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Myers ML, Gallagher JR, Kim AJ, Payne WH, Maldonado-Puga S, Assimakopoulos H, Bock KW, Torian U, Moore IN, Harris AK. Commercial influenza vaccines vary in HA-complex structure and in induction of cross-reactive HA antibodies. Nat Commun 2023; 14:1763. [PMID: 36997521 PMCID: PMC10060936 DOI: 10.1038/s41467-023-37162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 03/03/2023] [Indexed: 04/04/2023] Open
Abstract
Influenza virus infects millions of people annually and can cause global pandemics. Hemagglutinin (HA) is the primary component of commercial influenza vaccines (CIV), and antibody titer to HA is a primary correlate of protection. Continual antigenic variation of HA requires that CIVs are reformulated yearly. Structural organization of HA complexes have not previously been correlated with induction of broadly reactive antibodies, yet CIV formulations vary in how HA is organized. Using electron microscopy to study four current CIVs, we find structures including: individual HAs, starfish structures with up to 12 HA molecules, and novel spiked-nanodisc structures that display over 50 HA molecules along the complex's perimeter. CIV containing these spiked nanodiscs elicit the highest levels of heterosubtypic cross-reactive antibodies in female mice. Here, we report that HA structural organization can be an important CIV parameter and can be associated with the induction of cross-reactive antibodies to conserved HA epitopes.
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Affiliation(s)
- Mallory L Myers
- Structural Informatics Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive, Room 6351, Bethesda, MD, 20892, USA
| | - John R Gallagher
- Structural Informatics Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive, Room 6351, Bethesda, MD, 20892, USA
| | - Alexander J Kim
- Structural Informatics Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive, Room 6351, Bethesda, MD, 20892, USA
| | - Walker H Payne
- Structural Informatics Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive, Room 6351, Bethesda, MD, 20892, USA
| | - Samantha Maldonado-Puga
- Structural Informatics Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive, Room 6351, Bethesda, MD, 20892, USA
| | - Haralabos Assimakopoulos
- Structural Informatics Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive, Room 6351, Bethesda, MD, 20892, USA
| | - Kevin W Bock
- Infectious Disease Pathogenesis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 33 North Drive, Room BN25, Bethesda, MD, 20892, USA
| | - Udana Torian
- Structural Informatics Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive, Room 6351, Bethesda, MD, 20892, USA
- Laboratory of Human Carcinogenesis, National Cancer Institute, 37 Convent Drive, Room 306C, Bethesda, MD, 20892, USA
| | - Ian N Moore
- Infectious Disease Pathogenesis Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 33 North Drive, Room BN25, Bethesda, MD, 20892, USA
- Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA, 30329 37, USA
| | - Audray K Harris
- Structural Informatics Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 50 South Drive, Room 6351, Bethesda, MD, 20892, USA.
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Barriers Associated with the Uptake Ratio of Seasonal Flu Vaccine and Ways to Improve Influenza Vaccination Coverage among Young Health Care Workers in Poland. Vaccines (Basel) 2021; 9:vaccines9050530. [PMID: 34065371 PMCID: PMC8161323 DOI: 10.3390/vaccines9050530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 01/27/2023] Open
Abstract
Despite not being full-time health care workers, annual flu vaccination is nevertheless an important consideration for medical students. This study examined the reasons for refusing flu vaccination among medical students, a group characterized by low vaccination coverage, despite the fact that the flu vaccine is arguably the most effective way of preventing serious flu complications. A cross-sectional survey was performed of 1313 students at the Medical University of Lodz. The findings indicate that the main sites of vaccination were primary care centers, and main source of information about influenza vaccination (about 90% of cases) was the general practitioner (GP). The most common motivations for vaccination were a recommendation by the family doctor or the belief that it was an important factor for protection against influenza. Most students reported various adverse effects after vaccination, usually mild pain at the site of vaccination, malaise, or fever. The main reasons for rejecting influenza vaccination were the apparent low risk of disease, the need for annual vaccination, the need to pay for it, lack of time or opportunity, lack of vaccination promotion, negative attitudes toward the flu vaccine, or the belief that there are other methods of preventing flu. To increase long-term vaccine acceptance and increase the vaccination rate among medical students and qualified health care workers, there is a need to adapt the health system and to initiate ongoing promotion programs at university to raise consciousness, promote vaccinations, and develop clinical skills for immunization.
