Immunization against influenza: comparison of various topical and parenteral regimens containing inactivated and/or live attenuated vaccines in healthy adults.

Methods for enhancing immune responses to influenza were explored in 2 double-blind, placebo-controlled trials. Intranasal (inl) immunization with monovalent, live attenuated, cold-adapted recombinant (CR) or inactivated influenza virus (MIV) vaccine and intramuscular (im) immunization with MIV were evaluated in various combinations. Healthy susceptible adults were assigned randomly to receive 10(7.1) TCID(50) of CR (A/H1N1 or A/H3N2), homologous MIV (15 microg), or placebo inl and placebo or homologous MIV im (6 groups in each study). Serum antibody responses were greatest in groups given im vaccine (with or without inl vaccine). A 2-fold increase in nasal wash antibody response frequencies was seen in groups given combined inl (CR or MIV) and im vaccine, compared with subjects given a single im (MIV) or inl (CR or MIV) vaccine. Combined inl and im immunization is a promising approach for enhancing both local and systemic immune responses against influenza.

Increasing doses of purified influenza virus hemagglutinin and subvirion vaccines enhance antibody responses in the elderly.

The reactogenicities and immunogenicities of two influenza virus vaccines were compared in a placebo-controlled clinical trial among healthy ambulatory persons > or = 65 years old (mean age, 72 years). Volunteers were assigned randomly to receive 15-, 45-, or 135-micrograms doses of monovalent influenza A/Taiwan (H1N1) hemagglutinin (HA) or subvirion (SV) vaccine intramuscularly or a placebo. Increasing doses of SV vaccine were associated with a higher rate of injection site discomfort (P < 0.05; chi-square test for linear trend), but all doses of both vaccines were well tolerated. Increasing the dose of the HA or the SV vaccine resulted in increasingly higher postimmunization levels of serum hemagglutination inhibition and neutralizing antibody levels (P < 0.001; multiple linear regression). Mean serum antibody titers at 1 month increased two- to threefold with a ninefold increase in dose; the frequencies of fourfold or greater rises in titer likewise increased. An increase in the dose of the HA or the SV vaccine also resulted in increased frequencies of rises in immunoglobulin A or G antibody titers in nasal wash specimens. The frequencies increased approximately twofold for each vaccine with a ninefold increase in the dose. These data suggest that increasing the HA vaccine dose is a promising approach to the development of improved influenza virus vaccines for use in elderly people.

High doses of purified influenza A virus hemagglutinin significantly augment serum and nasal secretion antibody responses in healthy young adults.

The reactogenicity and immunogenicity of purified influenza virus hemagglutinin (HA) vaccines administered intramuscularly were evaluated in two placebo-controlled clinical trials. A total of 139 healthy young adults were randomized to receive increasing doses of monovalent influenza A/Taiwan/1/86 (H1N1) virus HA (range, 0 to 405 micrograms per dose [study 1]). An additional 139 subjects were given increasing doses of a trivalent HA vaccine containing equal amounts of A/H1N1 virus, A/Shanghai/16/89 (H3N2) virus, and influenza B/Yamagata/16/88 virus HA (range, 0 to 135 micrograms of HA per strain, 0 to 405 micrograms per dose) or a standard dose of commercial influenza vaccine (study 2). Increasing doses of HA were associated with increasing frequencies of symptoms at the vaccination site early after vaccination, but all doses were well tolerated. Occurrence of systemic symptoms was unrelated to dose. Increasing the dose of HA resulted in increasingly higher postimmunization levels of serum hemagglutination inhibiting and neutralizing antibody levels versus influenza A/H1N1 virus in study 1 (P < 0.05); these enhanced responses persisted for up to 6 months. Nasal secretory immunoglobulin A and G antibody responses were assessed 2 weeks after immunization with monovalent H1N1 virus HA; the frequencies of significant responses also increased in a dose-related fashion. Similar increases in serum antibody levels were noted for both A/H1N1 and A/H3N2 viruses in study 2. These data provide a basis for proceeding with the evaluation of high doses of purified HA in the elderly.

