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Bieńkowski C, Żak Z, Fijołek F, Cholewik M, Stępień M, Skrzat-Klapaczyńska A, Kowalska JD. Immunological and Clinical Responses to Vaccinations among Adults Living with HIV. Life (Basel) 2024; 14:540. [PMID: 38792562 PMCID: PMC11122059 DOI: 10.3390/life14050540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/07/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
People living with human immunodeficiency virus (HIV) are at higher risk of morbidity and mortality due to vaccine-preventable diseases. At the same time, they are less likely to respond to vaccinations, and might have a higher rate of vaccine adverse event and faster waning of protective effect. International and national guidelines emphasize the importance of vaccinating people living with HIV against respiratory system disease pathogens including seasonal influenza, Streptococcus pneumoniae, and COVID-19, as well as against sexually transmitted infections, i.e., Hepatitis A and B (HAV, HBV) and human papillomavirus (HPV). This narrative review aims to provide a comprehensive examination of the current knowledge regarding the immune and clinical responses elicited by vaccinations in the older adult population living with HIV.
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Affiliation(s)
- Carlo Bieńkowski
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (F.F.); (A.S.-K.); (J.D.K.)
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Zuzanna Żak
- Department of Internal Medicine, Endocrinology, and Diabetes, Medical University of Warsaw, 01-201 Warsaw, Poland;
| | - Filip Fijołek
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (F.F.); (A.S.-K.); (J.D.K.)
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Martyna Cholewik
- Student’s Scientific Group at the Department of Adults’ Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland; (M.C.); (M.S.)
| | - Maciej Stępień
- Student’s Scientific Group at the Department of Adults’ Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland; (M.C.); (M.S.)
| | - Agata Skrzat-Klapaczyńska
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (F.F.); (A.S.-K.); (J.D.K.)
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
| | - Justyna D. Kowalska
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (F.F.); (A.S.-K.); (J.D.K.)
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland
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Hentzien M, Bonnet F, Bernasconi E, Biver E, Braun DL, Munting A, Leuzinger K, Leleux O, Musardo S, Prendki V, Schmid P, Staehelin C, Stoeckle M, Walti CS, Wittkop L, Appay V, Didierlaurent AM, Calmy A. Immune response to the recombinant herpes zoster vaccine in people living with HIV over 50 years of age compared to non-HIV age-/gender-matched controls (SHINGR'HIV): a multicenter, international, non-randomized clinical trial study protocol. BMC Infect Dis 2024; 24:329. [PMID: 38504173 PMCID: PMC10949601 DOI: 10.1186/s12879-024-09192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The burden of herpes zoster (shingles) virus and associated complications, such as post-herpetic neuralgia, is higher in older adults and has a significant impact on quality of life. The incidence of herpes zoster and post-herpetic neuralgia is increased in people living with HIV (PLWH) compared to an age-matched general population, including PLWH on long-term antiretroviral therapy (ART) with no detectable viremia and normal CD4 counts. PLWH - even on effective ART may- exhibit sustained immune dysfunction, as well as defects in cells involved in the response to vaccines. In the context of herpes zoster, it is therefore important to assess the immune response to varicella zoster virus vaccination in older PLWH and to determine whether it significantly differs to that of HIV-uninfected healthy adults or younger PLWH. We aim at bridging these knowledge gaps by conducting a multicentric, international, non-randomised clinical study (SHINGR'HIV) with prospective data collection after vaccination with an adjuvant recombinant zoster vaccine (RZV) in two distinct populations: in PLWH on long-term ART (> 10 years) over 50 years of and age/gender matched controls. METHODS We will recruit participants from two large established HIV cohorts in Switzerland and in France in addition to age-/gender-matched HIV-uninfected controls. Participants will receive two doses of RZV two months apart. In depth-evaluation of the humoral, cellular, and innate immune responses and safety profile of the RZV will be performed to address the combined effect of aging and potential immune deficiencies due to chronic HIV infection. The primary study outcome will compare the geometric mean titer (GMT) of gE-specific total IgG measured 1 month after the second dose of RZV between different age groups of PLWH and between PLWH and age-/gender-matched HIV-uninfected controls. DISCUSSION The SHINGR'HIV trial will provide robust data on the immunogenicity and safety profile of RZV in older PLWH to support vaccination guidelines in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT05575830. Registered on 12 October 2022. Eu Clinical Trial Register (EUCT number 2023-504482-23-00).
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Affiliation(s)
- Maxime Hentzien
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- University of Reims Champagne-Ardenne, Reims, France
| | - Fabrice Bonnet
- CHU de Bordeaux, Hôpital Saint-André, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
- Université de Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, F-33000, France
| | - Enos Bernasconi
- Department of Infectious Diseases, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Emmanuel Biver
- Division of Bone Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Dominique L Braun
- Division Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aline Munting
- Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudoise (CHUV), Lausanne, Switzerland
| | | | - Olivier Leleux
- Université de Bordeaux, INSERM, Institut Bergonié, BPH, U1219, CIC-EC 1401, Bordeaux, F-33000, France
| | - Stefano Musardo
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Virginie Prendki
- Division of Infectious Disease, Geneva University Hospital, Geneva, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital, St Gallen, Switzerland
| | - Cornelia Staehelin
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Carla S Walti
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Linda Wittkop
- CHU de Bordeaux, Hôpital Saint-André, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
- CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, F-33000, France
- Inria équipe SISTM team, Talence, France
| | - Victor Appay
- Université de Bordeaux, CNRS UMR 5164, INSERM ERL 1303, ImmunoConcEpT, Bordeaux, 33000, France
| | - Arnaud M Didierlaurent
- Department of Pathology and Immunology, Center of Vaccinology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
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Reichinger D, Reithofer M, Hohagen M, Drinic M, Tobias J, Wiedermann U, Kleitz F, Jahn-Schmid B, Becker CFW. A Biomimetic, Silaffin R5-Based Antigen Delivery Platform. Pharmaceutics 2022; 15:pharmaceutics15010121. [PMID: 36678751 PMCID: PMC9866965 DOI: 10.3390/pharmaceutics15010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/01/2023] Open
Abstract
Nature offers a wide range of evolutionary optimized materials that combine unique properties with intrinsic biocompatibility and that can be exploited as biomimetic materials. The R5 and RRIL peptides employed here are derived from silaffin proteins that play a crucial role in the biomineralization of marine diatom silica shells and are also able to form silica materials in vitro. Here, we demonstrate the application of biomimetic silica particles as a vaccine delivery and adjuvant platform by linking the precipitating peptides R5 and the RRIL motif to a variety of peptide antigens. The resulting antigen-loaded silica particles combine the advantages of biomaterial-based vaccines with the proven intracellular uptake of silica particles. These particles induce NETosis in human neutrophils as well as IL-6 and TNF-α secretion in murine bone marrow-derived dendritic cells.
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Affiliation(s)
- Daniela Reichinger
- Institute of Biological Chemistry, Faculty of Chemistry, University of Vienna, Währinger Str. 38, 1090 Vienna, Austria
- Vienna Doctoral School in Chemistry (DoSChem), University of Vienna, Währinger Str. 42, 1090 Vienna, Austria
| | - Manuel Reithofer
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, Gregor-Mendel-Straße 33, 1180 Vienna, Austria
| | - Mariam Hohagen
- Vienna Doctoral School in Chemistry (DoSChem), University of Vienna, Währinger Str. 42, 1090 Vienna, Austria
- Department of Inorganic Chemistry–Functional Materials, Faculty of Chemistry, University of Vienna, Währinger Str. 42, 1090 Vienna, Austria
| | - Mirjana Drinic
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Joshua Tobias
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Freddy Kleitz
- Department of Inorganic Chemistry–Functional Materials, Faculty of Chemistry, University of Vienna, Währinger Str. 42, 1090 Vienna, Austria
| | - Beatrice Jahn-Schmid
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Christian F. W. Becker
- Institute of Biological Chemistry, Faculty of Chemistry, University of Vienna, Währinger Str. 38, 1090 Vienna, Austria
- Correspondence:
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4
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Kitchen M, Leierer G, Kistner O, Wodal W, Gisinger M, Zangerle R, Sarcletti M. High seroprotection rates and geometric mean titre increases after repeated annual influenza vaccinations in a cohort of HIV-infected adults in Austria. Vaccine 2022; 40:3948-3953. [PMID: 35606234 DOI: 10.1016/j.vaccine.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Vaccination against seasonal influenza is recommended for all HIV-infected persons. Few data have been reported on the effect of repeated annual vaccination in this population. METHODS We measured haemagglutination inhibition antibody responses and investigated seroprotection rates in 344 HIV-infected adults before and 12 weeks after influenza vaccination with a trivalent subunit vaccine. RESULTS 68.3% of patients were male, the median age was 45 years. 83.7% had a viral load < 50 copies/mL. The median CD4 count was 604/µL. 304 patients (88.4%) had received influenza vaccinations in previous years. Seroprotection rates for A/H1N1 and B were over 90% in all age groups before vaccination and close to 100% after vaccination. For A/H3N2, seroprotection rates were lowest in individuals below 30 years both before and after vaccination (22.2% and 50.0%) and higher in older age groups (48.4% and 83.9% in people over 60 years). GMT fold increases were not significantly different across the age groups (3.0 to 4.2, p = 0.425). Previous influenza vaccinations were associated with higher seroprotection rates before and after vaccination (62.2% and 84.2% in patients with 8 or more previous vaccinations vs. 15.0% and 57.5% without previous vaccinations, respectively). Individuals with detectable viral load, elevated immune activation (urine neopterin ≥ 250 µmol/mol creatinine), and higher CD4 nadir (≥200 cells/µL) showed a trend towards inferior immune responses to vaccination, whereas gender and CD4 count did not have an effect. CONCLUSION The lower seroprotection rates observed in younger individuals may be explained by the higher proportion of patients without HIV treatment and with fewer previous encounters with influenza strains. Good seroprotection rates can be achieved in elderly HIV-infected patients and after repeated annual vaccinations.
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Affiliation(s)
- Maria Kitchen
- HIV Unit, Department of Dermatology, Venerology and Allergology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Gisela Leierer
- HIV Unit, Department of Dermatology, Venerology and Allergology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Otfried Kistner
- Baxter Innovations GmbH, Uferstrasse 15, 2304 Orth an der Donau, Austria
| | - Walter Wodal
- Baxter Innovations GmbH, Uferstrasse 15, 2304 Orth an der Donau, Austria
| | - Martin Gisinger
- HIV Unit, Department of Dermatology, Venerology and Allergology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Robert Zangerle
- HIV Unit, Department of Dermatology, Venerology and Allergology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Mario Sarcletti
- HIV Unit, Department of Dermatology, Venerology and Allergology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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O Murchu E, Comber L, Jordan K, Hawkshaw S, Marshall L, O'Neill M, Ryan M, Teljeur C, Carnahan A, Pérez JJ, Robertson AH, Johansen K, Jonge JD, Krause T, Nicolay N, Nohynek H, Pavlopoulou I, Pebody R, Penttinen P, Soler-Soneira M, Wichmann O, Harrington P. Systematic review of the efficacy, effectiveness and safety of MF59 ® adjuvanted seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age. Rev Med Virol 2022; 33:e2329. [PMID: 35142401 DOI: 10.1002/rmv.2329] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/18/2023]
Abstract
The most effective means of preventing seasonal influenza is through vaccination. In this systematic review, we investigated the efficacy, effectiveness and safety of MF59® adjuvanted trivalent and quadrivalent influenza vaccines to prevent laboratory-confirmed influenza. A systematic literature search was conducted in electronic databases and grey literature sources up to 7 February 2020. Randomised controlled trials and non-randomised studies of interventions (NRSIs) were eligible for inclusion. The search returned 28,846 records, of which 48 studies on MF59® adjuvanted vaccines met our inclusion criteria. No efficacy trials were identified. In terms of vaccine effectiveness (VE), MF59® adjuvanted trivalent influenza vaccines were effective in preventing laboratory-confirmed influenza in older adults (aged ≥65 years) compared with no vaccination (VE = 45%, 95% confidence interval (CI) 23%-61%, 5 NRSIs across 3 influenza seasons). By subtype, significant effect was found for influenza A(H1N1) (VE = 61%, 95% CI 44%-73%) and B (VE = 29%, 95% CI 5%-46%), but not for A(H3N2). In terms of relative VE, there was no significant difference comparing MF59® adjuvanted trivalent vaccines with either non-adjuvanted trivalent or quadrivalent vaccines. Compared with traditional trivalent influenza vaccines, MF59® adjuvanted trivalent influenza vaccines were associated with a greater number of local adverse events (RR = 1.90, 95% CI 1.50-2.39) and systemic reactions (RR = 1.18, 95% CI 1.02-1.38). In conclusion, MF59® adjuvanted trivalent influenza vaccines were found to be more effective than 'no vaccination'. Based on limited data, there was no significant difference comparing the effectiveness of MF59® adjuvanted vaccines with their non-adjuvanted counterparts.
