Influenza update: vaccine development and clinical trials

Animal models for evaluation of influenza vaccines

Influenza viruses are emerging and re-emerging viruses that cause worldwide epidemics and pandemics. Despite substantial knowledge of the mechanisms of infection and immunity, only modest progress has been made in human influenza vaccine development. The rational basis for influenza vaccine development originates in animal models that have helped us to understand influenza species barriers, virus-host interactions, factors that affect transmission, disease pathogenesis, and disease intervention strategies. As influenza evolution can surmount species barriers and disease intervention strategies that include vaccines, our need for appropriate animal models and potentially new host species will evolve to meet these adaptive challenges. This chapter discusses animal models for evaluating vaccines and discusses the challenges and strengths of these models.

Structure-based design of peptides that self-assemble into regular polyhedral nanoparticles

Artificial particulate systems such as polymeric beads and liposomes are being applied in drug delivery, drug targeting, antigen display, vaccination, and other technologies. Here we used computer modeling to design a novel type of nanoparticles composed of peptides as building blocks. We verified the computer models via solid-phase peptide synthesis and biophysical analyses. We describe the structure-based design of a novel type of nanoparticles with regular polyhedral symmetry and a diameter of about 16 nm, which self-assembles from single polypeptide chains. Each peptide chain is composed of two coiled coil oligomerization domains with different oligomerization states joined by a short linker segment. In aqueous solution the peptides form nanoparticles of about 16 nm diameter. Such peptide nanoparticles are ideally suited for medical applications such as drug targeting and drug delivery systems, such as imaging devices, or they may be used for repetitive antigen display.

Reactogenicity and immunogenicity of an inactivated influenza vaccine administered by intramuscular or subcutaneous injection in elderly adults

In many countries there is no clear recommendation regarding the preferred route of administration of inactivated influenza vaccines. In a randomised, observer blind study of 720 elderly subjects, a split, trivalent influenza vaccine was significantly more immunogenic for both A strains (H3N2 and H1N1, p = 0.0016 and 0.003, respectively) when given intramuscularly compared to subcutaneously. This difference was due entirely to a gender effect, with females in the intramuscular (IM) group having a significantly greater serological response than females in the subcutaneous (SC) group for both of these strains. Similar results were seen with local adverse effects. These data suggest that vaccination practices that ensure intramuscular injection are required for optimal administration of influenza vaccines in the elderly.

Immunisation in the current management of cystic fibrosis patients

Although no special recommendations exist, clearly patients with cystic fibrosis (CF) can benefit from immunisation. We reviewed the literature regarding vaccination in CF and other chronic diseases. CF subjects should follow national immunisation programmes without delay to obtain optimal vaccination coverage. Indeed they may escape normal programmes due to frequent hospital admissions and school absenteeism and may be more at risk to get "vaccine-controlled" diseases at any age. There is no uniform European immunisation schedule for basic infant and childhood vaccines or for vaccines against hepatitis A (HAV) and B (HBV), varicella (VZ) and booster vaccinations. HAV and HBV vaccination is appropriate in CF as recommended in general for patients with chronic liver disease (CLD). Varicella (VZ) vaccination is not recommended in all European countries. There are no recent data about possible worsening of pulmonary status following VZ in CF, but it is known to cause pulmonary damage in non-CF adults and to be potentially fatal post transplantation and during steroid treatment. Therefore it is recommended at least for seronegative adolescents and transplant candidates. Influenza vaccine is recommended annually for CF patients aged > or =6 months. Pneumococcal vaccine is generally indicated for CF patients. RSV infection might play a role in the initial Pseudomonas colonization and the decline in pulmonary function. However no RSV vaccine is available at present. There are no recommendations for palivizumab in CF as an alternative but expensive prophylaxis. Anti-bacterial vaccinations protecting directly against Pseudomonas aeruginosa colonisation are promising for the future, potential candidates are currently being assessed in phase III clinical trials. More studies are needed to complete recommendations especially for CF adults and transplant candidates.