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Desikan R, Germani M, van der Graaf PH, Magee M. A Quantitative Clinical Pharmacology-Based Framework For Model-Informed Vaccine Development. J Pharm Sci 2024; 113:22-32. [PMID: 37924975 DOI: 10.1016/j.xphs.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
Historically, vaccine development and dose optimization have followed mostly empirical approaches without clinical pharmacology and model-informed approaches playing a major role, in contrast to conventional drug development. This is attributed to the complex cascade of immunobiological mechanisms associated with vaccines and a lack of quantitative frameworks for extracting dose-exposure-efficacy-toxicity relationships. However, the Covid-19 pandemic highlighted the lack of sufficient immunogenicity due to suboptimal vaccine dosing regimens and the need for well-designed, model-informed clinical trials which enhance the probability of selection of optimal vaccine dosing regimens. In this perspective, we attempt to develop a quantitative clinical pharmacology-based approach that integrates vaccine dose-efficacy-toxicity across various stages of vaccine development into a unified framework that we term as model-informed vaccine dose-optimization and development (MIVD). We highlight scenarios where the adoption of MIVD approaches may have a strategic advantage compared to conventional practices for vaccines.
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Affiliation(s)
- Rajat Desikan
- Clinical Pharmacology Modelling & Simulation, GSK, United Kingdom.
| | | | - Piet H van der Graaf
- Certara QSP, Canterbury Innovation Centre, University Road, Canterbury CT2 7FG, United Kingdom; Leiden Academic Centre for Drug Research, Einsteinweg 55, 2333 CC Leiden, Netherlands
| | - Mindy Magee
- Clinical Pharmacology Modelling & Simulation, GSK, United States
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2
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Trombetta CM, Marchi S, Montomoli E. The baculovirus expression vector system: a modern technology for the future of influenza vaccine manufacturing. Expert Rev Vaccines 2022; 21:1233-1242. [DOI: 10.1080/14760584.2022.2085565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Serena Marchi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi srl, Siena, Italy
- VisMederi Research srl, Siena, Italy
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3
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Influenza Viruses and Vaccines: The Role of Vaccine Effectiveness Studies for Evaluation of the Benefits of Influenza Vaccines. Vaccines (Basel) 2022; 10:vaccines10050714. [PMID: 35632470 PMCID: PMC9143275 DOI: 10.3390/vaccines10050714] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Influenza is a vaccine preventable disease and vaccination remains the most effective method of controlling the morbidity and mortality of seasonal influenza, especially with respect to risk groups. To date, three types of influenza vaccines have been licensed: inactivated, live-attenuated, and recombinant haemagglutinin vaccines. Effectiveness studies allow an assessment of the positive effects of influenza vaccines in the field. The effectiveness of current influenza is suboptimal, being estimated as 40% to 60% when the vaccines strains are antigenically well-matched with the circulating viruses. This review focuses on influenza viruses and vaccines and the role of vaccine effectiveness studies for evaluating the benefits of influenza vaccines. Overall, influenza vaccines are effective against morbidity and mortality in all age and risk groups, especially in young children and older adults. However, the effectiveness is dependent on several factors such as the age of vaccinees, the match between the strain included in the vaccine composition and the circulating virus, egg-adaptations occurring during the production process, and the subject’s history of previous vaccination.
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Devi AB, Sarala R. Substantial effect of phytochemical constituents against the pandemic disease influenza-a review. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021; 7:120. [PMID: 34150912 PMCID: PMC8196934 DOI: 10.1186/s43094-021-00269-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Background Influenza is an acute respiratory tract infection caused by the influenza virus. Vaccination and antiviral drugs are the two methods opted to control the disease. Besides their efficiency, they also cause adverse side effects. Hence, scientists turned their attention to powerful herbal medicines. This review put focus on various proven, scientifically validated anti-influenza compounds produced by the plants suggested for the production of newer drugs for the better treatment of influenza and its related antiviral diseases too. Main body In this review, fifty medicinal herb phytochemical constituents and their anti-influenza activities have been documented. Specifically, this review brings out the accurate and substantiates mechanisms of action of these constituents. This study categorizes the phytochemical constituents into primary and secondary metabolites which provide a source for synthesizing and developing new drugs. Conclusion This article provides a summary of the actions of the herbal constituents. Since the mechanisms of action of the components are elucidated, the pandemic situation arising due to influenza and similar antiviral diseases can be handled promisingly with greater efficiency. However, clinical trials are in great demand. The formulation of usage may be a single drug compound or multi-herbal combination. These, in turn, open up a new arena for the pharmaceutical industries to develop innovative drugs.
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Affiliation(s)
- A Brindha Devi
- Department of Botany, Periyar EVR College (Autonomous), (Affiliated to Bharathidasan University, Trichy-24), Trichy-620 023, Tamil Nadu, India
| | - R Sarala
- Department of Botany, Periyar EVR College (Autonomous), (Affiliated to Bharathidasan University, Trichy-24), Trichy-620 023, Tamil Nadu, India
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Ortiz de Lejarazu R, Martinón Torres F, Gil de Miguel A, Díez Domingo J, Redondo Marguello E. [High-dose trivalent influenza vaccine: safety and immunogenicity]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 34:1-11. [PMID: 33210106 PMCID: PMC7876900 DOI: 10.37201/req/110.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Las personas mayores son uno de los colectivos que más sufren los efectos de la gripe estacional. Aunque la vacuna antigripal es efectiva a la hora de prevenir la infección por el virus de la gripe y sus complicaciones, no resulta tan efectiva en personas de edad avanzada debido al fenómeno de inmunosenescencia asociado a la edad. Desde 2009 existe en EE. UU. una vacuna antigripal trivalente de alta dosis aprobada para la inmunización de personas ≥ 65 años con una concentración de antígeno cuatro veces mayor que la vacuna estándar. Múltiples ensayos clínicos llevados a cabo a lo largo de distintas temporadas, y mediante diferentes metodologías, han demostrado que la vacuna antigripal trivalente de alta dosis no solo es más efectiva, sino que además presenta un perfil de seguridad similar y es más inmunogénica que la vacuna de dosis estándar en la prevención de la gripe y sus complicaciones en personas de avanzada edad. En este documento se hace una revisión de la evidencia científica actual sobre la seguridad e inmunogenicidad de la vacuna antigripal de alta dosis en personas ≥ 65 años, y se incluye información de ensayos clínicos aleatorizados, estudios observacionales con datos de práctica clínica real y revisiones sistemáticas y metaanálisis.
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Affiliation(s)
- R Ortiz de Lejarazu
- Raúl Ortiz de Lejarazu, Centro Nacional de Gripe de Valladolid, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003. Valladolid, Spain.