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Affiliation(s)
- Eamon O Murchu
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Laura Comber
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Sarah Hawkshaw
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Liam Marshall
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | | | - Jaime Jesús Pérez
- General Directorate of Public Health and Addictions, IMIB-Arrixaca. Murcia University, Region of Murcia, Spain
| | - Anna Hayman Robertson
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Johansen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jorgen de Jonge
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ioanna Pavlopoulou
- Pediatric Research Laboratory, School of Health Sciences, Faculty of Nursing National and Kapodistrian University of Athens, Athens, Greece.,National Advisory Committee on Immunisation, Hellenic Ministry of Health, Athens, Greece
| | - Richard Pebody
- Institute of Epidemiology & Health, University College London, London, UK
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Marta Soler-Soneira
- Vigilancia de Enfermedades Prevenibles por Vacunación, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
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Vazquez-Pagan A, Schultz-Cherry S. Serological Responses to Influenza Vaccination during Pregnancy. Microorganisms 2021; 9:microorganisms9112305. [PMID: 34835431 PMCID: PMC8619416 DOI: 10.3390/microorganisms9112305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
Pregnant women, newborns, and infants under six months old are at the highest risk of developing severe and even fatal influenza. This risk is compounded by the inability to vaccinate infants under six months, highlighting the importance of vertically transferred immunity. This review identifies novel insights that have emerged from recent studies using animal models of pregnancy and vaccination. We also discuss the knowledge obtained using existing clinical trials that have evaluated influenza-specific serological responses in pregnant women and how these responses may impact early life immunity. We delineate the mechanisms involved in transferring specific maternal antibodies and discuss the consequences for early life immunity. Most importantly, we highlight the need for continued research using pregnant animal models and the inclusion of pregnant women, a commonly neglected population, when evaluating novel vaccine platforms to better serve and treat communicable diseases.
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Affiliation(s)
- Ana Vazquez-Pagan
- Graduate School of Biomedical Sciences, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
| | - Stacey Schultz-Cherry
- Graduate School of Biomedical Sciences, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Correspondence:
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7
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Lin X, Lin F, Liang T, Ducatez MF, Zanin M, Wong SS. Antibody Responsiveness to Influenza: What Drives It? Viruses 2021; 13:v13071400. [PMID: 34372607 PMCID: PMC8310379 DOI: 10.3390/v13071400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 02/06/2023] Open
Abstract
The induction of a specific antibody response has long been accepted as a serological hallmark of recent infection or antigen exposure. Much of our understanding of the influenza antibody response has been derived from studying antibodies that target the hemagglutinin (HA) protein. However, growing evidence points to limitations associated with this approach. In this review, we aim to highlight the issue of antibody non-responsiveness after influenza virus infection and vaccination. We will then provide an overview of the major factors known to influence antibody responsiveness to influenza after infection and vaccination. We discuss the biological factors such as age, sex, influence of prior immunity, genetics, and some chronic infections that may affect the induction of influenza antibody responses. We also discuss the technical factors, such as assay choices, strain variations, and viral properties that may influence the sensitivity of the assays used to measure influenza antibodies. Understanding these factors will hopefully provide a more comprehensive picture of what influenza immunogenicity and protection means, which will be important in our effort to improve influenza vaccines.
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Affiliation(s)
- Xia Lin
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, 195 Dongfengxi Rd, Guangzhou 510182, China; (X.L.); (F.L.); (T.L.); (M.Z.)
| | - Fangmei Lin
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, 195 Dongfengxi Rd, Guangzhou 510182, China; (X.L.); (F.L.); (T.L.); (M.Z.)
| | - Tingting Liang
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, 195 Dongfengxi Rd, Guangzhou 510182, China; (X.L.); (F.L.); (T.L.); (M.Z.)
| | | | - Mark Zanin
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, 195 Dongfengxi Rd, Guangzhou 510182, China; (X.L.); (F.L.); (T.L.); (M.Z.)
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Sook-San Wong
- State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, 195 Dongfengxi Rd, Guangzhou 510182, China; (X.L.); (F.L.); (T.L.); (M.Z.)
- School of Public Health, The University of Hong Kong, Hong Kong, China
- Correspondence: ; Tel.: +86-178-2584-6078
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8
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Caldera F, Mercer M, Samson SI, Pitt JM, Hayney MS. Influenza vaccination in immunocompromised populations: Strategies to improve immunogenicity. Vaccine 2021; 39 Suppl 1:A15-A23. [PMID: 33422377 DOI: 10.1016/j.vaccine.2020.11.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/22/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Immunocompromised individuals are at high risk of severe illness and complications from influenza infection. For this reason, immunization using inactivated influenza vaccines is recommended for transplant patients, individuals receiving immunosuppressant treatments, and other persons with immunodeficiency. However, these immunocompromised populations are more likely to have lower and non-protective responses to annual vaccination with a standard influenza vaccine. Here, we review strategies aimed to improve the immunogenicity of influenza vaccines in immunocompromised populations. The different strategies employed have included adjuvanted vaccines, high-dose vaccines, booster doses, intradermal vaccination, and temporary discontinuation of immunosuppressant treatment regimens. High-dose trivalent, inactivated, split-virus influenza vaccine (IIV3-HD) is so far one of the leading strategies for improving vaccine responses in HIV patients, transplant patients, and persons receiving immunosuppressant therapies for inflammatory diseases. Several studies in these populations have shown stronger humoral responses with IIV3-HD than existing standard-dose trivalent vaccine, and comparable safety. Accordingly, some scientific societies have stated that high-dose influenza vaccine could be a preferred option for immunocompromised patients. However, larger randomized controlled studies are needed to validate relative immunogenicity and safety of IIV3-HD and other enhanced vaccines and vaccination strategies in immunocompromised individuals.
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Affiliation(s)
- Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | | | | | | | - Mary S Hayney
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
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9
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L'huillier AG, Ferreira VH, Hirzel C, Natori Y, Slomovic J, Ku T, Hoschler K, Ierullo M, Selzner N, Schiff J, Singer LG, Humar A, Kumar D. Cell-Mediated Immune Responses After Influenza Vaccination of Solid Organ Transplant Recipients: Secondary Outcomes Analyses of a Randomized Controlled Trial. J Infect Dis 2020; 221:53-62. [PMID: 31550354 DOI: 10.1093/infdis/jiz471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/12/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite annual immunization, solid organ transplant (SOT) patients remain at increased risk for severe influenza infection because of suboptimal vaccine immunogenicity. We aimed to compare the CD4+ and CD8+ T-cell responses of the high-dose (HD) and the standard-dose (SD) trivalent inactivated vaccine. METHODS We collected peripheral blood mononuclear cells pre- and postimmunization from 60 patients enrolled in a randomized trial of HD versus SD vaccine (30 HD; 30 SD) during the 2016-2017 influenza season. RESULTS The HD vaccine elicited significantly greater monofunctional and polyfunctional CD4+ and CD8+ T-cell responses against influenza A/H1N1, A/H3N2, and B. For example, median vaccine-elicited influenza-specific polyfunctional CD4+ T cells were higher in recipients of the HD than SD vaccine after stimulation with influenza A/H1N1 (1193 vs 0 per 106 CD4+ T cells; P = .003), A/H3N2 (1154 vs 51; P = .008), and B (1102 vs 0; P = .001). Likewise, vaccine-elicited influenza-specific polyfunctional CD8+ T cells were higher in recipients of the HD than SD vaccine after stimulation with influenza B (367 vs 0; P = .002). CONCLUSIONS Our study provides novel evidence that HD vaccine elicits greater cellular responses compared with the SD vaccine in SOT recipients, which provides support to preferentially consider use of HD vaccination in the SOT setting.
