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Prasert K, Praphasiri P, Lerdsamran H, Nakphook S, Ditsungnoen D, Chawalchitiporn S, Sornwong K, Poopipatpol K, Wirachwong P, Narakorn P, Surichan S, Suthepakul N, Thangsupanimitchai N, Pittayawonganon C, Puthavathana P, Davis WW, Mott JA, Olsen SJ, Patumanond J. Safety and immunogenicity of locally produced trivalent inactivated influenza vaccine (Tri Fluvac) in healthy Thai adults aged 18-64 years in Nakhon Phanom: A Phase III double blinded, three-arm, randomized, controlled trial. Vaccine 2024; 42:24-32. [PMID: 38042698 PMCID: PMC10733862 DOI: 10.1016/j.vaccine.2023.11.050] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Domestic influenza vaccine production facilitates a sustainable supply for mitigating seasonal influenza and improves national health security by providing infrastructure and experience for pandemic vaccine production, if needed. METHODS A Phase III, double blind, randomized controlled trial was conducted from Sep 2019-Oct 2020 in healthy adults 18-64 years in Nakhon Phanom, Thailand. Randomization (3:3:1) compared study vaccine (Tri Fluvac), saline placebo, and an active comparator (licensed vaccine). Primary outcomes were superior efficacy compared to placebo based on RT-PCR-confirmed influenza virus infection within 12 months and non-inferiority compared to active comparator based on immunogenicity (HAI assay) at 28 days. Safety was also assessed. RESULTS The trial enrolled 4,284 participants (Tri Fluvac = 1,836; placebo = 1,836; active comparator = 612). There were 29 RT-PCR positive influenza infections (10 Tri Fluvac, 5.5/1,000 PY; 19 placebo, 10.4/1,000PY; 0 comparator) for an absolute protective efficacy of 46.4 (95 % CI = -22.0-76.5) compared with placebo, but the power was 43.7 %. Seroconversion difference rates between Tri Fluvac and comparator at Day 28 were 1.74 (95 % CI: -2.77, 6.25), 2.22 (-2.40, 6.84), and -0.57 (-5.41, 4.27) for A(H1N1), A(H3N2), and B strains, respectively. Adverse and severe adverse events occurred in 175 (9.5 %) Tri Fluvac, 177 (10.8 %) placebo, and 66 (10.8 %) comparator arms (p-value = 0.437, Tri Fluvac vs. comparator) CONCLUSIONS: Tri Fluvac was well tolerated, and immunogenicity was non-inferior to the active comparator, meeting U.S. Food and Drug Administration (FDA) criteria for adult vaccine licensure. Few acute respiratory infections were reported during intense COVID-19 pandemic restrictions, resulting in insufficient power to evaluate clinical efficacy.
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Affiliation(s)
- Kriengkrai Prasert
- Nakhon Phanom Provincial Hospital, Nakhon Phanom, Thailand; Faculty of Public Health, Kasetsart University, Chalermprakiat Sakon Nakhon Province Campus, Thailand
| | - Prabda Praphasiri
- Faculty of Public Health, Kasetsart University, Chalermprakiat Sakon Nakhon Province Campus, Thailand; Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
| | - Hatairat Lerdsamran
- Center for Research and Innovation, Faculty of Medical Technology, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Sutthichai Nakphook
- Faculty of Public Health, Kasetsart University, Chalermprakiat Sakon Nakhon Province Campus, Thailand; Institute of Preventive Medicine, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Darunee Ditsungnoen
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | | | | | | | | | | | - Nava Suthepakul
- Government Pharmaceutical Organization (GPO), Bangkok, Thailand
| | | | - Chakrarat Pittayawonganon
- Institute of Preventive Medicine, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Pilaipan Puthavathana
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - William W Davis
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Mott
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sonja J Olsen
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jayanton Patumanond
- Clinical Epidemiology Unit, Faculty of Medicine, Chiang Mai University, Thailand
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Raina MacIntyre C, Kevin Yin J, Felter C, Menzies RI, Thommes E, Largeron N, Moa AM, Trent M, Costantino V, Choi S, Alvarez FP. Estimated health and economic impact of using high-dose influenza vaccine on respiratory and circulatory plus respiratory hospitalizations of older adults in Australia. Vaccine X 2023; 15:100365. [PMID: 37609557 PMCID: PMC10440578 DOI: 10.1016/j.jvacx.2023.100365] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Background Standard dose influenza vaccine provides moderate protection from infection, but with lower effectiveness among the elderly. High dose and adjuvanted vaccines (HD-TIV and aTIV) were developed to address this. This study aims to estimate the incremental health and economic impact of using HD-TIV (high dose trivalent vaccine) instead