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6
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Recombinant HA-based vaccine outperforms split and subunit vaccines in elicitation of influenza-specific CD4 T cells and CD4 T cell-dependent antibody responses in humans. NPJ Vaccines 2020; 5:77. [PMID: 32884842 PMCID: PMC7450042 DOI: 10.1038/s41541-020-00227-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
Abstract
Although traditional egg-based inactivated influenza vaccines can protect against infection, there have been significant efforts to develop improved formats to overcome disadvantages of this platform. Here, we have assessed human CD4 T cell responses to a traditional egg-based influenza vaccine with recently available cell-derived vaccines and recombinant baculovirus-derived vaccines. Adults were administered either egg-derived Fluzone®, mammalian cell-derived Flucelvax® or recombinant HA (Flublok®). CD4 T cell responses to each HA protein were assessed by cytokine EliSpot and intracellular staining assays. The specificity and magnitude of antibody responses were quantified by ELISA and HAI assays. By all criteria, Flublok vaccine exhibited superior performance in eliciting both CD4 T cell responses and HA-specific antibody responses, whether measured by mean response magnitude or percent of responders. Although the mechanism(s) underlying this advantage is not yet clear, it is likely that both qualitative and quantitative features of the vaccines impact the response.
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7
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Gil de Miguel A, Redondo Marguello E, Díez Domingo J, Ortiz de Lejarazu R, Martinón Torres F. [High-dose trivalent influenza vaccine. Efficacy and effectiveness]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:226-239. [PMID: 32515178 PMCID: PMC7374036 DOI: 10.37201/req/043.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
Abstract
Seasonal influenza is a major public health problem, particularly in older people. Influenza vaccine is the most effective way to prevent influenza virus infection and its complications, but due to immunosenescence, older people do not respond efficiently to immunization. In 2009, a high-dose trivalent influenza vaccine (IIV3-HD), containing four times more antigen than the standard-dose vaccine, was approved in the United States for the immunization of people aged 65 years and over. Numerous clinical trials, carried out at different seasons and using different methodologies, have shown that the IIV3-HD vaccine is, as well as safe, more immunogenic and more effective than the standard-dose vaccine in preventing influenza virus infection and its complications in older people. This paper reviews the available evidence on the efficacy and effectiveness of the IIV3-HD influenza vaccine in the elderly, with information from randomized clinical trials, as well as observational studies of real-world clinical practice and in systematic reviews/meta-analyses.
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Affiliation(s)
- A Gil de Miguel
- Ángel Gil de Miguel, Departamento de Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid (Spain).
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8
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Chang YC, Tung HJ, Huang YT, Lu CT, Ernawaty E, Wu SY. Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Elderly Individuals with and without Disabilities: A Nationwide, Population-Based Cohort Study. Vaccines (Basel) 2020; 8:vaccines8010112. [PMID: 32121645 PMCID: PMC7157235 DOI: 10.3390/vaccines8010112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: The effects of influenza vaccines are unclear for elderly individuals with disabilities. We use a population-based cohort study to estimate the effects of influenza vaccines in elderly individuals with and without disabilities. Methods: Data were taken from the National Health Insurance Research Database and Disabled Population Profile of Taiwan. A total of 2,741,403 adults aged 65 or older were identified and 394,490 were people with a disability. These two groups were further divided into those who had or had not received an influenza vaccine. Generalized estimating equations (GEE) were used to compare the relative risks (RRs) of death and hospitalization across the four groups. Results: 30.78% elderly individuals without a disability and 34.59% elderly individuals with a disability had vaccinated for influenza. Compared to the unvaccinated elderly without a disability, the vaccinated elderly without a disability had significantly lower risks in all-cause mortality (RR = 0.64) and hospitalization for any of the influenza-related diseases (RR = 0.91). Both the unvaccinated and vaccinated elderly with a disability had significantly higher risks in all-cause mortality (RR = 1.81 and 1.18, respectively) and hospitalization for any of the influenza-related diseases (RR = 1.73 and 1.59, respectively). Conclusions: The elderly with a disability had higher risks in mortality and hospitalization than those without a disability; however, receiving influenza vaccinations could still generate more protection to the disabled elderly.
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Affiliation(s)
- Yu-Chia Chang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan;
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Ho-Jui Tung
- Department of Health Policy and Community Health, JPH College of Public Health, Georgia Southern University, Statesboro, GA 30458, USA;
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Chin-Te Lu
- Department of Infectious Diseases, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan;
| | - Ernawaty Ernawaty
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Szu-Yuan Wu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan;
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Correspondence:
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Saenwongsa W, Nithichanon A, Chittaganpitch M, Buayai K, Kewcharoenwong C, Thumrongwilainet B, Butta P, Palaga T, Takahashi Y, Ato M, Lertmemongkolchai G. Metformin-induced suppression of IFN-α via mTORC1 signalling following seasonal vaccination is associated with impaired antibody responses in type 2 diabetes. Sci Rep 2020; 10:3229. [PMID: 32094377 PMCID: PMC7039947 DOI: 10.1038/s41598-020-60213-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/07/2020] [Indexed: 12/22/2022] Open
Abstract
Diabetes mellitus (DM) patients are at an increased risk of complications following influenza-virus infection, seasonal vaccination (SV) is recommended. However, SV with trivalent influenza vaccine (TIV) can induce antibody and type-I interferon (IFN) responses, and the effect of anti-DM treatment on these responses is incompletely understood. We evaluated the antibody response and IFN-α expression in individuals with and without type 2 DM (T2DM) following SV, and examined the effects on anti-DM treatment. TIV elicited sero-protection in all groups, but antibody persistency was <8 months, except for the antibody response to B-antigens in non-DM. T2DM impaired the IgG avidity index, and T2DM showed a significantly decreased response against H1N1 and H3N2, in addition to delaying and reducing haemagglutination-inhibition persistency against influenza B-antigens in DM groups treated with metformin (Met-DM) or glibenclamide (GB-DM). Following TIV, the Met-DM and GB-DM groups exhibited reduced IFN-α expression upon stimulation with whole- and split-virion influenza vaccines. Suppression of IFN-α expression in the Met-DM group was associated with a reduction in the mechanistic target of rapamycin complex-1 pathway and impaired IgG avidity index. Thus, single-dose TIV each year might not be suitable for T2DM. Our data could aid the development of an efficacious influenza vaccine for T2DM.
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Affiliation(s)
- Wipawee Saenwongsa
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Disease Prevention and Control Region 10th, Ubonratchathani, Ministry of Public Health, Mueang Nonthaburi, Thailand
| | - Arnone Nithichanon
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Malinee Chittaganpitch
- National Influenza Centre, Department of Medical Science, Ministry of Public Health, Mueang Nonthaburi, Thailand
| | - Kampaew Buayai
- National Influenza Centre, Department of Medical Science, Ministry of Public Health, Mueang Nonthaburi, Thailand
| | - Chidchamai Kewcharoenwong
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | | | - Patcharavadee Butta
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Tanapat Palaga
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | | | - Manabu Ato
- National Institute of Infectious Diseases, Tokyo, Japan
| | - Ganjana Lertmemongkolchai
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.