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Affiliation(s)
| | - Victor H Ferreira
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Cedric Hirzel
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Yoichiro Natori
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, Florida, USA
| | - Jaclyn Slomovic
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Terrance Ku
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | | | - Matthew Ierullo
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Nazia Selzner
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Jeffrey Schiff
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Lianne G Singer
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Atul Humar
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - Deepali Kumar
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
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10
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Nunes MC, Cutland CL, Moultrie A, Jones S, Ortiz JR, Neuzil KM, Klugman KP, Simões EAF, Weinberg A, Madhi SA. Immunogenicity and safety of different dosing schedules of trivalent inactivated influenza vaccine in pregnant women with HIV: a randomised controlled trial. Lancet HIV 2020; 7:e91-e103. [PMID: 31911146 PMCID: PMC7167514 DOI: 10.1016/s2352-3018(19)30322-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Standard-dose, seasonal, trivalent, inactivated influenza vaccine induces moderate-to-low haemagglutination-inhibition antibody responses in people living with HIV. This study assessed the immunogenicity and safety of different dosing schedules of inactivated influenza vaccine in pregnant women living with HIV in South Africa. METHODS In this double-blind, randomised, controlled trial, we recruited pregnant women with HIV from seven antenatal clinics in Soweto, South Africa. Pregnant women were eligible if they were aged 18-38 years, infected with HIV, and had an estimated gestational age of 12-36 weeks. Women were randomly assigned (1:1:1), using a computer-generated randomisation list, to receive inactivated influenza vaccine containing 15 μg of each of the three seasonal influenza strains for that year, as a single dose, a double dose, or two single doses 1 month apart. Participants and study personnel were masked to group allocation. Haemagglutination-inhibition antibody responses were measured for all groups in the mothers at enrolment and at 1 month after each vaccine dose, and in the single-dose and double-dose groups within 7 days of birth in the neonates. Immunogenicity analyses only included women with visits 28-35 days apart and infants who were born at least 28 days after maternal immunisation. The primary was seroconversion rate to each of the vaccine strains in the mothers 1 month after completion of the dosing schedule, and the primary safety outcomes were frequency of local and systemic reactions. Safety was assessed in mothers and infants until 24 weeks post partum and analysed in all participants who received at least one dose of vaccine. This study is registered with ClinicalTrials.gov, NCT01527825, and is closed to accrual. FINDINGS Between Feb 11, and June 6, 2013, 800 pregnant women living with HIV were enrolled and randomly assigned to the single-dose (n=266), double-dose (n=265), or two-single-doses (n=269) group. In the analysable population, seroconversion rates in mothers 1 month after the final vaccine dose were significantly higher in the double-dose group (n=230; ranging from 29% to 65% for the three vaccine strains) than in the single-dose group (n=230; ranging from 18% to 49%; p≤0·019 for the three vaccine strains), but were similar between the two-single-doses group (n=220; ranging from 23% to 52%) and the single-dose group (p≥0·20 for the three vaccine strains). Safety outcomes were similar in the three groups, except for more injection-site reactions in recipients in the double-dose group. INTERPRETATION A regimen of double-dose inactivated influenza vaccine gave slightly greater immunogenicity than did a single-dose regimen in pregnant women living with HIV. However, immunogenicity in the double-dose group was still lower than historical data from the same setting in pregnant women without HIV. More immunogenic vaccines are needed for pregnant women living with HIV to enhance transplacental transfer of vaccine-induced protective antibodies to their newborn infants. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Marta C Nunes
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, SARCHI: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
| | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, SARCHI: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Moultrie
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, SARCHI: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Jones
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, SARCHI: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Keith P Klugman
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa
| | - Eric A F Simões
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa; School of Public Health, Center for Global Health, University of Colorado, Aurora, CO, USA; Department of Pediatric Infectious Diseases, University of Colorado, Aurora, CO, USA
| | - Adriana Weinberg
- Department of Pediatrics, Medicine and Pathology, University of Colorado, Aurora, CO, USA
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, School of Pathology, Faculty of Health Sciences, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation, SARCHI: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
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11
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Colmegna I, Useche ML, Rodriguez K, McCormack D, Alfonso G, Patel A, Ramanakumar AV, Rahme E, Bernatsky S, Hudson M, Ward BJ. Immunogenicity and safety of high-dose versus standard-dose inactivated influenza vaccine in rheumatoid arthritis patients: a randomised, double-blind, active-comparator trial. THE LANCET. RHEUMATOLOGY 2020; 2:e14-e23. [PMID: 38258270 DOI: 10.1016/s2665-9913(19)30094-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with rheumatoid arthritis have increased risk of seasonal influenza and influenza-related complications but have reduced vaccine immunogenicity. It is unknown whether patients with rheumatoid arthritis would benefit from more immunogenic vaccine formulations. This study investigated the immunogenicity and safety of a high-dose trivalent inactivated influenza vaccine (HD-TIV) in patients with rheumatoid arthritis compared to a standard-dose quadrivalent influenza vaccine (SD-QIV). METHODS This study was a treatment-stratified, randomised, double-blind trial to compare the immunogenicity and safety of SD-QIV (15 μg of haemagglutinin [HA] per strain) versus HD-TIV (60 μg of HA per strain) in adults with rheumatoid arthritis who are positive for rheumatoid factor or anti-cyclic citrullinated peptide, or both, recruited during the 2016-17 and 2017-18 influenza seasons at three hospitals affiliated with McGill University (Montreal, QC, Canada). Participants had received treatment for rheumatoid arthritis with conventional or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) or biological DMARDs, or combinations of them, were still on treatment at the time of enrolment, and their treatment had not been modified during the 3 months before enrolment. They were stratified into one of three groups according to treatment. Patients who, at enrolment, were taking conventional or targeted synthetic DMARDs (methotrexate, hydroxychloroquine, and sulfasalazine) as monotherapy or in combination were stratified to group 1; those who were taking a biological DMARD (anti-tumour necrosis factor or anti-interleukin 6), with or without methotrexate, hydroxychloroquine, or sulfasalazine (or a combination thereof) were stratified to group 2; and those who were taking abatacept, tofacitinib, or rituximab, with or without methotrexate, hydroxychloroquine, or sulfasalazine (or a combination thereof) were stratified to group 3. Participants were randomly allocated (1:1) to receive the SD-QIV or HD-TIV vaccine. Randomisation was based on a computer-generated allocation sequence, and participants, investigators, and research nurses responsible for safety assessments were masked to vaccine assignment. The primary outcome was the seroconversion rate (as measured by haemagglutination-inhibition assay) per strain at day 28. Analysis was done in the modified intention-to-treat population, which included all randomly assigned participants for whom seroconversion status was available. Safety was assessed throughout the surveillance period (day 0-186). This trial is registered at ClinicalTrials.gov, number NCT02936180. FINDINGS Between Oct 24, 2016, and Dec 6, 2017, 696 patients with rheumatoid arthritis were invited to participate in the study and 279 were randomly assigned and vaccinated (140 [50%] received SD-QIV and 139 [50%] HD-TIV). 136 patients who received SD-QIV and 138 who received HD-TIV were included in the modified intention-to-treat anaysis. Patients who received HD-TIV were more likely to seroconvert than those who received SD-QIV: the odds ratio was 2·99 (95% CI 1·46-6·11) for seroconversion to strain A/H3N2, 1·95 (1·19-3·22) for seroconversion to strain B/Bris, 3·21 (1·57-6·56) for seroconversion to strain A/H1N1 (in 2016-2017), and 2·44 (1·18-5·06) for seroconversion to strain A/H1N1 (in 2017-2018). Similar results were observed in patients from groups 1 and 2; the number of individuals in group 3 was insufficient to draw conclusions. Local and systemic adverse events were similar in both vaccine groups, no serious adverse events were reported between days 0 and 28 in any group, and neither vaccine increased rheumatoid arthritis disease activity. INTERPRETATION Our data suggest that in patients with seropositive rheumatoid arthritis, HD-TIV is safe and more immunogenic than SD-QIV. These results are the first evidence to support the use of the HD-TIV in these patients. FUNDING The Arthritis Society-Canada.
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Affiliation(s)
- Inés Colmegna
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada; Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada.
| | - Mariana L Useche
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Katherine Rodriguez
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Deirdre McCormack
- Department of Medicine, and Vaccine Study Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Giuliana Alfonso
- Department of Medicine, and Vaccine Study Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Aakash Patel
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Agnihotram V Ramanakumar
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Elham Rahme
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada; Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Marie Hudson
- Division of Rheumatology, McGill University Health Centre, Montreal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Brian J Ward
- Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada; Division of Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada
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12
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Chen YC, Zhou JH, Tian JM, Li BH, Liu LH, Wei K. Adjuvanted-influenza vaccination in patients infected with HIV: a systematic review and meta-analysis of immunogenicity and safety. Hum Vaccin Immunother 2019; 16:612-622. [PMID: 31567058 DOI: 10.1080/21645515.2019.1672492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Adjuvanted-influenza vaccination is an efficient method for enhancing the immunogenicity of influenza split-virus vaccines for preventing influenza. However, the medical community's understanding of its performance in patients infected with HIV remains limited. To identify the advantages, we conducted a systematic review and meta-analysis with randomized controlled trials (RCTs) and cohort and case-control studies that have the immunogenicity and safety of influenza vaccines in patients infected with HIV as outcomes. We searched six different databases, and 1698 patients infected with HIV in 11 studies were included. Statistical analysis was performed to calculate the pooled standardized mean differences (SMD) or relative risk (RR) and 95% confidence interval (CI). Regarding immunogenicity, the pooled SMD of GMT (Geometric mean titer) for A/H1N1 was 0.61 (95%CI (0.40,0.82)), the pooled RR of seroconversion was 1.34 (95%CI (0.91,1.98)) for the H1N1 vaccine, 1.27(95%CI (0.64,2.52)) for the H3N2 vaccine, 1.19(95%CI (0.97,1.46)) for the B-type influenza vaccine. The pooled RR of seroprotection was 1.61 (95%CI (1.00,2.58)) for the H1N1 vaccine, 1.06 (95%CI(0.83,1.35)) for the H3N2 vaccine, and 1.13(95%CI(0.91,1.41)) for the B-type vaccine. Adjuvanted-influenza vaccination showed good general tolerability in patients infected with HIV, with the only significant increase being the rate of local pain at the injection site (RR = 2.03, 95%CI (1.06,3.86)). In conclusion, all studies evaluating injected adjuvanted influenza vaccination among patients infected with HIV showed acceptable levels of safety and immunogenicity.
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Affiliation(s)
- Yong-Chao Chen
- Medical school, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Jia-Hao Zhou
- Medical school, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Jia-Ming Tian
- Medical school, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Bai-Hui Li
- Medical school, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Li-Hui Liu
- Medical school, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Ke Wei
- Medical school, Hunan University of Chinese Medicine, Changsha, Hunan, China
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13
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Chang L, Lim BCW, Flaherty GT, Torresi J. Travel vaccination recommendations and infection risk in HIV-positive travellers. J Travel Med 2019; 26:5486056. [PMID: 31066446 DOI: 10.1093/jtm/taz034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND With the advent of highly active antiretroviral drugs for the treatment of human immunodeficiency virus (HIV) it has become possible for people with HIV to travel to destinations that may place them at risk of a number of infectious diseases. Prevention of infections by vaccination is therefore of paramount importance for these travellers. However, vaccine responsiveness in HIV-positive individuals is not infrequently reduced compared to HIV-negative individuals. An understanding of the expected immune responses to vaccines in HIV-positive travellers is therefore important in planning the best approach to a pretravel consultation. METHODS A PubMed search was performed on HIV or acquired immune deficiency syndrome together with a search for specific vaccines. Review of the literature was performed to develop recommendations on vaccinations for HIV-positive travellers to high-risk destinations. RESULTS The immune responses to several vaccines are reduced in HIV-positive people. In the case of vaccines for hepatitis A, hepatitis B, influenza, pneumococcus, meningococcus and yellow fever there is a good body of data in the literature showing reduced immune responsiveness and also to help guide appropriate vaccination strategies. For other vaccines like Japanese encephalitis, rabies, typhoid fever, polio and cholera the data are not as robust; however, it is still possible to gain some understanding of the reduced responses seen with these vaccines. CONCLUSION This review provides a summary of the immunological responses to commonly used vaccines for the HIV-positive travellers. This information will help guide travel medicine practitioners in making decisions about vaccination and boosting of travellers with HIV.
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Affiliation(s)
- Lisa Chang
- Department of Microbiology, Dorevitch Pathology, Melbourne, Victoria, Australia
| | - Bryan Chang Wei Lim
- School of Medicine, National University of Ireland, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Joseph Torresi
- Department of Microbiology and Immunology, Peter Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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14
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Heger E, Schuetz A, Vasan S. HIV Vaccine Efficacy Trials: RV144 and Beyond. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1075:3-30. [PMID: 30030787 DOI: 10.1007/978-981-13-0484-2_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Despite progress in antiretroviral therapy, pre-exposure prophylaxis, microbicides, and other preventive strategies, a vaccine to prevent HIV-1 infection remains desperately needed. Development of an effective vaccine is challenged by several immunologic features of HIV-1 evidenced by the failure of five of the six HIV-1 candidate vaccine efficacy trials to date. This chapter reviews these efficacy trials with a focus on the Phase 3 RV144 trial in Thailand, the only HIV-1 vaccine efficacy trial to show a moderate protective effect of 31% with respect to placebo administration. Although modest, this protection has allowed for the study of potential immunologic correlates of protection to improve development of future HIV-1 pox-protein and other vaccine strategies. Trials in Thailand and South Africa have built upon the RV144 framework to provide additional immunologic insights which enable current and future efficacy testing of related vaccine candidates.
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Affiliation(s)
- Elizabeth Heger
- US Army Medical Materiel Development Activity, Fort Detrick, MD, USA
| | - Alexandra Schuetz
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Sandhya Vasan
- US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
- Henry M. Jackson Foundation, Bethesda, MD, USA.