of aTIV (adjuvanted trivalent vaccine) on respiratory and circulatory plus respiratory hospitalizations of older people (≥65 years) in Australia. Methods This is a modelling study comparing predicted hospitalization outcomes in people receiving HD-TIV or aTIV during an average influenza season in Australia. Hospitalization records of Australian adults ≥65 years of age from 01 April to 30 November during 15 influenza seasons (2002-2017 excluding 2009, which was a pandemic) were extracted from the Australian Institute of Health and Welfare [AIHW] and used to calculate hospitalisation rates during an average season. Relative vaccine effectiveness data for aTIV and HD-TIV were used to estimate morbidity burden related to influenza. Results Between 2002 and 2017, the average respiratory hospitalization rate among older people during influenza season (April-November) was 3,445/100,000 population-seasons, with an average cost of AU$ 7,175 per admission. The average circulatory plus respiratory hospitalization rate among older Australian people during that time was 10,393/100,000 population-seasons, with an average cost of AU$ 7829 per admission. For older Australians, HD-TIV may avert an additional 6,315-9,410 respiratory admissions each year, with an incremental healthcare cost saving of AU$ 15.9-38.2 million per year compared to aTIV. Similar results were also noted for circulatory plus respiratory hospitalizations. Conclusions From the modelled estimations, HD-TIV was associated with less economic burden and fewer respiratory, and circulatory plus respiratory hospitalizations than aTIV for older Australians.
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Affiliation(s)
| | - J. Kevin Yin
- Medical Department, Greater China, Sanofi Vaccines, Beijing, China
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Edward Thommes
- New Products and Innovation, Sanofi, Toronto, Ontario, Canada
- Department of Mathematics and Statistics, University of Guelph, Guelph, ON, Canada
| | | | - Aye M. Moa
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mallory Trent
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Seulki Choi
- Market Access, Sanofi, Sydney, NSW, Australia
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Kiely M, Tadount F, Lo E, Sadarangani M, Wei SQ, Rafferty E, Quach C, MacDonald SE. Sex differences in adverse events following seasonal influenza vaccines: a meta-analysis of randomised controlled trials. J Epidemiol Community Health 2023; 77:791-801. [PMID: 37734937 PMCID: PMC10646905 DOI: 10.1136/jech-2023-220781] [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: 04/26/2023] [Accepted: 07/20/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Despite being a vaccine-preventable disease, influenza remains a major public health threat with vaccine safety concerns reducing vaccine acceptability. Immune responses to vaccines and adverse events may differ between males and females, but most studies do not report results by sex. Using data from clinical trials, we explored sex differences in adverse events following seasonal influenza vaccines. METHODS We obtained data for phase III randomised controlled trials identified through a systematic review and clinical trials registries, and performed a two-stage meta-analysis. Risk ratios (RR) and 95% confidence intervals (95% CI) comparing solicited reactions in females versus males were pooled using the Mantel-Haenszel method and a random-effects model. We used the ROBINS-I tool to assess risk of bias and the I2 statistic for heterogeneity. Main analysis was stratified by age: 18-64 years and ≥65 years. RESULTS The dataset for this analysis included 34 343 adults from 18 studies (12 with individual-level data and 6 with aggregate data). There was a higher risk of injection site reactions in females compared with males for both younger and older participants, with RRs of 1.29 (95% CI 1.21 to 1.37) and 1.43 (95% CI 1.28 to 1.60), respectively. Higher risk in females was also observed for systemic reactions, with RRs of 1.25 (95% CI 1.20 to 1.31) and 1.27 (95% CI 1.20 to 1.34) for younger and older participants, respectively. We also observed elevated risks of severe reactions in females, with a higher RR in younger versus older participants for systemic reactions (RRs 2.12 and 1.48, p=0.03, I2=79.7%). RRs were not found to vary between quadrivalent and trivalent vaccines. CONCLUSION This meta-analysis suggested a higher risk of solicited reactions following influenza vaccines for females compared with males, irrespective of age and vaccine type. Transparent communication of this risk could increase the trust in vaccines and limit vaccine hesitancy. Future studies should report results stratified by sex and explore the role of gender in the occurrence of adverse events.
