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Recommended composition of influenza virus vaccines for use in the 2006?2007 influenz

Mingus

Well-known member
<nobr>2006-02-14 16:28:04 </nobr>
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<nobr>Recommended composition of influenza virus vaccines for use in the 2006?2007 influenza season </nobr>
<nobr>This recommendation relates to the composition of vaccines for the forthcoming influenza season in the </nobr>
<nobr>northern hemisphere (November 2006 to April 2007). A recommendation will be made in September 2006 </nobr>
<nobr>relating to vaccines that will be used for the influenza season in the southern hemisphere (May to September </nobr>
<nobr>2007). Epidemiological considerations will influence which recommendation (February or September) is more </nobr>
<nobr>appropriate for countries in equatorial regions. </nobr>
<nobr>Influenza activity October 2005?January 2006 </nobr>
<nobr>Between October 2005 and January 2006, influenza was reported in Africa, the Americas, Asia, Europe and </nobr>
<nobr>Oceania. In general, influenza activity was low compared with the same period in recent years.</nobr>
<nobr>1</nobr>
<nobr>In North </nobr>
<nobr>America and Asia, influenza activity began in October and increased in December in some countries, while in </nobr>
<nobr>Europe, activity remained low throughout the period.</nobr>
<nobr>Influenza A(H1) viruses circulated at a low level and were responsible for one outbreak in Africa. </nobr>
<nobr>Influenza A(H3N2) viruses predominated in North America and Asia and caused outbreaks. </nobr>
<nobr>Influenza B viruses circulated at low levels in many countries; they were the predominant viruses in some</nobr>
<nobr>European countries. </nobr>
<nobr>Influenza A(H1) </nobr>
<nobr>Between October 2005 and January 2006, an influenza A(H1) outbreak was reported in Africa (Tunisia). </nobr>
<nobr>Influenza A(H1N1) viruses and A(H1) viruses, for which the neuraminidase subtype was not identified, were </nobr>
<nobr>also isolated in Africa (Egypt and Madagascar), the Americas (Brazil, Mexico and the United States), Asia</nobr>
<nobr>(China, Hong Kong Special Administrative Region of China (Hong Kong SAR), Japan, Kuwait, Mongolia, </nobr>
<nobr>Republic of Korea, Qatar, Taiwan Province of China and Thailand), Europe (France, Germany, Iran, Israel, </nobr>
<nobr>Norway, Portugal, Russian Federation, Sweden, Switzerland, Turkey and the United Kingdom) and Oceania </nobr>
<nobr>(Australia and New Zealand). No influenza A(H1N2) viruses were reported. </nobr>
<nobr>Influenza A(H3N2) </nobr>
<nobr>Between October 2005 and January 2006, outbreaks caused by influenza A(H3N2) viruses were reported in the </nobr>
<nobr>Americas (Canada and the United States), and Asia (Japan). </nobr>
<nobr>Influenza A(H3N2) viruses were also isolated in Africa (Madagascar, South Africa and Tunisia), the Americas </nobr>
<nobr>(Argentina, Brazil and Mexico), Asia (China, Hong Kong SAR, Kuwait, Malaysia, Mongolia, Republic of </nobr>
<nobr>Korea, Taiwan Province of China and Thailand), Europe (Denmark, Finland, France, Greece, Iceland, Ireland, </nobr>
<nobr>Israel, Italy, Latvia, Norway, Russian Federation, Slovenia, Sweden, Turkey and the United Kingdom) and </nobr>
<nobr>Oceania (Australia, New Caledonia and New Zealand). </nobr>
<nobr>Influenza B </nobr>
<nobr>1</nobr>
<nobr>http://www.who.int/wer/en/</nobr>
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<nobr>Outbreaks caused by influenza B viruses were not reported between October 2005 and January 2006. </nobr>
<nobr>Influenza B viruses were isolated in Africa (Madagascar, Morocco, South Africa and Tunisia), the Americas </nobr>
<nobr>(Argentina, Brazil, Canada, Chile, Colombia, Honduras, Mexico, Peru and the United States), Asia (Hong </nobr>
<nobr>Kong SAR, Japan, Kuwait, Philippines and Thailand), Europe (Belarus, Denmark, France, Greece, Iran, Israel, </nobr>