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Sabri AH, Kim Y, Marlow M, Scurr DJ, Segal J, Banga AK, Kagan L, Lee JB. Intradermal and transdermal drug delivery using microneedles - Fabrication, performance evaluation and application to lymphatic delivery. Adv Drug Deliv Rev 2020; 153:195-215. [PMID: 31634516 DOI: 10.1016/j.addr.2019.10.004] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/26/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Abstract
The progress in microneedle research is evidenced by the transition from simple 'poke and patch' solid microneedles fabricated from silicon and stainless steel to the development of bioresponsive systems such as hydrogel-forming and dissolving microneedles. In this review, we provide an outline on various microneedle fabrication techniques which are currently employed. As a range of factors, including materials, geometry and design of the microneedles, affect the performance, it is important to understand the relationships between them and the resulting delivery of therapeutics. Accordingly, there is a need for appropriate methodologies and techniques for characterization and evaluation of microneedle performance, which will also be discussed. As the research expands, it has been observed that therapeutics delivered via microneedles has gained expedited access to the lymphatics, which makes them a favorable delivery method for targeting the lymphatic system. Such opportunity is valuable in the area of vaccination and treatment of lymphatic disorders, which is the final focus of the review.
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Expanding the applications of microneedles in dermatology. Eur J Pharm Biopharm 2019; 140:121-140. [DOI: 10.1016/j.ejpb.2019.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022]
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Whitaker JA, von Itzstein MS, Poland GA. Strategies to maximize influenza vaccine impact in older adults. Vaccine 2018; 36:5940-5948. [PMID: 30153995 DOI: 10.1016/j.vaccine.2018.08.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 07/30/2018] [Accepted: 08/15/2018] [Indexed: 01/13/2023]
Abstract
Older adults are disproportionately affected by influenza morbidity and mortality. In most high income countries, influenza vaccine policies target persons age ≥65 years for influenza vaccination. Many low-resource settings do not utilize seasonal influenza vaccination. Barriers to influenza prevention among older adults around the globe are multiple and some vary between high- and low-resource settings. To maximize influenza prevention in the older adult population, gaps in influenza vaccination coverage and improvements in vaccine efficacy are needed. The focus of this article is on the data for currently available vaccine strategies to maximize influenza vaccine impact, with a focus on high-resource settings. We also discuss novel influenza vaccine strategies needed for older adults worldwide.
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Affiliation(s)
| | | | - Gregory A Poland
- Mayo Vaccine Research Group, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Schaffner W, Chen WH, Hopkins RH, Neuzil K. Effective Immunization of Older Adults Against Seasonal Influenza. Am J Med 2018; 131:865-873. [PMID: 29544989 DOI: 10.1016/j.amjmed.2018.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 01/23/2018] [Accepted: 02/20/2018] [Indexed: 12/19/2022]
Abstract
The 2017-2018 influenza season reminds us that it is important for health care professionals to be prepared for the annual onslaught of this contagious respiratory disease associated with potentially serious complications. Vaccination is by far the best method to prevent and control influenza, reducing illness, hospitalizations, and mortality. The highest rates of influenza-associated morbidity and mortality are observed in older adults. The immune function of older adults decreases with increasing age, a phenomenon termed immunosenescence. Immunosenescence not only confers increased susceptibility to influenza disease, but also renders vaccination less effective. To address the need for improved vaccines that provide enhanced protection to this high-risk group, 2 formulations-a high-dose vaccine and an adjuvanted vaccine-have been approved in recent years specifically for people aged 65 years and over. Here we discuss: the challenges of influenza immunization in those 65 years and older; the recent advancements in vaccines targeted at this age group; and the latest influenza vaccine recommendations for the 2017-2018 influenza season in the United States.
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Affiliation(s)
- William Schaffner
- Department of Health Policy and Division of Infectious Diseases, School of Medicine, Vanderbilt University, Nashville, Tenn.
| | - Wilbur H Chen
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore
| | - Robert H Hopkins
- Division of General Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Kathleen Neuzil
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore
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Sesay S, Brzostek J, Meyer I, Donazzolo Y, Leroux-Roels G, Rouzier R, Astruc B, Szymanski H, Toursarkissian N, Vandermeulen C, Kowalska E, Van Damme P, Salamand C, Pepin S. Safety, immunogenicity, and lot-to-lot consistency of a split-virion quadrivalent influenza vaccine in younger and older adults: A phase III randomized, double-blind clinical trial. Hum Vaccin Immunother 2017; 14:596-608. [PMID: 28968138 PMCID: PMC5861783 DOI: 10.1080/21645515.2017.1384106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Here, we report a randomized multicenter phase III trial assessing the lot-to-lot consistency of the 2014–2015 Northern Hemisphere quadrivalent split-virion inactivated influenza vaccine (IIV4; Sanofi Pasteur) and comparing its immunogenicity and safety with that of trivalent inactivated influenza vaccine (IIV3) in younger and older adults (EudraCT no. 2014-000785-21). Younger (18–60 y, n = 1114) and older (>60 y, n = 1111) adults were randomized 2:2:2:1:1 to receive a single dose of one of three lots of IIV4, the licensed IIV3 containing the B Yamagata lineage strain, or an investigational IIV3 containing the B Victoria lineage strain. Post-vaccination (day 21) hemagglutination inhibition antibody titers were equivalent for the three IIV4 lots. For the pooled IIV4s vs. IIV3, hemagglutination inhibition antibody titers were also non-inferior for the A strains, non-inferior for the B strain when present in the comparator IIV3, and superior for the B strain lineage when absent from the comparator IIV3. For all vaccine strains, seroprotection rates were ≥98% in younger adults and ≥90% in older adults. IIV4 also increased seroneutralizing antibody titers against all three vaccine strains of influenza. All vaccines were well tolerated, with no safety concerns identified. Solicited injection-site reactions were similar for IIV4 and IIV3 and mostly grade 1 and transient. This study showed that in younger and older adults, IIV4 had a similar safety profile as the licensed IIV3 and that including a second B strain lineage in IIV4 provided superior immunogenicity for the added B strain without affecting the immunogenicity of the three IIV3 strains.