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Affiliation(s)
- Marilou Kiely
- Department of Microbiology, Infectiology, immunology & Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Fazia Tadount
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Ernest Lo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University if British Columbia, Vancouver, British Columbia, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | | | - Caroline Quach
- Department of Microbiology, Infectiology, immunology & Pediatrics, University of Montreal, Montreal, Quebec, Canada
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Mannocci A, Pellacchia A, Millevolte R, Chiavarini M, de Waure C. Quadrivalent Vaccines for the Immunization of Adults against Influenza: A Systematic Review of Randomized Controlled Trials. IJERPH 2022; 19:ijerph19159425. [PMID: 35954781 PMCID: PMC9368426 DOI: 10.3390/ijerph19159425] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/10/2022]
Abstract
Vaccination is the most effective intervention to prevent influenza. Adults at risk of complications are among the targets of the vaccination campaigns and can be vaccinated with different types of quadrivalent influenza vaccines (QIVs). In the light of assessing the relative immunogenicity and efficacy of different QIVs, a systematic review was performed. Randomized controlled trials conducted in adults aged 18–64 years until 30 March 2021 were searched through three databases (Medline, Cochrane Library and Scopus). Twenty-four RCTs were eventually included. After data extraction, a network meta-analysis was not applicable due to the lack of common comparators. However, in the presence of at least two studies, single meta-analyses were performed to evaluate immunogenicity and efficacy; on the contrary, data from single studies were considered. Seroconversion rate for H1N1 was higher for standard QIVs, while for the remaining strains it was higher for low-dose adjuvanted QIVs. For seroprotection rate, the recombinant vaccine recorded the highest values for H3N2, while for the other strains, the cell-based QIVs achieved better results. In general, standard and cell-based QIVs showed an overall good immunogenicity profile. Nevertheless, as a relative comparative analysis was not possible, further research would be deserved.
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Affiliation(s)
- Alice Mannocci
- Faculty of Economics, Universitas Mercatorum, 00186 Rome, Italy;
| | - Andrea Pellacchia
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.M.); (M.C.); (C.d.W.)
- Correspondence:
| | - Rossella Millevolte
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.M.); (M.C.); (C.d.W.)
| | - Manuela Chiavarini
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.M.); (M.C.); (C.d.W.)
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (R.M.); (M.C.); (C.d.W.)
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Liang Y, Jing-Xia G, Ma L, Ni L, Chaolie R, Zhou J, Guo-Yang L. Immunogenicity and safety levels of inactivated quadrivalent influenza vaccine in healthy adults via meta-analysis. Hum Vaccin Immunother 2021; 17:3652-3661. [PMID: 34156322 DOI: 10.1080/21645515.2021.1932218] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective: The aim of the current study was to evaluate immunogenicity and safety levels of human inactivated quadrivalent influenza vaccine (QIV) which includes two A strains (A/H1N1, A/H3N2) and two B lineages (B/Victoria, B/Yamagata) in healthy adults via meta-analysis. Methods: Searches were conducted in PubMed, Cochrane Library, ClinicalTrials.gov, and EMBASE databases published in 2011-2020 according to inclusion and exclusion criteria. The purpose was to collect and perform meta-analysis of related randomized clinical trial (RCT) data concerning safety and immunogenicity levels of human QIV compared with inactivated trivalent influenza vaccine (TIV). Results: A total of 9 literatures were included. There was no significant difference in the seroconversion(SCR) and seroprotection(SPR) between QIV and TIV for influenza A strains (A/H1N1, A/H3N2) and the B lineage included in the TIV. QIV showed superior efficacy for the B lineage not included in the TIV: SCR RR of 2.20 (95%CI: 1.44-3.37, p = .0003) and SPR RR of 1.34 (95%CI: 1.10-1.63, p = .004) for B/Victoria, and SCR RR of 1.88 (95%CI: 1.53-2.31, p < .00001) and SPR RR of 1.11 (95%CI: 1.03-1.19, p = .006) for B/Yamagata, respectively. There were no significant differences between QIV and TIV for local and systemic adverse events(AE) post-vaccination. Conclusion: In adults 18-64 years old, QIV not only produced similar immunogenicity and safety levels to TIV, but also had better immunogenicity against influenza B vaccine strains not included in TIV.