Liposomes that provide T-dependent help to weak antigens (T-independent antigens).

The design of an adjuvant for eliciting a thymus-dependent response to LPS, a well-defined thymus-independent antigen, is presented. Hybrid liposomes containing LPS and HA2 peptide from the hemagglutinin protein of influenza virus within the liposome bilayer were prepared (LPS/HA2 liposomes). The HA2 polypeptide contains epitopes recognized by T-helper lymphocytes and T-cytotoxic lymphocytes. Outbred mice immunized with LPS/HA2 liposomes produced anti-LPS-specific IgG responses. IgG subclass analysis indicated that IgG1, IgG2, and IgG3 antibodies were produced by these animals. LPS liposomes (liposomes without HA2) stimulated a T-independent response only. This was demonstrated by the detection of IgG3 but not IgG1 or IgG2 in serum of mice immunized with LPS liposomes. These results support the concept that the simultaneous incorporation into liposomes of a polypeptide with T-cell recognition sites along with a T-independent antigen can lead to the generation of cognate T-cell help for the T-independent antigen. The synthesis and characterization of a neo-lipopolysaccharide T-independent antigen for incorporation in hybrid HA2 liposomes are also presented. Findings are discussed relative to the liposome model used and implications for development of vaccines for use in humans.

Maternal immunization with the capsular polysaccharide vaccine for Haemophilus influenzae type b.

Maternal immunization with the capsular polysaccharide (PRP) vaccine of Haemophilus influenzae type b has been shown to extend the time that protective levels of maternal antibody are detected in infants. In a randomized, blinded trial, PRP or placebo was administered uneventfully to 213 women in the third trimester of pregnancy. Infants born to PRP recipients had significantly higher levels of antibody to PRP than did infants born to placebo recipients: 2.73 micrograms/ml compared with 0.33 microgram/ml. It was estimated that infants of mothers who received the PRP vaccine would be protected for an average of 4 months compared to an average of only 2 months for those of mothers who received placebo. Infants were followed for invasive H. influenzae type b disease through the first year of life; none was detected.

Universal vaccine carrier. Liposomes that provide T-dependent help to weak antigens.

The design of a thymus-dependent synthetic vaccine that will provide a universal T cell epitope for B cell epitopes is described in this study. Simultaneous incorporation into liposomes of both a peptide recognized by Th lymphocytes and a lipophilic hapten and the IgG antibody responses to this hapten were assessed in outbred mice. DNP-aminocaproyl phosphatidylethanolamine (DNP-CapPE) is a well characterized T-independent hapten Ag. HA2 peptide derived from the hemagglutinin protein of influenza virus contains amino acid sequences recognized by Th and T cytotoxic lymphocytes. In addition, HA2 contains a sequence of hydrophobic amino acids near the carboxyl terminus, allowing its incorporation into liposomes. Results of immunization show that (i), when DNP-CapPE is carried by liposomes without the HA2 peptide, an IgM antibody response is induced, (ii) liposomes carrying both HA2 and DNP-CapPE elicit an IgG antibody response to DNP in a dose-dependent fashion for both HA2 and DNP, (iii) the liposomes must be processed intracellularly in order to elicit a response, (iv) the system leads to a memory response for DNP, and (v) all of the IgG subclasses are elicited. These data suggest that liposomes containing the HA2 peptide exhibit a T-dependent carrier effect for a T-independent Ag. The significance of these findings is discussed in conjunction with the characteristics of the liposome model used.

Serum IgG subclass antibody responses in children vaccinated with influenza virus antigens by live attenuated or inactivated vaccines.

