Long-Term Immunogenicity of the Pandemic Influenza A/H1N1 2009 Vaccine among Health Care Workers: Influence of Prior Seasonal Influenza Vaccination
01 Apr 2013-Clinical and Vaccine Immunology (American Society for Microbiology)-Vol. 20, Iss: 4, pp 513-516
TL;DR: HCWs should be encouraged to receive an annual influenza vaccination, considering the risk of repeated exposure, however, prior reception of seasonal influenza vaccine showed a negative influence on immunogenicity for the pandemic A/H1N1 2009 influenza vaccine.
Abstract: Health care workers (HCWs) are at great risk of influenza infection and transmission. Vaccination for seasonal influenza is routinely recommended, but this strategy should be reconsidered in a pandemic situation. Between October 2009 and September 2010, a multicenter study was conducted to assess the long-term immunogenicity of the A/H1N1 2009 monovalent influenza vaccine among HCWs compared to non-health care workers (NHCWs). The influence of prior seasonal influenza vaccination was also assessed with respect to the immunogenicity of pandemic H1N1 influenza vaccine. Serum hemagglutinin inhibition titers were determined prevaccination and then at 1, 6, and 10 months after vaccination. Of the 360 enrolled HCW subjects, 289 participated in the study up to 10 months after H1N1 monovalent influenza vaccination, while 60 of 65 NHCW subjects were followed up. Seroprotection rates, seroconversion rates, and geometric mean titer (GMT) ratios fulfilled the European Union's licensure criteria for influenza A/California/7/2009 (H1N1) at 1 month after vaccination in both the HCWs and NHCWs, without any significant difference. At 6 months after vaccination, the seroprotection rate was more significantly lowered among the NHCWs than among the HCWs (P < 0.01). Overall, postvaccination (1, 6, and 10 months after vaccination) GMTs for A/California/7/2009 (H1N1) were significantly lower among the seasonal influenza vaccine recipients than among the nonrecipients (P < 0.05). In conclusion, HCWs should be encouraged to receive an annual influenza vaccination, considering the risk of repeated exposure. However, prior reception of seasonal influenza vaccine showed a negative influence on immunogenicity for the pandemic A/H1N1 2009 influenza vaccine.
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TL;DR: Experience thus far indicates a favorable balance of benefit to risk for MF59, which may reflect the adjuvant's mechanism of action in which the squalene oil emulsion increases antibody responses to co-administered antigen without acting more generally as an immunopotentiator.
Abstract: Influenza directly or indirectly contributes to the four leading causes of global mortality, at rates that are highest in older adults. As the proportion of older adults in the Korean population is greater than in most other countries, influenza prevention is a greater public health priority in Korea than elsewhere. Conventional inactivated influenza vaccine (IIV) is less immunogenic and efficacious (-50%) in older than in young adults, but adjuvanting the vaccine with oil-in-water emulsion MF59® increases immunogenicity, resulting in comparatively higher levels of hemagglutination inhibition antibodies and greater protection against all influenza, as well as cases requiring hospitalization. A recent observational study demonstrated that the adjuvanted vaccine protected older adults against influenza in a year when nonadjuvanted IIV was ineffective. In another multiyear study, the adjuvanted vaccine was estimated to be 25% more effective in preventing pneumonia and influenza hospitalizations compared to nonadjuvanted vaccine. Although MF59-adjuvanted vaccine is transiently more reactogenic than nonadjuvanted vaccine, there is no evidence that it increases risks for serious adverse events, including those with an autoimmune etiology. Experience thus far indicates a favorable balance of benefit to risk for MF59. This may reflect the adjuvant's mechanism of action in which the squalene oil emulsion increases antibody responses to co-administered antigen without acting more generally as an immunopotentiator.
77 citations
TL;DR: It is shown that subjects vaccinated with an insect cell-derived VLP vaccine, in the midst of the 2009 H1N1 influenza pandemic outbreak in Mexico City, showed antibody persistence up to 24 months post-vaccination, and that subjects that reported being revaccinated with a subsequent inactivated influenza virus vaccine showed higher antibody titres to the pandemic influenza virus than those who were not Revaccinated.
Abstract: The influenza virus is a human pathogen that causes epidemics every year, as well as potential pandemic outbreaks, as occurred in 2009. Vaccination has proven to be sufficient in the prevention and containment of viral spreading. In addition to the current egg-based vaccines, new and promising vaccine platforms, such as cell culture-derived vaccines that include virus-like particles (VLPs), have been developed. VLPs have been shown to be both safe and immunogenic against influenza infections. Although antibody persistence has been studied in traditional egg-based influenza vaccines, studies on antibody response durations induced by VLP influenza vaccines in humans are scarce. Here, we show that subjects vaccinated with an insect cell-derived VLP vaccine, in the midst of the 2009 H1N1 influenza pandemic outbreak in Mexico City, showed antibody persistence up to 24 months post-vaccination. Additionally, we found that subjects that reported being revaccinated with a subsequent inactivated influenza virus vaccine showed higher antibody titres to the pandemic influenza virus than those who were not revaccinated. These findings provide insights into the duration of the antibody responses elicited by an insect cell-derived pandemic influenza VLP vaccine and the possible effects of subsequent influenza vaccination on antibody persistence induced by this VLP vaccine in humans.
