Published Date: 2009-07-20 18:00:06
Subject: PRO> Influenza pandemic (H1N1) 2009 (10): vaccine
Archive Number: 20090720.2577
INFLUENZA PANDEMIC (H1N1) 2009 (10): VACCINE
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In this update:
[1] Intradermal vaccination
[2] Vaccine delivery
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[1] Intradermal vaccination
Date: Mon 20 Jul 2009
From: Aldo Dekker <Aldo.Dekker@wur.nl>
I think the use of intradermal vaccination could be a very good tool
when vaccine quantity is limited [see: Influenza pandemic (H1N1) 2009
(05): vaccine, archive number 20090716.2540]. We have recently
published a similar finding for foot-and-mouth disease vaccine.
Although the neutralising antibody response was lower after
intradermal vaccination with a 1/10 dose compared to the neutralising
antibody response after a full dose intramuscularly applied,
protection against challenge was similar.
Statistical analysis of the virus excretion data in relation to the
neutralising antibody response showed that pigs vaccinated
intradermally needed a significantly lower neutralising antibody
response to protect against virus excretion than intramuscular
vaccinated pigs. So standard correlates of protection can also be
different depending on the route of vaccination. (Reference: P.L.,
Weerdmeester, K., van Hemert-Kluitenberg, F., Dekker, A. 2009
Intradermal vaccination of pigs against FMD with 1/10 dose results in
comparable vaccine efficacy as intramuscular vaccination with a full
dose. Vaccine 27; 1272-1278) [abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/19114077>].
The overwhelming data on influenza vaccination surely supports the
suggestion of using intradermal vaccination, I would suggest that
governments not only procure vaccine but also injection material for
intradermal application, preferably needle-less.
--
Aldo Dekker
Project leader Vesicular Diseases
Central Veterinary Institute of Wageningen UR
P.O. Box 65, 8200 AB Lelystad, The Netherlands
Visitors' address: Houtribweg 39, 8221 RA Lelystad, Netherlands.
<Aldo.Dekker@wur.nl>
******
[2] Vaccine delivery
Date: Mon 20 Jul 2009
Source: The London Free Press, ex The Canadian Press [edited]
<http://lfpress.ca/newsstand/Today/2009/07/20/10190946-sun.html>
A flurry of innovative vaccine trials is in the offing as governments
and regulatory agencies prepare for the probable launch of mass swine
flu vaccination programs in the fall [2009].
The results of the trials could determine whether people with egg
allergies can be offered pandemic (and regular) flu vaccine, whether
pandemic and seasonal flu shots could be given at the same time and
whether one company's vaccine can be given with another's adjuvant, a
compound that boosts its potency. Vaccine manufacturers are either
unable or unlikely to undertake the complicated studies required to
answer these questions. Governments will fund the work instead.
Infectious diseases expert Dr. Anthony Fauci says the goal here for
organizations like the U.S. National Institute of Allergy and
Infectious Diseases -- which he heads -- is to fill key knowledge
gaps for vaccine regulators. "What are they going to need that
somebody else can't do?" Fauci explains.
Some of those priorities will be aired Thursday [23 Jul 2009] in
Washington when the U.S. Food and Drug Administration's vaccine and
related biological products advisory committee meets in a session on
clinical trials for pandemic vaccines. Vaccine manufacturers will do
the basic testing, work designed to assure regulators and would-be
recipients that their vaccine is safe and likely to protect against
the pandemic strain, an H1N1 virus of swine origin [or more
accurately undetermined origin - Mod.CP].
But there are many other key questions. In fact, the list is too long
to tackle in its entirety in the limited time available. So
discussions between planners and regulators over the past few weeks
have led to a paring down of priorities. In the case of the U.S.,
it's not yet clear which studies have survived the cut. However,
Fauci says his institute will green-light one looking at whether the
pandemic vaccine -- to protect against the new H1N1 virus -- could be
given at the same time as seasonal flu vaccine, which protects
against 3 types of flu viruses including a different H1N1.
Co-administration, as it is called, would make the logistics of
pandemic vaccine delivery much easier, if the pandemic vaccine is
ready in time. But would giving people vaccines that protect against
2 different H1N1 viruses at once actually undermine the effort by
weakening the response to one or both? "As an immunologist, I don't
think you're going to have any trouble with that. But you don't
know," Fauci explains. "Would presenting 2 different H1N1 antigens to
the body at the same time result in antigenic competition? On the
other hand, we could be surprised, and giving them together might
enhance the response to both."
In Canada, plans are underway to try to test whether people with egg
allergies could be given flu shots containing vaccine produced in
eggs. Currently, that is considered unsafe and is not done. With some
manufacturers moving to grow their vaccine viruses in cell culture,
that may be less of a problem in the future. But for now, egg-based
production still generates the lion's share of the global flu vaccine
output. Canada's entire supply will be egg-based vaccine. Dr. Scott
Halperin, a vaccinologist from Dalhousie University in Halifax, says
a newly formed, federally funded research network hopes to get ethics
approval to test the assumption it is unsafe to give people with egg
allergies flu shots. The goal will be "to basically look at what is
the real risk and to immunize individuals under very carefully
controlled (circumstances)," says Halperin, principal investigator of
the Public Health Agency of Canada/Canadian Institutes of Health
Research Influenza Research Network. "That is a real concern," he
says of the current position on people with egg allergies. "You can't
leave a whole segment of the population without access to protection."
[Byline: Helen Branswell]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The logistics of delivering so far unevaluated vaccines produced by
different pharmaceutical companies are immense. If the potencies of
the different products vary, some vaccines may require more than a
single dose to achieve equivalent efficacy. There is certainly reason
to explore the potential of intradermal vaccination to conserve
supplies, at least in the early stages of the programme, when
adequately evaluated vaccines will be in short supply. In addition,
the overall mildness of the disease associated with influenza
pandemic (H1N1) 2009 virus infection will rapidly expose any
detrimental effects of inadequately tested products. - Mod.CP]
See Also
Influenza pandemic (H1N1) 2009 (09): UK, pig stockman 20090718.2560Influenza pandemic (H1N1) 2009 (08): pandemic origins
Influenza pandemic (H1N1) 2009 (07): Argentina, swine, alert 20090718.2557
Influenza pandemic (H1N1) 2009 (06): case reporting 20090717.2553
Influenza pandemic (H1N1) 2009 (05): vaccine 20090716.2540
Influenza pandemic (H1N1) 2009 (04): pandemic origins 20090715.2527
Influenza pandemic (H1N1) 2009 (03): vaccine 20090713.2505
Influenza pandemic (H1N1) 2009 (02): obesity risk factor 20090711.2482
Influenza pandemic (H1N1) 2009 - Viet Nam: patient data 20090708.2450
Influenza A (H1N1) - worldwide (86): official nomenclature 20090706.2430
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