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Affiliation(s)
- Yu Liang
- The Fifth Department of Biological Products, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Gao Jing-Xia
- The Fifth Department of Biological Products, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Lei Ma
- The Fifth Department of Biological Products, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Li Ni
- The Fifth Department of Biological Products, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Ruan Chaolie
- The Fifth Department of Biological Products, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Jian Zhou
- Vaccine Technology and Process Research Center, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
| | - Liao Guo-Yang
- The Fifth Department of Biological Products, Institute of Medical Biology, Chinese Academy of Medical Science and Peking Union Medical College, Kunming, China
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Jagielska AM, Brydak LB, Nitsch-Osuch AS. Immunogenicity of Split Inactivated Quadrivalent Influenza Vaccine in Adults with Obesity in the 2017/2018 Season. Med Sci Monit 2021; 27:e929572. [PMID: 33994536 PMCID: PMC8139133 DOI: 10.12659/msm.929572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Obesity is associated with susceptibility to severe influenza infection and several disturbances of the immune response to the influenza vaccine. However, the effect of obesity on the immunogenicity of the influenza vaccine is not fully understood. Our objective here was to assess the immunogenicity of the split, inactivated quadrivalent influenza vaccine (QIV) in Polish adults with obesity. MATERIAL AND METHODS Fifty-three subjects with obesity aged 21-69 years were vaccinated with the QIV in 2017/2018 season. Antibody titers against the 4 vaccine strains were measured using the hemagglutination inhibition (HI) assay. The mean fold antibody increase (MFI), seroprotection rate (protection rate, PR), and seroconversion rate (response rate, RR) were calculated to assess vaccine immunogenicity. RESULTS The vaccine elicited a significant increase in the anti-HI titers against the QIV antigens. The MFI, PR, and RR for the QIV antigens also reached the required age-specific values, indicating the QIV meets current immunogenicity criteria. Individuals with class I and class II/III obesity had similar anti-HI titers, MFI, PR, and RR to each of the vaccine strains. Adults aged <60 years had similar anti-HI titers, MFI, PR, and RR to the QIV strains to those aged ≥60 years. CONCLUSIONS Our results indicate that the split virion, inactivated QIV is immunogenic in adults with obesity regardless of their degree of obesity and age (ie, <60 and ≥60 years).
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Affiliation(s)
- Anna M Jagielska
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Lidia B Brydak
- Department of Influenza Research, National Influenza Center, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Aneta S Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
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Thiem VD, Chabanon AL, Fournier M, Lavis N, Quang ND, Ha VH, Sanicas M. Safety of a quadrivalent influenza vaccine in Vietnamese healthy subjects aged 6 months and older. Hum Vaccin Immunother 2021; 17:690-693. [PMID: 32783746 PMCID: PMC7993207 DOI: 10.1080/21645515.2020.1795477] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Quadrivalent influenza vaccines (QIVs) provide protection against the two influenza A viruses (H1N1 and H3N2) and both co-circulating influenza B lineages. QIVs have been found safe, immunogenic, and efficacious in several phase III clinical trials. Here we assess the safety of QIV after vaccination in Vietnamese infants, children, and adults. Participants (n = 228) were asked to report any solicited adverse events (AEs) occurring within 7 days, unsolicited non-serious AEs occurring within 28 days post-vaccination, and serious adverse events (SAEs) at any time during the study. The study was completed by 224 participants (97.4%). Thirty-one children (39.7%) aged 6 − 35 months, 32 children (40.0%) aged 3 − 8 years, 2 participants (9.0%) aged 9 − 17 years, 5 participants (17.9%) aged 18 − 60 years, and 3 participants (15.0%) aged ≥60 years reported ≥1 solicited reaction within 7 days following vaccination. The most frequent-solicited AEs were injection-site tenderness or pain, appetite loss, fever, and abnormal crying in 6 − 35 month-olds, and fever, headache, and myalgia in other age groups. No severe-unsolicited AEs or vaccine-related SAEs were reported. These results suggest that QIV is well tolerated across age groups in Vietnam, and can be safely used to protect the Vietnamese population against influenza and its potentially serious complications.
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Affiliation(s)
- Vu Dinh Thiem
- Center for Clinical Trials, National Institute of Hygiene and Epidemiology (NIHE), Hanoi, Vietnam
| | | | - Marion Fournier
- Sanofi Pasteur, Medical Operations, Campus Sanofi Lyon, Lyon, France
| | - Nathalie Lavis
- Sanofi Pasteur, Medical Operations, Campus Sanofi Lyon, Lyon, France
| | - Nguyen Dang Quang
- Center for Clinical Trials, National Institute of Hygiene and Epidemiology (NIHE), Hanoi, Vietnam
| | - Vu Hai Ha
- Center for Clinical Trials, National Institute of Hygiene and Epidemiology (NIHE), Hanoi, Vietnam
| | - Melvin Sanicas
- Sanofi Pasteur Medical Asia and JPAC, Sanofi-Aventis (Singapore) Pte. Ltd, Singapore, Singapore
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Abstract
INTRODUCTION Quadrivalent Influenza Vaccine (Sinovac Biotech) is a quadrivalent split-virion-inactivated influenza vaccine approved in China in June 2020 for individuals ≥3 years of age. It contains 15 µg hemagglutinin per strain including A/H1N1, A/H3N2, B/Victoria, and B/Yamagata, which could potentially improve protection against influenza B viruses. AREAS COVERED In this review, we summarize the development of quadrivalent influenza vaccines in China and foreign countries, and assess the immunogenicity and safety from the phase I and III clinical trials of Quadrivalent Influenza Vaccine in individuals ≥3 years of age. We also discuss the potential application of Quadrivalent Influenza Vaccine in young children 6-35 months of age according to the results of the phase III trial. EXPERT COMMENTARY The immunogenicity and safety profiles of Quadrivalent Influenza Vaccine containing two A and two B strains were comparable to the trivalent vaccines for the shared strains. The addition of a second B strain to the trivalent vaccine could induce superior immune responses for the alternate B strain. Since the two B strains co-circulated worldwide, the introduction of quadrivalent influenza vaccines has been expected to be a cost-effective strategy.
