consultant of: AbbVie, Boerhinger Ingelheim, BMS, Celltrion, Ferring, Gilead, Janssen Cilag MSD, Napp Pharma, Novartis, Orion Pharma, Pfizer, Pharmacosmos, Takeda, Sandoz, Unimedic Pharma, Grant/research support from: Abbvie, Pharmacosmos, Ferring, Ludvig A. Munthe Speakers bureau: Novartis, Cellgene, Espen A Haavardsholm: None declared, John Torgils Vaage: None declared, Gunnveig Grodeland Speakers bureau: Bayer, Sanofi Pasteur, Thermo Fisher, Consultant of: Consulting fees from the Norwegian System of Compensation to Patients and AstraZeneca, Fridtjof Lund-Johansen: None declared, Sella Aarrestad Provan: None declared, Kristin Kaasen Jørgensen Speakers bureau: Roche, BMS, Consultant of: Celltrion, Norgine, Guro Løvik Goll Speakers bureau: AbbVie, Pfizer, UCB, Sandoz, Orion Pharma, Novartis, Consultant of: Pfizer, AbbVie, Silje Watterdal Syversen: None declared
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Egeland Christensen I, Jyssum I, Tveter AT, Sexton J, Tran TT, Mjaaland S, Kro GB, Kvien TK, Worren D, Jahnsen J, Munthe LA, Haavardsholm E, Vaage JT, Grodeland G, Lund-Johansen F, Jørgensen KK, Syversen SW, Goll GL, Aarrestad Provan S. OP0176 THE PERSISTENCE OF ANTI-SPIKE ANTIBODIES FOLLOWING TWO SARS-CoV-2 VACCINES IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES USING IMMUNOSUPPRESSIVE THERAPY, COMPARED TO HEALTHY CONTROLS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLimited data is available regarding long-term effectiveness of SARS-CoV-2 vaccines in patients with immune-mediated inflammatory diseases (IMIDs) on immunosuppressive therapy. Whether the persistence of vaccine-induced humoral immunity against SARS-CoV-2 differs between this patient population and the general public is currently unknown.ObjectivesTo compare the persistence of anti-Spike antibodies following two SARS-CoV-2 vaccine doses between IMID patients using immunosuppressive medication and healthy controls and identify predictors of antibody decline.MethodsWe included patients with inflammatory joint- and bowel diseases on immunosuppressive medication and healthy controls enrolled in the prospective observational Nor-vaC study. Serum samples were collected at two time points following two dose SARS-CoV-2 vaccination (first assessment within 6–48 days and second within 49–123 days). Sera were analysed for antibodies binding the receptor-binding domain (RBD) of the SARS-CoV-2 Spike protein. Anti-RBD <200 BAU /ml were defined as low levels. The estimated percent reduction in anti-RBD standardised to 30 days was calculated and factors associated with reduction were identified in multivariable regression models.ResultsA total of 1097 patients (400 rheumatoid arthritis, 189 psoriatic arthritis, 189 spondyloarthritis, 129 ulcerative colitis, 190 Crohn´s disease) (median age 54 years [IQR 43–64]; 56% women) and 133 controls (median age 45 years [IQR 35–56]; 83% women) provided blood samples within the defined intervals (median 19 days [IQR 15–24] and 97 days [86–105] after second vaccine dose). Antibody levels were significantly lower in patients compared to controls at both assessments, with median anti-RBD 1468 BAU/ml [IQR 500–5062] in patients and 5514 BAU/ml [2528–9580] in controls (p<0.0001) and 298 BAU/ml [IQR 79–500] in patients and 715 BAU/ml [28–2870] in controls (p<0.0001), at first and second assessment respectively. Figure 1 show antibody levels at both assessments after medication group. At the second assessment, anti-RBD antibody levels decreased below 200 BAU/ml in 452 (41%) patients and in 1 (0.8%) control (p<0.0001) (Table 1). The percentage change in anti-RBD levels were -86 % in patients and -77 % in controls (p<0.0001). The majority of patients using rituximab had low antibody levels at both assessments, Figure 1. In the multivariable regression analyses, patients had a greater decline in anti-RBD levels compared to controls β -3.7 (95% CI -6.0, -1.4) (p<0.001). Use of tumor necrosis factor inhibitors in mono- or combination therapy was associated with the greatest decline compared to controls, β -6.1 (95% CI -8.1, -4.1) and β -6.4 (-8.4, -4.2) respectively (p<0.001).Table 1.Serological response in patients and controlsControls (n=133)Patients (n=1097)Anti-RBD antibodies (BAU/ml)1stassessment2ndassessment1stassessment2ndassessment<5, n (%)0018 (1.6)54 (5)5-19, n (%)004 (0.4)60 (5)20-199, n (%)01 (1)40 (4)338 (31)200-1999, n (%)25 (19)89 (67)548 (50)558 (51)2000-8999, n (%)71 (53)40 (30)398 (36)82 (7.5)≥ 9000, n (%)37 (28)3 (2)89 (8)5 (0.5)1st assessment 6 - 48 days and 2nd assessment 49 -123 days after second vaccine dose. BAU= Binding antibody UnitsConclusionWithin four months after the second vaccine dose, anti-Spike antibody levels declined considerably in both IMID patients and controls. Patients had lower antibody levels at the first assessment and a more pronounced decline compared to controls, and were consequently more likely to have low antibody levels four months after the second vaccine dose. Our results support that IMID patients lose humoral protection and need additional vaccine doses sooner than healthy individuals.Disclosure of InterestsIngrid Egeland Christensen: None declared, Ingrid Jyssum: None declared, Anne Therese Tveter: None declared, Joe Sexton: None declared, Trung T. Tran: None declared, Siri Mjaaland: None declared, Grete B. Kro: None declared, Tore K. Kvien Speakers bureau: Amgen, Celltrion, Egis, Evapharma, Ewopharma, Hikma, Oktal, Sandoz, Sanofi, Consultant of: Abbvie, Amgen, Biogen, Celltrion, Eli Lilly, Gilead, Mylan, Novartis, Pfizer, Sandoz, Sanofi, Grant/research support from: Grants to institution (Diakonhjemmet Hospital): Abbvie, Amgen, BMS, MSD, Novartis, Pfizer, UCB, David Worren: None declared, Jørgen Jahnsen Speakers bureau: AbbVie, Astro Pharma, Boerhinger Ingelheim, BMS, Celltrion, Ferring, Gilead, Hikma, Janssen Cilag, Meda, MSD, Napp Pharma, Novartis, Orion Pharma Pfizer, Pharmacosmos, Roche, Takeda, Sandoz, Consultant of: AbbVie, Boerhinger Ingelheim, BMS, Celltrion, Ferring, Gilead, Janssen Cilag MSD, Napp Pharma, Novartis, Orion Pharma, Pfizer, Pharmacosmos, Takeda, Sandoz, Unimedic Pharma, Grant/research support from: Abbvie, Pharmacosmos, Ferring, Ludvig A. Munthe Speakers bureau: Novartis, Cellgene, Espen Haavardsholm: None declared, John Torgils Vaage: None declared, Gunnveig Grodeland Speakers bureau: Bayer, Sanofi Pasteur, Thermo Fisher, Consultant of: Consulting fees from the Norwegian System of Compensation to Patients and AstraZeneca, Fridtjof Lund-Johansen: None declared, Kristin Kaasen Jørgensen Speakers bureau: Roche, BMS, Consultant of: Celltrion, Norgine, Silje Watterdal Syversen: None declared, Guro Løvik Goll Speakers bureau: AbbVie, Pfizer, UCB, Sandoz, Orion Pharma, Novartis, Consultant of: Pfizer, AbbVie, Sella Aarrestad Provan: None declared
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Syversen SW, Jyssum I, Tveter AT, Tran TT, Sexton J, Provan SA, Mjaaland S, Warren DJ, Kvien TK, Grødeland G, Nissen‐Meyer LSH, Ricanek P, Chopra A, Andersson AM, Kro GB, Jahnsen J, Munthe LA, Haavardsholm EA, Vaage JT, Lund‐Johansen F, Jørgensen KK, Goll GL. Immunogenicity and Safety of Standard and Third Dose SARS-CoV-2 Vaccination in Patients on Immunosuppressive Therapy. Arthritis Rheumatol 2022; 74:1321-1332. [PMID: 35507355 PMCID: PMC9347774 DOI: 10.1002/art.42153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/29/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022]
Abstract
Objective Immunogenicity and safety following receipt of the standard SARS–CoV‐2 vaccination regimen in patients with immune‐mediated inflammatory diseases (IMIDs) are poorly characterized, and data after receipt of the third vaccine dose are lacking. The aim of the study was to evaluate serologic responses and adverse events following the standard 2‐dose regimen and a third dose of SARS–CoV‐2 vaccine in IMID patients receiving immunosuppressive therapy. Methods Adult patients receiving immunosuppressive therapy for rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, Crohn's disease, or ulcerative colitis, as well as healthy adult controls, who received the standard 2‐dose SARS–CoV‐2 vaccination regimen were included in this prospective observational study. Analyses of antibodies to the receptor‐binding domain (RBD) of the SARS–CoV‐2 spike protein were performed prior to and 2–4 weeks after vaccination. Patients with a weak serologic response, defined as an IgG antibody titer of ≤100 arbitrary units per milliliter (AU/ml) against the receptor‐binding domain of the full‐length SARS–Cov‐2 spike protein, were allotted a third vaccine dose. Results A total of 1,505 patients (91%) and 1,096 healthy controls (98%) had a serologic response to the standard regimen (P < 0.001). Anti‐RBD antibody levels were lower in patients (median 619 AU/ml interquartile range [IQR] 192–4,191) than in controls (median 3,355 AU/ml [IQR 896–7,849]) (P < 0.001). The proportion of responders was lowest among patients receiving tumor necrosis factor inhibitor combination therapy, JAK inhibitors, or abatacept. Younger age and receipt of messenger RNA–1273 vaccine were predictors of serologic response. Of 153 patients who had a weak response to the standard regimen and received a third dose, 129 (84%) became responders. The vaccine safety profile among patients and controls was comparable. Conclusion IMID patients had an attenuated response to the standard vaccination regimen as compared to healthy controls. A third vaccine dose was safe and resulted in serologic response in most patients. These data facilitate identification of patient groups at risk of an attenuated vaccine response, and they support administering a third vaccine dose to IMID patients with a weak serologic response to the standard regimen.
