Clinical and Immunological Characteristics of Patients with 2009 Pandemic Influenza A (H1N1) Virus Infection after Vaccination

Liu, Wei; Vlas, Sake J. de; Tang, Fang; Ma, Mai‐Juan; Wei, Minxin; Liu, Lijuan; Li, Zengde; Zhang, Lei; Xin, Zhong-Tao; Tong, Yigang; Jiang, Tao; Zhang, Xiao-Ai; He, Cui; Li, Chris; Xu, Xiao-Ning; Yang, Hong; Richardus, Jan Hendrik; Cao, Wu‐Chun

doi:10.1086/656588

Cited by 12 publications

(14 citation statements)

References 20 publications

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“…Seroprotection rates following seasonal influenza vaccination do not tend to drop substantially from their peak, within 3 months of vaccination [44], [45]. Another study found that geometric mean titers could remain above seroprotective levels within 3 months of pH1N1 vaccination for adults aged between 18 and 28 [46]. Therefore a delay or decline in antibody response following receipt of pH1N1 vaccine is unlikely to explain our findings.…”

Section: Discussionmentioning

confidence: 55%

Seroprevalence of Pandemic H1N1 Antibody among Health Care Workers in Hong Kong Following Receipt of Monovalent 2009 H1N1 Influenza Vaccine

Zhou

Seto

et al. 2011

PLoS ONE

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BackgroundHealthcare workers in many countries are recommended to receive influenza vaccine to protect themselves as well as patients. A monovalent H1N1 vaccine became available in Hong Kong in December 2009 and around 10% of local healthcare workers had received the vaccine by February 2010.MethodsWe conducted a cross-sectional study of the prevalence of antibody to pandemic (H1N1) 2009 among HCWs in Hong Kong in February–March 2010 following the first pandemic wave and the pH1N1 vaccination campaign. In this study we focus on the subset of healthcare workers who reported receipt of non-adjuvanted monovalent 2009 H1N1 vaccine (Panenza, Sanofi Pasteur). Sera collected from HCWs were tested for antibody against the pH1N1 virus by hemagglutination inhibition (HI) and viral neutralization (VN) assays.ResultsWe enrolled 703 HCWs. Among 104 HCWs who reported receipt of pH1N1 vaccine, 54% (95% confidence interval (CI): 44%–63%) had antibody titer ≥1∶40 by HI and 42% (95% CI: 33%–52%) had antibody titer ≥1∶40 by VN. The proportion of HCWs with antibody titer ≥1∶40 by HI and VN significantly decreased with age, and the proportion with antibody titer ≥1∶40 by VN was marginally significantly lower among HCWs who reported prior receipt of 2007–08 seasonal influenza vaccine (odds ratio: 0.43; 95% CI: 0.19–1.00). After adjustment for age, the effect of prior seasonal vaccine receipt was not statistically significant.ConclusionsOur findings suggest that monovalent H1N1 vaccine may have had suboptimal immunogenicity in HCWs in Hong Kong. Larger studies are required to confirm whether influenza vaccine maintains high efficacy and effectiveness in HCWs.

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Section: Discussionmentioning

confidence: 55%

Seroprevalence of Pandemic H1N1 Antibody among Health Care Workers in Hong Kong Following Receipt of Monovalent 2009 H1N1 Influenza Vaccine

Zhou

Seto

et al. 2011

PLoS ONE

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“…In addition to local infection, live virus can also disseminate systemically and can be found in the gut or in the blood (43,44). In a recent study, similar peak levels of MN titer were found in patients with pandemic 2009 H1N1 infection or vaccine recipients (23). However, the sample size was small, and only military personnel aged between 18 and 28 were recruited in the study.…”

Section: Discussionmentioning

confidence: 97%

Differences in Antibody Responses of Individuals with Natural Infection and Those Vaccinated against Pandemic H1N1 2009 Influenza

Chan

Hung

et al. 2011

Clin. Vaccine Immunol.