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Affiliation(s)
- Yan-Yang Tao
- School of Public Health, Southeast University; Nanjing, China
| | - Jing-Xin Li
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yue-Mei Hu
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yuan-Sheng Hu
- Clinical Research Department, Sinovac Biotech Co., LTD., Beijing, China
| | - Gang Zeng
- Clinical Research Department, Sinovac Biotech Co., LTD., Beijing, China
| | - Feng-Cai Zhu
- School of Public Health, Southeast University; Nanjing, China.,NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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Kwetkat A, Endres AS, Leischker A, Heppner HJ. [Vaccination in older adults: compulsory or voluntary exercise?]. Dtsch Med Wochenschr 2020; 145:1133-1137. [PMID: 32791548 DOI: 10.1055/a-1073-3171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Immunosenescence leads to an increasing susceptibility to infections. Therefore, vaccination is an essential element of prevention. The recommendations of the permanent vaccination commission (STIKO), a committee at the Robert-Koch-Institute, affiliated to the German Government, are updated every year and include a particular section dealing with older adults. CURRENT DEVELOPMENTS Immunosenescence reduces vaccine effectiveness. Thus, older adults and patients with multimorbidity are in need of more immunogenic vaccines. Cell culture derived quadrivalent influenza vaccine, trivalent adjuvanted vaccine and a high dose influenza vaccine show higher immune response in these groups. STIKO actually recommends an adjuvanted herpes zoster subunit vaccine to all adults in the age of 60 and above because of its vaccine effectiveness of 90 % in all age groups. The increasing travel activities of older adults require travel vaccination advice that takes into account travel destination as well as multimorbidity. Adjusted vaccination schedules and controlling of antibody titers have to be considered. OUTLOOK New vaccines are under development, that are more immunogenic and therefore more effective (e. g. pneumococcal vaccine) or that prevent infections for which a vaccine was previously not available (e. g. norovirus vaccine).
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Affiliation(s)
| | | | - Andreas Leischker
- Klinik für Geriatrie, Alexianer Krefeld GmbH und Klinik für Geriatrische Rehabilitation, Alexianer Tönisvorst GmbH
| | - Hans Jürgen Heppner
- Helios Klinikum, Schwelm und Lehrstuhl Geriatrie der Universität Witten-Herdecke
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Meng Z, Zhang J, Shi J, Zhao W, Huang X, Cheng L, Yang X. Immunogenicity of influenza vaccine in elderly people: a systematic review and meta-analysis of randomized controlled trials, and its association with real-world effectiveness. Hum Vaccin Immunother 2020; 16:2680-2689. [PMID: 32347787 PMCID: PMC7746244 DOI: 10.1080/21645515.2020.1747375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 02/08/2023] Open
Abstract
Background: Older people (≥60 years old) are particularly vulnerable to influenza virus infection, and vaccine is effective in reducing the disease burden in this population. However, it remains obscure whether their antibody response is lower than those of younger adults (18–60 years old). Thus, this meta-analysis was performed to compare the immunogenicity of influenza vaccines and understand their association with real-world vaccine effectiveness (VE) between these two age groups. Methods: A systematic literature search was conducted to identify relevant studies from Jan 01, 2008 to Nov 10, 2018. These are randomized controlled trials that included older adult samples, which assessed the immunogenicity of inactivated quadrivalent influenza vaccines produced in embryonated eggs. We excluded the studies focused only in children or adults. The outcomes were seroprotecton rate (SPR) and seroconversion rate (SCR). Results: Six studies were eventually included in the present meta-analysis (7,976 participants). For the SPR, the pooled risk ratio (RR) was 0.92 (95% CI: 0.90–0.94, I2 = 66%, P < .0001) for A/H1N1 and 0.94 (95% CI: 0.90–0.98, I2 = 91%, P = .002) for B/Victoria, and the antibody responses of A/H3N2 and B/Yamagata were similar in the two age groups. For the SCR, the pooled RR was 0.85 (95% CI: 0.76–0.94, I2 = 93%, P = .003), 0.77 (95% CI: 0.66–0.91, I2 = 94%, P = .002), and 0.83 (95% CI: 0.71–0.96, I2 = 94%, P = .02) for A/H1N1, B/Victoria and B/Yamagata, respectively, and the antibody responses of A/H3N2 were similar in the two groups. Some variations were found in the antibody responses across virus types and subtypes after influenza vaccination. Conclusion: The SPR and SCR of older adults were lower than those in younger adults for A/H1N1 and B/Victoria, while the two age groups had similar antibody responses for A/H3N2. The antibody responses to vaccines were not significantly associated with real-world VE, indicating that antibody response might not fully reflect the vaccine effectiveness of A/H3N2.