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15
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Zhang W, Sun H, Atiquzzaman M, Sou J, Anis AH, Cooper C. Influenza vaccination for HIV-positive people: Systematic review and network meta-analysis. Vaccine 2018; 36:4077-4086. [PMID: 29859802 DOI: 10.1016/j.vaccine.2018.05.077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/30/2018] [Accepted: 05/21/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND People with Human Immunodeficiency Virus (HIV) are highly susceptible to influenza-related morbidity and mortality. In order to assess comparative efficacy of influenza vaccine strategies among HIV-positive people, we performed a systematic review and Bayesian network meta-analysis (NMA). METHODS In this systematic review, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL between 1946 and July 2015 for randomized controlled trials (RCTs) on influenza vaccines for HIV-positive adults reporting seroconversion or seroprotection outcomes. The NMAs were conducted within a Bayesian framework and logistic models were used for comparing the effect of the vaccine strategies on the two outcomes. RESULTS A total of 1957 publications were identified, 143 were selected for full review, and 13 RCTs were included in our final analysis. Fourteen separate NMAs were conducted by outcomes, vaccine strain, and different outcome measurement timepoints. For example, compared with the 15 μg single vaccine strategy, the odds ratio was the highest for the adjuvant 7.5 μg booster strategy (2.99 [95% credible interval 1.18-7.66]) when comparing seroconversion for H1N1 at 14-41 days after the last dose of vaccination and for the 60 μg single strategy (2.33 [1.31-4.18]) when comparing seroconversion for strain B. CONCLUSIONS The adjuvant 7.5 μg booster and 60 μg single vaccine strategies provided better seroconversion and seroprotection outcomes. These findings have important implications for national and international guidelines for influenza vaccination for HIV-positive people and future research.
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Affiliation(s)
- Wei Zhang
- School of Population and Public Health, University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Canada.
| | - Huiying Sun
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Canada
| | | | - Julie Sou
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Canada
| | - Aslam H Anis
- School of Population and Public Health, University of British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Canada
| | - Curtis Cooper
- Department of Medicine, University of Ottawa, Canada
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16
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Dini G, Toletone A, Sticchi L, Orsi A, Bragazzi NL, Durando P. Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature. Hum Vaccin Immunother 2017; 14:772-789. [PMID: 28787234 PMCID: PMC5861785 DOI: 10.1080/21645515.2017.1348442] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Influenza imposes a significant burden worldwide from the healthcare and socio-economic standpoints. This is also due to suboptimal vaccination coverage among the target population, even though immunization is recommended since many years and still remains the fundamental tool for its prevention. Healthcare workers (HCWs) are at increased risk of exposure to respiratory pathogens compared with the general population, including flu, with potential threat for their health and for patients' safety. Nevertheless, despite recommendation for immunization of this work-category in most of Western Countries, inadequate flu vaccine uptake is reported during the last decade in the European area. According to recent systematic reviews on this topic, the main determinants of vaccine acceptance among HCWs have been largely investigated and include desire for self-protection and to protect family rather than absolute disease risk or desire to protect patients, among the main drivers. On the other hand, concerns regarding safety of the vaccines resulted in decreased vaccine uptake. Moreover, influenza vaccine hesitancy among HCWs was also associated with several issues such as low risk perception, denial of the social benefit of influenza vaccination, low social pressure, lack of perceived behavioral control, negative attitude toward vaccines, not having been previously vaccinated against influenza, not having previously had influenza, lack of adequate influenza-specific knowledge, lack of access to vaccination facilities, and socio-demographic variables. The topic of influenza vaccination among HCWs is challenging, full of ethical issues. Systematic reviews of randomized controlled trials (RCTs) investigating the effectiveness of interventions for improving vaccine uptake among HCWs found that combined strategies were more effective than isolate approaches. Mandatory policies are currently under debate in several countries. High quality studies would help policy-makers and stake-holders to shape evidence-based initiatives and programs to improve the control of influenza.
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Affiliation(s)
- Guglielmo Dini
- a Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine , University of Genoa , Genoa , Italy.,b Occupational Medicine Unit, Ospedale Policlinico San Martino , Genoa , Italy
| | - Alessandra Toletone
- a Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine , University of Genoa , Genoa , Italy
| | - Laura Sticchi
- c Department of Health Sciences (DISSAL), Postgraduate School of Public Health , University of Genoa , Genoa , Italy.,d Hygiene Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | - Andrea Orsi
- c Department of Health Sciences (DISSAL), Postgraduate School of Public Health , University of Genoa , Genoa , Italy.,d Hygiene Unit , Ospedale Policlinico San Martino , Genoa , Italy
| | - Nicola Luigi Bragazzi
- c Department of Health Sciences (DISSAL), Postgraduate School of Public Health , University of Genoa , Genoa , Italy
| | - Paolo Durando
- a Department of Health Sciences (DISSAL), Postgraduate School of Occupational Medicine , University of Genoa , Genoa , Italy.,b Occupational Medicine Unit, Ospedale Policlinico San Martino , Genoa , Italy
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17
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Seo YB, Lee J, Song JY, Choi HJ, Cheong HJ, Kim WJ. Safety and immunogenicity of influenza vaccine among HIV-infected adults: Conventional vaccine vs. intradermal vaccine. Hum Vaccin Immunother 2016; 12:478-84. [PMID: 26431466 DOI: 10.1080/21645515.2015.1076599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Several studies have reported poor immune responses to conventional influenza vaccines in HIV-infected individuals. This study sought to elicit more potent immunogenicity in HIV-infected adults using an intradermal vaccine compared with a conventional intramuscular vaccine. This multicenter, randomized, controlled, open-label study was conducted at 3 university hospitals during the 2011/2012 pre-influenza season. Three vaccines were used in HIV-infected adults aged 18 - 60 years: an inactivated intramuscular vaccine (Agrippal), a reduced-content intradermal vaccine (IDflu9μg) and a standard-content intradermal vaccine (IDflu15μg). Serum hemagglutination-inhibiting (HI) antibodies and INF-γ ELISpot assay were measured at the time of vaccination and 1 month after vaccination. Adverse events were recorded for 7 d. A total of 28 Agrippal, 30 IDflu9μg, and 28 IDflu15μg volunteers were included in this analysis. One month after vaccination, the GMTs and differences in INF-γ ELISpot assay results were similar among the 3 groups. Seroprotection rates, seroconversion rates and mean fold increases (MFI) among the 3 groups were also similar, at approximately 80%, 50-60% and 2.5 - 10.0, respectively. All three vaccines satisfied the CHMP criteria for the A/H1N1 and A/H3N2 strains, but not those for the B strain. In univariate analysis, no demographic or clinical factors, including age, CD4+ T-cell counts, HIV viral load, ART status and vaccine type, were related to failure to achieve seroprotection. The three vaccines were all well-tolerated and all reported reactions were mild to moderate. However, there was a tendency toward a higher incidence of local and systemic reactions in the intradermal vaccine groups. The intradermal vaccine did not result in higher immunogenicity compared to the conventional intramuscular vaccine, even with increased antigen dose.
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Affiliation(s)
- Yu Bin Seo
- a Division of Infectious Diseases ; Department of Internal Medicine; Hallym University College of Medicine ; Chuncheon , Republic of Korea
| | - Jacob Lee
- a Division of Infectious Diseases ; Department of Internal Medicine; Hallym University College of Medicine ; Chuncheon , Republic of Korea
| | - Joon Young Song
- b Division of Infectious Diseases ; Department of Internal Medicine; Korea University College of Medicine ; Seoul , Republic of Korea
| | - Hee Jung Choi
- c Division of Infectious Diseases ; Department of Internal Medicine; Ewha Woman University College of Medicine ; Seoul , Republic of Korea
| | - Hee Jin Cheong
- b Division of Infectious Diseases ; Department of Internal Medicine; Korea University College of Medicine ; Seoul , Republic of Korea
| | - Woo Joo Kim
- b Division of Infectious Diseases ; Department of Internal Medicine; Korea University College of Medicine ; Seoul , Republic of Korea
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Abstract
First identified in 2012, Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) is listed as a new Category C Priority Pathogen. While the high mortality of MERS-CoV infection is further intensified by potential human-to-human transmissibility, no MERS vaccines are available for human use. This review explains immune responses resulting from MERS-CoV infection, describes MERS vaccine criteria, and presents available small animal models to evaluate the efficacy of MERS vaccines. Current advances in vaccine development are summarized, focusing on specific applications and limitations of each vaccine category. Taken together, this review provides valuable guidelines toward the development of an effective and safe MERS vaccine. This article is written for a Special Focus Issue of Expert Review of Vaccines on 'Vaccines for Biodefence'.
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Affiliation(s)
- Lanying Du
- a Lindsley F. Kimball Research Institute , New York Blood Center , New York , NY , USA
| | - Wanbo Tai
- a Lindsley F. Kimball Research Institute , New York Blood Center , New York , NY , USA.,b State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , China
| | - Yusen Zhou
- b State Key Laboratory of Pathogen and Biosecurity , Beijing Institute of Microbiology and Epidemiology , Beijing , China
| | - Shibo Jiang
- a Lindsley F. Kimball Research Institute , New York Blood Center , New York , NY , USA.,c Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Sciences , Fudan University , Shanghai , China
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19
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Impaired immune response to Candida albicans in cells from Fanconi anemia patients. Cytokine 2015; 73:203-7. [DOI: 10.1016/j.cyto.2015.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 12/25/2022]
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Cooper C, Klein M, Walmsley S, Haase D, MacKinnon-Cameron D, Marty K, Li Y, Smith B, Halperin S, Law B, Scheifele D. High-Level Immunogenicity Is Achieved Vaccine With Adjuvanted Pandemic H1N12009and Improved With Booster Dosing in a Randomized Trial of HIV-Infected Adults. HIV CLINICAL TRIALS 2015. [DOI: 10.1310/hct1301-23] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Banday AH, Jeelani S, Hruby VJ. Cancer vaccine adjuvants--recent clinical progress and future perspectives. Immunopharmacol Immunotoxicol 2014; 37:1-11. [PMID: 25318595 DOI: 10.3109/08923973.2014.971963] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Despite recent breakthroughs in the prognosis, prevention and treatment, cancer still remains the leading cause of death and affects millions of people worldwide. With the US FDA approval of various preventive cancer vaccines such as Gardasil (Merck), Cervarix (Glaxosmithkline) and the therapeutic vaccine Sipulencel-T (Provenge), cancer vaccine development is gaining huge ground. Approval of these vaccines has encouraged the concept of cancer treatment through cellular immunotherapy. The FDA approval of the above vaccines has provided support for renewed interest and attention which the development of new therapeutic cancer vaccines deserves. However, most of the new generation vaccines including that for cancer are poorly immunogenic sub-unit vaccines and thus essentially need adjuvants in their formulations to compensate for the immune suppression. Adjuvants are the essential components of a potent vaccine which increases the efficacy by enhancing the antigen-specific immune response. However, the design of a successful adjuvant is not easy because of the complexity and the difficulty in designing adjuvants that are safe, potent and economically viable. The present communication takes a short review of the advancements in adjuvant technology, current clinical scenario of new adjuvants and application of their molecularly defined formulations to new generation cancer vaccines which are currently under development.