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Affiliation(s)
| | - Ingrid Jyssum
- Diakonhjemmet Hospital and University of OsloOsloNorway
| | | | | | | | | | | | | | - Tore K. Kvien
- Diakonhjemmet Hospital and University of OsloOsloNorway
| | | | | | | | | | | | | | - Jørgen Jahnsen
- University of Oslo, Oslo, and Akershus University HospitalLørenskogNorway
| | | | | | - John T. Vaage
- Oslo University Hospital and University of OsloOsloNorway
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Walle KM, Askeland RB, Gustavson K, Mjaaland S, Ystrom E, Lipkin WI, Magnus PM, Stoltenberg C, Susser E, Bresnahan M, Hornig M, Reichborn‐Kjennerud T, Ask H. Risk of attention‐deficit hyperactivity disorder in offspring of mothers with infections during pregnancy. JCPP Advances 2022. [DOI: 10.1002/jcv2.12070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Ragna B. Askeland
- Norwegian Institute of Public Health Oslo Norway
- Medical Research Council Integrative Epidemiology Unit University of Bristol Bristol UK
| | - Kristin Gustavson
- Norwegian Institute of Public Health Oslo Norway
- Department of Psychology University of Oslo Oslo Norway
| | | | - Eivind Ystrom
- Norwegian Institute of Public Health Oslo Norway
- Promenta Research Center University of Oslo Oslo Norway
- School of Pharmacy University of Oslo Oslo Norway
| | - W. Ian Lipkin
- Department of Epidemiology Columbia University Mailman School of Public Health New York New York USA
- Center for Infection and Immunity Columbia University Mailman School of Public Health New York New York USA
- Departments of Neurology and Pathology Mailman School of Public Health New York New York USA
- Department of Psychology College of Physicians and Surgeons Columbia University University of Oslo Oslo Norway
| | - Per M. Magnus
- Centre for Fertility and Health Norwegian Institute of Public Health Oslo Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health Oslo Norway
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Ezra Susser
- Mailman School of Public Health Columbia University New York New York USA
- New York State Psychiatric Institute New York New York USA
| | | | - Mady Hornig
- Mailman School of Public Health Columbia University New York New York USA
| | - Ted Reichborn‐Kjennerud
- Norwegian Institute of Public Health Oslo Norway
- Department of Medicine University of Oslo Oslo Norway
| | - Helga Ask
- Norwegian Institute of Public Health Oslo Norway
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15
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Jyssum I, Kared H, Tran TT, Tveter AT, Provan SA, Sexton J, Jørgensen KK, Jahnsen J, Kro GB, Warren DJ, Vaage EB, Kvien TK, Nissen-Meyer LSH, Anderson AM, Grødeland G, Haavardsholm EA, Vaage JT, Mjaaland S, Syversen SW, Lund-Johansen F, Munthe LA, Goll GL. Humoral and cellular immune responses to two and three doses of SARS-CoV-2 vaccines in rituximab-treated patients with rheumatoid arthritis: a prospective, cohort study. Lancet Rheumatol 2022; 4:e177-e187. [PMID: 34977602 PMCID: PMC8700278 DOI: 10.1016/s2665-9913(21)00394-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In rituximab-treated patients with rheumatoid arthritis, humoral and cellular immune responses after two or three doses of SARS-CoV-2 vaccines are not well characterised. We aimed to address this knowledge gap. METHODS This prospective, cohort study (Nor-vaC) was done at two hospitals in Norway. For this sub-study, we enrolled patients with rheumatoid arthritis on rituximab treatment and healthy controls who received SARS-CoV-2 vaccines according to the Norwegian national vaccination programme. Patients with insufficient serological responses to two doses (antibody to the receptor-binding domain [RBD] of the SARS-CoV-2 spike protein concentration <100 arbitrary units [AU]/mL) were allotted a third vaccine dose. Antibodies to the RBD of the SARS-CoV-2 spike protein were measured in serum 2-4 weeks after the second and third doses. Vaccine-elicited T-cell responses were assessed in vitro using blood samples taken before and 7-10 days after the second dose and 3 weeks after the third dose from a subset of patients by stimulating cryopreserved peripheral blood mononuclear cells with spike protein peptides. The main outcomes were the proportions of participants with serological responses (anti-RBD antibody concentrations of ≥70 AU/mL) and T-cell responses to spike peptides following two and three doses of SARS-CoV-2 vaccines. The study is registered at ClinicalTrials.gov, NCT04798625, and is ongoing. FINDINGS Between Feb 9, 2021, and May 27, 2021, 90 patients were enrolled, 87 of whom donated serum and were included in our analyses (69 [79·3%] women and 18 [20·7%] men). 1114 healthy controls were included (854 [76·7%] women and 260 [23·3%] men). 49 patients were allotted a third vaccine dose. 19 (21·8%) of 87 patients, compared with 1096 (98·4%) of 1114 healthy controls, had a serological response after two doses (p<0·0001). Time since last rituximab infusion (median 267 days [IQR 222-324] in responders vs 107 days [80-152] in non-responders) and vaccine type (mRNA-1273 vs BNT162b2) were significantly associated with serological response (adjusting for age and sex). After two doses, 10 (53%) of 19 patients had CD4+ T-cell responses and 14 (74%) had CD8+ T-cell responses. A third vaccine dose induced serological responses in eight (16·3%) of 49 patients, but induced CD4+ and CD8+ T-cell responses in all patients assessed (n=12), including responses to the SARS-CoV-2 delta variant (B.1.617.2). Adverse events were reported in 32 (48%) of 67 patients and in 191 (78%) of 244 healthy controls after two doses, with the frequency not increasing after the third dose. There were no serious adverse events or deaths. INTERPRETATION This study provides important insight into the divergent humoral and cellular responses to two and three doses of SARS-CoV-2 vaccines in rituximab-treated patients with rheumatoid arthritis. A third vaccine dose given 6-9 months after a rituximab infusion might not induce a serological response, but could be considered to boost the cellular immune response. FUNDING The Coalition for Epidemic Preparedness Innovations, Research Council of Norway Covid, the KG Jebsen Foundation, Oslo University Hospital, the University of Oslo, the South-Eastern Norway Regional Health Authority, Dr Trygve Gythfeldt og frues forskningsfond, the Karin Fossum Foundation, and the Research Foundation at Diakonhjemmet Hospital.
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Affiliation(s)
- Ingrid Jyssum
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hassen Kared
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Trung T Tran
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Anne T Tveter
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Sella A Provan
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kristin K Jørgensen
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Grete B Kro
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - David J Warren
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Eline B Vaage
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Ane Marie Anderson
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Gunnveig Grødeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Espen A Haavardsholm
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John Torgils Vaage
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | | | | | - Fridtjof Lund-Johansen
- ImmunoLingo Convergence Center, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Ludvig A Munthe
- KG Jebsen Centre for B cell Malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Guro Løvik Goll
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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16
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Wæhre T, Tunheim G, Bodin JE, Laake I, Kvale D, Kran AMB, Brekke H, Løken R, Oftung F, Mjaaland S, Dyrhol-Riise AM. Clinical characteristics and outcomes in hospitalized adult influenza patients: an observational study from Norway 2014-2018. Infect Dis (Lond) 2022; 54:367-377. [PMID: 34983302 DOI: 10.1080/23744235.2021.2022196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Seasonal influenza causes substantial numbers of hospitalizations annually. We have characterized the clinical picture and treatment practice in hospitalized adult influenza patients and assessed whether clinical risk scores on admission or influenza type were associated with severe outcomes. METHODS Clinical characteristics and risk scores on admission (CRB65, CRB, SIRS and quick Sequential Organ Failure Assessment [qSOFA]), treatment and severe outcomes (defined as: stay in intensive care unit (ICU), receiving oxygen supplementation or staying ≥5 days in hospital), were recorded in patients hospitalized with influenza at Oslo University Hospital, Norway, between 2014 and 2018. RESULTS Among the 156 included patients, 52.6% had influenza A(H3N2), 32.6% influenza B and 12.8% influenza A(H1N1). Median age was 70 years and 59.6% of patients were ≥65 years. Nine (5.8%) of the patients were treated in ICU, 43.0% received oxygen and 47.4% stayed ≥5 days in hospital. Overall, 34.6% of the patients had a high CRB score on admission which was associated with stay in ICU and oxygen supplementation. Multivariate analyses identified age, and pneumonia (46.8%), but not influenza type, to be associated with severe outcomes. Antiviral treatment was given to 37.2% of the patients, while 77.6% received antibiotics. Only 25.5% of patients with influenza B received antiviral therapy. CONCLUSIONS The influenza patients were mostly elderly, and few patients were treated in ICU. A high CRB score was associated with severe outcomes with possible implications for patient monitoring. Less than 40% of the patients received antiviral therapy, whereas the majority were treated with antibiotics, indicating potential for optimising treatment strategies.
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Affiliation(s)
- Torgun Wæhre
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway
| | - Gro Tunheim
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Johanna Eva Bodin
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Dag Kvale
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Hanne Brekke
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Løken
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Fredrik Oftung
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Margarita Dyrhol-Riise
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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17
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Juvet LK, Robertson AH, Laake I, Mjaaland S, Trogstad L. Safety of Influenza A H1N1pdm09 Vaccines: An Overview of Systematic Reviews. Front Immunol 2021; 12:740048. [PMID: 34777351 PMCID: PMC8581668 DOI: 10.3389/fimmu.2021.740048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background In 2009, a new influenza A H1N1 virus emerged causing a global pandemic. A range of monovalent influenza A H1N1pdm09 vaccines with or without adjuvants were developed. After the mass vaccination campaigns safety concerns related to H1N1pdm09 vaccines were reported. More than a decade later, reported AEFIs are still under scrutiny. We performed a systematic review aiming to synthesize the evidence on the safety of the H1N1pdm09 vaccines on reported outcomes from existing systematic reviews. Methods Four electronic databases, PubMed, EMBASE, Epistimonikos and the Cochrane Database of Systematic Reviews were searched for articles on H1N1pdm09 vaccination published from 2009 to January 2021. Systematic reviews assessing short- or long-term adverse events after H1N1pdm09 vaccination were considered for inclusion. Data was extracted from all selected reviews. Outcomes were grouped and results from each included review were presented narratively and in tables. Results 16 systematic reviews met the inclusion criteria. Reported outcomes were short-term events (3 reviews), fetal/pregnancy outcomes (8 reviews), Guillain-Barré syndrome (GBS) (4 reviews), narcolepsy (2 reviews) demyelinating diseases (1 review based on one study only) and inflammatory bowel disease (IBD) (1 review). Short-term serious adverse events were rare, 3 cases amongst 16725 subjects in 18 randomized controlled trials (0.018%). No deaths were reported. The risks of local events were generally higher for adjuvanted vaccines as compared to unadjuvanted vaccines. Maternal H1N1pdm09 vaccination in any trimester was not associated with an increase in preterm birth, small for gestational age, congenital malformations or fetal death. For GBS, results were conflicting. The main systematic review on narcolepsy found a 5-14-fold increased risk in children, and a 2-7- fold increased risk in adults after vaccination with Pandemrix. The attributable risk of narcolepsy one year after vaccination was 1 case per 18 400 vaccine doses in children/adolescents, and 1 case per 181 000 vaccine doses in adults. Conclusion Adjuvanted vaccines had more local but not serious adverse events compared to unadjuvanted vaccines. Vaccination with Pandemrix was strongly associated with narcolepsy, particularly in children. No increased risks of pregnancy outcomes were seen after pandemic vaccination. The findings on GBS were inconclusive.
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Affiliation(s)
- Lene Kristine Juvet
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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18
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Andersen TK, Bodin J, Oftung F, Bogen B, Mjaaland S, Grødeland G. Pandemic Preparedness Against Influenza: DNA Vaccine for Rapid Relief. Front Immunol 2021; 12:747032. [PMID: 34691056 PMCID: PMC8531196 DOI: 10.3389/fimmu.2021.747032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/20/2021] [Indexed: 01/14/2023] Open
Abstract
The 2009 “swine flu” pandemic outbreak demonstrated the limiting capacity for egg-based vaccines with respect to global vaccine supply within a timely fashion. New vaccine platforms that efficiently can quench pandemic influenza emergences are urgently needed. Since 2009, there has been a profound development of new vaccine platform technologies with respect to prophylactic use in the population, including DNA vaccines. These vaccines are particularly well suited for global pandemic responses as the DNA format is temperature stable and the production process is cheap and rapid. Here, we show that by targeting influenza antigens directly to antigen presenting cells (APC), DNA vaccine efficacy equals that of conventional technologies. A single dose of naked DNA encoding hemagglutinin (HA) from influenza/A/California/2009 (H1N1), linked to a targeting moiety directing the vaccine to major histocompatibility complex class II (MHCII) molecules, raised similar humoral immune responses as the adjuvanted split virion vaccine Pandemrix, widely administered in the 2009 pandemic. Both vaccine formats rapidly induced serum antibodies that could protect mice already 8 days after a single immunization, in contrast to the slower kinetics of a seasonal trivalent inactivated influenza vaccine (TIV). Importantly, the DNA vaccine also elicited cytotoxic T-cell responses that reduced morbidity after vaccination, in contrast to very limited T-cell responses seen after immunization with Pandemrix and TIV. These data demonstrate that DNA vaccines has the potential as a single dose platform vaccine, with rapid protective effects without the need for adjuvant, and confirms the relevance of naked DNA vaccines as candidates for pandemic preparedness.