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Affiliation(s)
| | - Jerzy Brzostek
- b Clinic of Infectious Diseases Health Care Team , Dębica , Poland
| | - Ingo Meyer
- c CRS Clinical Research Services Kiel GmbH , Lübeck , Germany
| | | | - Geert Leroux-Roels
- e Center for Vaccinology, Ghent University and University Hospital , Gent , Belgium
| | - Régine Rouzier
- f Centre CAP, Centre Médical Odysseum , Montpellier , France
| | | | - Henryk Szymanski
- h St Hedwig of Silesia Hospital , Department of Paediatrics , Prusicka , Trzebnica , Poland
| | | | | | | | - Pierre Van Damme
- l Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute , Antwerpen (Wilrijk) , Belgium
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Leischker AH, Heppner HJ. [Travel medicine - characteristics in the elderly]. MMW Fortschr Med 2017; 159:50-54. [PMID: 28608067 DOI: 10.1007/s15006-017-9792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Andreas H Leischker
- Klinik für Geriatrie und Gelbfieberimpfstation, Alexianer Krefeld GmbH, Dießemer Bruch 81, D-47805, Krefeld, Deutschland.
| | - Hans Jürgen Heppner
- Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Schwelm, Deutschland
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Robertson CA, DiazGranados CA, Decker MD, Chit A, Mercer M, Greenberg DP. Fluzone® High-Dose Influenza Vaccine. Expert Rev Vaccines 2016; 15:1495-1505. [PMID: 27813430 DOI: 10.1080/14760584.2016.1254044] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Fluzone® High-Dose (IIV3-HD) is a trivalent, inactivated, split-virus influenza vaccine indicated for use in older adults (≥65 years of age). It contains 60 µg hemagglutinin of each influenza strain, which is four times the hemagglutinin content of standard-dose influenza vaccines, including Fluzone (IIV3-SD). IIV3-HD has been licensed for use in older adults in the US since December 2009 and in Canada since February 2016. Areas covered: In this review, we summarize postlicensure studies on the immunogenicity, safety, and effectiveness of IIV3-HD and estimates of its cost-effectiveness in older adults. We also discuss the potential application of IIV3-HD in adults 50-64 years of age and in individuals who may respond poorly to standard-dose influenza vaccines. Expert commentary: Multiple studies conducted since 2004 have consistently shown that, in older adults, IIV3-HD induces substantially greater antibody responses and better protection against influenza and influenza-associated hospitalization than IIV3-SD. Health economic analyses suggest that IIV3-HD can be a cost-effective alternative to standard-dose trivalent or quadrivalent inactivated influenza vaccines and can even be cost-saving compared to IIV3-SD in older adults. Further investigation of IIV3-HD vaccination as a way to improve immune responses and protection against influenza in immunocompromised individuals is warranted.
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Affiliation(s)
| | | | - Michael D Decker
- a Sanofi Pasteur Inc. , Swiftwater , PA , USA.,b Department of Health Policy , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Ayman Chit
- a Sanofi Pasteur Inc. , Swiftwater , PA , USA.,c Leslie Dan Faculty of Pharmacy , University of Toronto , Toronto , Canada
| | | | - David P Greenberg
- a Sanofi Pasteur Inc. , Swiftwater , PA , USA.,d Department of Pediatrics , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
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Bragazzi NL, Orsi A, Ansaldi F, Gasparini R, Icardi G. Fluzone® intra-dermal (Intanza®/Istivac® Intra-dermal): An updated overview. Hum Vaccin Immunother 2016; 12:2616-2627. [PMID: 27246556 DOI: 10.1080/21645515.2016.1187343] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Influenza is a highly contagious respiratory acute viral disease which imposes a very heavy burden both in terms of epidemiology and costs, in the developed countries as well as in the developing ones. It represents a serious public health concern and vaccination constitutes an important tool to reduce or at least mitigate its burden. Despite the existence of a broad armamentarium against influenza and despite all the efforts and recommendations of international organisms to broaden immunization, influenza vaccination coverage is still far from being optimal. This, taken together with logistic and technical difficulties that can result into vaccine shortage, makes intra-dermal (ID) vaccines, such as Fluzone® ID and Intanza®, particularly attractive. ID vaccines are comparable and, in some cases, superior to intra-muscular/sub-cutaneous vaccines in terms of immunogenicity, safety, reactogenicity, tolerability and cross-protection profiles, as well as in terms of patient preference, acceptance and vaccine selection. Further advances, such as Fluzone® ID with alternative B strains and Quadrivalent Fluzone® ID or the possibility of self-administering the vaccines, make influenza ID vaccines even more valuable.
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Affiliation(s)
| | - Andrea Orsi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
| | - Filippo Ansaldi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
| | - Roberto Gasparini
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy
| | - Giancarlo Icardi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
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18
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Nakaya HI, Hagan T, Duraisingham SS, Lee EK, Kwissa M, Rouphael N, Frasca D, Gersten M, Mehta AK, Gaujoux R, Li GM, Gupta S, Ahmed R, Mulligan MJ, Shen-Orr S, Blomberg BB, Subramaniam S, Pulendran B. Systems Analysis of Immunity to Influenza Vaccination across Multiple Years and in Diverse Populations Reveals Shared Molecular Signatures. Immunity 2016; 43:1186-98. [PMID: 26682988 DOI: 10.1016/j.immuni.2015.11.012] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/17/2015] [Accepted: 09/01/2015] [Indexed: 02/07/2023]
Abstract
Systems approaches have been used to describe molecular signatures driving immunity to influenza vaccination in humans. Whether such signatures are similar across multiple seasons and in diverse populations is unknown. We applied systems approaches to study immune responses in young, elderly, and diabetic subjects vaccinated with the seasonal influenza vaccine across five consecutive seasons. Signatures of innate immunity and plasmablasts correlated with and predicted influenza antibody titers at 1 month after vaccination with >80% accuracy across multiple seasons but were not associated with the longevity of the response. Baseline signatures of lymphocyte and monocyte inflammation were positively and negatively correlated, respectively, with antibody responses at 1 month. Finally, integrative analysis of microRNAs and transcriptomic profiling revealed potential regulators of vaccine immunity. These results identify shared vaccine-induced signatures across multiple seasons and in diverse populations and might help guide the development of next-generation vaccines that provide persistent immunity against influenza.