<nobr>Latvia, Norway, Portugal, Russian Federation, Slovenia, Sweden, Switzerland, Turkey and the United </nobr>
<nobr>Kingdom) and Oceania (Australia and New Zealand). </nobr>
<nobr>Influenza A(H5N1) </nobr>
<nobr>Between October 2005 and 13 February 2006, 49 human cases of influenza A(H5N1) were associated with </nobr>
<nobr>outbreaks of highly pathogenic avian influenza A(H5N1) in poultry in China, Indonesia, Iraq, Thailand and</nobr>
<nobr>Turkey. Since December 2003, a total of 165 human cases have been confirmed from 7 countries </nobr>
<nobr>(http://www.who.int/csr/disease/avian_influenza/country/en/). The WHO influenza pandemic preparedness </nobr>
<nobr>level remains unchanged at Phase 3 (http://www.who.int/csr/disease/avian_influenza/phase/en/index.html). So </nobr>
<nobr>far there has been no evidence of sustained human-to-human transmission. </nobr>
<nobr>Antigenic characteristics of recent isolates </nobr>
<nobr>Influenza A(H1N1) viruses </nobr>
<nobr>In haemagglutination-inhibition (HI) tests with postinfection ferret sera, the majority of influenza A(H1N1) </nobr>
<nobr>viruses were closely related to A/New Caledonia/20/99. Although a genetic variant emerged during 2004 and </nobr>
<nobr>has become more prevalent in recent months, viruses in this genetic group were antigenically indistinguishable </nobr>
<nobr>from A/New Caledonia/20/99-like viruses. </nobr>
<nobr>Influenza A(H3N2) viruses </nobr>
<nobr>In HI tests with postinfection ferret sera, many influenza A(H3N2) viruses were closely related to the reference </nobr>
<nobr>virus, A/California/7/2004. However, an increasing proportion were antigenically more closely related to </nobr>
<nobr>A/Wisconsin/67/2005 (Table 1). </nobr>
<nobr>Table 1 Results of haemagglutination-inhibition tests of influenza A(H3N2) viruses with postinfection </nobr>
<nobr>ferret sera </nobr>
<nobr>Antigens </nobr>
<nobr>A/California/7/2004 A/New York/55/2004 </nobr>
<nobr>A/Wisconsin/67/2005</nobr>
<nobr>A/California/7/2004 </nobr>
<nobr>1280 </nobr>
<nobr>320 </nobr>
<nobr>640 </nobr>
<nobr>A/New York/55/2004 </nobr>
<nobr>640 </nobr>
<nobr>320 </nobr>
<nobr>640 </nobr>
<nobr>A/Wisconsin/67/2005 </nobr>
<nobr>320 </nobr>
<nobr>160 </nobr>
<nobr>1280</nobr>
<nobr>Recent isolates</nobr>
<nobr>A/Anhui/544/2005 </nobr>
<nobr>640 </nobr>
<nobr>320 </nobr>
<nobr>320 </nobr>
<nobr>A/Georgia/1/2005 </nobr>
<nobr>640 </nobr>
<nobr>160 </nobr>
<nobr>640 </nobr>
<nobr>A/Ishikawa/1/2006 </nobr>
<nobr>640 </nobr>
<nobr>320 </nobr>
<nobr>320 </nobr>
<nobr>A/Ulan Bator/1806/2005 </nobr>
<nobr>160 </nobr>
<nobr>80</nobr>
<nobr>640 </nobr>
<nobr>A/Guam/963/2005 </nobr>
<nobr>160 </nobr>
<nobr>80</nobr>
<nobr>640 </nobr>
<nobr>A/Taiwan/567/2005 </nobr>
<nobr>320 </nobr>
<nobr>160 </nobr>
<nobr>1280 </nobr>
<nobr>A/Mexico/2014/2005 </nobr>
<nobr>320 </nobr>
<nobr>160 </nobr>
<nobr>1280 </nobr>
<nobr>A/Oregon/14/2005 </nobr>
<nobr>320 </nobr>
<nobr>160 </nobr>
<nobr>1280 </nobr>
<nobr>A/Hiroshima/52/2005 </nobr>
<nobr>320 </nobr>
<nobr>160 </nobr>
<nobr>1280</nobr>
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<nobr>Influenza B viruses </nobr>
<nobr>Influenza B viruses of both the B/Victoria/2/87 and B/Yamagata/16/88 lineages continued to circulate. While </nobr>
<nobr>the relative proportions of viruses of the two lineages varied in different countries over time, in recent months </nobr>
<nobr>viruses of the B/Victoria/2/87 lineage have predominated. </nobr>
<nobr>In HI tests with postinfection ferret antisera, viruses of the B/Victoria/2/87 lineage were closely related to the </nobr>
<nobr>vaccine virus B/Malaysia/2506/2004. Many of the B/Yamagata/16/88 lineage viruses were distinguishable </nobr>
<nobr>from the vaccine viruses B/Shanghai/361/2002 and B/Jiangsu/10/2003 and were more closely related to </nobr>
<nobr>reference viruses such as B/Florida/7/2004 and B/Egypt/144/2005. </nobr>
<nobr>Studies with inactivated influenza virus vaccines </nobr>