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Affiliation(s)
- Abid H Banday
- Department of Chemistry and Biochemistry, University of Arizona , Tucson, AZ , USA
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Yam KK, Gipson E, Klein M, Walmsley S, Haase D, Halperin S, Scheifele D, Ward BJ, Cooper C. High level antibody avidity is achieved in HIV-seropositive recipients of an inactivated split adjuvanted (AS03A) influenza vaccine. J Clin Immunol 2014; 34:655-62. [PMID: 24824648 DOI: 10.1007/s10875-014-0054-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 05/05/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE More severe influenza disease and poor vaccine immunogenicity is reported in HIV-infected patients. We measured antibody avidity after influenza vaccination in HIV patients to assess vaccine efficacy. METHODS Two dosing strategies (Group1: single dose, n = 28. Group2: single dose plus booster, n = 36) with an AS03A-adjuvanted H1N12009 pandemic influenza vaccine (Arepanrix, GSK) were assessed in HIV patients. Serum hemagglutination inhibition (HAI) titers and antibody avidity reported as an avidity index (AI) were measured at days 21 and 42 and at 6 months. RESULTS Baseline HIV parameters were similar among all participants. Eighteen participants had measurable baseline HAI titers. In these subjects, AI was at ~9 at baseline and was not significantly increased by one or two vaccine doses. In those without detectable baseline antibodies, immunization induced modest antibody titers [Group1 HAI, 61 (26-144); Group2 HAI, 46 (28-76)] with high AI after one dose at day 21 [Group1 AI, 8.8 (7.3-10.7); Group2 AI, 8.9 (7.8-10.1)]. A second dose of vaccine generated significantly higher HAI titers at day 42 [Group1 HAI, 41 (18-90); Group2 HAI, 92 (64-132)] and persisted to 6 months [Group1 HAI, 9 (6-13); Group2 HAI, 19 (13-30)]. All subjects who produced detectable HAI titers after vaccination generated high antibody avidity (AI, 9-10), which persisted up to 6 months. CONCLUSION In participants initially seronegative, two doses of vaccine enabled a greater percentage of subjects to respond to the vaccine and elicited higher HAI titers. All subjects who produced detectable HAI titers also rapidly generated high AI in the short and long term. We demonstrate that high avidity antibodies can be achieved after vaccination and support a two-dose immunization strategy for HIV-positive subjects.
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Affiliation(s)
- Karen K Yam
- Department of Experimental Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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23
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Pass RF, Nachman S, Flynn PM, Muresan P, Fenton T, Cunningham CK, Borkowsky W, McAuley JB, Spector SA, Petzold E, Levy W, Siberry GK, Handelsman E, Utech LJ, Weinberg A. Immunogenicity of Licensed Influenza A (H1N1) 2009 Monovalent Vaccines in HIV-Infected Children and Youth. J Pediatric Infect Dis Soc 2013; 2:352-60. [PMID: 24363932 PMCID: PMC3869470 DOI: 10.1093/jpids/pit040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 04/25/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND With the emergence of pandemic influenza A (pH1N1) in 2009, children and youth infected with human immunodeficiency virus (HIV) were vulnerable because of immunologic impairment and the greater virulence of this infection in young persons. METHODS A multicenter study of the immunogenicity of 3 licensed influenza A (H1N1) monovalent vaccines (1 live attenuated and 2 inactivated) was conducted in children and youth with perinatal HIV infection, most of whom were receiving ≥3 antiretroviral drugs, had CD4% ≥15, and plasma HIV RNA levels <400 copies/mL. Serum hemagglutinin inhibition assay (HAI) antibody levels were measured and correlated with baseline demographic and clinical variables. RESULTS One hundred forty-nine subjects were enrolled at 26 sites in the United States and Puerto Rico. Over 40% had baseline HAI titers ≥40. For subjects aged 6 months to <10 years, 79% and 68%, respectively, achieved a ≥40- and ≥4-fold rise in HAI titers after the second dose of vaccine. Three weeks after a single immunization with an inactivated vaccine, similar immunogenicity results were achieved in youth aged 10-24 years. With multivariable analysis, only Hispanic ethnicity and CD4% ≥15 were associated with achieving both HAI titer ≥40- and ≥4-fold rise in titer. CONCLUSIONS Although licensed pH1N1 vaccines produced HAI titers that were considered to be protective in the majority of HIV-infected children and youth, the proportion with titers ≥40- and ≥4-fold rise in titer was lower than expected for children without HIV infection. Vaccine immunogenicity was lower in HIV-infected children and youth with evidence of immune suppression.
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Affiliation(s)
- Robert F. Pass
- University of Alabama at Birmingham,Corresponding Author: Robert F. Pass, MD, UAB Department of Pediatrics, Children's of Alabama, 1600 7th Ave S, Ste 108, Birmingham, AL 35233. E-mail:
| | | | | | - Petronella Muresan
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts
| | - Terence Fenton
- Statistical and Data Analysis Center, Harvard School of Public Health, Boston, Massachusetts
| | | | | | | | - Stephen A. Spector
- University of California San Diego, La Jolla,Rady Children's Hospital, San Diego, California
| | | | - Wende Levy
- Social and Scientific Systems, Silver Spring
| | - George K. Siberry
- Pediatric Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Ed Handelsman
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - L. Jill Utech
- St Jude's Children's Research Hospital, Memphis, Tennessee
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O'Hagan DT, Ott GS, Nest GV, Rappuoli R, Giudice GD. The history of MF59(®) adjuvant: a phoenix that arose from the ashes. Expert Rev Vaccines 2013; 12:13-30. [PMID: 23256736 DOI: 10.1586/erv.12.140] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The first clinical trial of an MF59(®)-adjuvanted influenza vaccine (Novartis) was conducted 20 years ago in 1992. The product that emerged (Fluad(®), Novartis) was licensed first in Italy in 1997 and is now licensed worldwide in 30 countries. US licensure is expected in the coming years. By contrast, many alternative adjuvanted vaccines have failed to progress. The key decisions that allowed MF59 to succeed in such a challenging environment are highlighted here and the lessons that were learned along the way are discussed. MF59 was connected to vaccines that did not succeed and was perceived as a 'failure' before it was a success. Importantly, it never failed for safety reasons and was always well tolerated. Even when safety issues have emerged for alternative adjuvants, careful analysis of the substantial safety database for MF59 have shown that there are no significant concerns with widespread use, even in more 'sensitive' populations.
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Affiliation(s)
- Derek T O'Hagan
- Novartis Vaccines and Diagnostics, Cambridge, MA 02139, USA.
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25
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Fenoglio D, Traverso P, Parodi A, Tomasello L, Negrini S, Kalli F, Battaglia F, Ferrera F, Sciallero S, Murdaca G, Setti M, Sobrero A, Boccardo F, Cittadini G, Puppo F, Criscuolo D, Carmignani G, Indiveri F, Filaci G. A multi-peptide, dual-adjuvant telomerase vaccine (GX301) is highly immunogenic in patients with prostate and renal cancer. Cancer Immunol Immunother 2013; 62:1041-52. [PMID: 23591981 PMCID: PMC11029691 DOI: 10.1007/s00262-013-1415-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anti-tumor vaccination is a new frontier in cancer treatment applicable to immunogenic neoplasms such as prostate and renal cancers. GX301 is a vaccine constituted by four telomerase peptides and two adjuvants, Montanide ISA-51 and Imiquimod. OBJECTIVE The aim of this study was to analyze safety and tolerability of GX301 in an open-label, phase I/II trial. Immunological and clinical responses were also evaluated as secondary endpoints. EXPERIMENTAL DESIGN GX301 was administered by intradermally injecting 500 μg of each peptide (dissolved in Montanide ISA-51) in the skin of the abdomen. Imiquimod was applied as a cream at the injection sites. The protocol included 8 administrations at days 1, 3, 5, 7, 14, 21, 35, 63. Eligible patients were affected with stage IV prostate or renal cancer resistant to conventional treatments. Patients were clinically and immunologically monitored up to 6 months from the first immunization. RESULTS No grade 3-4 adverse events were observed. Evidence of vaccine-specific immunological responses was detected in 100 % of patients. Disease stabilization occurred in 4 patients. Prolonged progression-free survival and overall survival were observed in patients showing a full pattern of vaccine-specific immunological responses. CONCLUSION GX301 demonstrated to be safe and highly immunogenic. Further studies are needed to determine its clinical efficacy.
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Affiliation(s)
- Daniela Fenoglio
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Traverso
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
- Department of Surgical Sciences, University of Genoa, Genoa, Italy
| | - Alessia Parodi
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Laura Tomasello
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Simone Negrini
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Francesca Kalli
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Florinda Battaglia
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Francesca Ferrera
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
| | - Stefania Sciallero
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Maurizio Setti
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Alberto Sobrero
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Francesco Boccardo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Giuseppe Cittadini
- Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliero Universitaria San Martino—IST, Genoa, Italy
| | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Domenico Criscuolo
- Genovax srl, Colleretto Giacosa, Italy
- Present Address: Mediolanum Farmaceutici Spa, Milan, Italy
| | | | - Francesco Indiveri
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Gilberto Filaci
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Viale Benedetto XV n. 7, 16132 Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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Baluch A, Humar A, Eurich D, Egli A, Liacini A, Hoschler K, Campbell P, Berka N, Urschel S, Wilson L, Kumar D. Randomized controlled trial of high-dose intradermal versus standard-dose intramuscular influenza vaccine in organ transplant recipients. Am J Transplant 2013; 13:1026-1033. [PMID: 23406320 DOI: 10.1111/ajt.12149] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/10/2012] [Accepted: 12/14/2012] [Indexed: 01/25/2023]
Abstract
The immunogenicity of standard intramuscular (IM) influenza vaccine is suboptimal in transplant recipients. Also, recent studies suggest that alloantibody may be upregulated due to vaccination. We evaluated a novel high-dose intradermal (ID) vaccine strategy. In conjunction, we assessed alloimmunity. Transplant recipients were randomized to receive IM or high-dose ID vaccine. Strain-specific serology and HLA alloantibody production was determined pre- and postimmunization. In 212 evaluable patients (105 IM, 107 ID), seroprotection to H1N1, H3N2 and B strains was 70.5%, 63.8% and 52.4% in the IM group, and 71.0%, 70.1%, 63.6% in the ID group (p=ns). Seroconversion to ≥1 antigen was 46.7% and 51.4% in the IM and ID groups respectively (p=0.49). Response was more likely in those≥6 months posttransplant (53.2% vs. 19.2%; p=0.001). Use of mycophenolate mofetil was inversely associated with vaccine response in a dose-dependent manner (p<0.001). Certain organ subgroups had higher response rates for influenza B in the ID vaccine group. Differences in anti-HLA antibody production were detected in only 3/212(1.4%) patients with no clinical consequences. High-dose intradermal vaccine is an alternative to standard vaccine and has potential enhanced immunogenicity in certain subgroups. In this large cohort, we also show that seasonal influenza does not result in significant alloantibody production.
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Affiliation(s)
- A Baluch
- Alberta Transplant Institute, University of Alberta, Canada
| | - A Humar
- Alberta Transplant Institute, University of Alberta, Canada
| | - D Eurich
- School of Public Health, University of Alberta, Canada
| | - A Egli
- Alberta Transplant Institute, University of Alberta, Canada
| | - A Liacini
- Calgary Laboratory Services & University of Calgary, Canada
| | - K Hoschler
- Health Protection Agency, London, United Kingdom
| | - P Campbell
- Alberta Transplant Institute, University of Alberta, Canada
| | - N Berka
- Calgary Laboratory Services & University of Calgary, Canada
| | - S Urschel
- Alberta Transplant Institute, University of Alberta, Canada
| | - L Wilson
- Alberta Transplant Institute, University of Alberta, Canada
| | - D Kumar
- Alberta Transplant Institute, University of Alberta, Canada
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CERAVOLO A, ORSI A, PARODI V, ROSSELLI R, ANSALDI F. Influenza vaccination in HIV-positive subjects: latest evidence and future perspective. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2013; 54:1-10. [PMID: 24396998 PMCID: PMC4718365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Annual influenza vaccination is recommended for persons with human immunodeficiency virus (HIV) infection. Recent reports indicate that immunizations may increase IIeplication in infected individuals. Generally, vaccination against influenza is well tolerated in both children and adult individuals with HNIVand does not induce significant changes in viral load and CD4+ cell counts. The observed increase in viral replication is usually transient and a clear, measurable progression of the underlying HIV disease is hard to be determined. Several studies reported immunogenicity data in HIV+ population, by comparing diferfent influenza vaccines, adjuvanted or not, and different administration routes. Data are encouraging because an adequate immune response is shown, although split/subunit vaccines do not elicite an efficient immune response in these subjects. New strategies have been evaluated to increase the immune response in immunocompromised patients.The aim of this review is to evaluate tolerability, safety, immunogenicity and efficacy of vaccines actually approved for human use and to consider latest evidence and future perspective in HIV positive subjects.