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Affiliation(s)
- Helder I Nakaya
- School of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes 580, São Paulo 05508, Brazil; Department of Pathology, School of Medicine, Emory University, 1648 Pierce Drive NE, Atlanta, GA 30307, USA
| | - Thomas Hagan
- Department of Bioengineering, University of California, 9500 Gilman Drive MC 0412, San Diego, La Jolla, CA 92093, USA
| | - Sai S Duraisingham
- Department of Immunology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford OX3 7J, UK
| | - Eva K Lee
- Center for Operations Research in Medicine & Healthcare, School of Industrial & Systems Engineering, Georgia Institute of Technology, North Avenue NW, Atlanta, GA 30332, USA
| | - Marcin Kwissa
- Institute for Molecular Engineering, University of Chicago, 5640 S. Elis Avenue, Chicago, IL 60637, USA
| | - Nadine Rouphael
- Hope Clinic of Emory University, 500 Irvin Court/Suite 200, Atlanta, GA 30030, USA
| | - Daniela Frasca
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA
| | - Merril Gersten
- Department of Bioengineering, University of California, 9500 Gilman Drive MC 0412, San Diego, La Jolla, CA 92093, USA
| | - Aneesh K Mehta
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 1648 Pierce Drive NE, Atlanta, GA 30307, USA
| | - Renaud Gaujoux
- Department of Immunology, Faculty of Medicine, Technion, 1 Efron Street, Haifa 3109601, Israel
| | - Gui-Mei Li
- Department of Microbiology and Immunology, Emory University, 1510 Clifton Road, Atlanta, GA 30322, USA; Emory Vaccine Center, Yerkes National Primate Research Center, 954 Gatewood Road, Atlanta, GA 30329, USA
| | - Shakti Gupta
- Department of Bioengineering, University of California, 9500 Gilman Drive MC 0412, San Diego, La Jolla, CA 92093, USA
| | - Rafi Ahmed
- Department of Microbiology and Immunology, Emory University, 1510 Clifton Road, Atlanta, GA 30322, USA; Emory Vaccine Center, Yerkes National Primate Research Center, 954 Gatewood Road, Atlanta, GA 30329, USA
| | - Mark J Mulligan
- Hope Clinic of Emory University, 500 Irvin Court/Suite 200, Atlanta, GA 30030, USA
| | - Shai Shen-Orr
- Department of Immunology, Faculty of Medicine, Technion, 1 Efron Street, Haifa 3109601, Israel
| | - Bonnie B Blomberg
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, USA
| | - Shankar Subramaniam
- Department of Bioengineering, University of California, 9500 Gilman Drive MC 0412, San Diego, La Jolla, CA 92093, USA; Department of Cellular and Molecular Medicine, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92093, USA; Department of Nanoengineering, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92093, USA; Department of Computer Science and Engineering, University of California, 9500 Gilman Drive, San Diego, La Jolla, CA 92093, USA.
| | - Bali Pulendran
- Department of Pathology, School of Medicine, Emory University, 1648 Pierce Drive NE, Atlanta, GA 30307, USA; Emory Vaccine Center, Yerkes National Primate Research Center, 954 Gatewood Road, Atlanta, GA 30329, USA.
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19
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Nace DA, Lin CJ, Ross TM, Saracco S, Churilla RM, Zimmerman RK. Randomized, controlled trial of high-dose influenza vaccine among frail residents of long-term care facilities. J Infect Dis 2015; 211:1915-24. [PMID: 25525051 PMCID: PMC4539906 DOI: 10.1093/infdis/jiu622] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/02/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite vaccination, residents of long-term-care facilities (LTCFs) remain at high risk of influenza-related morbidity and mortality. More-effective vaccine options for this population are needed. METHODS We conducted a single-blinded, randomized, controlled trial comparing high-dose (HD) to standard-dose (SD) inactivated influenza vaccine (IIV) in 205 frail, elderly residents of LTCFs during the 2011-2012 and 2012-2013 influenza seasons. Hemagglutination inhibition (HI) antibody titers were measured at baseline and 30 and 180 days following vaccination. RESULTS A total of 187 subjects (91%) completed the study. The mean age was 86.7 years. Geometric mean titers (GMTs) were significantly higher (P < .05) at day 30 for HD recipients, compared with SD recipients, for all comparisons except influenza A(H1N1) during 2012-2013 (the HD formulation was noninferior to the SD formulation for influenza A[H1N1] during 2012-2013). GMTs for HD and SD recipients during 2011-2012 were as follows: influenza A(H1N1), 78 (95% confidence interval [CI], 45-136) and 27 (95% CI, 17-44), respectively; influenza A(H3N2), 26 (95% CI, 17-40) and 10 (95% CI, 7-15), respectively; and influenza B, 26 (95% CI, 19-35) and 14 (95% CI, 11-18), respectively. During 2012-2013, GMTs for HD and SD recipients were as follows: influenza A(H1N1), 46 (95% CI, 33-63) and 50 (95% CI, 37-67); influenza A(H3N2), 23 (95% CI, 18-31) and 14 (95% CI, 11-18), respectively; and influenza B, 26 (95% CI, 21-32) and 17 (95% CI, 14-22), respectively. GMTs were significantly higher at day 180 for HD recipients, compared with SD recipients, for influenza A(H3N2) in both years (P < .001). CONCLUSIONS Among frail, elderly residents of LTCFs, HD influenza vaccine produced superior responses for all strains except influenza A(H1N1) in 2012-2013. CLINICAL TRIALS REGISTRATION NCT01654224.
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Affiliation(s)
| | | | - Ted M. Ross
- Vaccine and Gene Therapy Institute of Florida, Port Saint Lucie
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20
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Affiliation(s)
- Michael Woodward
- Aged and Residential Care Research, Austin Health; Heidelberg Victoria
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21
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22
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McGrath LJ, Brookhart MA. On-label and off-label use of high-dose influenza vaccine in the United States, 2010-2012. Hum Vaccin Immunother 2015; 11:537-44. [PMID: 25751700 PMCID: PMC4514225 DOI: 10.1080/21645515.2015.1011026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/02/2014] [Accepted: 11/18/2014] [Indexed: 01/10/2023] Open
Abstract
High-dose inactivated, influenza vaccine was licensed by the FDA in December 2009 for adults aged 65 y and older. The ACIP did not issue or state a preference for a specific vaccine in the elderly population. The extent of its on-label and off-label use is unknown. Using the MarketScan Commercial Claims and Encounters and the Medicare Supplemental database, we identified individuals who received the high-dose influenza vaccine or the standard, seasonal trivalent influenza vaccine between January 1, 2010 and December 31, 2012. For people aged ≥65 y, we used multivariable regression to assess the association between patient and provider level variables and high-dose influenza vaccine versus standard influenza vaccine. We characterized all off-label high-dose vaccine administered to people younger than 65 y of age, and investigated whether sicker patients were targeted for off-label use by examining the association between various comorbid conditions and receipt of the high-dose vaccine among adults aged 18-64. Among patients aged ≥65 y who received an influenza vaccine, 18.4% received the high-dose vaccine. Uptake was minimal in 2010, but 25% and 32% of influenza shots were the high-dose formulation in 2011 and 2012, respectively. Almost 27,000 seniors received a second high-dose vaccine with a median of 368 d (IQR: 350-387 days) between doses. Older age, family practice physicians, and having PPO insurance were positively associated with receiving high-dose vaccine. There were 36,624 off-label high-dose vaccines administered. Half of the patients receiving off-label doses were aged 50-64. Adults aged 18-64 y receiving high-dose vaccine were more likely to have chronic comorbidities than people receiving standard influenza vaccine; however, there was not one specific illness that seemed to be targeted by physicians. In the first 3 y since licensure, use of the high-dose vaccine among seniors has been limited. The safety of this vaccine should be monitored closely among 2 groups of people - seniors receiving repeat doses and people <65.