<nobr>Antibodies to haemagglutinin (HA) were measured by HI tests in panels of sera from people who had received </nobr>
<nobr>trivalent inactivated vaccines containing the antigens of A/New Caledonia/20/99(H1N1), A/New </nobr>
<nobr>York/55/2004(H3N2) and either B/Shanghai/361/2002 or B/Jiangsu/10/2003, administered in doses of 15 mcg </nobr>
<nobr>of each HA. Cross-reactions of postimmunization antibody to recent isolates were examined in 5 panels of sera </nobr>
<nobr>3 of which were selected for postimmunization antibody ?40 to the vaccine virus. </nobr>
<nobr>Vaccines containing influenza A/New Caledonia/20/99(H1N1) antigen stimulated postimmunization HA </nobr>
<nobr>antibodies at titres ?40 to the influenza A(H1N1) vaccine virus in the sera of 55% of children, 75% of adults </nobr>
<nobr>and 62% of elderly people who had been vaccinated. In children, adults, and elderly people, the </nobr>
<nobr>postimmunization average geometric mean HI titres and proportions of titres ?40 to recent isolates were similar. </nobr>
<nobr>Vaccines containing influenza A/New York/55/2004(H3N2) antigen stimulated postimmunization HA </nobr>
<nobr>antibodies at titres ?40 to the vaccine virus in the sera of 86% of children, 79% of adults and 77% of elderly </nobr>
<nobr>people who had been vaccinated. In adults and elderly people, the postimmunization average geometric mean</nobr>
<nobr>HI titres and proportions of titres ?40 to recent isolates were similar, but in children only 55% had titres ?40 to </nobr>
<nobr>recent isolates. Furthermore, the average postimmunization geometric mean HI titre to recent </nobr>
<nobr>A/Wisconsin/67/2005-like viruses was 55% lower for children, 42% lower for adults and 43% lower for elderly</nobr>
<nobr>people than to the vaccine virus. </nobr>
<nobr>Vaccines containing influenza B/Shanghai/361/2002-like antigens stimulated postimmunization HA antibodies </nobr>
<nobr>at titres ?40 to the vaccine virus in the sera of 56% of children, 74% of adults and 73% of elderly people who </nobr>
<nobr>had been vaccinated. In adults and elderly people, the proportions with titres ?40 were similar for representative </nobr>
<nobr>recent B/Shanghai/361/2002-like (B/Yamagata/16/88 lineage) viruses, but in children only 36% had titres ?40 </nobr>
<nobr>to recent B/Shanghai/361/2002-like isolates. For representative recent B/Malaysia/2506/2004-like viruses </nobr>
<nobr>(B/Victoria/2/87 lineage), the proportions with titres ?40 were lower: 4% of children, 39% of adults and 44% of </nobr>
<nobr>elderly people who had been vaccinated. Furthermore, the average postimmunization geometric mean HI titre </nobr>
<nobr>to recent B/Malaysia/2506/2004-like viruses was 85% lower for children, 64% lower for adults and 49% lower </nobr>
<nobr>for elderly people than to the vaccine virus. </nobr>
<nobr>Recommended composition of influenza virus vaccines for use in the 2006?2007 influenza season </nobr>
<nobr>During the period October 2005 to January 2006, influenza A(H1N1), A(H3N2) and B viruses circulated in </nobr>
<nobr>many parts of the world. </nobr>
<nobr>Influenza A(H1N1) viruses were isolated from sporadic cases in many countries; only one country reported an </nobr>
<nobr>outbreak. In HI tests, most isolates were antigenically similar to A/New Caledonia/20/99. Influenza A(H1N2) </nobr>
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<nobr>2006-02-14 16:28:04 </nobr>
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<nobr>viruses were not reported. Current vaccines containing A/New Caledonia/20/99 antigens stimulated HA </nobr>
<nobr>antibodies that were similar in titre to recent influenza A(H1N1) viruses and to the vaccine virus. </nobr>
<nobr>Influenza A(H3N2) viruses were associated with outbreaks in several countries. Many recent isolates were</nobr>
<nobr>antigenically similar to the current reference virus, A/California/7/2004, but an increasing proportion of recent </nobr>