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Affiliation(s)
- Tor Kristian Andersen
- Department of Immunology and Transfusion Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johanna Bodin
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Fredrik Oftung
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Bjarne Bogen
- Department of Immunology and Transfusion Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Immunology and Transfusion Medicine, Clinic for Laboratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Siri Mjaaland
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gunnveig Grødeland
- Department of Immunology and Transfusion Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Immunology and Transfusion Medicine, Clinic for Laboratory Medicine, Oslo University Hospital, Oslo, Norway
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19
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Holm S, Kared H, Michelsen AE, Kong XY, Dahl TB, Schultz NH, Nyman TA, Fladeby C, Seljeflot I, Ueland T, Stensland M, Mjaaland S, Goll GL, Nissen-Meyer LS, Aukrust P, Skagen K, Gregersen I, Skjelland M, Holme PA, Munthe LA, Halvorsen B. Immune complexes, innate immunity, and NETosis in ChAdOx1 vaccine-induced thrombocytopenia. Eur Heart J 2021; 42:4064-4072. [PMID: 34405870 PMCID: PMC8385969 DOI: 10.1093/eurheartj/ehab506] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 01/04/2023] Open
Abstract
Aims We recently reported five cases of vaccine-induced immune thrombotic thrombocytopenia (VITT) 7–10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against corona virus disease 2019 (COVID-19). We aimed to investigate the pathogenic immunological responses operating in these patients. Methods and results We assessed circulating inflammatory markers by immune assays and immune cell phenotyping by flow cytometry analyses and performed immunoprecipitation with anti-platelet factor (PF)4 antibody in plasma samples followed by mass spectrometry from all five patients. A thrombus was retrieved from the sinus sagittal superior of one patient and analysed by immunohistochemistry and flow cytometry. Precipitated immune complexes revealed multiple innate immune pathway triggers for platelet and leucocyte activation. Plasma contained increased levels of innate immune response cytokines and markers of systemic inflammation, extensive degranulation of neutrophils, and tissue and endothelial damage. Blood analyses showed activation of neutrophils and increased levels of circulating H3Cit, dsDNA, and myeloperoxidase–DNA complex. The thrombus had extensive infiltration of neutrophils, formation of neutrophil extracellular traps (NETs), and IgG deposits. Conclusions The results show that anti-PF4/polyanion IgG-mediated thrombus formation in VITT patients is accompanied by a massive innate immune activation and particularly the fulminant activation of neutrophils including NETosis. These results provide novel data on the immune response in this rare adenoviral vector-induced VITT.
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Affiliation(s)
- Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway
| | - Hassen Kared
- KG Jebsen Centre for B Cell Malignancies, University of Oslo, Postbox 4950, 0424 Oslo, Norway.,Department of Immunology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Annika E Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway
| | - Tuva B Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Nina H Schultz
- Department of Haematology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway.,Department of Haematology, Akershus University Hospital, Postbox 1000, 1478 Lørenskog, Norway
| | - Tuula A Nyman
- Department of Immunology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Cathrine Fladeby
- Department of Microbiology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Ingebjørg Seljeflot
- Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Postbox 6050, Langnes 9037 Tromsø, Norway
| | - Maria Stensland
- Department of Immunology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Siri Mjaaland
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Postbox 222, Skøyen, 0213 Oslo, Norway
| | - Guro Løvik Goll
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Postbox 23 Vindern, 0319 Oslo, Norway
| | | | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Ida Gregersen
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway
| | - Mona Skjelland
- Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Department of Neurology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Pål A Holme
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway.,Department of Haematology, Oslo University Hospital, Postbox 4950, N-0424 Oslo, Norway
| | - Ludvig A Munthe
- KG Jebsen Centre for B Cell Malignancies, University of Oslo, Postbox 4950, 0424 Oslo, Norway.,Department of Immunology, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Postbox 4950, 0424 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern 0318 Oslo, Norway
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20
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Trogstad L, Robertson AH, Mjaaland S, Magnus P. Association between ChAdOx1 nCoV-19 vaccination and bleeding episodes: Large population-based cohort study. Vaccine 2021; 39:5854-5857. [PMID: 34479760 PMCID: PMC8406020 DOI: 10.1016/j.vaccine.2021.08.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/24/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022]
Abstract
Objective To compare prevalence of skin, nose and gingival bleedings after receipt of adeno-vectored or mRNA-vaccines against COVID-19. The hypothesis is that milder symptoms indicating altered thrombocyte function may affect a larger proportion of vaccinated individuals than the recently reported severe cases with thrombosis and thrombocytopenia. Methods Using an ongoing large, population-based cohort study, more than 80 000 cohort participants were asked through electronic questionnaires about COVID-19 vaccination and potential side effects during weeks 11–13, 2021. The response rate was 58% (81267/138924). Among the vaccinated, 83% were female, 85% health care workers and 80% were aged 40–55 years. The prevalence of self-reported episodes of skin, nose and gingival bleedings were compared after mRNA and adenovirus-vectored vaccination. Estimates were adjusted for age, sex, occupation, previous COVID-19 infection and chronic disease. Results Four of the 3416 subjects (0.2%) who were vaccinated with a single dose of mRNA vaccine reported skin bleeding as a side effect, as opposed to 163 of 5132 subjects (3.2%) vaccinated with a single dose of the adenovirus-vectored vaccine, OR (odds ratio) = 16.0 (95% confidence interval (CI) 7.5–34.1). Corresponding ORs for nose and gingival bleeding were 8.0 (4.0–15.8) and 9.3 (4.3–20.0), respectively. Conclusions These findings could potentially indicate that the adenovirus-vectored vaccine may lead to mild bleeding episodes in a larger proportion of vaccinated individuals, and not only in rare cases with documented thrombosis and thrombocytopenia. Studies are needed to understand the possible mechanisms behind these observations, and to establish or refute whether they share similarities with the severe thromboembolic bleeding complications.
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Affiliation(s)
- Lill Trogstad
- The Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway.
| | - Anna Hayman Robertson
- The Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - Siri Mjaaland
- The Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - Per Magnus
- The Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
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21
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Gustavson K, Ystrom E, Ask H, Ask Torvik F, Hornig M, Susser E, Lipkin WI, Lupattelli A, Stoltenberg C, Magnus P, Mjaaland S, Askeland RB, Walle KM, Bresnahan M, Nordeng H, Reichborn‐Kjennerud T. Acetaminophen use during pregnancy and offspring attention deficit hyperactivity disorder – a longitudinal sibling control study. JCPP Advances 2021. [DOI: 10.1002/jcv2.12020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kristin Gustavson
- Norwegian Institute of Public Health Oslo Norway
- Promenta Research Center University of Oslo Oslo Norway
| | - Eivind Ystrom
- Norwegian Institute of Public Health Oslo Norway
- Promenta Research Center University of Oslo Oslo Norway
| | - Helga Ask
- Norwegian Institute of Public Health Oslo Norway
| | - Fartein Ask Torvik
- Department of Psychology University of Oslo Oslo Norway
- Center for Fertility and Health Norwegian Institute of Public Health Oslo Norway
| | - Mady Hornig
- Mailman School of Public Health Columbia University New York NY USA
| | - Ezra Susser
- Mailman School of Public Health Columbia University New York NY USA
- New York State Psychiatric Institute New York NY USA
| | - W. Ian Lipkin
- Department of Epidemiology Columbia University Mailman School of Public Health New York NY USA
- Center for Infection and Immunity Columbia University Mailman School of Public Health New York NY USA
- Departments of Neurology and Pathology Mailman School of Public Health New York NY USA
- College of Physicians and Surgeons Columbia University New York NY USA
| | - Angela Lupattelli
- Pharmacoepidemiology and Drug Safety Research Group Department of Pharmacy, and PharmaTox Strategic Research Initiative Faculty of Mathematics and Natural Sciences University of Oslo Oslo Norway
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health Oslo Norway
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Per Magnus
- Norwegian Institute of Public Health Oslo Norway
| | | | | | | | | | - Hedvig Nordeng
- Norwegian Institute of Public Health Oslo Norway
- Pharmacoepidemiology and Drug Safety Research Group Department of Pharmacy, and PharmaTox Strategic Research Initiative Faculty of Mathematics and Natural Sciences University of Oslo Oslo Norway
| | - Ted Reichborn‐Kjennerud
- Norwegian Institute of Public Health Oslo Norway
- Department of Medicine University of Oslo Oslo Norway
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22
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Muller AE, Tveito K, Bakken IJ, Flottorp SA, Mjaaland S, Larun L. Potential causal factors of CFS/ME: a concise and systematic scoping review of factors researched. J Transl Med 2020; 18:484. [PMID: 33317576 PMCID: PMC7734915 DOI: 10.1186/s12967-020-02665-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/04/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is understood as a complex condition, likely triggered and sustained by an interplay of biological, psychological, and social factors. Little oversight exists of the field of causal research. This systematic scoping review explores potential causal factors of CFS/ME as researched by primary studies. METHODS We searched eight databases for primary studies that examined potential causal factors of CFS/ME. Based on title/abstract review, two researchers independently sorted each study's factors into nine main categories and 71 subordinate categories, using a system developed with input given during a 2018 ME conference, specialists and representatives from a ME patient advocacy group, and using BMJ Best Practice's description of CFS/ME etiology. We also extracted data related to study design, size, diagnostic criteria and comparison groups. RESULTS We included 1161 primary studies published between January 1979 and June 2019. Based on title/abstract analysis, no single causal factor dominated in these studies, and studies reported a mean of 2.73 factors. The four most common factors were: immunological (297 studies), psychological (243), infections (198), and neuroendocrinal (198). The most frequent study designs were case-control studies (894 studies) comparing CFS/ME patients with healthy participants. More than half of the studies (that reported study size in the title/abstract) included 100 or fewer participants. CONCLUSION The field of causal hypotheses of CFS/ME is diverse, and we found that the studies examined all the main categories of possible factors that we had defined a priori. Most studies were not designed to adequately explore causality, rather to establish hypotheses. We need larger studies with stronger study designs to gain better knowledge of causal factors of CFS/ME.