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Affiliation(s)
- Leah J McGrath
- Department of Epidemiology; Gillings School of Global Public Health; University of North Carolina; Chapel Hill, NC USA
- RTI Health Solutions; Research Triangle Park, NC USA
| | - M Alan Brookhart
- Department of Epidemiology; Gillings School of Global Public Health; University of North Carolina; Chapel Hill, NC USA
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23
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Christian LM. Optimizing benefits of influenza virus vaccination during pregnancy: potential behavioral risk factors and interventions. Vaccine 2014; 32:2958-64. [PMID: 24709586 PMCID: PMC4043397 DOI: 10.1016/j.vaccine.2014.03.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/14/2014] [Accepted: 03/25/2014] [Indexed: 12/31/2022]
Abstract
Pregnant women and infants are at high risk for complications, hospitalization, and death due to influenza. It is well-established that influenza vaccination during pregnancy reduces rates and severity of illness in women overall. Maternal vaccination also confers antibody protection to infants via both transplacental transfer and breast milk. However, as in the general population, a relatively high proportion of pregnant women and their infants do not achieve protective antibody levels against influenza virus following maternal vaccination. Behavioral factors, particularly maternal weight and stress exposure, may affect initial maternal antibody responses, maintenance of antibody levels over time (i.e., across pregnancy), as well as the efficiency of transplacental antibody transfer to the fetus. Conversely, behavioral interventions including acute exercise and stress reduction can enhance immune protection following vaccination. Such behavioral interventions are particularly appealing in pregnancy because they are safe and non-invasive. The identification of individual risk factors for poor responses to vaccines and the application of appropriate interventions represent important steps towards personalized health care.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States; Department of Psychology, The Ohio State University, Columbus, OH 43210, United States; Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
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24
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Concannon MA, Jiang J. The effect of adjuvants on vaccine-induced antibody response against influenza in aged mice. ACTA ACUST UNITED AC 2014; 9:89-94. [PMID: 32215006 PMCID: PMC7089211 DOI: 10.1007/s11515-014-1301-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 02/21/2014] [Indexed: 11/26/2022]
Abstract
While influenza remains a major threat to public health, researchers continue to search for a universal solution to improving the efficacy of the influenza vaccine. Even though influenza affects people of all different ages, it can be extremely hazardous to people of 65 years of age or older since that is the population that makes up the high majority of the death toll caused by influenza-related diseases. Elderly individuals suffer the effects of immunosenescence as they age, which is the diminishing of the overall immune response. Immunosenescence occurs by specifically affecting the adaptive immune response which controls the establishment of immunity after vaccination or infection. There are many studies under way that are trying to find a resolution to the problem of the influenza vaccine not providing enough protection in the elderly population. One of the possible strategies is to seek the use of an optimal adjuvant, an immunological agent that can enhance immune responses, with the current vaccine formulation. Here, we used the murine model to review the effects of adjuvants on the antibody response to influenza vaccines in aged mice. Since adjuvants can enhance the production of important inflammatory cytokines and activation of dendritic cells, the stimulation of these cells are boosted to increase the effectiveness of the influenza vaccine in aged mice which would hopefully translate to the elderly.
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Affiliation(s)
- Mark A. Concannon
- Department of Biology, Drexel University, Philadelphia, PA 19104 USA
| | - Jiu Jiang
- Department of Biology, Drexel University, Philadelphia, PA 19104 USA
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25
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Khan T, Heffron CL, High KP, Roberts PC. Tailored vaccines targeting the elderly using whole inactivated influenza vaccines bearing cytokine immunomodulators. J Interferon Cytokine Res 2014; 34:129-39. [PMID: 24102577 PMCID: PMC3924801 DOI: 10.1089/jir.2012.0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 08/07/2013] [Indexed: 01/05/2023] Open
Abstract
Influenza and its complications disproportionately affect the elderly, leading to high morbidity and mortality in this ever-increasing population. Despite widespread vaccination efforts, the current influenza vaccines are less effective in the elderly; hence newer vaccine strategies are needed to improve their efficacy in this age group. We have previously shown that co-presentation of cytokines on the surface of inactivated influenza virus particles affords better protection from lethal homotypic viral challenge in young adult mice than conventional non-adjuvanted whole inactivated vaccine. Here, we determined the efficacy of these vaccine formulations in Balb/c mice "aged" to 17 months ("aged mice") along with the addition of a membrane-bound interleukin-12 (IL-12) vaccine formulation. Our investigations found that a single low-dose intramuscular vaccination with inactivated whole influenza vaccine co-presenting IL-12 was sufficient to provide enhanced protection from subsequent influenza challenge as compared with non-adjuvanted whole inactivated vaccine. Our results indicate that incorporation of cytokines such as IL-12 in a membrane-bound formulation in whole inactivated vaccine may provide a means to lower the vaccine dose while eliciting enhanced protective responses in the elderly, an age group that responds poorly to current vaccination regimens.
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Affiliation(s)
- Tila Khan
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, Virginia
| | - Connie L. Heffron
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, Virginia
| | - Kevin P. High
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Paul C. Roberts
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, Virginia
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26
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Del Giudice G, Rappuoli R. Inactivated and adjuvanted influenza vaccines. Curr Top Microbiol Immunol 2014; 386:151-80. [PMID: 25038938 DOI: 10.1007/82_2014_406] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Inactivated influenza vaccines are produced every year to fight against the seasonal epidemics of influenza. Despite the nonoptimal coverage, even in subjects at risk like the elderly, pregnant women, etc., these vaccines significantly reduce the burden of mortality and morbidity linked to the influenza infection. Importantly, these vaccines have also contributed to reduce the impact of the last pandemics. Nevertheless, the performance of these vaccines can be improved mainly in those age groups, like children and the elderly, in which their efficacy is suboptimal. The use of adjuvants has proven effective to this scope. Oil-in-water adjuvants like MF59 and AS03 have been licensed and widely used, and shown efficacious in preventing influenza infection in the last pandemic. MF59-adjuvanted inactivated vaccine was more efficacious than non-adjuvanted vaccine in preventing influenza infection in young children and in reducing hospitalization due to the influenza infection in the elderly. Other adjuvants are now at different stages of development and some are being tested in clinical trials. The perspective remains to improve the way inactivated vaccines are prepared and to accelerate their availability, mainly in the case of influenza pandemics, and to enhance their efficacy/effectiveness for a more successful impact at the public health level.