<nobr>viruses was more closely related to A/Wisconsin/67/2005. Current vaccines containing A/New York/55/2004 </nobr>
<nobr>antigens stimulated HA antibodies that were lower in titre to A/Wisconsin/67/2005-like viruses than to the </nobr>
<nobr>vaccine virus. </nobr>
<nobr>No outbreaks of influenza B were reported, although low levels of activity were reported in many countries. </nobr>
<nobr>The majority of recent isolates were antigenically similar to B/Malaysia/2506/2004. Vaccines containing </nobr>
<nobr>influenza B/Shanghai/361/2002-like antigens stimulated HA antibodies that were similar in titre to recent </nobr>
<nobr>B/Shanghai/361/2002-like viruses but were lower in titre to recent B/Malaysia/2506/2004-like viruses. </nobr>
<nobr>It is recommended that vaccines to be used in the 2006-7 season </nobr>
<nobr>(northern hemisphere winter) contain the following: </nobr>
<nobr>? an A/New Caledonia/20/99(H1N1)-like virus; </nobr>
<nobr>? an A/Wisconsin/67/2005 (H3N2)-like virus</nobr>
<nobr>a</nobr>
<nobr>; </nobr>
<nobr>? a B/Malaysia/2506/2004-like virus</nobr>
<nobr>b</nobr>
<nobr>Candidate vaccine viruses include: </nobr>
<nobr>a</nobr>
<nobr>A/Wisconsin/67/2005 (H3N2) and A/Hiroshima/52/2005 </nobr>
<nobr>b</nobr>
<nobr>B/Malaysia/2506/2004 virus and B/Ohio/1/2005 </nobr>
<nobr>As in previous years, national control authorities should approve the specific vaccine viruses used in each </nobr>
<nobr>country. National public health authorities are responsible for making recommendations regarding the use of</nobr>
<nobr>the vaccine. </nobr>
<nobr>WHO has published recommendations on the prevention of influenza.</nobr>
<nobr>2</nobr>
<nobr>Most of the population is likely to have </nobr>
<nobr>been infected with influenza A(H1N1), influenza A(H3N2) and influenza B viruses. As a consequence, 1 dose </nobr>
<nobr>of inactivated influenza vaccine should be immunogenic for individuals of all ages except young children. </nobr>
<nobr>Previously unimmunized children should receive 2 doses of inactivated vaccine with an interval between doses </nobr>
<nobr>of at least 4 weeks. </nobr>
<nobr>Reagents for use in the laboratory standardization of inactivated vaccine may be obtained from: Immunology</nobr>
<nobr>(Vaccines), Therapeutic Goods Administration Laboratories, P.O. Box 100, Woden ACT, 2606 Australia (fax: </nobr>
<nobr>+61 2 6232 8564, web site: http://www.tga.gov.au); Division of Virology, National Institute for Biological </nobr>
<nobr>Standards and Control, Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, England (fax: +44 </nobr>
<nobr>1707 641050, e-mail: enquiries@nibsc.ac.uk, web site: http://www.nibsc.ac.uk); or Division of Viral Products, </nobr>
<nobr>Center for Biologics Evaluation and Research, Food and Drug Administration, 1401 Rockville Pike, Rockville, </nobr>
<nobr>MD 20892, United States (fax: +1 301 402 5128). Requests for reference strains for antigenic analysis should </nobr>
<nobr>be addressed to the WHO Collaborating Centre for Reference and Research on Influenza, 45 Poplar Road, </nobr>
<nobr>Parkville, Victoria 3052, Australia (fax: +61 3 9389 1881, web site: http://www.influenzacentre.org); the WHO </nobr>
<nobr>Collaborating Centre for Reference and Research on Influenza, National Institute of Infectious Diseases, </nobr>
<nobr>Gakuen 4-7-1, Musashi-Murayama, Tokyo 208-0011, Japan (fax: +81 42 561 0812 or +81 42 565 2498, web </nobr>
<nobr>site: http://www.nih.go.jp/niid/indexe.html); the WHO Collaborating Center for Surveillance, Epidemiology </nobr>
<nobr>and Control of Influenza, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail stop G16, </nobr>
<nobr>Atlanta, GA 30333, United States (fax: +1 404 639 2334, web site: http://www.cdc.gov/flu/); or the WHO </nobr>
<nobr>Collaborating Centre for Reference and Research on Influenza, National Institute for Medical Research, The </nobr>
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