25 citations
TL;DR: Although the vaccine was well tolerated, and all adverse reactions were mild to moderate, there was a tendency toward a reduced incidence of local reactions in the diabetic group, and in multivariate analysis, long-term immunogenicity was associated with age and prevaccination titer, regardless of diabetes status.
Abstract: No previous studies have assessed the persistence of immune responses in individuals with diabetes. We conducted this study to evaluate the long-term immunogenicity and safety of an influenza vaccine in type 2 diabetic subjects compared with nondiabetic controls. A randomized and controlled study was conducted at two university hospitals during the 2012-2013 influenza season. The study vaccine was a standard-dose trivalent subunit inactivated intramuscular vaccine. Serum hemagglutination-inhibiting (HI) antibodies were measured at the time of vaccination and 1 month and 6 months after vaccination. Local and systemic reactions were recorded for 7 days. A total of 105 diabetic patients and 108 controls were included in the analysis. One month after vaccination, both the diabetic and nondiabetic groups satisfied all of the criteria of the Committee for Medical Products for Human Use (CHMP), and the immunogenicity profiles were statistically similar between the two groups. Although the vaccine was well tolerated, and all adverse reactions were mild to moderate, there was a tendency toward a reduced incidence of local reactions in the diabetic group. All values in the long-term immunogenicity profiles were statistically similar between the two groups, except for the seroprotection rate for the A/H1N1 influenza virus strain, which was significantly lower in the elderly diabetic group than that in the elderly nondiabetic group. However, in multivariate analysis, long-term immunogenicity was associated with age and prevaccination titer, regardless of diabetes status. (This study has been registered at CRIS [https://cris.nih.go.kr/cris/en/] under registration no. KCT0001423.).
21 citations
Cites result from "Long-Term Immunogenicity of the Pan..."
...Consistent with a previous study, age appeared to be an important factor influencing immune response and persistence (16)....
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29 Aug 2016
TL;DR: This review discusses Influenza Strains/Vaccines in Canada in from 2011/2012-2013/2014, and estimates of Vaccine Effectiveness and Prevention of Influenza.
Abstract: ....................................................................................................................................... xiii List of Abbreviations Used .......................................................................................................... xiv Acknowledgements ........................................................................................................................xv CHAPTER 1: INTRODUCTION .............................................................................. 1 CHAPTER 2: STUDY BACKGROUND AND LITERATURE REVIEW ............. 3 2.1. What is Influenza? ....................................................................................................................3 2.1.1. Influenza Infection .......................................................................................................................... 3 2.1.2. The Influenza Virus ........................................................................................................................ 3 2.2. What is the Burden of Influenza? .............................................................................................4 2.3. Influenza and the Human Immune System ...............................................................................5 2.4. Treatment of Influenza ..............................................................................................................6 2.5. Prevention of Influenza: The Influenza Vaccine ......................................................................6 2.5.1. Types of Influenza Vaccines .......................................................................................................... 6 2.5.2. Influenza Vaccine Composition Selection ...................................................................................... 7 2.5.3. Influenza Vaccination in Canada .................................................................................................... 7 2.6. Influenza Vaccination and the Human Immune System...........................................................8 2.7. Influenza Strains/Vaccines in Canada in from 2011/2012-2013/2014 ...................................10 2.8. Vaccine Effectiveness (VE) ....................................................................................................11 2.8.1. What is Vaccine Effectiveness (VE)? ........................................................................................... 11 2.8.2. Estimates of Vaccine Effectiveness .............................................................................................. 11
2 citations
Cites background from "Long-Term Immunogenicity of the Pan..."
...One group examined healthcare workers who had been previously vaccinated with season TIV and then subsequently vaccinated for pH1N1, and then looked at their GMTs for H1N1 one, six, and ten months after vaccination (86)....
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...Not only did fewer recipients of seasonal influenza vaccine achieve seroprotective titres against pH1N1, but their ability to generate an HI response following vaccination with pH1N1 was impaired (86)....
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...They found that GMTs for H1N1 were significantly lower in seasonal vaccine recipients, compared to those who did not receive seasonal vaccine (86)....
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TL;DR: The youngest age group had significantly higher geometric mean titers for H3N2v compared with the two older groups, aged 32–33 and 47–48 years, who had geometric mean Titers of 68 and 46, respectively, which were similar to previous findings.
Abstract: Background
In 2011, a new variant of influenza A(H3N2) emerged that contained a recombination of genes from swine H3N2 viruses and the matrix (M) gene of influenza A(H1N1)pdm09 virus. New combinations and variants of pre-existing influenza viruses are worrisome if there is low or nonexistent immunity in a population, which increases chances for an outbreak or pandemic.
1 citations
References
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TL;DR: In this article, the effectiveness of trivalent influenza vaccine in reducing infection, illness, and absence from work in young, healthy health care professionals was evaluated over three consecutive years, from 1992-1993 to 1994-1995.