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Affiliation(s)
- Ziyan Meng
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Jiayou Zhang
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Jinrong Shi
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Wei Zhao
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Xiaoyuan Huang
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,Wuhan Institute of Biological Products 430207 , Wuhan, China
| | - Li Cheng
- Center for Evaluation and Inspection of Hubei Food and Drug Administration , Wuhan, China
| | - Xiaoming Yang
- National Institute of Engineering Technology Research in Combination Vaccines , Wuhan, China.,China National Biotech Group Company Limited , Beijing, China
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11
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Vesikari T, Virta M, Heinonen S, Eymin C, Lavis N, Chabanon AL, Gresset-Bourgeois V. Immunogenicity and safety of a quadrivalent inactivated influenza vaccine in pregnant women: a randomized, observer-blind trial. Hum Vaccin Immunother 2019; 16:623-629. [PMID: 31526225 PMCID: PMC7227680 DOI: 10.1080/21645515.2019.1667202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 01/16/2023] Open
Abstract
Vaccination against influenza during pregnancy provides direct protection to pregnant women and indirect protection to their infants. Trivalent inactivated influenza vaccines (IIV3s) are safe and effective during pregnancy, but quadrivalent inactivated influenza vaccines (IIV4s) have not been evaluated in pregnant women and their infants. Here, we report the results of a randomized phase IV study to evaluate the immunogenicity and safety of IIV4 vs. IIV3 in pregnant women. Participants aged ≥18 years at weeks 20 to 32 of gestation were randomly assigned in a 2:1 ratio to receive a single dose of IIV4 (n = 230) or IIV3 (n = 116). Between baseline and 21 days after vaccination, hemagglutination inhibition (HAI) antibody titers increased in both groups by similar magnitudes for the two influenza A strains and single B strain common to IIV4 and IIV3. For the additional B strain in IIV4, HAI titers were higher in IIV4 recipients than IIV3 recipients (post-/pre-vaccination geometric mean titer ratio, 6.3 [95% CI: 5.1 − 7.7] vs. 3.4 [95% CI: 2.7 − 4.3]). At delivery, in both groups, HAI antibody titers for all strains were 1.5 − 1.9-fold higher in umbilical cord blood than in maternal blood, confirming active transplacental antibody transfer. Rates of solicited and unsolicited vaccine-related adverse events in mothers were similar between the two groups. Live births were reported for all participants and there were no vaccine-related adverse events in newborns. These results suggest IIV4 is as safe and immunogenic as IIV3 in pregnant women, and that maternal immunization with IIV4 should protect newborns against influenza via passively acquired antibodies.