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Affiliation(s)
- Giuseppe Del Giudice
- Research and Development, Novartis Vaccines, Via Fiorentina 1, 53100, Siena, Italy,
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27
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Abstract
Influenza is a worldwide public health concern. Since the introduction of trivalent influenza vaccine in 1978, vaccination has been the primary means of prevention and control of influenza. Current influenza vaccines have moderate efficacy, good safety, and acceptable tolerability; however, they have unsatisfactory efficacy in older adults, are dependent on egg supply for production, and are time-consuming to manufacture. This review outlines the unmet medical needs of current influenza vaccines. Recent developments in influenza vaccines are also described.
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Affiliation(s)
- Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. ; Asian Pacific Influenza Institute, Korea University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. ; Asian Pacific Influenza Institute, Korea University College of Medicine, Seoul, Korea. ; Transgovernmental Enterprise for Pandemic Influenza in Korea, Seoul, Korea
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28
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Reber A, Katz J. Immunological assessment of influenza vaccines and immune correlates of protection. Expert Rev Vaccines 2013; 12:519-36. [PMID: 23659300 DOI: 10.1586/erv.13.35] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Influenza vaccines remain the primary public health tool in reducing the ever-present burden of influenza and its complications. In seeking more immunogenic, more effective and more broadly cross-protective influenza vaccines, the landscape of influenza vaccines is rapidly expanding, both in near-term advances and next-generation vaccine design. Although the first influenza vaccines were licensed over 60 years ago, the hemagglutination-inhibition antibody titer is currently the only universally accepted immune correlate of protection against influenza. However, hemagglutination-inhibition titers appear to be less effective at predicting protection in populations at high risk for severe influenza disease; older adults, young children and those with certain medical conditions. The lack of knowledge and validated methods to measure alternate immune markers of protection against influenza remain a substantial barrier to the development of more immunogenic, broadly cross-reactive and effective influenza vaccines. Here, the authors review the knowledge of immune effectors of protection against influenza and discuss assessment methods for a broader range of immunological parameters that could be considered in the evaluation of traditional or new-generation influenza vaccines.
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Affiliation(s)
- Adrian Reber
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road Atlanta, GA 30333, USA
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29
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Abstract
Primary prevention strategies, such as vaccinations at the age extremes, in neonates and elderly individuals, demonstrate a challenge to health professionals and public health specialists. The aspects of the differentiation and maturation of the adaptive immune system, the functional implications of immunological immaturity or immunosenescence and its impact on vaccine immunogenicity and efficacy will be highlighted in this review. Several approaches have been undertaken to promote Th1 responses in neonates and to enhance immune functions in elderly, such as conjugation to carrier proteins, addition of adjuvants, concomitant vaccination with other vaccines, change in antigen concentrations or dose intervals or use of different administration routes. Also, early protection by maternal vaccination seems to be beneficial in neonates. However, it also appears necessary to think of other end points than antibody concentrations to assess vaccine efficacy in neonates or elderly, as also the cellular immune response may be impaired by the mechanisms of immaturity, underlying health conditions, immunosuppressive treatments or immunosenescence. Thus, lifespan vaccine programs should be implemented to all individuals on a population level not only to improve herd protection and to maintain protective antibody levels and immune memory, but also to cover all age groups, to protect unvaccinated elderly persons and to provide indirect protection for neonates and small infants.
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Affiliation(s)
- Martina Prelog
- Department of Pediatrics, University of Würzburg, Würzburg, Germany.
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30
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Abstract
With advances in global health care, ageing populations are expected to grow worldwide throughout the 21st century. Increased lifespan is a testament to modern medical and social practices, but also presents a growing challenge to a system with limited resources. Elderly populations present specific concerns related to preventative health practices, especially vaccination. Although the power of vaccination is unquestionable in controlling infectious disease, immunosenescence can lead to reduced immune responses following immunization in the elderly, and increased morbidity and mortality. Further complicating this issue, some vaccines themselves may pose a substantial safety risk in the elderly when compared to younger counterparts. Though any health care intervention must balance risk and reward, safety and immunogenicity are often poorly characterized in older populations. This review explores several domestic and travel vaccines, examining what is known concerning efficacy and safety in the elderly, and considers future alternatives.
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Affiliation(s)
- Ian J Amanna
- Najít Technologies, Inc. 505 NW 185 th Avenue Beaverton, OR 97006, USA
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31
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Abstract
PURPOSE OF REVIEW The use of systems biology approaches to understand and predict vaccine-induced immunity promises to revolutionize vaccinology. For centuries vaccines were developed empirically, with very little understanding of the mechanisms by which they mediate protective immunity. The so-called systems vaccinology approach employs high-throughput technologies (e.g. microarrays, RNA-seq and mass spectrometry-based proteomics and metabolomics) and computational modeling to describe the complex interactions between all the parts of immune system, with a view to elucidating new biological rules capable of predicting the behavior of the system. RECENT FINDINGS Systems biology successfully applied to yellow-fever and influenza vaccines has led to the discovery of signatures that predict vaccine immunogenicity, and promises to advance basic immunology research by providing novel mechanistic insights about immune regulation. However a major challenge of systems vaccinology concerns the analyses and interpretation of the large and noisy data sets generated by high-throughput techniques. Overcoming these issues, we envision that systems vaccinology will have a potential impact on vaccine development, including HIV vaccines. SUMMARY High-throughput technologies allow the investigation of vaccine-induced immune responses at system and molecular levels. These are currently being used to unravel new molecular insights about the immune system, and are on the verge of being integrated into clinical trials to enable rational vaccine design and development.
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Cao W, Kim JH, Chirkova T, Reber AJ, Biber R, Shay DK, Sambhara S. Improving immunogenicity and effectiveness of influenza vaccine in older adults. Expert Rev Vaccines 2012; 10:1529-37. [PMID: 22043953 DOI: 10.1586/erv.11.137] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aging is associated with a decline in immune function (immunosenescence) that leads to progressive deterioration in both innate and adaptive immune functions. These changes contribute to the subsequent increased risk for infectious diseases and their sequelae. Vaccination is the most effective and inexpensive public health strategy for prevention of infection, despite the decreased efficacy of vaccines in older adults due to immunosenescence. The rapid rise in the older adult population globally represents a great challenge for vaccination programs. This article first addresses the status of innate and adaptive immune functions in aging and then focuses on influenza vaccine. The development history of influenza vaccines, current status, and potential strategies to improve the immunogenicity and vaccine effectiveness in older adults are discussed.