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Ho BS, Chao KM. On the influenza vaccination policy through mathematical modeling. Int J Infect Dis 2020; 98:71-79. [PMID: 32561427 DOI: 10.1016/j.ijid.2020.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Aimed at mitigating influenza transmission, this study assessed the timing of the vaccination program and took vaccine capacity, strain mismatch and priority group into consideration. METHODS An age-structured dynamic transmission model was fitted to the laboratory data of the national influenza surveillance system to reconstruct a baseline scenario with which the vaccination scenarios of interest could be compared. Outcome measures were defined as the impacts on the seasonal epidemic: decompression of the epidemic peak, reduction of the epidemic burden and change of the epidemic peak time. RESULTS It was found that vaccine capacity building, although indispensable, could not guarantee substantial impact on the seasonal influenza epidemic. Vaccine mismatch might greatly offset vaccine capacity building. Notably, advance vaccine distribution could compensate for some vaccine underperformance. In the case of a well-matched vaccine, advance vaccine distribution could even exploit its utility. CONCLUSIONS This study indicated that timely vaccine distribution should be put high on the agenda of seasonal influenza control policies. It provided a tangible platform for the policymakers to evaluate health policy impacts and to enhance risk communication with the public through mathematical modeling.
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Affiliation(s)
- Bin-Shenq Ho
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan, ROC; Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Kun-Mao Chao
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan, ROC; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC.
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Enkirch T, Sauber S, Anderson DE, Gan ES, Kenanov D, Maurer-Stroh S, von Messling V. Identification and in vivo Efficacy Assessment of Approved Orally Bioavailable Human Host Protein-Targeting Drugs With Broad Anti-influenza A Activity. Front Immunol 2019; 10:1097. [PMID: 31244822 PMCID: PMC6563844 DOI: 10.3389/fimmu.2019.01097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/30/2019] [Indexed: 12/12/2022] Open
Abstract
The high genetic variability of influenza A viruses poses a continual challenge to seasonal and pandemic vaccine development, leaving antiviral drugs as the first line of defense against antigenically different strains or new subtypes. As resistance against drugs targeting viral proteins emerges rapidly, we assessed the antiviral activity of already approved drugs that target cellular proteins involved in the viral life cycle and were orally bioavailable. Out of 15 candidate compounds, four were able to inhibit infection by 10- to 100-fold without causing toxicity, in vitro. Two of the drugs, dextromethorphan and ketotifen, displayed a 50% effective dose between 5 and 50 μM, not only for the classic H1N1 PR8 strain, but also for a pandemic H1N1 and a seasonal H3N2 strain. Efficacy assessment in mice revealed that dextromethorphan consistently resulted in a significant reduction of viral lung titers and also enhanced the efficacy of oseltamivir. Dextromethorphan treatment of ferrets infected with a pandemic H1N1 strain led to a reduction in clinical disease severity, but no effect on viral titer was observed. In addition to identifying dextromethorphan as a potential influenza treatment option, our study illustrates the feasibility of a bioinformatics-driven rational approach for repurposing approved drugs against infectious diseases.