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Affiliation(s)
- A. CERAVOLO
- Correspondence: Antonella Ceravolo, Department of Health Sciences, University of Genoa, via A. Pastore 1, 16132 Genoa, Italy - Tel. +39 010 3533001 - E-mail
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Orsi A, Ansaldi F, de Florentiis D, Ceravolo A, Parodi V, Canepa P, Coppelli M, Icardi G, Durando P. Cross-protection against drifted influenza viruses: options offered by adjuvanted and intradermal vaccines. Hum Vaccin Immunother 2013; 9:582-90. [PMID: 23295230 DOI: 10.4161/hv.23239] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Antigenic drift, the evolutionary mechanism of influenza viruses, results in an increased susceptibility of vaccinated subjects against circulating viruses. New vaccines able to grant a broader and cross-reactive immune response against drifted influenza variants are needed. Several strategies were explored to enhance the immunogenicity of plain vaccines: adjuvants, carriers and intradermal administration of influenza vaccine emerge as a promising options. To evaluate the ability of a MF59-adjuvanted and intradermal influenza vaccine to elicit an effective antibody response against circulating viruses presenting antigenic patterns different from those of the vaccine strains, we compared antibody responses elicited by "implemented" vaccines and conventional intramuscular trivalent inactivated vaccine against heterologous circulating influenza A viruses. Different studies, simulating different epidemiological pictures produced by the natural antigenic drift of seasonal influenza viruses, highlighted the superior cross-reactivity of the antibodies elicited by MF59 and intradermal vaccines, compared with subunit or split vaccine against heterologous viruses.
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Affiliation(s)
- Andrea Orsi
- Department of Health Sciences; University of Genoa; Genoa, Italy
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Tetsutani K, Ishii KJ. Adjuvants in influenza vaccines. Vaccine 2012; 30:7658-61. [DOI: 10.1016/j.vaccine.2012.10.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 09/07/2012] [Indexed: 11/26/2022]
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Nielsen AB, Nielsen HS, Nielsen L, Thybo S, Kronborg G. Immune response after one or two doses of pandemic influenza A (H1N1) monovalent, AS03-adjuvanted vaccine in HIV infected adults. Vaccine 2012; 30:7067-71. [PMID: 23036498 DOI: 10.1016/j.vaccine.2012.09.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 09/18/2012] [Accepted: 09/20/2012] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Continued research is needed to evaluate and improve the immunogenicity of influenza vaccines in HIV infected patients. We aimed to determine the antibody responses after one or two doses of the AS03-adjuvanted pandemic influenza A (H1N1) vaccine in HIV infected patients. METHOD Following the influenza season 2009/2010, 219 HIV infected patients were included and divided into three groups depending on whether they received none (n=60), one (n=31) or two (n=128) doses of pandemic influenza A (H1N1) vaccine. At inclusion, antibody titers for all patients were analyzed and compared to pre-pandemic antibody titers analyzed from serum samples in a local storage facility. RESULTS 4-9 months after a single immunization, we found a seroprotection rate of 77.4% and seroconversion rate of 67.7%. After two immunizations the rates increased significantly to seroprotection rate of 97.7% and seroconversion rate of 86.7%. CONCLUSION A single dose of AS03-adjuvanted pandemic influenza A (H1N1) vaccine created an adequate immune response in HIV infected patients lasting as long as 4-9 months. Two doses improved the immunogenicity further.
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Affiliation(s)
- Allan Bybeck Nielsen
- Department for Infectious Diseases, Hvidovre Hospital, University Hospital of Copenhagen, Copenhagen, Denmark.
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Ansaldi F, Valle L, de Florentiis D, Parodi V, Murdaca G, Bruzzone B, Durando P, Setti M, Icardi G. Phase 4 randomized trial of intradermal low-antigen-content inactivated influenza vaccine versus standard-dose intramuscular vaccine in HIV-1-infected adults. Hum Vaccin Immunother 2012; 8:1048-52. [PMID: 22832261 DOI: 10.4161/hv.20347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study evaluated safety, tolerability and immunogenicity of intradermal (ID) trivalent inactivated split influenza vaccine, with a lower antigen content (9 mcg HA per strain) than the conventional intramuscular one (15 mcg), in HIV-1-infected adults younger than 60 years. A total of 54 HIV-1-positive participants were enrolled and randomly assigned to receive a single dose of either ID-administered low-antigen-content split inactivated vaccine or intramuscularly-administered (IM) standard-dose inactivated split vaccine. Subjects were provided with a diary to monitor any local and/or systemic reactions to the vaccine for 7 days following vaccination. Serum samples were collected before, 28 days and 90 days after immunization. The plasma HIV-RNA and CD4+ T-lymphocyte count were checked at day 0 and day 90. Serum hemagglutination-inhibition (HI) activity for the three influenza strains included in the vaccine composition was measured to assess the antibody response at one month and 3 months after vaccination. Both vaccines showed optimal safety and tolerability profiles. All the three Committee for Medicinal Products for Human Use immunogenicity criteria for vaccine approval in adults younger than 60 were met by both vaccines against A(H1N1) and A(H3N2) viruses. Both vaccines met mean-fold-increase and seroprotection criteria but failed seroconversion criteria against B virus. No difference in terms of post-vaccination geometric mean titers, mean fold increase, seroprotection and seroconversion rates were found comparing ID and IM vaccines. In conclusion, the recently available low-antigen-content ID vaccine is safe, well-tolerated and as immunogenic as IM standard-dose influenza vaccine.
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Phase III, randomized controlled trial to evaluate lot consistency of a trivalent subunit egg-based influenza vaccine in adults. Vaccine 2012; 30:5285-92. [DOI: 10.1016/j.vaccine.2012.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 11/22/2022]
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Gasparini R, Amicizia D, Lai PL, Panatto D. Aflunov(®): a prepandemic influenza vaccine. Expert Rev Vaccines 2012; 11:145-57. [PMID: 22309663 DOI: 10.1586/erv.11.170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Influenza viruses are adept in human populations. Indeed, they have the capacity to evade the immune system through mechanisms of mutations (antigenic drift) and major variations in surface protein expression (antigenic shift). When a major change occurs, the risk of a human pandemic arises. Three influenza pandemics occurred during the 20th century, the most serious being the Spanish influenza. The last pandemic of the past century occurred in 1968, and the responsible virus infected an estimated 1-3 million people throughout the world. The first pandemic of the present century occurred in 2009 and was sustained by a H1N1 strain (A/California/07/09). In 1997, a novel avian influenza virus, H5N1, first infected humans in China. Since its emergence, the H5N1 virus has spread from Asia to Europe and Africa, resulting in the infection of millions of poultry and wild birds. So far, 522 human cases and 322 deaths have been reported by the WHO. Many studies have therefore been performed to obtain efficacious and safe H5N1 vaccines. One of these is Aflunov(®). Aflunov is a prepandemic monovalent A/H5N1 influenza vaccine adjuvanted with MF59 produced by Novartis Vaccines and Diagnostics. In nonclinical studies conducted in rabbits, Aflunov proved to be well-tolerated, did not cause maternal or embryo-fetal toxicity, was not teratogenic, and had no effects on postnatal development. In clinical studies, Aflunov proved safe and well-tolerated in infants, children, adolescents, adults and the elderly. In the same subjects, the vaccine elicited robust immunogenicity against both homologous (A/Vietnam/1194/2004 clade 1) and heterologous viral strains (for instance, A/Indonesia/05/2005 or A/Turkey/15/2006) and induced immunologic memory. Thus, in 2010, the CHMP issued a positive opinion on Aflunov and in January 2011 Aflunov was given marketing authorization. This vaccine could be very useful in the event of adaptation of the H5N1 virus to humans, which could cause a new pandemic.
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Affiliation(s)
- Roberto Gasparini
- Department of Health Science, University of Genoa (Italy), Via Pastore, 1-16132, Genoa, Italy.
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Deficient long-term response to pandemic vaccine results in an insufficient antibody response to seasonal influenza vaccination in solid organ transplant recipients. Transplantation 2012; 93:847-54. [PMID: 22377789 DOI: 10.1097/tp.0b013e318247a6ef] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the long-term antibody response to the 2009-H1N1 vaccine in solid organ transplant recipients (SOTR) and its clinical repercussion on the efficacy of following 2010-2011 influenza vaccine. METHODS We performed a multicenter prospective study in SOTR receiving one dose of the nonadjuvant 2010-2011 seasonal influenza vaccine and determined the immunological response at 5 weeks after vaccination. RESULTS One hundred SOTR were included. Long-term antibody titers to the previous vaccine were only detected in one third of the patients. Patients with baseline titers had significantly higher seroprotection for the 2009-H1N1 strain (100% vs. 73%, relative risks [RR] 1.37, 95% confidence intervals [CI] 1.19-1.57; P=0.006), for H3N2 strain (100% vs. 62.2%, RR 1.61, 95% CI 1.36-1.90; P=0.005), and for B strain (100% vs. 69%; P=0.02). The seroconversion rate in patients with baseline titers was 90.9% vs. 73% (RR 2.97, 95% CI 0.75-11.74; P=0.07) for the 2009-H1N1 strain, 92.2% vs. 62.2% (RR 5.29, 95% CI 0.8-35.7; P=0.02) for the H3N2 strain, and 58.3% vs. 69% (P=0.45) for the B strain. CONCLUSIONS SOTR response to the 2010-2011 influenza vaccine was not optimal. The response was related to baseline titers; however, most of the patients did not exhibit detectable antibodies at vaccination lacking long-term response. New strategies are necessary to improve vaccination efficacy.
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McCullers JA, Huber VC. Correlates of vaccine protection from influenza and its complications. Hum Vaccin Immunother 2012; 8:34-44. [PMID: 22252001 DOI: 10.4161/hv.8.1.18214] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Despite use of influenza vaccines for more than 65 y, influenza and its complications are a major cause of morbidity and mortality worldwide. Most deaths during influenza virus infections are due to underlying co-morbidities or secondary bacterial pneumonia. The measures of immune response currently used for licensure of influenza vaccines are relevant mainly for protection from viral infection in healthy adults. Development of new or improved influenza vaccines will require a definition of novel, and specific correlates of protection. These correlates should associate immune responses with outcomes that are relevant to specific risk groups, such as asthma exacerbation, hospitalization or disruptions to care or daily activities. Assessment of vaccine effectiveness for both viral and bacterial vaccines should include measures of impact on secondary bacterial pneumonia.
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Affiliation(s)
- Jonathan A McCullers
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
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Abstract
Vaccinations are key to limiting the increased risk of severe infectious diseases in HIV-infected patients for whom the risk–benefit ratio has been re-evaluated. Vaccine safety and immunogenicity depend on both vaccine type and immune deficiency, while vaccine-induced immune activation promotes a transient increase in viral load. Vaccine immunogenicity is reduced and wanes more rapidly, strengthening the need for revaccination. While inactivated vaccines are safe, attenuated vaccines are theoretically contraindicated, but the risk of infectious diseases outweighs the risks of severe adverse events in endemic areas, where the majority of HIV-infected individuals live, thus allowing their use when immune deficiency is moderate. Immune reconstitution with HAART has improved vaccine immune response, highlighting the importance of global access to and early initiation of therapy.