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Affiliation(s)
| | - Kari Tveito
- Journal of the Norwegian Medical Association, Sentrum, PO Box 1152, 0107, Oslo, Norway
| | | | - Signe A Flottorp
- Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Siri Mjaaland
- Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213, Oslo, Norway
| | - Lillebeth Larun
- Norwegian Institute of Public Health, Skøyen, PO Box 222, 0213, Oslo, Norway
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23
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Sonnet F, Namork E, Stylianou E, Gaare-Olstad I, Huse K, Andorf S, Mjaaland S, Dirven H, Nygaard U. Reduced polyfunctional T cells and increased cellular activation markers in adult allergy patients reporting adverse reactions to food. BMC Immunol 2020; 21:43. [PMID: 32698761 PMCID: PMC7376650 DOI: 10.1186/s12865-020-00373-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background The underlying cellular mechanisms causing adverse reactions to food are complex and still not fully understood. Therefore, in this study we aimed to identify functional and/or phenotypical immune cell signatures characteristic for adult patients reporting adverse reactions to food. By mass cytometry, we performed high-dimensional profiling of peripheral blood mononuclear cells (PBMC) from adult patients reporting adverse reactions to food and healthy controls. The patients were grouped according to sIgE-positive or sIgE-negative serology to common food and inhalant allergens. Two broad antibody panels were used, allowing determination of major immune cell populations in PBMC, as well as activation status, proliferation status, and cytokine expression patterns after PMA/ionomycin-stimulation on a single cell level. Results By use of data-driven algorithms, several cell populations were identified showing significantly different marker expression between the groups. Most striking was an impaired frequency and function of polyfunctional CD4+ and CD8+ T cells in patients reporting adverse reactions to food compared to the controls. Further, subpopulations of monocytes, T cells, and B cells had increased expression of functional markers such as CD371, CD69, CD25, CD28, and/or HLA-DR as well as decreased expression of CD23 in the patients. Most of the differing cell subpopulations were similarly altered in the two subgroups of patients. Conclusion Our results suggest common immune cell features for both patient subgroups reporting adverse reactions to food, and provide a basis for further studies on mechanistic and diagnostic biomarker studies in food allergy.
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Affiliation(s)
- Friederike Sonnet
- Department of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Lovisenberggata 8, Oslo, Norway. .,, Utrecht, the Netherlands.
| | - Ellen Namork
- Department of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Lovisenberggata 8, Oslo, Norway
| | - Eva Stylianou
- Regional Unit for Asthma, Allergy and Hypersensitivity, Department of Pulmonary Diseases, Oslo University Hospital, Kirkeveien 166, Oslo, Norway
| | - Ingvild Gaare-Olstad
- Regional Unit for Asthma, Allergy and Hypersensitivity, Department of Pulmonary Diseases, Oslo University Hospital, Kirkeveien 166, Oslo, Norway
| | - Kanutte Huse
- Department of Cancer Immunology, Oslo University Hospital, Ullernchausseen 70, Oslo, Norway
| | - Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, USA
| | - Siri Mjaaland
- Department of Infectious Diseases Epidemiology and Modelling, Norwegian Institute of Public Health, Lovisenberggata 8, Oslo, Norway.,K.G. Jebsen Center for Influenza Vaccine Research Oslo, Kirkeveien 166, Oslo, Norway
| | - Hubert Dirven
- Department of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Lovisenberggata 8, Oslo, Norway
| | - Unni Nygaard
- Department of Toxicology and Risk Assessment, Norwegian Institute of Public Health, Lovisenberggata 8, Oslo, Norway
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24
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Robertson AH, Mahic M, Savic M, Tunheim G, Hungnes O, Trogstad L, Lipkin WI, Mjaaland S. Detection of anti-NS1 antibodies after pandemic influenza exposure: Evaluation of a serological method for distinguishing H1N1pdm09 infected from vaccinated cases. Influenza Other Respir Viruses 2020; 14:294-301. [PMID: 31955522 PMCID: PMC7182603 DOI: 10.1111/irv.12712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 12/26/2022] Open
Abstract
Background Reliable exposure information is crucial for assessing health outcomes of influenza infection and vaccination. Current serological methods are unable to distinguish between anti‐hemagglutinin (HA) antibodies induced by infection or vaccination. Objectives We aimed to explore an alternative method for differentiating influenza infection and vaccination. Methods Sera from animals inoculated with influenza viruses or purified H1N1pdm09 HA were obtained. Human samples were selected from a pregnancy cohort established during the 2009 H1N1 pandemic. Unvaccinated, laboratory‐confirmed cases (N = 18), vaccinated cases without influenza‐like‐illness (N = 18) and uninfected, unvaccinated controls (N = 18) were identified based on exposure data from questionnaires, national registries and maternal hemagglutination inhibition (HI) titres at delivery. Animal and human samples were tested for antibodies against the non‐structural protein 1 (NS1) and HA from H1N1pdm09, using a Luciferase Immunoprecipitation System (LIPS). Results Anti‐NS1 H1N1pdm09 antibodies were detected in sera from experimentally infected, but not from vaccinated, animals. Anti‐HA H1N1pdm09 antibodies were detectable after either of these exposures. In human samples, 28% of individuals with laboratory‐confirmed influenza were seropositive for H1N1pdm09 NS1, whereas vaccinated cases and controls were seronegative. There was a trend for H1N1pdm09 NS1 seropositive cases reporting more severe and longer duration of symptomatic illness than seronegative cases. Anti‐HA H1N1pdm09 antibodies were detected in all cases and in 61% of controls. Conclusions The LIPS method could differentiate between sera from experimentally infected and vaccinated animals. However, in human samples obtained more than 6 months after the pandemic, LIPS was specific, but not sufficiently sensitive for ascertaining cases by exposure.
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Affiliation(s)
- Anna Hayman Robertson
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Milada Mahic
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Miloje Savic
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gro Tunheim
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,KG Jebsen Center for Influenza Vaccine Research, Oslo, Norway
| | - Olav Hungnes
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,WHO National Influenza Centre, Oslo, Norway
| | - Lill Trogstad
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Walter Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Siri Mjaaland
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, USA.,KG Jebsen Center for Influenza Vaccine Research, Oslo, Norway
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25
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Bodin J, Mihret A, Holm-Hansen C, Dembinski JL, Trieu MC, Tessema B, Tarekegne A, Yimer SA, Cox R, Aseffa A, Haneberg B, Mjaaland S. Vitamin D Deficiency is Associated with Increased Use of Antimicrobials among Preschool Girls in Ethiopia. Nutrients 2019; 11:nu11030575. [PMID: 30866564 PMCID: PMC6471093 DOI: 10.3390/nu11030575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 12/12/2022] Open
Abstract
Preschool children in Addis Ababa, Ethiopia, are highly exposed to influenza viruses. Factors related to infections, nutrition, and environmental conditions that might explain the burden of influenza among these children were investigated. Ninety-five preschool children, 48 girls and 47 boys, were followed clinically for 12 months. Illness and immune responses to influenza; three other respiratory viruses; five airway pathogenic bacteria; and levels of vitamins D, A, and B12 were assessed. Most of the children had antibodies to numerous respiratory viral and bacterial agents at study start, and many were infected during follow-up. Twenty-five girls and 25 boys fell ill during the study, and were treated with one or more courses of systemic antimicrobials. Ninety percent of both girls and boys had 25-hydroxyvitamin D [25(OH)D] levels below the recommended levels. While there was no overall difference in the levels of vitamins D, A, and B12 between girls and boys, treated girls had significantly lower 25(OH)D levels than non-treated girls and treated boys. There was a considerable number of short for age children, but only the short treated girls had significantly lower 25(OH)D levels than the non-treated children. Preschool girls with low 25(OH)D levels were more vulnerable to pathogenic microbes than boys.
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Affiliation(s)
- Johanna Bodin
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0316 Oslo, Norway.
| | - Adane Mihret
- Armauer Hansen Research Institute, 1005 Addis Ababa, Ethiopia.
| | - Carol Holm-Hansen
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Jennifer L Dembinski
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- Department of Virology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Mai-Chi Trieu
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0316 Oslo, Norway.
- The Influenza Centre and Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Bamlak Tessema
- Armauer Hansen Research Institute, 1005 Addis Ababa, Ethiopia.
| | - Azeb Tarekegne
- Armauer Hansen Research Institute, 1005 Addis Ababa, Ethiopia.
| | - Solomon A Yimer
- Coalition for Epidemic Preparedness Innovations (CEPI), 0306 Oslo, Norway.
- Department of Microbiology, University of Oslo, 0316 Oslo, Norway.
| | - Rebecca Cox
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0316 Oslo, Norway.
- The Influenza Centre and Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Abraham Aseffa
- Armauer Hansen Research Institute, 1005 Addis Ababa, Ethiopia.
| | - Bjørn Haneberg
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
| | - Siri Mjaaland
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, 0456 Oslo, Norway.
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0316 Oslo, Norway.
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26
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Tunheim G, Laake I, Robertson AH, Waalen K, Hungnes O, Naess LM, Cox RJ, Mjaaland S, Trogstad L. Antibody levels in a cohort of pregnant women after the 2009 influenza A(H1N1) pandemic: Waning and association with self-reported severity and duration of illness. Influenza Other Respir Viruses 2018; 13:191-200. [PMID: 30536590 PMCID: PMC6379636 DOI: 10.1111/irv.12623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/05/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND A population-based pregnancy cohort was established in Norway to study potential effects of exposure to the 2009 influenza pandemic or pandemic vaccination during pregnancy. OBJECTIVES We studied maternal A(H1N1)pdm09-specific hemagglutination inhibition (HI)-titer levels and waning in women with influenza-like illness (ILI) in pregnancy compared to vaccinated women. Moreover, we studied the association between HI-titers and self-reported severity and duration of ILI. METHODS HI-titers against the pandemic virus were measured in maternal blood samples obtained at birth, 3-9 months after exposure, and linked with information about pregnancy, influenza and vaccination from national registries and a cohort questionnaire. RESULTS Among 1821 pregnant women included, 43.7% were unvaccinated and 19.3% of these had ILI. HI-titers were low (geometric mean titer (GMT) 11.3) in the unvaccinated women with ILI. Higher HI-titers (GMT 37.8) were measured in the vaccinated women. Estimated HI-titer waning was similar for vaccinated women and women with ILI. Most ILI episodes were moderate and lasted 3-5 days. Women with ILI reporting specific influenza symptoms such as fever or cough had higher HI-titers than women without these symptoms. Women who reported being "very ill" or illness duration of >5 days had higher HI-titers than women reporting less severe illness or illness of shorter duration, respectively. CONCLUSIONS Antibody waning was similar in vaccinated women and women with ILI. More severe ILI or longer duration of illness was associated with higher HI-titers. Most unvaccinated pregnant women with ILI had low HI-titers, probably due to moderate illness and HI-titer waning between exposure and sampling.
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Affiliation(s)
- Gro Tunheim
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway
| | - Ida Laake
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Hayman Robertson
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristian Waalen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Olav Hungnes
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lisbeth M Naess
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Rebecca J Cox
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Siri Mjaaland
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway
| | - Lill Trogstad
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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27
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Laake I, Tunheim G, Robertson AH, Hungnes O, Waalen K, Håberg SE, Mjaaland S, Trogstad L. Risk of pregnancy complications and adverse birth outcomes after maternal A(H1N1)pdm09 influenza: a Norwegian population-based cohort study. BMC Infect Dis 2018; 18:525. [PMID: 30348103 PMCID: PMC6196446 DOI: 10.1186/s12879-018-3435-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 10/05/2018] [Indexed: 12/04/2022] Open
Abstract
Background The effects of maternal influenza infection on the fetus remain unclear. We studied mild influenza and influenza antibodies in relation to birth weight and risks of pre-eclampsia, preterm birth (PTB), and small for gestational age (SGA) birth among the unvaccinated participants in the Norwegian Influenza Pregnancy Cohort. Methods Pregnant women attending a routine ultrasound were recruited from four hospitals in Norway shortly after the 2009 A(H1N1) pandemic. The present study was restricted to unvaccinated participants who were pregnant during the pandemic. Information on the participants was obtained through questionnaires and linkage with national registries. Maternal blood samples were collected at delivery. Women with laboratory-confirmed A(H1N1)pdm09 influenza, a clinical diagnosis of influenza, or self-reported influenza during the pandemic were classified as having had influenza. A(H1N1)pdm09-specific antibodies in serum were detected with the hemagglutination-inhibition assay. Detection of antibodies was considered an indicator of infection during the pandemic in the unvaccinated participants. Odds ratios were estimated with logistic regression. Quantile regression was used to estimate differences in the distribution of birth weight. Results Among the 1258 women included in this study, there were 37 cases of pre-eclampsia, 41 births were PTB, and 103 births were SGA. 226 women (18.0%) had influenza during the pandemic. The majority of cases did not receive medical care, and only a small proportion (1.3%) of the cases were hospitalized. Thus, the cases consisted primarily of women with mild illness. No significant associations between influenza and risk of pre-eclampsia, PTB, or SGA birth were observed. Detection of A(H1N1)pdm09-specific antibodies was associated with a lower 10th percentile of birth weight, β = − 159 g (95% CI − 309, − 9). Conclusions Mild influenza illness during pregnancy was not associated with increased risk of pre-eclampsia, PTB or SGA birth. However, influenza infection during pregnancy may reduce the birth weight of the smallest children.