To ascertain whether live attenuated or inactivated vaccines can be considered equivalent, we examined the primary antibody response of children following vaccination with influenza virus antigens in three different formulations. Nine children received cold recombinant vaccine (CRV) containing A/Korea/82 (H3N2) and A/Dunedin/83 (H1N1) variants. Eight of these children responded to HA of the H3N2 subtype and the major portion of the elicited antibody was in the IgG1 subclass. Antibody of low titer in the IgG2 and IgG3 subclasses was detected in two and six serum specimens, respectively. Six of the nine children administered with CRV responded to the H1 antigen and only IgG1 antibody was detected. Serum specimens from eight children less than one year of age (5 less than 6 months of age) who had developed an antibody response to trivalent inactivated vaccine (TIV) vaccination were examined. High levels of IgG1 antibody to purified H3 were detected in all eight children. Low titers of antibody in IgG2 and IgG3 subclasses were detected in two and five children, respectively. Antibody responses to purified H1 showed a similar subclass distribution. In order to examine secondary response, eight children primed by immunization with TIV vaccine were subsequently given a single booster dose of purified hemagglutinin (HA) conjugated to diphtheria toxoid (HA-D). In 6/8 specimens antibody rises were detected to purified H3 and H1 antigens. Prior to the HA-D immunization, low levels of HA specific IgG1 antibody were detected in all serum specimens and vaccine induced responses were primarily of the IgG1 subclass.(ABSTRACT TRUNCATED AT 250 WORDS)

Vaccination with inactivated influenza A virus during pregnancy protects neonatal mice against lethal challenge by influenza A viruses representing three subtypes.

A single intraperitoneal injection of pregnant mice with a monovalent Formalin-inactivated influenza A virus vaccine protected their offspring against a lethal challenge dose of the same influenza A virus H3N2, H2N2, and H1N1 subtypes, as well as against challenge with the other two subtypes. Degree of protection was vaccine dose related. Cross-fostering of neonates indicated that protection was conferred by breast milk antibodies. Serum virus-specific neutralizing antibodies in the mothers and neonates correlated with resistance to vaccine virus, but were detected against other subtypes only in a complement enhancement test or when high doses of vaccine were given.

Muramyl peptides and polyinosinic-polycytodylic acid given to mice prior to influenza virus challenge reduces pulmonary disease and mortality.

Muramyl dipeptide (MDP), murabutide (a derivative of MDP), mouse alpha-interferon (MoIFN), and polyinosinic-polycytodylic acid (poly (I-C) were tested in a mouse-influenza virus model for anti-influenza virus activity. None of these compounds administered alone prior to virus challenge had more than minimal ability to protect mice from influenza virus infection. In contrast, mice given either MDP or murabutide 2 days prior to challenge with influenza A/Hong Kong/68 virus and poly I-C 1 day prior to virus challenge had significantly reduced pulmonary virus titers and mortality compared to comparably challenged control mice. No significant reductions in pulmonary virus titers or mortality were seen if MoIFN was given in place of poly I-C in this sequence.

Cold recombinant influenza B/Texas/1/84 vaccine virus (CRB 87): attenuation, immunogenicity, and efficacy against homotypic challenge.

Healthy susceptible young adults were inoculated intranasally with increasing doses of wild-type influenza B/Texas/1/84, or the cold-adapted vaccine possessing the genes specifying the hemagglutinin and neuraminidase of the wild-type parent and the six internal genes of cold adapted B/Ann Arbor/1/66 (CRB 87). Most volunteers inoculated with 10(6.6)-10(7.6) TCID50 of CRB 87 were infected, but a high frequency of serum antibody responses was seen only at the highest dose (17/29; 59%). The dose of CRB 87 necessary to infect 50% of all human volunteers (1 HID50) was approximately 10(5.4) TCID50. All volunteers given 10(3.9)-10(7.1) TCID50 of the wild-type virus were infected (i.e., 1 HID50 was less than 10(3.9) TCID50). The frequency of mild febrile reactions, mean peak titer of virus in respiratory secretions, and duration of virus shedding were significantly greater in volunteers given 10(7.1) TCID50 of wild-type virus than in those given 10(7.6) TCID50 of CRB 87. Thirteen volunteers were rechallenged with a second 10(7.6) TCID50 dose of CRB 87 3-4 months after vaccination. The frequencies of mild upper respiratory symptoms and signs, virus shedding, and infection were significantly reduced in prior vaccinees compared with volunteers inoculated with a similar dose for the first time. These data suggest that CRB 87 is attenuated, immunogenic, and can confer protection against homotypic virus challenge in this susceptible population.