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Affiliation(s)
- Theresa Enkirch
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.,Veterinary Medicine Division, Paul-Ehrlich-Institut, Langen, Germany
| | - Svenja Sauber
- Veterinary Medicine Division, Paul-Ehrlich-Institut, Langen, Germany
| | - Danielle E Anderson
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Esther S Gan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Dimitar Kenanov
- Biomolecular Function Discovery Division, Bioinformatics Institute, Agency for Science, Technology and Research, Singapore, Singapore
| | - Sebastian Maurer-Stroh
- Biomolecular Function Discovery Division, Bioinformatics Institute, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Veronika von Messling
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.,Veterinary Medicine Division, Paul-Ehrlich-Institut, Langen, Germany
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Abalkhail MS, Alzahrany MS, Alghamdi KA, Alsoliman MA, Alzahrani MA, Almosned BS, Gosadi IM, Tharkar S. Uptake of influenza vaccination, awareness and its associated barriers among medical students of a University Hospital in Central Saudi Arabia. J Infect Public Health 2017; 10:644-648. [PMID: 28545902 DOI: 10.1016/j.jiph.2017.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/06/2017] [Accepted: 05/01/2017] [Indexed: 01/02/2023] Open
Abstract
Outbreaks of influenza epidemics are common but influenza vaccination is sub-optimal among the healthcare staff including the medical students. The study aims to assess the rate of vaccine uptake among medical students, its associated barriers and levels of awareness. A cross sectional study was done at a University Hospital in Saudi Arabia on 421 medical students by self administered questionnaire from February to March 2015. The immunization rate of seasonal influenza vaccine was just 20.7% in 2015, while it was 57% for cumulative of previous three-year period. The intended uptake among those offered vaccination was 68%. The significant determinants of vaccine uptake were clinical years of medical study (p<0.05) and previous history of vaccination (p<0.0001). The major sources influencing vaccine uptake decision were health department guidelines, medical training, social and media influence. Barriers of vaccination constituted, assumption of not being at risk of influenza (37.9%), vaccine side effects (28.9%), questioned effectiveness of the vaccine (14.5%), and inability to allocate time (11%). Knowledge levels were unsatisfactory and males scored lower (5.4±1.7) than females (6.5±1.4) out of total score of 9. Both knowledge and uptake of annual influenza vaccination was inadequate. Policy makers can formulate strategies with a focus on larger coverage of medical students.
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Affiliation(s)
- Mohammed S Abalkhail
- Department of Family and Community Medicine, College Of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohannad S Alzahrany
- Department of Family and Community Medicine, College Of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaled A Alghamdi
- Department of Family and Community Medicine, College Of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muath A Alsoliman
- Department of Family and Community Medicine, College Of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mosa A Alzahrani
- Department of Family and Community Medicine, College Of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Badr S Almosned
- Department of Family and Community Medicine, College Of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim M Gosadi
- Department of Family and Community Medicine, College Of Medicine, King Saud University, Riyadh, Saudi Arabia; Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shabana Tharkar
- Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Ren ST, Zhang XM, Sun PF, Sun LJ, Guo X, Tian T, Zhang J, Guo QY, Li X, Guo LJ, Che J, Wang B, Zhang H. Intranasal Immunization Using Mannatide as a Novel Adjuvant for an Inactivated Influenza Vaccine and Its Adjuvant Effect Compared with MF59. PLoS One 2017; 12:e0169501. [PMID: 28052136 PMCID: PMC5215226 DOI: 10.1371/journal.pone.0169501] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022] Open
Abstract
Intranasal vaccination is more potent than parenteral injection for the prevention of influenza. However, because the poor efficiency of antigen uptake across the nasal mucosa is a key issue, immunostimulatory adjuvants are essential for intranasal vaccines. The immunomodulator mannatide or polyactin (PA) has been used for the clinical treatment of impaired immunity in China, but its adjuvant effect on an inactivated trivalent influenza vaccine (ITIV) via intranasal vaccination is unclear. To explore the adjuvant effect of PA, an inactivated trivalent influenza virus with or without PA or MF59 was instilled intranasally once a week in BALB/c mice. Humoral immunity was assessed by both the ELISA and hemagglutination inhibition (HI) methods using antigen-specific antibodies. Splenic lymphocyte proliferation and the IFN-γ level were measured to evaluate cell-mediated immunity. The post-vaccination serum HI antibody geometric mean titers (GMTs) for the H1N1 and H3N2 strains, antigen-specific serum IgG and IgA GMTs, mucosal SIgA GMT, splenic lymphocyte proliferation, and IFN-γ were significantly increased in the high-dose PA-adjuvanted vaccine group. The seroconversion rate and the mucosal response for the H3N2 strain were significantly elevated after high-dose PA administration. These adjuvant effects of high-dose PA for the influenza vaccine were comparable with those of the MF59 adjuvant, and abnormal signs or pathological changes were not found in the evaluated organs. In conclusion, PA is a novel mucosal adjuvant for intranasal vaccination with the ITIV that has safe and effective mucosal adjuvanticity in mice and successfully induces both serum and mucosal antibody responses and a cell-mediated response.