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Affiliation(s)
- Ida Laake
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway.
| | - Gro Tunheim
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway.,K.G. Jebsen Center for Influenza Vaccine Research, University of Oslo, Oslo, Norway
| | - Anna Hayman Robertson
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Olav Hungnes
- Department of Influenza, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristian Waalen
- Department of Influenza, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway.,K.G. Jebsen Center for Influenza Vaccine Research, University of Oslo, Oslo, Norway
| | - Lill Trogstad
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
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28
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Trieu MC, Zhou F, Lartey SL, Sridhar S, Mjaaland S, Cox RJ. Augmented CD4 + T-cell and humoral responses after repeated annual influenza vaccination with the same vaccine component A/H1N1pdm09 over 5 years. NPJ Vaccines 2018; 3:37. [PMID: 30131880 PMCID: PMC6092382 DOI: 10.1038/s41541-018-0069-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
Annual seasonal influenza vaccination is recommended for high-risk populations and often occupational groups such as healthcare workers (HCWs). Repeated annual vaccination has been reported to either have no impact or reduce antibody responses or protection. However, whether repeated vaccination influences T-cell responses has not been sufficiently studied, despite the increasing evidence of the protective roles of T-cell immunity. Here, we explored the impact of repeated annual vaccination with the same vaccine strain (H1N1pdm09) over multiple seasons in the post-2009 pandemic era and showed that repeated vaccination increased both T-cell and humoral responses. Using the T-cell FluroSpot and intracellular cytokine-staining, the hemagglutination inhibition (HI), and the memory B-cell (MBC) ELISpot assays, we investigated pre- and postvaccination T cells, antibodies, and MBCs in a cohort of HCWs repeatedly vaccinated with H1N1pdm09 for 5 years (pandemic vaccination in 2009 and subsequently annual seasonal vaccination containing H1N1pdm09 during 2010-2013). We found that the prevaccination H1N1pdm09-specific T cells, antibodies, and MBCs were significantly increased after 3-4 repeated vaccinations and maintained at high levels throughout seasons 2012 and 2013. The cross-reactive IFN-γ-secreting CD4+ cells recognizing conserved viral external or internal epitopes were also maintained throughout 2012 and 2013. Repeated vaccination improved the multifunctional memory CD4+ responses. Particularly, the IFN-γ+TNF-α+CD4+ T cells were boosted following each vaccination. HI antibodies were significantly induced after each vaccination over 5 years. Our findings indicate a broad impact of repeated annual vaccination, even with the same vaccine component, on the influenza-specific T-cell and humoral immunity and support the continuing recommendation of annual influenza vaccination. Despite the widespread implementation of annual influenza vaccination, the effect of repeated vaccinations on the immune response in subsequent seasons is poorly understood. A team led by Rebecca Jane Cox at the University of Bergen examined the humoral and T-cell response elicited by 2009's H1N1pdm09 seasonal vaccine. Since the H1N1pdm09 strain continued to circulate in subsequent years it was included in later vaccine formulations and the authors could therefore examine the effects of repeated annual vaccination over multiple seasons. They observed that H1N1pdm09-specific polyfunctional T-cell responses and antibodies were enhanced by multiple annual vaccinations. In particular, T cells showed progressive skewing to IFN-γ+TNF+ double producers, but the magnitude of the T-cell response tended to plateau after 3-4 repeated vaccinations. The findings suggest that including the same component in subsequent annual vaccines can significantly impact the influenza immune response.
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Affiliation(s)
- Mai-Chi Trieu
- 1The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,2K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Fan Zhou
- 1The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,2K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sarah Larteley Lartey
- 1The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,2K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Saranya Sridhar
- 3Jenner Institute, University of Oxford, Oxford, UK.,6Present Address: Sanofi Pasteur, 1541 Avenue Marcel Mérieux, 69280 Marcy l'Etoile, France
| | - Siri Mjaaland
- 2K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,4Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Rebecca Jane Cox
- 1The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,2K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, Norway.,5Department of Research and Development, Haukeland University Hospital, Bergen, Norway
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29
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Savic M, Dembinski JL, Laake I, Hungnes O, Cox R, Oftung F, Trogstad L, Mjaaland S. Distinct T and NK cell populations may serve as immune correlates of protection against symptomatic pandemic influenza A(H1N1) virus infection during pregnancy. PLoS One 2017; 12:e0188055. [PMID: 29145441 PMCID: PMC5690673 DOI: 10.1371/journal.pone.0188055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/31/2017] [Indexed: 11/24/2022] Open
Abstract
Maternal influenza infection during pregnancy is associated with increased risk of morbidity and mortality. However, the link between the anti-influenza immune responses and health-related risks during infection is not well understood. We have analyzed memory T and NK cell mediated immunity (CMI) responses in pandemic influenza A(H1N1)pdm09 (pdm09) virus infected non-vaccinated pregnant women participating in the Norwegian Influenza Pregnancy Cohort (NorFlu). The cohort includes information on immunization, self-reported health and disease status, and biological samples (plasma and PBMC). Infected cases (N = 75) were defined by having a serum hemagglutination inhibition (HI) titer > = 20 to influenza pdm09 virus at the time of delivery, while controls (N = 75) were randomly selected among non-infected pregnant women (HI titer <10). In ELISpot assays cases had higher frequencies of IFNγ+ CD8+ T cells responding to pdm09 virus or conserved CD8 T cell-restricted influenza A virus epitopes, compared to controls. Within this T cell population, frequencies of CD95+ late effector (CD45RA+CCR7-) and naive (CD45RA+CCR7+) CD8+ memory T cells correlated inversely with self-reported influenza illness (ILI) symptoms. ILI symptoms in infected women were also associated with lower numbers of poly-functional (IFNγ+TNFα+, IL2+IFNγ+, IL2+IFNγ+TNFα+) CD4+ T cells and increased frequencies of IFNγ+CD3-CD7+ NK cells compared to asymptomatic cases, or controls, after stimulation with the pdm09 virus. Taken together, virus specific and functionally distinct T and NK cell populations may serve as cellular immune correlates of clinical outcomes of pandemic influenza disease in pregnant women. Our results may provide information important for future universal influenza vaccine design.
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Affiliation(s)
- Miloje Savic
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- KG Jebsen Centre for Influenza Vaccine Research, Oslo-Bergen, Norway
- * E-mail: ;
| | - Jennifer L. Dembinski
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- KG Jebsen Centre for Influenza Vaccine Research, Oslo-Bergen, Norway
| | - Ida Laake
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Olav Hungnes
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Rebecca Cox
- KG Jebsen Centre for Influenza Vaccine Research, Oslo-Bergen, Norway
- Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Fredrik Oftung
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- KG Jebsen Centre for Influenza Vaccine Research, Oslo-Bergen, Norway
| | - Lill Trogstad
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- KG Jebsen Centre for Influenza Vaccine Research, Oslo-Bergen, Norway
- * E-mail: ;
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30
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Trieu MC, Zhou F, Lartey S, Jul-Larsen Å, Mjaaland S, Sridhar S, Cox RJ. Long-term Maintenance of the Influenza-Specific Cross-Reactive Memory CD4+ T-Cell Responses Following Repeated Annual Influenza Vaccination. J Infect Dis 2017; 215:740-749. [PMID: 28007925 DOI: 10.1093/infdis/jiw619] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/09/2016] [Indexed: 11/14/2022] Open
Abstract
Background Annual vaccination for healthcare workers and other high-risk groups is the mainstay of the public health strategy to combat influenza. Inactivated influenza vaccines confer protection by inducing neutralizing antibodies efficiently against homologous and closely matched virus strains. In the absence of neutralizing antibodies, cross-reactive T cells have been shown to limit disease severity. However, animal studies and a study in immunocompromised children suggested that repeated vaccination hampers CD8+ T cells. Yet the impact of repeated annual influenza vaccination on both cross-reactive CD4+ and CD8+ T cells has not been explored, particularly in healthy adults. Methods We assembled a unique cohort of healthcare workers who received a single AS03-adjuvanted H1N1pdm09 vaccine in 2009 and subsequently either repeated annual vaccination or no further vaccination during 2010-2013. Blood samples were collected before the influenza season or vaccination to assess antibody and T-cell responses. Results Antibody titers to H1N1pdm09 persisted above the protective level in both the repeated- and single-vaccination groups. The interferon γ+ (IFN-γ+) and multifunctional CD4+ T-cell responses were maintained in the repeated group but declined significantly in the single-vaccination group. The IFN-γ+CD8+ T cells remained stable in both groups. Conclusions This study provides the immunological evidence base for continuing annual influenza vaccination in adults.
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Affiliation(s)
- Mai-Chi Trieu
- The Influenza Centre, Department of Clinical Science, University of Bergen, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Bergen, Norway
| | - Fan Zhou
- The Influenza Centre, Department of Clinical Science, University of Bergen, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Bergen, Norway
| | - Sarah Lartey
- The Influenza Centre, Department of Clinical Science, University of Bergen, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Bergen, Norway
| | - Åsne Jul-Larsen
- The Influenza Centre, Department of Clinical Science, University of Bergen, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Bergen, Norway
| | - Siri Mjaaland
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Bergen, Norway.,Domain for Infection Control and Environmental Health, Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Rebecca Jane Cox
- The Influenza Centre, Department of Clinical Science, University of Bergen, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Bergen, Norway.,Department of Research and Development, Haukeland University Hospital, Bergen, Norway
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31
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Dembinski JL, Mihret A, Yimer SA, Tessema B, Trieu MC, Tarekegn A, Getachew N, Cox RJ, Oftung F, Haneberg B, Aseffa A, Mjaaland S. High Prevalence of Humoral and Cellular Immunity to Influenza Viruses in Preschool Children Living in Addis Ababa, Ethiopia. Open Forum Infect Dis 2017; 4:ofx026. [PMID: 28480294 PMCID: PMC5414001 DOI: 10.1093/ofid/ofx026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/06/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Influenza in children who reside in tropical and subtropical regions has until recently been regarded as insignificant. However, new evidence suggests that it significantly impacts hospitalization and promotes secondary bacterial coinfections. Ethiopia is situated in a subtropical area where influenza viruses are likely to circulate year round. METHODS Clinical data were recorded in a cohort of 103 healthy preschool children recruited in Addis Ababa, Ethiopia. Humoral and cellular immune responses to influenza virus were determined by hemagglutination inhibition (HI) and interferon-γ enzyme-linked immunospot assays. RESULTS Ninety-six percent of the children (2-5 years old) had pre-existing HI antibody responses to 1 or more of the circulating influenza A subtypes, H1N1 (51%), H3N2 (86%), or influenza B (51%) strains. At the age of 4, all children had been infected with at least 1 strain, and 75% had been infected with 2-4 different viral strains. CD4+ and CD8+ T-cell responses against conserved viral antigens increased with repeated exposures, indicating boosting of cross-reactive cellular immunity. Malnutrition did not seem to affect these immune responses to influenza. CONCLUSIONS Influenza is highly prevalent among children in this area of Ethiopia. Due to the risk of secondary bacterial pneumonia, increased influenza awareness might benefit child health.