Influenza virus infection and bacterial clearance in young adult and aged mice.

The effects of influenza A/Hong Kong/68 (H3N2) virus infection on clearance of bacteria (Staphylococcus aureus or Serratia marcescens) from lungs of young adult (8-week-old) and aged (2-year-old) CBA/2N mice were studied. No consistent differences in pulmonary bacterial clearance were observed in uninfected animals of either age group. However, both young and aged virus-infected mice consistently exhibited significantly reduced ability to clear challenge bacteria from their lungs compared to age-matched nonvirus-infected controls; this deficit was markedly more pronounced in virus-infected aged mice. The extra deficit seen in virus-infected aged animals did not correlate with pulmonary virus or interferon titers, or with severity of pulmonary histopathology. Moreover, the phagocytic and bactericidal activities of pulmonary macrophages and polymorphonuclear neutrophiles from virus-infected young and aged mice were comparable.

Liposomes of enviroxime and phosphatidylcholine: definition of the drug-phospholipid interactions.

Interaction of the antiviral compound, enviroxime (E), with natural and synthetic phosphatidylcholines in organic and aqueous media was studied. Although insoluble in chloroform, E dissolved in chloroform solutions containing phosphatidylcholines. Solvation was directly related to the length of the fatty acid chains of the phospholipid. Proton spin resonance studies suggested an interaction of the fatty acid chains with the aromatic rings of E. Suspension of E-phosphatidylcholine mixtures of molar ratios up to 0.7:1.0 in aqueous media resulted in the formation of multilamellar liposomes. Liposomes containing E were more stable permeability barriers than those prepared with phospholipid alone, a property previously observed with cholesterol. Competition experiments suggested that E bound to the same sites in lipid bilayers as does cholesterol. These data indicate that E is incorporated into lipid bilayers of liposomes and that it alters the physical properties of the liposomes in a manner similar to that of cholesterol.

Human monoclonal antibodies to influenza virus: IgG subclass and light chain distribution.

Three adults and three children were immunized with inactivated or live attenuated influenza vaccines and 98 IgG monoclonal antibodies derived from EBV immortalization of their blood lymphocytes were studied. All antibodies reacted specifically with influenza A H3N2 or H1N1 whole virus and 73 of 74 tested reacted with the purified HA glycoproteins. The majority (76%) of 77 monoclonal antibodies adequately tested by ELISA or solid phase RIA contained lambda light chains. ELISA analysis of the IgG subclass of the six persons' postimmunization anti-influenza serum activity and of monoclonal antibodies derived from them showed a similar predominance of IgG1.

Small particle aerosols of enviroxime-containing liposomes.

Enviroxime inhibits the replication of all rhinoviruses tested in vitro at very low concentrations (10-100 ng/ml), but evaluations in humans have not consistently shown efficacy. Lack of an appropriate method for administering this water-insoluble drug may have contributed to the latter result. The present report describes the characteristics and utilization of small particle aerosols to continuously deliver enviroxime-containing liposomes (LE) throughout the respiratory tract. The enviroxime content of liposomes and biological fluids of exposed individuals was quantified by high performance liquid chromatography using C18 resin, a mobile phase of 60:40 acetonitrile:water, and monitoring at 215 nm. Small particle aerosols of LE generated by Puritan-Bennett nebulizers had mass median diameters ranging from 2.4 to 3.1 microns. The concentration of enviroxime in aerosol particles was proportional to the reservoir concentration; during the first hour of operation, the mean concentration was 20 micrograms of enviroxime/l of aerosol. Liposome particles in the reservoir, although initially heterogeneous in size (less than 0.1 to greater than 1 micron), were processed by passage through the nebulizer to smaller, more homogeneous particles; the majority were less than 0.2 micron. In a preliminary study to evaluate short term tolerance and toxicity, five volunteers were exposed to small particle aerosol of LE for 1 h. At 1 h post-treatment, large amounts of enviroxime were still present in the nasal wash as determined both by HPLC and biological assay. Enviroxime was not detected in any urine sample and was detected in only 1 of 5 serum samples. No side effects were noted. This data suggest that liposome aerosols offer a method for the delivery of hydrophobic compounds for the treatment of respiratory diseases.

