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China Enters Bird Flu Vaccine Race

AlaskaDenise

In Memoriam
http://www.webmd.com/content/article/127/116585?src=RSS_PUBLIC

<TABLE cellSpacing=0 cellPadding=0 width="90%" border=0><TBODY><TR><TD vAlign=top width="45%">By Daniel DeNoon
WebMD Medical News </TD><TD vAlign=top width="55%">Reviewed By Louise Chang, MD
on Wednesday, September 06, 2006

</TD></TR></TBODY></TABLE>
Sept. 6, 2006 -- Chinese researchers report that a new bird flu vaccine shows promise in early human tests.

Like the previously announced Glaxo and Sanofi bird fluflu vaccines, the Chinese H5N1 bird flu vaccine is given with an immune-boosting substance called an adjuvant.

Jiangtao Lin, MD, of Beijing's Chinese-Japanese Friendship Hospital, and colleagues tested various doses of the vaccine in 120 adult volunteers aged 18-60.

They found that it worked best when given in two 10-microgram doses four weeks apart.

That's better than the Sanofi vaccine, which needs two 30-microgram doses. But it's not as low an effective dose as that reported for the Glaxo vaccine, which needs two 3.8-microgram doses.

Dose-Sparing Bird Flu Vaccines
Why is a low dose important? In an editorial accompanying the Lin report, British infectious disease specialist Iain Stephenson, MRCP, notes that if there's a bird-flu pandemic, the world will need hundreds of millions of doses -- fast.

This means scientists will be trying to make as much of the vaccine's main ingredient -- the vaccine antigen -- as quickly as possible. The lower the dose, the more doses you get. That's why researchers striving for a bird flu vaccine are looking for "dose-sparing" techniques.

Based on the seasonal flu vaccine, Stephenson estimates, current manufacturing processes could produce about 900 million 15-microgram doses of bird flu vaccine in six months. At two doses a person, this means 450 million people could be vaccinated within six months of a pandemic. A person would be protected only after the second dose, given one month after the first.

The Chinese vaccine, made by Sinovac Biotech Co. Ltd. in Beijing, uses a different approach than other experimental bird flu vaccines. Instead of using just the H5 protein -- in what's known as the "split virion" approach -- the Sinovac vaccine uses a whole killed virus. The vaccine virus is genetically engineered to lack the virulence gene that makes it lethal to the hen's eggs in which it is grown.

The Glaxo vaccine seems to offer more doses for less antigen: 3.8 micrograms versus 10 micrograms per dose. However, the Glaxo vaccine uses the split-virion approach. Lin and colleagues note that making a flu vaccine this way wastes 20% to 30% of the vaccine antigen.

On the other hand, whole-virus vaccines tend to cause more side effects than split-virion vaccines. In their clinical trial, Lin and colleagues did not see any troubling side effects. But they have not yet tested the vaccine in children, who tend to have more side effects with whole-virus vaccines.

And Stephenson notes that the world's current flu vaccine manufacturing process is geared to make split-virion vaccines. A change to whole-virus vaccines would mean lots of new equipment and new regulatory hurdles.
Of course, nobody has yet proved that any bird flu vaccine will protect a person against the disease. The ultimate test will come only if the bird flu virus learns to spread among humans.

Lin and colleagues report their findings in the Sept. 7 online issue of The Lancet.
 
Re: China Enters Bird Flu Vaccine Race

from babelfish

China and United Kingdom. - They develop a vaccine against the safe and effective bird influenza in healthy humans with low doses
MADRID, 6 (EUROPE PRESS)