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Affiliation(s)
- Jennifer L Dembinski
- Departments of Immunology and.,Vaccine Preventable Diseases, Domain for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,KG Jebsen Centre for Influenza Vaccine Research, Department of Immunology, University of Oslo, Norway
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Solomon A Yimer
- Departments of Immunology and.,Department of Microbiology, Oslo University Hospital, Norway
| | - Bamlak Tessema
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Mai-Chi Trieu
- KG Jebsen Centre for Influenza Vaccine Research, Department of Immunology, University of Oslo, Norway.,The Influenza Centre, Department of Clinical Science, University of Bergen, Norway; and
| | - Azeb Tarekegn
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Nahom Getachew
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Rebecca J Cox
- KG Jebsen Centre for Influenza Vaccine Research, Department of Immunology, University of Oslo, Norway.,The Influenza Centre, Department of Clinical Science, University of Bergen, Norway; and.,Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Fredrik Oftung
- Departments of Immunology and.,KG Jebsen Centre for Influenza Vaccine Research, Department of Immunology, University of Oslo, Norway
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Siri Mjaaland
- Departments of Immunology and.,KG Jebsen Centre for Influenza Vaccine Research, Department of Immunology, University of Oslo, Norway
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32
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Haneberg B, Mamelund SE, Mjaaland S. Hva er det med disse skolebarna? Tidsskriftet 2017; 137:17-0977. [DOI: 10.4045/tidsskr.17.0977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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33
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van Els C, Mjaaland S, Næss L, Sarkadi J, Gonczol E, Korsholm KS, Hansen J, de Jonge J, Kersten G, Warner J, Semper A, Kruiswijk C, Oftung F. Fast vaccine design and development based on correlates of protection (COPs). Hum Vaccin Immunother 2016; 10:1935-48. [PMID: 25424803 DOI: 10.4161/hv.28639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
New and reemerging infectious diseases call for innovative and efficient control strategies of which fast vaccine design and development represent an important element. In emergency situations, when time is limited, identification and use of correlates of protection (COPs) may play a key role as a strategic tool for accelerated vaccine design, testing, and licensure. We propose that general rules for COP-based vaccine design can be extracted from the existing knowledge of protective immune responses against a large spectrum of relevant viral and bacterial pathogens. Herein, we focus on the applicability of this approach by reviewing the established and up-coming COPs for influenza in the context of traditional and a wide array of new vaccine concepts. The lessons learnt from this field may be applied more generally to COP-based accelerated vaccine design for emerging infections.
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Affiliation(s)
- Cécile van Els
- a National Institute for Public Health and the Environment; Bilthoven, the Netherlands
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34
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Mamelund SE, Haneberg B, Mjaaland S. A Missed Summer Wave of the 1918-1919 Influenza Pandemic: Evidence From Household Surveys in the United States and Norway. Open Forum Infect Dis 2016; 3:ofw040. [PMID: 27006964 PMCID: PMC4800462 DOI: 10.1093/ofid/ofw040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 02/12/2016] [Indexed: 11/13/2022] Open
Abstract
Background. Reanalysis of influenza survey data from 1918 to 1919 was done to obtain new insights into the geographic and host factors responsible for the various waves. Methods. We analyzed the age- and sex-specific influenza morbidity, fatality, and mortality for the city of Baltimore and smaller towns and rural areas of Maryland and the city of Bergen (Norway), using survey data. The Maryland surveys captured the 1918 fall wave, whereas the Bergen survey captured 3 waves during 1918–1919. Results. Morbidity in rural areas of Maryland was higher than in the city of Baltimore during the fall of 1918, that was almost equal to that in Bergen during the summer of 1918. In Bergen, the morbidity in the fall was only half of that in the summer, with more females than males just above the age of 20 falling ill, as seen in both regions of Maryland. In contrast, more males than females fell ill during the summer wave in Bergen. Individuals <40 years had the highest morbidity, whereas school-aged children had the lowest fatality and mortality. Conclusion. A previously unrecognized pandemic summer wave may have hit the 2 regions of Maryland in 1918.
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Affiliation(s)
- Svenn-Erik Mamelund
- Work Research Institute; Oslo and Akershus University College of Applied Sciences
| | - Bjørn Haneberg
- Department of Bacteriology and Immunology, Division of Environmental Medicine and Infectious Disease Control , Norwegian Institute of Public Health
| | - Siri Mjaaland
- Department of Bacteriology and Immunology, Division of Environmental Medicine and Infectious Disease Control, Norwegian Institute of Public Health; KG Jebsen Centre for Influenza Vaccine Research, University of Oslo, Norway
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35
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Savic M, Dembinski JL, Kim Y, Tunheim G, Cox RJ, Oftung F, Peters B, Mjaaland S. Epitope specific T-cell responses against influenza A in a healthy population. Immunology 2015; 147:165-77. [PMID: 26489873 DOI: 10.1111/imm.12548] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/15/2015] [Accepted: 10/13/2015] [Indexed: 12/25/2022] Open
Abstract
Pre-existing human CD4(+) and CD8(+) T-cell-mediated immunity may be a useful correlate of protection against severe influenza disease. Identification and evaluation of common epitopes recognized by T cells with broad cross-reactivity is therefore important to guide universal influenza vaccine development, and to monitor immunological preparedness against pandemics. We have retrieved an optimal combination of MHC class I and class II restricted epitopes from the Immune Epitope Database (www.iedb.org), by defining a fitness score function depending on prevalence, sequence conservancy and HLA super-type coverage. Optimized libraries of CD4(+) and CD8(+) T-cell epitopes were selected from influenza antigens commonly present in seasonal and pandemic influenza strains from 1934 to 2009. These epitope pools were used to characterize human T-cell responses in healthy donors using interferon-γ ELISPOT assays. Upon stimulation, significant CD4(+) and CD8(+) T-cell responses were induced, primarily recognizing epitopes from the conserved viral core proteins. Furthermore, the CD4(+) and CD8(+) T cells were phenotypically characterized regarding functionality, cytotoxic potential and memory phenotype using flow cytometry. Optimized sets of T-cell peptide epitopes may be a useful tool to monitor the efficacy of clinical trials, the immune status of a population to predict immunological preparedness against pandemics, as well as being candidates for universal influenza vaccines.
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Affiliation(s)
- Miloje Savic
- Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, Oslo University Hospital, Oslo, Norway
| | - Jennifer L Dembinski
- Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, Oslo University Hospital, Oslo, Norway
| | - Yohan Kim
- La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - Gro Tunheim
- Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, Oslo University Hospital, Oslo, Norway
| | - Rebecca J Cox
- K. G. Jebsen Centre for Influenza Vaccine Research, Oslo University Hospital, Oslo, Norway.,The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Fredrik Oftung
- Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, Oslo University Hospital, Oslo, Norway
| | - Bjoern Peters
- La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA
| | - Siri Mjaaland
- Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, Oslo University Hospital, Oslo, Norway
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36
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Mohn KGI, Cox RJ, Tunheim G, Berdal JE, Hauge AG, Jul-Larsen Å, Peters B, Oftung F, Jonassen CM, Mjaaland S. Immune Responses in Acute and Convalescent Patients with Mild, Moderate and Severe Disease during the 2009 Influenza Pandemic in Norway. PLoS One 2015; 10:e0143281. [PMID: 26606759 PMCID: PMC4659565 DOI: 10.1371/journal.pone.0143281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/03/2015] [Indexed: 01/31/2023] Open
Abstract
Increased understanding of immune responses influencing clinical severity during pandemic influenza infection is important for improved treatment and vaccine development. In this study we recruited 46 adult patients during the 2009 influenza pandemic and characterized humoral and cellular immune responses. Those included were either acute hospitalized or convalescent patients with different disease severities (mild, moderate or severe). In general, protective antibody responses increased with enhanced disease severity. In the acute patients, we found higher levels of TNF-α single-producing CD4+T-cells in the severely ill as compared to patients with moderate disease. Stimulation of peripheral blood mononuclear cells (PBMC) from a subset of acute patients with peptide T-cell epitopes showed significantly lower frequencies of influenza specific CD8+ compared with CD4+ IFN-γ T-cells in acute patients. Both T-cell subsets were predominantly directed against the envelope antigens (HA and NA). However, in the convalescent patients we found high levels of both CD4+ and CD8+ T-cells directed against conserved core antigens (NP, PA, PB, and M). The results indicate that the antigen targets recognized by the T-cell subsets may vary according to the phase of infection. The apparent low levels of cross-reactive CD8+ T-cells recognizing internal antigens in acute hospitalized patients suggest an important role for this T-cell subset in protective immunity against influenza.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/immunology
- Cytokines/metabolism
- Epitopes, T-Lymphocyte/immunology
- Female
- Host-Pathogen Interactions/immunology
- Humans
- Immunity
- Immunity, Cellular
- Immunity, Humoral
- Immunoglobulin G/immunology
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A virus/immunology
- Influenza, Human/diagnosis
- Influenza, Human/epidemiology
- Influenza, Human/immunology
- Male
- Middle Aged
- Neutralization Tests
- Norway/epidemiology
- Pandemics
- Prospective Studies
- Severity of Illness Index
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
- Young Adult
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Affiliation(s)
- Kristin G.-I. Mohn
- The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
- Infectious Diseases Unit, Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, and The Norwegian Institute of Public Health, Oslo, Norway
- * E-mail: (KGIM); (SM)
| | - Rebecca Jane Cox
- The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Research & Development, Haukeland University Hospital, Bergen, Norway
- K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, and The Norwegian Institute of Public Health, Oslo, Norway
| | - Gro Tunheim
- Division of Infectious Disease Control, Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
- K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, and The Norwegian Institute of Public Health, Oslo, Norway
| | - Jan Erik Berdal
- Department of Infectious Diseases, Akershus University Hospital, Nordbyhagen, Norway
| | - Anna Germundsson Hauge
- Section for Virology, Department of Laboratory Services, Norwegian Veterinary Institute, Oslo, Norway
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Åsne Jul-Larsen
- The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Bjoern Peters
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, La Jolla, California, United States of America
| | - Fredrik Oftung
- Division of Infectious Disease Control, Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
- K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, and The Norwegian Institute of Public Health, Oslo, Norway
| | - Christine Monceyron Jonassen
- Genetic Unit, Department of Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Nordbyhagen, Norway
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Fredrikstad, Norway
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Siri Mjaaland
- Division of Infectious Disease Control, Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
- K.G. Jebsen Centre for Influenza Vaccine Research, Department of Clinical Science, University of Bergen, Bergen, and The Norwegian Institute of Public Health, Oslo, Norway
- * E-mail: (KGIM); (SM)
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Fossum E, Grødeland G, Terhorst D, Tveita AA, Vikse E, Mjaaland S, Henri S, Malissen B, Bogen B. Vaccine molecules targeting Xcr1 on cross-presenting DCs induce protective CD8+T-cell responses against influenza virus. Eur J Immunol 2014; 45:624-35. [DOI: 10.1002/eji.201445080] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/20/2014] [Accepted: 11/17/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Even Fossum
- K.G. Jebsen Center for Influenza Vaccine Research; Institute of Immunology; University of Oslo and Oslo University Hospital; Oslo Norway
| | - Gunnveig Grødeland
- K.G. Jebsen Center for Influenza Vaccine Research; Institute of Immunology; University of Oslo and Oslo University Hospital; Oslo Norway
| | - Dorothea Terhorst
- Department of Dermatology; Charité University Medicine Berlin; Berlin Germany
- Centre d'Immunologie de Marseille-Luminy (CIML); Aix-Marseille Université; Marseille France
- INSERM U1104; Marseille France
- CNRS UMR7280; Marseille France
| | - Anders A. Tveita
- Center for Immune Regulation; Institute of Immunology; University of Oslo and Oslo University Hospital; Oslo Norway
| | - Elisabeth Vikse
- K.G. Jebsen Center for Influenza Vaccine Research; Institute of Immunology; University of Oslo and Oslo University Hospital; Oslo Norway
| | - Siri Mjaaland
- K.G. Jebsen Center for Influenza Vaccine Research; Institute of Immunology; University of Oslo and Oslo University Hospital; Oslo Norway
- Division for Infectious Disease Control; Department of Bacteriology and Infection Immunology; Norwegian Institute of Public Health; Oslo Norway
| | - Sandrine Henri
- Centre d'Immunologie de Marseille-Luminy (CIML); Aix-Marseille Université; Marseille France
| | - Bernard Malissen
- Centre d'Immunologie de Marseille-Luminy (CIML); Aix-Marseille Université; Marseille France
| | - Bjarne Bogen
- K.G. Jebsen Center for Influenza Vaccine Research; Institute of Immunology; University of Oslo and Oslo University Hospital; Oslo Norway
- Center for Immune Regulation; Institute of Immunology; University of Oslo and Oslo University Hospital; Oslo Norway
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38
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Dembinski JL, Hungnes O, Hauge AG, Kristoffersen AC, Haneberg B, Mjaaland S. Hydrogen peroxide inactivation of influenza virus preserves antigenic structure and immunogenicity. J Virol Methods 2014; 207:232-7. [PMID: 25025814 DOI: 10.1016/j.jviromet.2014.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/01/2014] [Accepted: 07/04/2014] [Indexed: 11/17/2022]
Abstract
The use of live virus in the laboratory requires additional precautions, such as personnel training and special equipment, in order to limit the transmission risk. This is a requirement which not all laboratories can fulfill. In this study, a viral inactivation method is introduced using hydrogen peroxide (H2O2), which maintains antigenicity. Three strains of influenza viruses were inactivated and the ex vivo cellular and humoral immune responses were further analyzed, by comparing them to live viruses, in ELISpot, Multiplex and ELISA assays. In all assays, the H2O2 inactivated viruses displayed comparable responses to the live viruses, suggesting that the inactivated viruses still elicited immunogenic responses even though inactivation was confirmed by lack of viral replication in MDCK cells. Taken together, this study demonstrates that influenza viruses inactivated with H2O2 retain immunogenicity and are able to both detect humoral and elicit cellular immune responses in vitro, which could reduce the need to handle live viruses in the laboratory.