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Affiliation(s)
- Timo Vesikari
- Vaccine Research Center, Tampere University, Tampere, Finland
| | - Miia Virta
- Tampere Vaccine Research Clinic, Vaccine Research Center, Tampere University, Tampere, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Cécile Eymin
- Medical Operations, Sanofi Pasteur, Campus Sanofi Lyon, Lyon, France
| | - Nathalie Lavis
- Medical Operations, Sanofi Pasteur, Campus Sanofi Lyon, Lyon, France
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12
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Agarkhedkar S, Chhatwal J, Kompithra RZ, Lalwani SK, Narayan A, Muninarayanaswam V, Gogtay N, Dotter K, Gresset-Bourgeois V. Immunogenicity and safety of an intramuscular split-virion quadrivalent inactivated influenza vaccine in individuals aged ≥ 6 months in India. Hum Vaccin Immunother 2019; 15:973-977. [PMID: 30762467 PMCID: PMC6605869 DOI: 10.1080/21645515.2019.1565259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 10/27/2022] Open
Abstract
A quadrivalent split-virion inactivated influenza vaccine (IIV4; Fluzone® Quadrivalent, Sanofi Pasteur) has been available in the US since 2013 for individuals aged ≥ 6 months. Here, we describe the results of an open-label, multicenter trial (WHO Universal Trial Number U1111-1143-8370) evaluating the immunogenicity and safety of IIV4 in Indian children aged 6-35 months and 3-8 years, adolescents aged 9-17 years, and adults aged ≥ 18 years (n = 100 per group). Post-vaccination hemagglutination inhibition titers for all strains in all age groups were ≥ 8 fold higher than at baseline (range, 8-51). At least 70% of participants in all age groups seroconverted or had a significant increase in titer for each strain. The most common solicited reactions were injection-site pain and tenderness, plus fever in participants 6-23 months and myalgia in older children and adolescents. All injection-site reactions and most systemic reactions were grade 1 or 2 and resolved within 3 days. Only three vaccine-related unsolicited adverse events were reported, all of which were grade 1 or 2 and transient. No immediate adverse events, adverse events leading to study discontinuation, adverse events of special interest, or serious adverse events were reported. This study showed that IIV4 was well tolerated and highly immunogenic in all age groups. This adds important data on the safety, tolerability, and immunogenicity of influenza vaccines in India.
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Affiliation(s)
- Sharad Agarkhedkar
- a Dr. D. Y. Patil Medical College, Hospital & Research Centre , Pune , Maharashtra , India
| | - Jugesh Chhatwal
- b Department of Pediatrics , Christian Medical College & Hospital , Ludhiana , Punjab , India
| | - Rajeev Zachariah Kompithra
- c Well Baby Immunization Clinic, Department of Pediatrics , Christian Medical College & Hospital , Vellore , Tamil Nadu , India
| | - Sanjay K Lalwani
- d Department of Pediatrics , Medical College Road , Pune , Maharashtra , India
| | - Arun Narayan
- e Department of Medicine , M.S. Ramaiah Medical College and Hospitals , Bangalore , India
| | - Vinay Muninarayanaswam
- f Department of Community Medicine , Mandya Institute of Medical Sciences , Mandya , Karnataka , India
| | - Nithya Gogtay
- g Department of Clinical Pharmacology , Seth GS Medical College & KEM Hospital , Mumbai , Maharashtra , India
| | - Kristin Dotter
- h Medical Operations , Sanofi Pasteur , Swiftwater , PA , USA
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13
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Pepin S, Dupuy M, Borja-Tabora CFC, Montellano M, Bravo L, Santos J, de Castro JA, Rivera-Medina DM, Cutland C, Ariza M, Diez-Domingo J, Gonzalez CD, Martinón-Torres F, Papadopoulou-Alataki E, Theodoriadou M, Kazek-Duret MP, Gurunathan S, De Bruijn I. Efficacy, immunogenicity, and safety of a quadrivalent inactivated influenza vaccine in children aged 6–35 months: A multi-season randomised placebo-controlled trial in the Northern and Southern Hemispheres. Vaccine 2019; 37:1876-1884. [DOI: 10.1016/j.vaccine.2018.11.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
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14
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Affiliation(s)
- Susanna Esposito
- a Pediatric Clinic, Department of Surgical and Biomedical Sciences , Università degli Studi di Perugia , Perugia , Italy
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15
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López Trigo JA, López Mongil R, Mariano Lázaro A, Mato Chaín G, Moreno Villajos N, Ramos Cordero P. [Seasonal flu vaccination for older people: Evaluation of the quadrivalent vaccine. Positioning report]. Rev Esp Geriatr Gerontol 2018; 53 Suppl 2:185-202. [PMID: 30107941 DOI: 10.1016/j.regg.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/28/2018] [Accepted: 06/22/2018] [Indexed: 01/08/2023]
Abstract
Influenza is a significant health problem, particularly in those persons susceptible to having associated complications, older people, children less than 2 years, patients with chronic diseases, immunocompromised patients, and pregnant women. But influenza also has a large impact on the health system, with an increase in the healthcare demand and a spectacular increase in outpatient visits, overloading the emergency and hospital services. During epidemic outbreaks, the hospital admission rates of people over 65 years are at a maximum, and the mortality notified for the 2017/2018 influenza season was 960 deaths. The seasonal anti-influenza vaccine is the method with a better cost-effective ratio of primary prevention of influenza, reducing associated respiratory diseases, the number of hospital admissions, and deaths in high risk individuals, as well as work absenteeism in adults. In the last few years, influenza B has received little attention in the scientific literature, although in the periods between epidemics influenza B can be one of the main causes of seasonal epidemics, causing considerable morbidity and mortality and an increase in costs. The quadrivalent vaccine has a second-line immunological protection against influenza B, and according to a critical review of the scientific literature, it provides wider protection without affecting immunogenicity of the other three vaccine strains common to the trivalent and tetravalent vaccine. The quadrivalent vaccine is cost-effective in reducing the number of influenza cases, and is always a worthwhile intervention, with a significant cost saving for the health system and for society, by reducing the hospital admission rates and mortality associated with the complications of influenza. Supplement information: This article is part of a supplement entitled 'Seasonal flu vaccination for older people: Evaluation of the quadrivalent vaccine' which is sponsored by Sanofi-Aventis, S.A.