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Affiliation(s)
- Nicole Le Corre
- INSERM, UMRS-945, Hôpital Pitié-Salpêtrière, Département d’Immunologie Cellulaire et Tissulaire F-75013, Paris, France
- UPMC Université Paris 06, UMRS-945, Hôpital Pitié Salpêtrière, Département d’Immunologie Cellulaire et Tissulaire F-75013, Paris, France
| | - Brigitte Autran
- Laboratoire d’immunologie cellulaire et tissulaire - INSERM U945, Batiment CERVI - 4ème étage, Groupe Hospitalier Pitié-Salpêtrière, 83, boulevard de l’hôpital, 75651 Paris Cedex 13, France
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Beck CR, McKenzie BC, Hashim AB, Harris RC, Zanuzdana A, Agboado G, Orton E, Béchard-Evans L, Morgan G, Stevenson C, Weston R, Mukaigawara M, Enstone J, Augustine G, Butt M, Kim S, Puleston R, Dabke G, Howard R, O'Boyle J, O'Brien M, Ahyow L, Denness H, Farmer S, Figureroa J, Fisher P, Greaves F, Haroon M, Haroon S, Hird C, Isba R, Ishola DA, Kerac M, Parish V, Roberts J, Rosser J, Theaker S, Wallace D, Wigglesworth N, Lingard L, Vinogradova Y, Horiuchi H, Peñalver J, Nguyen-Van-Tam JS. Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective. PLoS One 2011; 6:e29249. [PMID: 22216224 PMCID: PMC3245259 DOI: 10.1371/journal.pone.0029249] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 11/23/2011] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events. METHODOLOGY/PRINCIPAL FINDINGS Electronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I(2) and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR]=0.23; 95% confidence interval [CI]=0.16-0.34; p<0.001) and laboratory confirmed influenza infection (OR=0.15; 95% CI=0.03-0.63; p=0.01) through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified. CONCLUSIONS/SIGNIFICANCE Infection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.
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Affiliation(s)
- Charles R Beck
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom.
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Recommendations on the use of MF59-Adjuvanted Trivalent Influenza Vaccine (Fluad ®): Supplemental Statement of Seasonal Influenza Vaccine for 2011-2012 An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) †. ACTA ACUST UNITED AC 2011; 37:1-68. [PMID: 31701945 DOI: 10.14745/ccdr.v37i00a06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pariani E, Boschini A, Amendola A, Poletti R, Anselmi G, Begnini M, Ranghiero A, Cecconi G, Zanetti AR. Response to 2009 pandemic and seasonal influenza vaccines co-administered to HIV-infected and HIV-uninfected former drug users living in a rehabilitation community in Italy. Vaccine 2011; 29:9209-13. [PMID: 21974995 DOI: 10.1016/j.vaccine.2011.09.103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/20/2011] [Accepted: 09/26/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND 2009 A(H1N1) pandemic influenza vaccination was recommended as a priority to essential workers and high-risk individuals, including HIV-infected patients and people living in communities. METHODS HIV-infected and HIV-uninfected former drug-users (18-60 years old) living in a rehabilitation community (San Patrignano, Italy) received one dose of a MF59-adjuvanted 2009 pandemic influenza vaccine and one dose of a 2009-2010 seasonal trivalent inactivated influenza vaccine (containing A/Brisbane/59/2007(H1N1), A/Brisbane/10/2007(H3N2), B/Brisbane/60/2008) simultaneously. Antibodies against each vaccine antigen were determined at the time of vaccination and one and six months post-vaccination by hemagglutination-inhibition test. RESULTS 49 HIV-infected and 60 HIV-uninfected subjects completed the study. Most (98%) HIV-infected participants were on antiretroviral treatment, the median CD4+ cell count was 350 (IQR 300)cells/μl and viremia was suppressed in 91.8% of cases. One month post-vaccination, no significant changes in immune-virological parameters were observed. One month post-vaccination, the immune responses to both pandemic and seasonal vaccine met the EMA-CPMP criteria for immunogenicity of influenza vaccines in both HIV-infected and HIV-uninfected subjects. No difference in vaccine responses was observed between the two groups. Six months after vaccination, the percentages of vaccinees with antibody titres ≥1:40 and antibody geometric mean titres significantly decreased in both groups. However, they were significantly lower in HIV-infected than in HIV-uninfected vaccinees. In subjects who had been primed to seasonal influenza the year before (through either vaccination or natural infection), levels of antibodies against 2009 A(H1N1) were higher than those measured in unprimed subjects, both one month and six months post-vaccination. CONCLUSIONS The co-administration of a single dose of 2009 pandemic MF59-adjuvanted influenza vaccine with a seasonal vaccine provided a protective immune response in both HIV-infected and HIV-uninfected individuals. Subjects who had been primed to seasonal influenza in the year preceding the pandemic had a more vigorous and long-lasting antibody response to 2009 pandemic vaccine.
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Affiliation(s)
- Elena Pariani
- Università degli Studi di Milano, Dipartimento di Sanità Pubblica-Microbiologia-Virologia, Milan, Italy.
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Pedersen G, Halstensen A, Sjursen H, Naess A, Kristoffersen EK, Cox RJ. Pandemic influenza vaccination elicits influenza-specific CD4+ Th1-cell responses in hypogammaglobulinaemic patients: four case reports. Scand J Immunol 2011; 74:210-8. [PMID: 21438900 DOI: 10.1111/j.1365-3083.2011.02561.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In these case reports, we investigated pandemic influenza 2009 vaccination of primary hypogammaglobulinaemic patients. Three combined variable immunodeficiency (CVID) patients and one X-linked agammaglobulinaemia (XLA) patient were vaccinated with the pandemic vaccine A/California/7/2009 (H1N1)-like split virus (X179a) adjuvanted with the oil-in-water emulsion AS03. Subsequently, serum and peripheral blood mononuclear cells were sampled and used to measure the haemagglutination inhibition (HI) and antibody-secreting cell (ASC) responses. In addition, the IFN-γ, IL-2 and TNF-α producing CD4(+) Th1-cell response was determined as these cytokines are important indicators of cell-mediated immunity. Two of the CVID patients responded to vaccination as determined by a >4-fold rise in HI antibodies. These subjects also had influenza-specific ASC numbers, which, albeit low, were higher than prevaccination levels. In addition, vaccination induced CD4(+) Th1-cell responses in both the XLA patient and the CVID patients, although the frequency of influenza-responsive cells varied amongst the patients. These results suggest that hypogammaglobulinaemia patients can mount a CD4(+) Th1 cell-mediated response to influenza vaccination and, additionally, that influenza vaccination of some hypogammaglobulinaemia patients can produce an influenza-specific humoral immune response. The findings should be confirmed in larger clinical studies.
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Affiliation(s)
- G Pedersen
- The Gade Institute, University of Bergen, Bergen, Norway.
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Launay O, Desaint C, Durier C, Loulergue P, Duval X, Jacomet C, Pialoux G, Ghosn J, Raffi F, Rey D, Ajana F, Colin de Verdière N, Reynes J, Foubert V, Roman F, Devaster JM, Delfraissy JF, Aboulker JP. Safety and immunogenicity of a monovalent 2009 influenza A/H1N1v vaccine adjuvanted with AS03A or unadjuvanted in HIV-infected adults: a randomized, controlled trial. J Infect Dis 2011; 204:124-34. [PMID: 21628666 DOI: 10.1093/infdis/jir211] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected patients have decreased immune response to vaccines. Few data are available about pandemic flu vaccination in this population. METHODS We conducted a multicenter, patient-blinded, randomized trial in a cohort of HIV-infected adults. Patients received 2 injections 21 days apart of a AS03(A)-adjuvanted H1N1v vaccine containing 3.75 μg hemagglutinin (HA) or a nonadjuvanted H1N1v vaccine containing 15 μg HA to assess hemagglutination inhibition (HI) response and safety. RESULTS A total of 309 patients were randomized, and 306 were vaccinated. After the first vaccine dose, HI titers ≥1:40 were observed in 93.4% of the patients in the adjuvanted group (A group) (n = 155) and in 75.5% in the nonadjuvanted group (B group) (n = 151) (P < .001); seroconversion rates were 88.8% and 71.2%, and factor increases in geometric mean titers (GMT) of 21.9 and 15.1, respectively. After 2 injections, 98.6% of patients of the A group and 92.1% of the B group demonstrated HI titers ≥1:40 (P = .018); seroconversion rates were 96.5% and 87.1%, respectively, and factor increases in GMT were 45.5 and 21.2, respectively. The majority of adverse events were mild to moderate in severity; no impact on CD4+ cell count or viral load has been detected. CONCLUSIONS In HIV-1-infected adults, the AS03(A)-adjuvanted H1N1v vaccine yielded a higher immune response than did the nonadjuvanted one, with no impact on HIV infection.
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Long-term immunogenicity after one and two doses of a monovalent MF59-adjuvanted A/H1N1 Influenza virus vaccine coadministered with the seasonal 2009-2010 nonadjuvanted Influenza virus vaccine in HIV-infected children, adolescents, and young adults in a randomized controlled trial. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1503-9. [PMID: 21795458 DOI: 10.1128/cvi.05200-11] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Few data are available on the safety and long-term immunogenicity of A/H1N1 pandemic influenza vaccines for HIV-infected pediatric patients. We performed a randomized controlled trial to evaluate the safety and long-term immunogenicity of 1 versus 2 doses of the 2009 monovalent pandemic influenza A/H1N1 MF59-adjuvanted vaccine (PV) coadministered with the seasonal 2009-2010 trivalent nonadjuvanted influenza vaccine (SV) to HIV-infected children, adolescents, and young adults. A total of 66 HIV-infected patients aged 9 to 26 years were randomized to receive one (group 1) or two (group 2) doses of PV coadministered with 1 dose of SV. The main outcome was the seroconversion rate for PV at 1 month. Secondary outcomes were the geometric mean titer ratios and the seroprotection rates at 1 month for all vaccines, seroconversion rates at 1 month for SV, and longitudinal changes of antibody titers (ABTs) at 1, 2, 6, and 12 months for all vaccines. Groups 1 and 2 had similar CD4 counts and HIV RNA levels during the study. The seroconversion rate for PV was 100% at 1 month in both groups. ABTs for PV were high during the first 6 months and declined below seroprotection levels thereafter. Longitudinal changes in ABTs were similar in groups 1 and 2 for both PV and SV. The side effects of vaccination were mild and mostly local. In HIV-infected children, adolescents, and young adults, the immune response triggered by a single dose of PV was similar to that obtained with a double dose and was associated with long-term antibody response.