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Affiliation(s)
- Jennifer L Dembinski
- Department of Bacteriology and Infection Immunology, Norwegian Institute of Public Health, Oslo, Norway; KG Jebsen Centre for Influenza Vaccine Research, Oslo, Norway.
| | - Olav Hungnes
- Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Germundsson Hauge
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Bjørn Haneberg
- Department of Bacteriology and Infection Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- Department of Bacteriology and Infection Immunology, Norwegian Institute of Public Health, Oslo, Norway; KG Jebsen Centre for Influenza Vaccine Research, Oslo, Norway
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39
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40
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Grødeland G, Mjaaland S, Tunheim G, Fredriksen AB, Bogen B. The specificity of targeted vaccines for APC surface molecules influences the immune response phenotype. PLoS One 2013; 8:e80008. [PMID: 24244595 PMCID: PMC3823800 DOI: 10.1371/journal.pone.0080008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/02/2013] [Indexed: 01/28/2023] Open
Abstract
Different diseases require different immune responses for efficient protection. Thus, prophylactic vaccines should prime the immune system for the particular type of response needed for protection against a given infectious agent. We have here tested fusion DNA vaccines which encode proteins that bivalently target influenza hemagglutinins (HA) to different surface molecules on antigen presenting cells (APC). We demonstrate that targeting to MHC class II molecules predominantly induced an antibody/Th2 response, whereas targeting to CCR1/3/5 predominantly induced a CD8+/Th1 T cell response. With respect to antibodies, the polarizing effect was even more pronounced upon intramuscular (i.m) delivery as compared to intradermal (i.d.) vaccination. Despite these differences in induced immune responses, both vaccines protected against a viral challenge with influenza H1N1. Substitution of HA with ovalbumin (OVA) demonstrated that polarization of immune responses, as a consequence of APC targeting specificity, could be extended to other antigens. Taken together, the results demonstrate that vaccination can be tailor-made to induce a particular phenotype of adaptive immune responses by specifically targeting different surface molecules on APCs.
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MESH Headings
- Adaptive Immunity/drug effects
- Animals
- Antibodies, Viral/biosynthesis
- Antigen Presentation
- Dendritic Cells/cytology
- Dendritic Cells/drug effects
- Dendritic Cells/immunology
- Female
- Gene Expression
- Hemagglutinin Glycoproteins, Influenza Virus/genetics
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Histocompatibility Antigens Class II/genetics
- Histocompatibility Antigens Class II/immunology
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/genetics
- Influenza Vaccines/immunology
- Injections, Intradermal
- Injections, Intramuscular
- Mice
- Mice, Inbred BALB C
- Orthomyxoviridae Infections/immunology
- Orthomyxoviridae Infections/prevention & control
- Ovalbumin/genetics
- Ovalbumin/immunology
- Receptors, CCR/genetics
- Receptors, CCR/immunology
- Th1 Cells/cytology
- Th1 Cells/drug effects
- Th1 Cells/immunology
- Th2 Cells/cytology
- Th2 Cells/drug effects
- Th2 Cells/immunology
- Vaccination
- Vaccines, Synthetic
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Affiliation(s)
- Gunnveig Grødeland
- Institute of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway
- * E-mail: (GG); (BB)
| | - Siri Mjaaland
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway
- Division for Infectious Disease Control, Department of Bacteriology and Infection Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Gro Tunheim
- Institute of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Agnete B. Fredriksen
- Institute of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Bjarne Bogen
- Institute of Immunology, University of Oslo and Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway
- Centre for Immune Regulation (CIR), University of Oslo and Oslo University Hospital, Oslo, Norway
- * E-mail: (GG); (BB)
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41
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Grodeland G, Mjaaland S, Roux KH, Fredriksen AB, Bogen B. DNA vaccine that targets hemagglutinin to MHC class II molecules rapidly induces antibody-mediated protection against influenza. J Immunol 2013; 191:3221-31. [PMID: 23956431 DOI: 10.4049/jimmunol.1300504] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
New influenza A viruses with pandemic potential periodically emerge due to viral genomic reassortment. In the face of pandemic threats, production of conventional egg-based vaccines is time consuming and of limited capacity. We have developed in this study a novel DNA vaccine in which viral hemagglutinin (HA) is bivalently targeted to MHC class II (MHC II) molecules on APCs. Following DNA vaccination, transfected cells secreted vaccine proteins that bound MHC II on APCs and initiated adaptive immune responses. A single DNA immunization induced within 8 d protective levels of strain-specific Abs and also cross-reactive T cells. During the Mexican flu pandemic, a targeted DNA vaccine (HA from A/California/07/2009) was generated within 3 wk after the HA sequences were published online. These results suggest that MHC II-targeted DNA vaccines could play a role in situations of pandemic threats. The vaccine principle should be extendable to other infectious diseases.
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Affiliation(s)
- Gunnveig Grodeland
- Centre for Immune Regulation, Institute of Immunology, University of Oslo and Oslo University Hospital, Oslo 0027, Norway.
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Schiøtz BL, Rosado EG, Baekkevold ES, Lukacs M, Mjaaland S, Sindre H, Grimholt U, Gjøen T. Enhanced transfection of cell lines from Atlantic salmon through nucoleofection and antibiotic selection. BMC Res Notes 2011; 4:136. [PMID: 21548922 PMCID: PMC3113957 DOI: 10.1186/1756-0500-4-136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 05/06/2011] [Indexed: 11/10/2022] Open
Abstract
Background Cell lines from Atlantic salmon kidney have made it possible to culture and study infectious salmon anemia virus (ISAV), an aquatic orthomyxovirus affecting farmed Atlantic salmon. However, transfection of these cells using calcium phosphate precipitation or lipid-based reagents shows very low transfection efficiency. The Amaxa Nucleofector technology™ is an electroporation technique that has been shown to be efficient for gene transfer into primary cells and hard to transfect cell lines. Findings Here we demonstrate, enhanced transfection of the head kidney cell line, TO, from Atlantic salmon using nucleofection and subsequent flow cytometry. Depending on the plasmid promoter, TO cells could be transfected transiently with an efficiency ranging from 11.6% to 90.8% with good viability, using Amaxa's cell line nucleofector solution T and program T-20. A kill curve was performed to investigate the most potent antibiotic for selection of transformed cells, and we found that blasticidin and puromycin were the most efficient for selection of TO cells. Conclusions The results show that nucleofection is an efficient way of gene transfer into Atlantic salmon cells and that stably transfected cells can be selected with blasticidin or puromycin.
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Affiliation(s)
- Berit L Schiøtz
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway.
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Müller A, Markussen T, Drabløs F, Gjøen T, Jørgensen TØ, Solem ST, Mjaaland S. Structural and functional analysis of the hemagglutinin-esterase of infectious salmon anaemia virus. Virus Res 2010; 151:131-41. [PMID: 20398710 PMCID: PMC7114507 DOI: 10.1016/j.virusres.2010.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 03/30/2010] [Accepted: 03/31/2010] [Indexed: 10/29/2022]
Abstract
Infectious salmon anaemia virus (ISAV) is a piscine orthomyxovirus causing a serious disease in farmed Atlantic salmon (Salmo salar L.). The virus surface glycoprotein hemagglutinin-esterase (HE) is responsible for both viral attachment and release. Similarity to bovine and porcine torovirus hemagglutinin-esterase (BToV HE, PToV HE), bovine coronavirus HE (BCoV HE) and influenza C hemagglutinin-esterase-fusion (InfC HEF) proteins were exploited in a computational homology-based structure analysis of ISAV HE. The analysis resolved structural aspects of the protein and identified important features of relevance to ISAV HE activity. By recombinant expression and purification of secretory HE (recHE) proteins, receptor-binding and quantitative analyses of enzymatic activities displayed by ISAV HE molecules are presented for the first time. Three different recHE molecules were constructed: one representing a high virulent isolate, one a low virulent, while in the third a Ser(32) to Ala(32) amino acid substitution was introduced in the enzymatic catalytic site as inferred from the model. The three amino acid differences between the high and low virulent variants, of which two localized to the putative receptor-binding domain and one in the esterase domain, had no impact on receptor-binding or -release activities. In contrast, the Ser(32) amino acid substitution totally abolished enzymatic activity while receptor binding increased, as observed by agglutination of Atlantic salmon red blood cells. This demonstrates the essential role of a serine in the enzyme's catalytic site. In conclusion, structural analysis of ISAV HE in combination with selected recHE proteins gave insights into structure-function relationships and opens up for further studies aiming at dissecting molecular determinants of ISAV virulence.