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Affiliation(s)
- Shu-Ting Ren
- Department of Pathology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
- * E-mail: (STR); (HZ); (BW)
| | - Xue-Mei Zhang
- No. 6 Vaccine Workshop, Changchun Institute of Biological Products Co., Ltd., Changchun, China
| | - Peng-Fei Sun
- Department of Pathology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Department of Pathology, Xi’an City Center Hospital, Xi’an, China
| | - Li-Juan Sun
- Reagent R&D Dep. Scientific Research Management Center, Capital Bio Technology, Beijing, China
| | - Xue Guo
- No. 6 Vaccine Workshop, Changchun Institute of Biological Products Co., Ltd., Changchun, China
| | - Tian Tian
- Department of Pathology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jian Zhang
- Department of Pathology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Qi-Yuan Guo
- No. 6 Vaccine Workshop, Changchun Institute of Biological Products Co., Ltd., Changchun, China
| | - Xue Li
- No. 6 Vaccine Workshop, Changchun Institute of Biological Products Co., Ltd., Changchun, China
| | - Li-Jun Guo
- Changchun Institute of Biological Products Co., Ltd., Changchun, China
| | - Jin Che
- Therapeutic Vaccines Engineering Center of Shaanxi Province, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Bing Wang
- Department of Pathology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Therapeutic Vaccines Engineering Center of Shaanxi Province, Xi’an Jiaotong University Health Science Center, Xi’an, China
- * E-mail: (STR); (HZ); (BW)
| | - Hui Zhang
- Department of Pharmacy, Xi’an Medical University Health Science Center, Xi’an, China
- * E-mail: (STR); (HZ); (BW)
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Abu-Rish EY, Elayeh ER, Mousa LA, Butanji YK, Albsoul-Younes AM. Knowledge, awareness and practices towards seasonal influenza and its vaccine: implications for future vaccination campaigns in Jordan. Fam Pract 2016; 33:690-697. [PMID: 27567011 PMCID: PMC7188315 DOI: 10.1093/fampra/cmw086] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Influenza is an underestimated contributor to morbidity and mortality. Population knowledge regarding influenza and its vaccination has a key role in enhancing vaccination coverage. OBJECTIVES This study aimed to identify the gaps of knowledge among Jordanian population towards influenza and its vaccine, and to identify the major determinants of accepting seasonal influenza vaccine in adults and children in Jordan. METHODS This was a cross-sectional study that enrolled 941 randomly selected adults in Amman, Jordan. A four-section questionnaire was used which included questions about the sociodemographic characteristics, knowledge about influenza and the factors that affect seasonal influenza vaccine acceptance and refusal. RESULTS Only 47.3% of the participants were considered knowledgeable. About half of the participants (51.9%) correctly identified the main influenza preventative measures. Lack of knowledge about the important role of seasonal influenza vaccine in disease prevention was observed. Low vaccination rate (20% of adults) was reported. The most critical barrier against vaccination in adults and children was the concern about the safety and the efficacy of the vaccine, while the most important predictors for future vaccination in adults and children were physician recommendation and government role. In children, the inclusion of the vaccine within the national immunization program was an important determinant of vaccine acceptance. CONCLUSION Formulating new strategies to improve the population's level of knowledge, assuring the population about the safety and the efficacy of the vaccine and the inclusion of the vaccine within the national immunization program are the essential factors to enhance vaccination coverage in Jordan.
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Affiliation(s)
- Eman Y Abu-Rish
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan and
| | - Eman R Elayeh
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan and
| | - Lubabah A Mousa
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan and
| | - Yasser K Butanji
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan and
| | - Abla M Albsoul-Younes
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan and.,Hamdi Mango Center for Scientific Research, The University of Jordan, Amman, Jordan
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