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The differential antibody response measured by the commonly used hemagglutination inhibition (HI) and microneutralization (MN) assays in patients with natural infection and vaccination has not been fully assessed. HI and conventional MN (CMN) assays were performed on sera from 651 patients with natural infection by pandemic H1N1 2009 influenza virus and on sera from 567 recipients of the corresponding vaccine. Surprisingly, the overall seroprotection rates determined by CMN and HI assays in vaccine recipients were only 44.8 and 35.1%, respectively. Antibody titers measured by the CMN assay was significantly higher than that obtained by HI assay in vaccine recipients aged >50 years, but these titers were not significantly different among younger vaccine recipients. In contrast, the HI titer was greater than the CMN titer for the age group from 16 to 29 years but was not significantly different in other age groups for natural infection. Lower antibody levels were found in both naturally infected patients and immunized recipients in the older than in the younger age groups, but naturally infected patients exhibited higher HI and CMN titers than did the corresponding vaccine recipients. In addition, we developed a rapid fluorescent focus microneutralization (FFMN) assay to test sera from naturally infected patients. The FFMN assay has a better correlation with CMN than with HI ( ‫؍‬ 0.810 versus 0.684), which is expected of neutralizing antibody mainly targeted toward the inhibition of viral entry into cells. The higher antibody level elicited by natural infection than by vaccination may be related to differences between antigen presentation by the intramuscular route of vaccination and mucosal viral replication in mucosal cells of the respiratory tract.

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“…Sensitivity was 100% for the specimens with influenza A copy numbers of greater than or equal to 10 5 copies/ml and was 96% for specimens with copy numbers greater than or equal to 10 3 copies/ml. Typical viral loads in the nasopharynx for patients recently infected with influenza A are rarely below 10 4 copies/ml [41], [42], and this has been verified for several strains [43]. So, while there are several ways that the reported microfluidic assay could be improved to lower the limit of detection, in the case of influenza A infections, this improvement would be of limited benefit.…”

Section: Discussionmentioning

confidence: 99%

Microfluidic Chip for Molecular Amplification of Influenza A RNA in Human Respiratory Specimens

et al. 2012

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A rapid, low cost, accurate point-of-care (POC) device to detect influenza virus is needed for effective treatment and control of both seasonal and pandemic strains. We developed a single-use microfluidic chip that integrates solid phase extraction (SPE) and molecular amplification via a reverse transcription polymerase chain reaction (RT-PCR) to amplify influenza virus type A RNA. We demonstrated the ability of the chip to amplify influenza A RNA in human nasopharyngeal aspirate (NPA) and nasopharyngeal swab (NPS) specimens collected at two clinical sites from 2008–2010. The microfluidic test was dramatically more sensitive than two currently used rapid immunoassays and had high specificity that was essentially equivalent to the rapid assays and direct fluorescent antigen (DFA) testing. We report 96% (CI 89%,99%) sensitivity and 100% (CI 95%,100%) specificity compared to conventional (bench top) RT-PCR based on the testing of n = 146 specimens (positive predictive value = 100% (CI 94%,100%) and negative predictive value = 96% (CI 88%,98%) ). These results compare well with DFA performed on samples taken during the same time period (98% (CI 91%,100%) sensitivity and 96% (CI 86%,99%) specificity compared to our gold standard testing). Rapid immunoassay tests on samples taken during the enrollment period were less reliable (49% (CI 38%,61%) sensitivity and 98% (CI 98%,100%) specificity). The microfluidic test extracted and amplified influenza A RNA directly from clinical specimens with viral loads down to 10 3 copies/ml in 3 h or less. The new test represents a major improvement over viral culture in terms of turn around time, over rapid immunoassay tests in terms of sensitivity, and over bench top RT-PCR and DFA in terms of ease of use and portability.

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Clinical and Immunological Characteristics of Patients with 2009 Pandemic Influenza A (H1N1) Virus Infection after Vaccination

Cited by 12 publications

References 20 publications

Seroprevalence of Pandemic H1N1 Antibody among Health Care Workers in Hong Kong Following Receipt of Monovalent 2009 H1N1 Influenza Vaccine

Seroprevalence of Pandemic H1N1 Antibody among Health Care Workers in Hong Kong Following Receipt of Monovalent 2009 H1N1 Influenza Vaccine

Differences in Antibody Responses of Individuals with Natural Infection and Those Vaccinated against Pandemic H1N1 2009 Influenza

Microfluidic Chip for Molecular Amplification of Influenza A RNA in Human Respiratory Specimens

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