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Affiliation(s)
- Anita Müller
- Department of Marine Biotechnology, Norwegian College of Fishery Science, Breivika, N-9037 Tromsø, Norway
| | - Turhan Markussen
- Department of Food Safety and Infection Biology, Norwegian School of Veterinary Science, P.O. Box 8146 Dep., N-0033 Oslo, Norway
| | - Finn Drabløs
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, N-7006 Trondheim, Norway
| | - Tor Gjøen
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, P.O. Box 1068 Blindern, N-0316 Oslo, Norway
| | - Trond Ø. Jørgensen
- Department of Marine Biotechnology, Norwegian College of Fishery Science, Breivika, N-9037 Tromsø, Norway
- Centre on Marine Bioactives and Drug Discovery (MabCent), University of Tromsø, N-9037 Tromsø, Norway
| | - Stein Tore Solem
- Department of Marine Biotechnology, Norwegian College of Fishery Science, Breivika, N-9037 Tromsø, Norway
| | - Siri Mjaaland
- Department of Food Safety and Infection Biology, Norwegian School of Veterinary Science, P.O. Box 8146 Dep., N-0033 Oslo, Norway
- Department of Bacteriology and Immunology, The Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, N-0403 Oslo, Norway
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Schiøtz BL, Baekkevold ES, Poulsen LC, Mjaaland S, Gjøen T. Analysis of host- and strain-dependent cell death responses during infectious salmon anemia virus infection in vitro. Virol J 2009; 6:91. [PMID: 19566966 PMCID: PMC2715388 DOI: 10.1186/1743-422x-6-91] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 07/01/2009] [Indexed: 12/20/2022] Open
Abstract
Background Infectious salmon anemia virus (ISAV) is an aquatic orthomyxovirus and the causative agent of infectious salmon anemia (ISA), a disease of great importance in the Atlantic salmon farming industry. In vitro, ISAV infection causes cytophatic effect (CPE) in cell lines from Atlantic salmon, leading to rounding and finally detachment of the cells from the substratum. In this study, we investigated the mode of cell death during in vitro ISAV infection in different Atlantic salmon cell lines, using four ISAV strains causing different mortality in vivo. Results The results show that caspase 3/7 activity increased during the course of infection in ASK and SHK-1 cells, infected cells showed increased surface expression of phosphatidylserine and increased PI uptake, compared to mock infected cells; and morphological alterations of the mitochondria were observed. Expression analysis of immune relevant genes revealed no correlation between in vivo mortality and expression, but good correlation in expression of interferon genes. Conclusion Results from this study indicate that there is both strain and cell type dependent differences in the virus-host interaction during ISAV infection. This is important to bear in mind when extrapolating in vitro findings to the in vivo situation.
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Affiliation(s)
- Berit L Schiøtz
- Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway.
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García-Rosado E, Markussen T, Kileng O, Baekkevold ES, Robertsen B, Mjaaland S, Rimstad E. Molecular and functional characterization of two infectious salmon anaemia virus (ISAV) proteins with type I interferon antagonizing activity. Virus Res 2008; 133:228-38. [PMID: 18304672 DOI: 10.1016/j.virusres.2008.01.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 01/11/2008] [Accepted: 01/12/2008] [Indexed: 12/25/2022]
Abstract
In this study we characterize two proteins encoded by the two smallest genomic segments of the piscine orthomyxovirus infectious salmon anaemia virus (ISAV). Both proteins, encoded by the un-spliced ORF from genomic segment 7 (s7ORF1) and the larger ORF from segment 8 (s8ORF2), are involved in modulation of the type I interferon (IFN) response. The data suggests that the s7ORF1 protein is collinearly encoded, non-structural, contains no nuclear localisation signals, localises mainly to the cytoplasmic perinuclear area and does not bind single- or double-stranded RNA. On the other hand, genomic segment 8 uses a bicistronic coding strategy and the encoded s8ORF2 protein is a structural component of the viral particle. This protein contains two nuclear localisation signals, has a predominantly nuclear localisation, binds both double-stranded RNA and poly-A tailed single-stranded RNA, but not double-stranded DNA. In poly I:C stimulated salmon cells both ISAV proteins independently down-regulate the type I IFN promoter activity. Thus, ISAV counteracts the type I IFN response by the action of at least two of its gene products, rather than just one, as appears to be the case for other known members of the Orthomyxoviridae.
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Affiliation(s)
- Esther García-Rosado
- Department of Food Safety and Infection Biology, Norwegian School of Veterinary Science, P.O. Box 8146 Dep., N-0033 Oslo, Norway.
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Markussen T, Jonassen CM, Numanovic S, Braaen S, Hjortaas M, Nilsen H, Mjaaland S. Evolutionary mechanisms involved in the virulence of infectious salmon anaemia virus (ISAV), a piscine orthomyxovirus. Virology 2008; 374:515-27. [PMID: 18280528 DOI: 10.1016/j.virol.2008.01.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Accepted: 01/04/2008] [Indexed: 11/25/2022]
Abstract
Infectious salmon anaemia virus (ISAV) is an orthomyxovirus causing a multisystemic, emerging disease in Atlantic salmon. Here we present, for the first time, detailed sequence analyses of the full-genome sequence of a presumed avirulent isolate displaying a full-length hemagglutinin-esterase (HE) gene (HPR0), and compare this with full-genome sequences of 11 Norwegian ISAV isolates from clinically diseased fish. These analyses revealed the presence of a virulence marker right upstream of the putative cleavage site R267 in the fusion (F) protein, suggesting a Q266-->L266 substitution to be a prerequisite for virulence. To gain virulence in isolates lacking this substitution, a sequence insertion near the cleavage site seems to be required. This strongly suggests the involvement of a protease recognition pattern at the cleavage site of the fusion protein as a determinant of virulence, as seen in highly pathogenic influenza A virus H5 or H7 and the paramyxovirus Newcastle disease virus.
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Affiliation(s)
- Turhan Markussen
- Department of Food Safety and Infection Biology, Norwegian School of Veterinary Science, P.O. Box 8146 Dep., N-0033 Oslo, Norway.
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Mjaaland S, Markussen T, Sindre H, Kjøglum S, Dannevig BH, Larsen S, Grimholt U. Susceptibility and immune responses following experimental infection of MHC compatible Atlantic salmon (Salmo salar L.) with different infectious salmon anaemia virus isolates. Arch Virol 2005; 150:2195-216. [PMID: 16012784 DOI: 10.1007/s00705-005-0588-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 05/13/2005] [Indexed: 10/25/2022]
Abstract
Infectious salmon anaemia virus (ISAV) is an aquatic orthomyxovirus causing a multisystemic disease in farmed Atlantic salmon (Salmo salar) where disease development, clinical signs, and histopathology vary to a large extent. Here, an experimental trial was designed to determine the effect of variation in viral genes on virus-host interactions, as measured by disease susceptibility and immune responses. The fish were infected using cohabitant transmission, representing a natural route of infection. Variation caused by host factors was minimized using MHC compatible A. salmon half-siblings as experimental fish. Virus isolates were selected according to HE genotype, as European ISAV isolates can be genotyped according to deletion patterns in their hemagglutinin-esterase (HE) surface glycoprotein, and the course of disease they typically induce, classified as acute versus protracted. The different ISAV isolates induced large variations in death prevalence, ranging from 0-47% in the test-group and 3-75% in the cohabitant fish. The use of MHC compatible experimental fish made it possible to determine the relative contribution of humoral versus cellular response in protection against ISA. Ability to induce a strong proliferative response correlated with survival and virus clearance, while induction of a humoral response was less protective.
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Affiliation(s)
- S Mjaaland
- Department of Food Safety and Infection Biology, Norwegian School of Veterinary Science, Oslo, Norway.
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Mikalsen AB, Sindre H, Mjaaland S, Rimstad E. Expression, antigenicity and studies on cell receptor binding of the hemagglutinin of infectious salmon anemia virus. Arch Virol 2005; 150:1621-37. [PMID: 15824888 DOI: 10.1007/s00705-005-0502-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 01/18/2005] [Indexed: 10/25/2022]
Abstract
Infectious salmon anemia (ISA) virus belongs to the proposed genus Isavirus of Orthomyxoviridae and is an emerging pathogen in Atlantic salmon (Salmo salar) farming. The hemagglutinin-esterase (HE) of ISA virus share several characteristics with the influenza virus hemagglutinin. This study reports recombinant expression of different ISA virus HE mutants in fish cell lines. Some introduced mutations, representing minimal differences in single amino acid residues, resulted in remarkable effects on expression efficiency in general and on surface expression specifically. Receptor binding assays showed that amino acid residues in the N-terminal half part are important in receptor binding, either being directly involved in the binding, or by influencing the structure of the binding site. Deletion of the putative N-glycosylation sites of the ISA virus HE, located near the transmembrane region, did not influence expression, receptor binding properties or staining by either a neutralising MAb, or salmon convalescent sera. The humoral immune response of Atlantic salmon after ISA virus infection showed weak neutralising activity and the results indicated that it was directed against HE.
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Affiliation(s)
- A B Mikalsen
- Department of Food Safety and Infection Biology, The Norwegian School of Veterinary Science, Oslo, Norway.
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Mjaaland S, Hungnes O, Teig A, Dannevig BH, Thorud K, Rimstad E. Polymorphism in the infectious salmon anemia virus hemagglutinin gene: importance and possible implications for evolution and ecology of infectious salmon anemia disease. Virology 2002; 304:379-91. [PMID: 12504577 DOI: 10.1006/viro.2002.1658] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Infectious salmon anemia (ISA) is an emerging disease in farmed Atlantic salmon with important commercial consequences. The pathogenicity of the ISA virus (ISAV; an orthomyxovirus) varies, observed as differences in disease development and clinical signs. A small polymorphic region (PR) in the ISAV genomic segment encoding the hemagglutinin (HA) has been described. An analysis of 33 HA gene sequences from historical and recent ISA outbreaks was performed, added to a selection of previously published HA sequences. A differential deletion model explaining the generation of HA polymorphism is proposed. The European ISAV sequences could be grouped according to deletion patterns in PR. Cell-culture replication and cytopathic effect varied between viruses from different PR groups. A rather complex epidemiology is suggested, as (a) HA sequences representing several PR variants were detected in three samples; (b) identical mutations occurred in different genetic lineages; and (c) large genetic differences were present in closely related viruses.
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Affiliation(s)
- Siri Mjaaland
- Norwegian School of Veterinary Science, Department of Pharmacology, Microbiology, and Food Hygiene, PO Box 8146 Dep N-0033 Oslo, Norway.
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Abstract
Infectious salmon anaemia virus (ISAV) is a commercially important orthomyxovirus causing disease in farmed Atlantic salmon. The cumulative mortality in a net pen during an outbreak may vary from insignificant to more than 90%. The infection is spread by management activity such as well-boat traffic, but possibly also through contact with wild fish. In many of its aspects, including the structure of the virus particle and replication strategy, the ISAV is similar to the influenza viruses. Variations between ISAV and the influenza viruses can mostly be related to differences in the temperature at which replication occurs and the immune response of their respective host animals. ISAV shows both haemagglutinating and receptor-destroying activity. The variability of the ISAV haemagglutinin molecule is concentrated around a small domain close to the transmembrane region. The function of this variable region is unknown, but it may be related to a recent or ongoing crossing of a species barrier. Alignment studies based on genetic data indicate that the phylogenetic relationship to the influenza viruses is distant, and that ISAV therefore could possibly warrant a new genus within Orthomyxoviridae.
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Affiliation(s)
- Espen Rimstad
- Norwegian School of Veterinary Science, Department of Pharmacology, Microbiology and Food Hygiene, Oslo, Norway.
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