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Affiliation(s)
- José Antonio López Trigo
- Geriatría, Ayuntamiento de Málaga. Presidencia de la Sociedad Española de Geriatría y Gerontología (SEGG), Málaga, España.
| | | | - Alberto Mariano Lázaro
- Medicina Preventiva y Salud Pública, Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | - Gloria Mato Chaín
- Medicina Preventiva y Salud Pública, Unidad de Vacunación del Adulto, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | | | - Primitivo Ramos Cordero
- Coordinación médico-asistencial, Servicio Regional de Bienestar Social, Comunidad de Madrid, Madrid, España
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16
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Boccalini S, Bechini A, Innocenti M, Sartor G, Manzi F, Bonanni P, Panatto D, Lai PL, Zangrillo F, Rizzitelli E, Iovine M, Amicizia D, Bini C, Marcellusi A, Mennini FS, Rinaldi A, Trippi F, Ferriero AM, Lisi GC. [The universal influenza vaccination in children with Vaxigrip Tetra ® in Italy: an evaluation of Health Technology Assessment]. J Prev Med Hyg 2018; 59:E1-E86. [PMID: 30465031 PMCID: PMC6219245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Sara Boccalini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - Angela Bechini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - Gino Sartor
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - Federico Manzi
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - Paolo Bonanni
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - Donatella Panatto
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - Piero Luigi Lai
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | | | | | | | - Daniela Amicizia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - Chiara Bini
- Economic Evaluation and HTA (CEIS- EEHTA) - Facoltà di Economia, Università Tor Vergata
| | - Andrea Marcellusi
- Economic Evaluation and HTA (CEIS- EEHTA) - Facoltà di Economia, Università Tor Vergata
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Montomoli E, Torelli A, Manini I, Gianchecchi E. Immunogenicity and Safety of the New Inactivated Quadrivalent Influenza Vaccine Vaxigrip Tetra: Preliminary Results in Children ≥6 Months and Older Adults. Vaccines (Basel) 2018; 6:E14. [PMID: 29518013 PMCID: PMC5874655 DOI: 10.3390/vaccines6010014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 02/02/2018] [Revised: 02/26/2018] [Accepted: 03/05/2018] [Indexed: 12/31/2022] Open
Abstract
Since the mid-1980s, two lineages of influenza B viruses have been distinguished. These can co-circulate, limiting the protection provided by inactivated trivalent influenza vaccines (TIVs). This has prompted efforts to formulate quadrivalent influenza vaccines (QIVs), to enhance protection against circulating influenza B viruses. This review describes the results obtained from seven phase III clinical trials evaluating the immunogenicity, safety, and lot-to-lot consistency of a new quadrivalent split-virion influenza vaccine (Vaxigrip Tetra®) formulated by adding a second B strain to the already licensed TIV. Since Vaxigrip Tetra was developed by means of a manufacturing process strictly related to that used for TIV, the data on the safety profile of TIV are considered supportive of that of Vaxigrip Tetra. The safety and immunogenicity of Vaxigrip Tetra were similar to those of the corresponding licensed TIV. Moreover, the new vaccine elicits a superior immune response towards the additional strain, without affecting immunogenicity towards the other three strains. Vaxigrip Tetra is well tolerated, has aroused no safety concerns, and is recommended for the active immunization of individuals aged ≥6 months. In addition, preliminary data confirm its immunogenicity and safety even in children aged 6-35 months and its immunogenicity in older subjects (aged 66-80 years).
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Affiliation(s)
- Emanuele Montomoli
- VisMederi srl, Strada del Petriccio e Belriguardo, 35, 53100 Siena, Italy.
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy.
| | - Alessandro Torelli
- VisMederi srl, Strada del Petriccio e Belriguardo, 35, 53100 Siena, Italy.
- Department of Life Sciences, University of Siena, 53100 Siena, Italy.
| | - Ilaria Manini
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy.
| | - Elena Gianchecchi
- VisMederi srl, Strada del Petriccio e Belriguardo, 35, 53100 Siena, Italy.
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