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Crum-Cianflone NF, Iverson E, Defang G, Blair PJ, Eberly LE, Maguire J, Ganesan A, Faix D, Duplessis C, Lalani T, Whitman T, Brandt C, Macalino G, Millar EV, Burgess T. Durability of antibody responses after receipt of the monovalent 2009 pandemic influenza A (H1N1) vaccine among HIV-infected and HIV-uninfected adults. Vaccine 2011; 29:3183-91. [PMID: 21371580 DOI: 10.1016/j.vaccine.2011.02.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 02/10/2011] [Accepted: 02/15/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected persons are at risk for severe influenza infections. Although vaccination against the H1N1 pandemic influenza strain is recommended, currently there are no data on the durability of post-vaccination antibody responses in this population. METHODS HIV-infected and HIV-uninfected adults (18-50 years old) received a single dose of monovalent 2009 influenza A (H1N1) vaccine (strain A/California/7/2009H1N1). Antibody levels to the 2009 H1N1 pandemic strain were determined at day 0, day 28, and 6 months by hemagglutination-inhibition assay. A seroprotective response was a post-vaccination titer of ≥1:40 among those with a pre-vaccination level of ≤1:10. Geometric mean titers (GMT) and factors associated with higher levels were also evaluated. RESULTS We studied 127 participants with a median age of 35 (interquartile range (IQR) 28, 42) years. Among the HIV-infected arm (n=63), the median CD4 count was 595 (IQR 476, 819)cells/mm(3) and 83% were receiving HAART. Thirty-five percent of all participants had a pre-vaccination level of >1:10. HIV-infected compared to HIV-uninfected adults were less likely to generate a seroprotective response at day 28 (54% vs. 75%, adjusted OR 0.23, p=0.021) or have a durable response at 6 months post-vaccination (28% vs. 56%, adjusted OR 0.19, p=0.005). Additionally, although pre-vaccination GMT were similar in both arms (median 7 vs. 8, p=0.11), the GMT at 6 months was significantly lower among HIV-infected versus HIV-uninfected adults (median 20 vs. 113, p=0.003). Among HIV-infected persons, younger age (p=0.035) and receipt of HAART (p=0.028) were associated with higher GMTs at 6 months. CONCLUSIONS Despite vaccination, most HIV-infected adults do not generate durable seroprotective antibody responses to the 2009 influenza A (H1N1) virus, and hence may remain vulnerable to infection. In addition to HAART use, more immunogenic vaccines are likely needed for improving protection against influenza in this population.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Esposito S, Tagliaferri L, Daleno C, Valzano A, Picciolli I, Tel F, Prunotto G, Serra D, Galeone C, Plebani A, Principi N. Pandemic influenza A/H1N1 vaccine administered sequentially or simultaneously with seasonal influenza vaccine to HIV-infected children and adolescents. Vaccine 2011; 29:1677-82. [DOI: 10.1016/j.vaccine.2010.12.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 11/29/2010] [Accepted: 12/14/2010] [Indexed: 11/29/2022]
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Enhancing effects of adjuvanted 2009 pandemic H1N1 influenza A vaccine on memory B-cell responses in HIV-infected individuals. AIDS 2011; 25:295-302. [PMID: 21157297 DOI: 10.1097/qad.0b013e328342328b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the humoral immune response to low-dose AS03-adjuvanted and standard-dose nonadjuvanted 2009 pandemic H1N1 influenza A vaccine in HIV-infected aviremic individuals receiving antiretroviral therapy and in uninfected individuals. DESIGN A three-arm study. SETTING Two clinics: one at the National Institutes of Health in Bethesda, Maryland, USA; and the other at the Maple Leaf Medical Clinic in Toronto, Ontario, Canada. PARTICIPANTS HIV-infected and HIV-uninfected adults. INTERVENTION Single intramuscular 15 μg dose of the monovalent inactivated 2009 pandemic H1N1 influenza A vaccine without adjuvant or 3.75 μg dose of the same strain with adjuvant AS03. MAIN OUTCOMES Immunogenicity, as measured by hemagglutination inhibition (HAI) antibody titers and vaccine-specific memory B-cell responses. RESULTS A total of 74 participants were enrolled. Twenty-one HIV-infected individuals received the low-dose adjuvanted 2009 pandemic H1N1 influenza A vaccine. Twenty-nine HIV-infected and 24 HIV-uninfected individuals received the standard-dose nonadjuvanted vaccine. There were no significant differences in antibody responses at 9 weeks postvaccination among the three groups studied. However, the IgG memory B-cell response against the vaccine was significantly higher in the HIV-infected group that received the low-dose adjuvanted vaccine when compared to the HIV-infected and uninfected groups that received the standard-dose nonadjuvanted vaccine. Conclusions remained unchanged after regression adjustment for age, gender, CD4 T-cell count, and baseline HAI titer. CONCLUSION These data suggest that adjuvants could be used to expand coverage through dose sparing and improve humoral immune responses in immunocompromised individuals.
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Induction of protective antibody response by MF59-adjuvanted 2009 pandemic A/H1N1v influenza vaccine in HIV-1-infected individuals. AIDS 2011; 25:177-83. [PMID: 21150561 DOI: 10.1097/qad.0b013e328341afa8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE to determine the immunogenicity of the monovalent vaccine against 2009 pandemic influenza A/H1N1 in HIV-1-infected individuals. DESIGN a total of 192 participants, including 44 HIV-1-positive individuals and 148 HIV-1-negative healthy controls were enrolled to receive a single dose of MF59-adjuvanted 2009 A/H1N1v vaccine formulated to contain 7.5 microg of haemagglutin antigen. METHODS standard haemagglutination inhibition (HAI) assay was performed to evaluate seroconversion and seroprotecsion rates against the pandemic virus in serum samples collected at baseline (T0) and 3-5-week postvaccination (T28). Seroconversion to vaccination was defined by either prevaccination HAI titer less than 1: 10 with a postvaccination titer higher than 1: 40, or a prevaccination titer higher than 1: 10 and increase of at least four-fold or more after vaccination. Seroprotection was defined by HAI titers higher than 1: 40. RESULTS the vaccine induced specific antibody titers in HIV-1-positive individuals similar to those of HIV-1-negative controls [215.3, 95% confidence interval (CI) 150.4-308.1 vs. 275.9, 95% CI 232.6-327.3] with postvaccination seroprotection rates higher than 97%. In contrast, the seroconversion rate was lower in the HIV-1-positive individuals as compared with the HIV-1-negative controls (36.4 vs. 79.0%, P < 0.0001), likely as a consequence of their high HAI baseline titers. Multivariable logistic regression analysis showed that seroconversion was less likely in HIV-1-positive individuals [odds ratio (OR) = 0.237, 95% CI 0.104-0.539, P = 0.0006) and with increasing age (OR = 0.805, 95% CI 0.684-0.947, P = 0.009). CONCLUSIONS a single dose of MF59-adjuvanted 2009 influenza H1N1 vaccine induced an immune response against pandemic H1N1 virus in HIV-1-positive individuals reaching titers similar to those of HIV-1-negative individuals. The seroconversion rate was negatively associated with HIV infection and increasing age.
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Tremblay CL, Rouleau D, Fortin C, Toma E, Sylla M, Cyr L, Cote S, Baz M, Sampalis J, Trautman L, Sékaly RP, Boivin G. Immunogenicity and tolerability of an inactivated and adjuvanted pandemic H1N1 influenza vaccine, in HIV-1-infected patients. Vaccine 2010; 29:1359-63. [PMID: 21185423 DOI: 10.1016/j.vaccine.2010.12.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 12/06/2010] [Accepted: 12/09/2010] [Indexed: 11/27/2022]
Abstract
We evaluated the efficacy and tolerability of a single dose of the split virion AS03-adjuvanted pandemic H1N1 influenza vaccine (A/California/7/2009) in 84 HIV-1 infected individuals. Antibody titers were determined by hemagglutination inhibition assay and by microneutralization. Vaccine was well tolerated. At 21 days post vaccination, 56 (67%) patients had seroconverted. There was no correlation between baseline CD4 cell count (p=0.539) or HIV viral load (p=0.381) and immune response. Other vaccine strategies should be evaluated in this HIV population, to improve response rates.
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Affiliation(s)
- Cécile L Tremblay
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Qc, Canada.
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Influence of antiretroviral therapy on immunogenicity of simultaneous vaccinations against influenza, pneumococcal disease and hepatitis A and B in human immunodeficiency virus positive individuals. J Infect 2010; 61:484-91. [DOI: 10.1016/j.jinf.2010.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 08/31/2010] [Accepted: 09/18/2010] [Indexed: 12/20/2022]
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Abstract
OBJECTIVE To evaluate the safety and immunogenicity of the H1N1 2009 vaccine in HIV-positive individuals. DESIGN A single-arm study. SETTING Clinic at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. PARTICIPANTS HIV-infected adults with an indication for H1N1 vaccination. INTERVENTION Single intramuscular 15 microg dose of the monovalent, unadjuvanted, inactivated, split virus H1N1 vaccine. MAIN OUTCOMES Immunogenicity, safety and tolerability. RESULTS A total of 120 participants were enrolled, 71% men, 68% African-American, with median age of 46 years. All of them but one were on antiretroviral treatment, with a median current CD4 cell counts of 502 cells/microl, and a nadir CD4 cell counts of 132 cells/microl. The HIV RNA level was below 400 copies/ml in 92% of participants. All participants completed the 3 weeks of follow-up. Thirty of the 120 (25%) participants had antibody hemagglutination-inhibition assay titers equal or greater than 1: 40 at baseline. Among participants without evidence of previous exposure, only 61% develop protective titers by week 3 of the study. Nonresponders had lower current and nadir CD4 cell counts than responders. Only four of nine participants with detectable HIV viral load at baseline developed protective antibody titers. Age and race were not predictors of the response to the vaccine. The vaccine was well tolerated. CONCLUSION These results suggest that only 60% of well controlled HIV-infected individuals without preexisting immunity to H1N1 develop protective antibody titers after immunization. Alternative vaccines, dosing, adjuvants or schedule strategies are needed to achieve effective immunization of this vulnerable population.
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Low rate of seroconversion after vaccination with a split virion, adjuvanted pandemic H1N1 influenza vaccine in HIV-1-infected patients. AIDS 2010; 24:F31-5. [PMID: 20559034 DOI: 10.1097/qad.0b013e3283398da1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine rates of seroconversion after single vaccination with a novel split virion, inactivated, adjuvanted pandemic H1N1 influenza vaccine (A/California/7/2009) in HIV-1-infected patients (ClinicalTrials.gov Identifier: NCT01017172). DESIGN Single center diagnostic study. SETTING Institutional HIV outpatient department of an urban university clinic. PARTICIPANTS Adult HIV-1-infected individuals. INTERVENTION Serum samples were taken before and 21 days after vaccination. MAIN OUTCOME MEASURES Antibody titers determined by hemagglutination inhibition assay. Seroconversion to vaccination was defined by either an antibody titer of 1: 10 or less before and of at least 1: 40 after or at least 1: 10 before and at least four-fold increase in antibody titer 21 days after single vaccination. RESULTS One hundred and sixty patients (125 men/35 women) were analyzed. Before vaccination, 23 patients (14.4%) had a hemagglutination inhibition assay titer of at least 1: 40. A median of 22 +/- 3 days after vaccination, 110 (69%) patients seroconverted. Seroconverters were younger (45.1 +/- 10.0 vs. 48.8 +/- 11.3 years; P = 0.04), had a higher CD4 cell count (532 +/- 227 vs. 475 +/- 281 cells/microl; P = 0.03) and were more likely to have received a previous H5N1 vaccination in 2009 (25 vs. 8%; P = 0.02) when compared to nonresponders. No other significant differences were found comparing the two groups (prevaccination hemagglutination inhibition assay titer of > or =1: 40, AIDS, HAART, HIV RNA PCR <50 copies/ml or CD4 nadir, CD4 and CD8 percentage, sex, BMI, chronic hepatitis B or C). CONCLUSION Seroconversion after one dose of a split virion, inactivated, adjuvanted pandemic H1N1 influenza vaccine of HIV-infected patients was 69%. Studies to investigate whether a second dose of the vaccine will increase seroconversion rate are needed.
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