Investigators of China and Leicester (United Kingdom) have developed a vaccine against the bird influenza that, by means of low doses, is safe and effective in healthy humans, according to a study published in the scientific magazine ' The Lancet'. The vaccines against the bird influenza are being developed and verifying clinically anywhere in the world by different laboratories, but those vaccines are more necessary than they are effective only with low doses since they would arrive at more people in case of a pandemic, indicates the report. In this study, the investigators have verified the effectiveness of a vaccine that contained a modified version of virus H5N1 plus an adjuvant treatment. The vaccines done only with the virus are known to cause a greater immune response front those that are done of particles of the virus, reason why in the case of first they only make lack dose low; nevertheless, also he has more indirect effect. The scientists chose to 120 volunteers of 18 to 60 years and they gave to two doses of placebo or one vaccine them that integrated the virus in dose of 1,25, 2,5, 5 either 10 micrograms the more an adjuvant one of hidróxido of aluminum. After 56 days, they verified that all the formulas produced antibodies against the virus, but the best answer was in the group that had consumed 10 micrograms in two doses. This vaccine reunites all the requirements necessary to be authorized like vaccine against the bird influenza. Pain, swelling and fever are the observed indirect effect more common in the study. Nevertheless, there is no difference with which consumed placebo and the frequency of its appearance is similar to which they have the vaccines that only have particles of the virus. One of the authors of the study, Weidong Yin, of the Sinovac Biotech in Beijing, China, indicated that "during a pandemic, the demand of vaccines will surpass the capacity of production of these, a situation that has taken to the World-wide Organization of the Health to animate to investigate different strategies and dose, including the use of adjuvant and bovine that integrates the own virus". "Our study demonstrates that a vaccine made with both formulas well is tolerated", it added.

http://www.flutrackers.com/forum/showthread.php?p=29307#post29307
 
Re: China Enters Bird Flu Vaccine Race

<table bgcolor="white" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td width="8">
</td> <td colspan="3" class="large_head2" valign="top">Dose-Sparing Avian Flu Vaccine Shows Promise in Early Trials
blue_dot.gif
</td> <td width="8">
</td> <td>
</td> <td width="8">
</td> </tr><tr> <td width="8"> </td> <td colspan="3" valign="top"> <table border="0" cellpadding="0" cellspacing="0"> <tbody><tr> <td class="credit" valign="top">http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/4061

By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
September 07, 2006
</td> </tr><tr> <td>
blue_dot.gif
</td> </tr> </tbody></table> <table border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td class="text" valign="top"> <table> <tbody><tr align="left" bgcolor="#edebe0" valign="top"> <td class="text">MedPage Today Action Points