Abstract: ContextData are limited and conflicting regarding the
effectiveness of influenza vaccine in health care professionals.ObjectiveTo determine the effectiveness of trivalent influenza
vaccine in reducing infection, illness, and absence from work in young,
healthy health care professionals.DesignRandomized, prospective, double-blind, controlled trial
over 3 consecutive years, from 1992-1993 to 1994-1995.SettingTwo large teaching hospitals in Baltimore, Md.ParticipantsTwo hundred sixty-four hospital-based health care
professionals without chronic medical problems were recruited; 49
participated for 2 seasons; 24 participated for 3 seasons. The mean age
was 28.4 years, 75% were resident physicians, and 57% were women.InterventionParticipants were randomly assigned to receive either
an influenza vaccine or a control (meningococcal vaccine, pneumococcal
vaccine, or placebo). Serum samples for antibody assays were collected
at the time of vaccination, 1 month after vaccination, and at the end
of the influenza season. Active weekly surveillance for illness was
conducted during each influenza epidemic period.Main Outcome MeasuresSerologically defined influenza infection
(4-fold increase in hemagglutination-inhibiting antibodies), days of
febrile respiratory illness, and days absent from work.ResultsWe conducted 359 person-winters of serologic
surveillance (99.4% follow-up) and 4746 person-weeks of illness
surveillance (100% follow-up). Twenty-four (13.4%) of 179 control
subjects and 3 (1.7%) of 180 influenza vaccine recipients had
serologic evidence of influenza type A or B infection during the study
period. Vaccine efficacy against serologically defined infection was
88% for influenza A (95% confidence interval [CI], 47%-97%;
P=.001) and 89% for influenza B (95% CI,
14%-99%; P=.03). Among influenza vaccinees,
cumulative days of reported febrile respiratory illness were 28.7 per
100 subjects compared with 40.6 per 100 subjects in controls
(P=.57) and days of absence were 9.9 per 100
subjects vs 21.1 per 100 subjects in controls
(P=.41).ConclusionsInfluenza vaccine is effective in preventing infection
by influenza A and B in health care professionals and may reduce
reported days of work absence and febrile respiratory illness. These
data support a policy of annual influenza vaccination of health care
professionals.
615 citations
TL;DR: Prior receipt of 2008-09 TIV was associated with increased risk of medically attended pH1N1 illness during the spring-summer 2009 in Canada and possible biological mechanisms and immunoepidemiologic implications are considered.
Abstract: Background
In late spring 2009, concern was raised in Canada that prior vaccination with the 2008–09 trivalent inactivated influenza vaccine (TIV) was associated with increased risk of pandemic influenza A (H1N1) (pH1N1) illness. Several epidemiologic investigations were conducted through the summer to assess this putative association.
292 citations
"Long-Term Immunogenicity of the Pan..." refers background in this paper
...This finding has been presented before in the ferret model (17) as well as in clinical studies (18, 19)....
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TL;DR: The risks to health care workers inherent in health care delivery should be considered by planners of health care for the next century as well as three antiretroviral drugs for high-risk exposures.
Abstract: Background: Health care workers are at occupational risk for a vast array of infections that cause substantial illness and occasional deaths. Despite this, few studies have examined the incidence, ...
260 citations
255 citations
"Long-Term Immunogenicity of the Pan..." refers methods in this paper
...Antibody responses were detected by means of hemagglutination inhibition (HI) assays, according to established procedures and with use of turkey erythrocytes (9, 10), at the Korea University Guro Hospital....
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TL;DR: Studying the spread of influenza in human populations and protection by influenza vaccines provides important insights into immunity against influenza, and comparisons between non‐adjuvanted inactivated vaccines and live attenuated vaccines demonstrate that both can protect.
Abstract: Studying the spread of influenza in human populations and protection by influenza vaccines provides important insights into immunity against influenza. The 2009 H1N1 pandemic has taught the most recent lessons. Neutralizing and receptor-blocking antibodies against hemagglutinin are the primary means of protection from the spread of pandemic and seasonal strains. Anti-neuraminidase antibodies seem to play a secondary role. More broadly cross-reactive forms of immunity may lessen disease severity but are insufficient to prevent epidemic spread. Priming by prior exposure to related influenza strains through infection or immunization permits rapid, potent antibody responses to immunization. Priming is of greater importance to the design of immunization strategies than the immunologically fascinating phenomenon of dominant recall responses to previously encountered strains (original antigenic sin). Comparisons between non-adjuvanted inactivated vaccines and live attenuated vaccines demonstrate that both can protect, with some advantage of live attenuated vaccines in children and some advantage of inactivated vaccines in those with multiple prior exposures to influenza antigens. The addition of oil-in-water emulsion adjuvants to inactivated vaccines provides enhanced functional antibody titers, greater breadth of antibody cross-reactivity, and antigen dose sparing. The MF59 adjuvant broadens the distribution of B-cell epitopes recognized on HA and NA following immunization.
159 citations
"Long-Term Immunogenicity of the Pan..." refers background in this paper
...the production of new antibodies by the pandemic influenza vaccine, which preferentially reactivates previously activated highaffinity memory B cells rather than naive B cells (the hypothesis of original antigenic sin) (20)....
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