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Affiliation(s)
- Weiping Cao
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Bldg 15, SSB 611 B, 1600 Clifton Road, Atlanta, GA, USA
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Fernando GJP, Chen X, Primiero CA, Yukiko SR, Fairmaid EJ, Corbett HJ, Frazer IH, Brown LE, Kendall MAF. Nanopatch targeted delivery of both antigen and adjuvant to skin synergistically drives enhanced antibody responses. J Control Release 2012; 159:215-21. [PMID: 22306334 DOI: 10.1016/j.jconrel.2012.01.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/20/2012] [Accepted: 01/22/2012] [Indexed: 01/17/2023]
Abstract
Many vaccines make use of an adjuvant to achieve stronger immune responses. Alternatively, potent immune responses have also been generated by replacing the standard needle and syringe (which places vaccine into muscle) with devices that deliver vaccine antigen to the skin's abundant immune cell population. However it is not known if the co-delivery of antigen plus adjuvant directly to thousands of skin immune cells generates a synergistic improvement of immune responses. In this paper, we investigate this idea, by testing if Nanopatch delivery of vaccine - both the antigen and the adjuvant - enhances immunogenicity, compared to intramuscular injection. As a test-case, we selected a commercial influenza vaccine as the antigen (Fluvax 2008®) and the saponin Quil-A as the adjuvant. We found, after vaccinating mice, that anti-influenza IgG antibody and haemagglutinin inhibition assay titre response induced by the Nanopatch (with delivered dose of 6.5ng of vaccine and 1.4μg of Quil-A) were equivalent to that of the conventional intramuscular injection using needle and syringe (6000ng of vaccine injected without adjuvant). Furthermore, a similar level of antigen dose sparing (up to 900 fold) - with equivalent haemagglutinin inhibition assay titre responses - was also achieved by delivering both antigen and adjuvant (1.4μg of Quil-A) to skin (using Nanopatches) instead of muscle (intramuscular injection). Collectively, the unprecedented 900 fold antigen dose sparing demonstrates the synergistic improvement to vaccines by co-delivery of both antigen and adjuvant directly to skin immune cells. Successfully extending these findings to humans with a practical delivery device - like the Nanopatch - could have a huge impact on improving vaccines.
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Affiliation(s)
- Germain J P Fernando
- The University of Queensland, Delivery of Drugs and Genes Group, Australian Institute for Bioengineering and Nanotechnology, Brisbane, QLD 4072, Australia
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Nakaya HI, Wrammert J, Lee EK, Racioppi L, Marie-Kunze S, Haining WN, Means AR, Kasturi SP, Khan N, Li GM, McCausland M, Kanchan V, Kokko KE, Li S, Elbein R, Mehta AK, Aderem A, Subbarao K, Ahmed R, Pulendran B. Systems biology of vaccination for seasonal influenza in humans. Nat Immunol 2011; 12:786-95. [PMID: 21743478 PMCID: PMC3140559 DOI: 10.1038/ni.2067] [Citation(s) in RCA: 653] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/06/2011] [Indexed: 12/15/2022]
Abstract
Here we have used a systems biology approach to study innate and adaptive responses to vaccination against influenza in humans during three consecutive influenza seasons. We studied healthy adults vaccinated with trivalent inactivated influenza vaccine (TIV) or live attenuated influenza vaccine (LAIV). TIV induced higher antibody titers and more plasmablasts than LAIV did. In subjects vaccinated with TIV, early molecular signatures correlated with and could be used to accurately predict later antibody titers in two independent trials. Notably, expression of the kinase CaMKIV at day 3 was inversely correlated with later antibody titers. Vaccination of CaMKIV-deficient mice with TIV induced enhanced antigen-specific antibody titers, which demonstrated an unappreciated role for CaMKIV in the regulation of antibody responses. Thus, systems approaches can be used to predict immunogenicity and provide new mechanistic insights about vaccines.
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MESH Headings
- Adaptive Immunity/immunology
- Adolescent
- Adult
- Animals
- Antibodies, Viral/blood
- Gene Expression Profiling
- Hemagglutination Inhibition Tests
- Humans
- Immunity, Innate/immunology
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Middle Aged
- Orthomyxoviridae/immunology
- Seasons
- Systems Biology/methods
- Vaccination/methods
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/immunology
- Vaccines, Inactivated/administration & dosage
- Vaccines, Inactivated/immunology
- Young Adult
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Affiliation(s)
- Helder I Nakaya
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329
| | - Jens Wrammert
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30329
| | - Eva K Lee
- Center for Operations Research in Medicine & Healthcare, School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Luigi Racioppi
- Department of Pharmacology and Cancer Biology, Duke University, Durham, NC 27705
- Department of Cellular and Molecular Biology and Pathology, University of Naples “Federico II”, Naples, Italy 80131
| | - Stephanie Marie-Kunze
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329
| | | | - Anthony R Means
- Department of Cellular and Molecular Biology and Pathology, University of Naples “Federico II”, Naples, Italy 80131
| | - Sudhir P Kasturi
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329
| | - Nooruddin Khan
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329
| | - Gui-Mei Li
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30329
| | - Megan McCausland
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30329
| | - Vibhu Kanchan
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30329
| | - Kenneth E Kokko
- Department of Medicine, Division of Nephrology, Emory University School of Medicine, Atlanta, GA 30329
| | - Shuzhao Li
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329
| | - Rivka Elbein
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322
| | - Aneesh K Mehta
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322
| | - Alan Aderem
- Institute for Systems Biology, 1441 North 34th Street, Seattle, WA 98103
| | - Kanta Subbarao
- Laboratory of Infectious Diseases, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30329
| | - Bali Pulendran
- Emory Vaccine Center, Emory University, Atlanta, GA 30329
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30329
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McElhaney JE. Influenza vaccine responses in older adults. Ageing Res Rev 2011; 10:379-88. [PMID: 21055484 PMCID: PMC3061971 DOI: 10.1016/j.arr.2010.10.008] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 10/19/2010] [Accepted: 10/22/2010] [Indexed: 12/21/2022]
Abstract
The most profound consequences of immune senescence with respect to public health are the increased susceptibility to influenza and loss of efficacy of the current split-virus influenza vaccines in older adults, which are otherwise very effective in younger populations. Influenza infection is associated with high rates of complicated illness including pneumonia, heart attacks and strokes in the 65+ population. Changes in both innate and adaptive immune function not only converge in the reduced response to vaccination and protection against influenza, but present significant challenges to new vaccine development. In older adults, the goal of vaccination is more realistically targeted to providing clinical protection against disease rather sterilizing immunity. Correlates of clinical protection may not be measured using standard techniques such as antibody titres to predict vaccine efficacy. Further, antibody responses to vaccination as a correlate of protection may fail to detect important changes in cellular immunity and enhanced vaccine-mediated protection against influenza illness in older people. This article will discuss the impact of influenza in older adults, immunologic targets for improved efficacy of the vaccines, and alternative correlates of clinical protection against influenza that are needed for more effective translation of novel vaccination strategies to improved protection against influenza in older adults.
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Affiliation(s)
- Janet E McElhaney
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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Petrovsky N, Ross TM. Challenges in improving influenza vaccine protection in the elderly. Expert Rev Vaccines 2011; 10:7-11. [PMID: 21162614 DOI: 10.1586/erv.10.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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