  • Explain to interested patients that an experimental vaccine against the H5N1 strain of avian influenza appeared to be effective in early clinical trials, but is not yet available commercially.
  • Explain that health authorities worldwide are concerned that the H5N1 strain of influenza A, which is currently seen only in people who are in close daily contact with infected birds, may mutate into a form that can more easily be transmitted among humans.
</td> </tr> </tbody></table> <table align="right"> <tbody><tr> <td style="padding: 2px; text-align: right; font-size: 10px; font-family: arial;"> Additional URI & the Flu Coverage </td> </tr> </tbody></table> Review
BEIJING, Sept. 7 -- A potentially dose-sparing avian influenza vaccine containing inactivated whole particles of the virulent H5N1 strain evoked good immune responses at low doses in early clinical trials, a Chinese-British team found.<o:p></o:p>
<o:p></o:p>
The vaccine was safe, and was most effective at eliciting virus-specific antibodies if given in two doses with aluminum hydroxide adjuvant four weeks apart, reported Jiangtao Lin, M.D., of the Chinese-Japanese Friendship Hospital here, and colleagues, in the online version of The Lancet. <o:p></o:p>
<o:p></o:p>
"These findings identify a potential dose-sparing approach that could be crucial for a global supply of pandemic vaccine," wrote Iain Stephenson, M.D., of the Leicester Royal Infirmary, in England, in an accompanying editorial.<o:p></o:p>
<o:p></o:p>
Foreseeing a shortage of vaccine should the pandemic H5N1 strain of avian flu leap from birds to humans, the World Health Organization has advocated investigations into dose-sparing strategies, such as the use of whole-virion vaccine and adjuvants. <o:p></o:p>
<o:p></o:p>
Seasonal influenza shots are split vaccines that elicit a response by presenting to the immune system the viral surface proteins hemagglutinin and neuraminidase. Additionally, seasonal flu shots are usually not given with adjuvant, according to the WHO.<o:p></o:p>
<o:p></o:p>
But avian flu is a bird of a different feather, and the best approach may be one that combines the powerful immunogenicity of a whole inactivated virus with adjuvant boosting, according to Dr. Lin and colleagues.<o:p></o:p>
<o:p></o:p>
"Our trial suggests that an H5N1 vaccine manufactured and formulated with both of these approaches is well tolerated and immunogenic," they wrote.<o:p></o:p>
<o:p></o:p>
Worldwide, vaccine manufacturers can produce about 300 million doses of trivalent seasonal influenza vaccines every six months, Dr. Stephenson wrote. Theoretically, they could produce 900 million doses of a monovalent H5N1 vaccine, but that would cover just 450 million people, because of the two doses needed for an immunogenic response.<o:p></o:p>
<o:p></o:p>
In addition, "clinical studies of split H5N1 vaccines are disappointing," he continued. "A U.S. study of non-adjuvanted H5N1 vaccine found that only two doses containing 90 μg hemagglutinin per dose induced acceptable antibody levels. In France, two 30 μg doses of alum-adjuvanted H5N1 vaccine were immunogenic, with no effect of alum adjuvant at lower doses. So, within current manufacturing constraints of split vaccines, supplies of either of these two vaccines would be limited to 75 or 225 million people only."<o:p></o:p>
<o:p></o:p>
The whole virion approach also preserves the estimated 20% to 30% of antigens typically lost during the split-vaccine manufacturing process, thereby making more vaccine available.<o:p></o:p>
<o:p></o:p>
In their phase I double-blinded study, Dr. Lin and colleagues randomly assigned 120 healthy volunteers, ages 18 to 60, to received either placebo or the inactivated whole-virion influenza A (H5N1) vaccine at one of four doses: 1.25 μg, 2.5 μg. 5 μg, or 10 μg hemagglutinin per dose with aluminium hydroxide adjuvant on days 0 and 28. <o:p></o:p>
<o:p></o:p>
The investigators obtained serum samples from the volunteers on days 0, 14, 28, 42, and 56. The samples were evaluated for hemagglutination inhibition and assayed for virus neutralization.<o:p></o:p>
<o:p></o:p>
They found that all four formulations of the vaccine were well tolerated, with no serious adverse events. Most local events such as injection site reactions and pain, and most systemic reactions such as myalgia, headache, fatigue or nausea, were mild and transient, the investigators wrote.<o:p></o:p>
<o:p></o:p>
All formulations produced an antibody response after the first dose. The most vigorous antibody response, 78% seropositivity for neutralizing antibodies, was seen after the second 10 μg dose was delivered. In addition, 96% of volunteers in this group had hemagglutinin inhibition responses.<o:p></o:p>
<o:p></o:p>
The two-dose regimen met all European regulatory requirements for annual licensing of seasonal influenza vaccine, the authors noted.<o:p></o:p>
<o:p></o:p>
"Lower doses of this vaccine could achieve immune responses equivalent to those elicited by adjuvanted or non-adjuvanted split-virion vaccines. The use of a whole virion vaccine could be more adaptable to the antigen-sparing strategy recommended by WHO for protection against an influenza pandemic," they wrote.<o:p></o:p>
<o:p></o:p>
The investigators noted that because whole-virion vaccines have been known to induce more adverse events in children, investigators should be cautious in their approach to testing such vaccines in children and in the elderly.
</td></tr></tbody></table></td></tr></tbody></table>

Primary source: The Lancet
Source reference:
Lin J et al. "Safety and immunogenicity of an inactivated adjuvanted whole-virion influenza A (H5N1) vaccine: a phase I randomized controlled trial" The Lancet Published online September 7, 2006 DOI:10.1016/S01406736(06)69294-5

Additional source: The Lancet
Source reference:
Stephenson I. "H5N1 vaccines: how prepared are we for a pandemic?" The Lancet Published online September 7, 2006 DOI:10.1016/S01406736(06)69340-9
 
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