Activity against rhinoviruses, toxicity, and delivery in aerosol of enviroxime in liposomes.

Enviroxime has been shown to inhibit the replication of rhinoviruses and other enteroviruses in concentrations as low as nanograms per milliliter in in vitro assays but is markedly less effective in clinical trials. The marked hydrophobicity and water insolubility of this compound may be a factor for this disparity. To overcome this handicap, we incorporated enviroxime into liposomes and then tested the antirhinovirus activity and toxicity of the liposome-incorporated enviroxime (LE) in cell culture and studied its administration by small-particle aerosol. Free enviroxime and LE were found to have equivalent efficacies against rhinovirus strains 1A and 13 in in vitro assays; however, preparations of LE were 10- to greater than or equal to 50-fold less toxic to tissue culture cells than was free enviroxime. In contrast to free enviroxime, which could not be delivered by small-particle aerosol because of its water insolubility, LE (4 mg/ml) was readily and successfully delivered by small-particle aerosol to the upper and lower respiratory tracts of mice; after just 20 min, significant levels of enviroxime were detected in the lungs and noses of exposed mice. Moreover, mice exposed to aerosols of liposomes containing both enviroxime and fluorescein isothiophosphatidylethanolamine showed accumulations of the fluorescent marker in the lungs, particularly in or around the tall columnar epithelial cells lining the bronchi and bronchioles.

Immunogenicity and efficacy of orally administered inactivated influenza virus vaccine in mice.

The immunogenicity and protective efficacy of formalin-inactivated whole influenza A/Bangkok/79 virus vaccine given to unprimed Swiss mice orally in capsules, in their drinking water, or by direct injection into the duodenum were studied. Virus-specific IgG and IgA antibody responses to all these methods were dose-dependent and varied according to immunization conditions. Following intranasal challenge with live A/Bangkok influenza virus, mice given greater than or equal to 66 micrograms haemagglutinin (HA) of vaccine in drinking water or capsules, and mice injected into the duodenum with greater than or equal to 0.66 microgram HA, had significantly lower virus titres in their noses and lungs than control mice comparably inoculated.

Epidemiologic characteristics of cytomegalovirus infection in mothers and their infants.

In this longitudinal study of cytomegalovirus in 4578 pregnant women of middle/upper socioeconomic status in Houston, 52% had cytomegalovirus antibody when enrolled, and 48% were serologically susceptible. Studies were completed on 3899 mothers and their infants; 2.2% of these women experienced primary cytomegalovirus during pregnancy and 24% of those with primary infection transmitted cytomegalovirus to their infants. Of 22 cytomegalovirus-infected infants, 2 had disease at birth and 20 were asymptomatic. One symptomatic infant (primary maternal infection) has developmental delay. The other (immunocompromised mother with cytomegalovirus antibody before pregnancy) had hepatitis but has no symptoms at 1 year of age. On follow-up, 4 of 16 infants asymptomatic at birth have sequelae (hearing loss in 3, developmental delay in 1). All four were born to mothers with primary cytomegalovirus infection. Infant outcome was not related to trimester of maternal infection.

Immunoglobulin G subclass antibody responses of mice to influenza virus antigens given in different forms.

Total IgG and IgG subclass antibody responses in mice were studied after infection with virulent and non-virulent influenza viruses, and after vaccination with inactivated whole virus or purified surface glycoproteins (HANA-flu). Infection induced high IgG2a, low IgG1 and IgG2b, and very low IgG3 levels of antibody in serum. Whole virus vaccine induced high IgG2a, moderate IgG2b, and very low IgG1 and IgG3 levels of antibody. In marked contrast, HANA-flu preparations induced high IgG1, low IgG2a, and very low IgG2b and IgG3 levels of antibody. Booster doses of whole virus and HANA-flu significantly elevated serum antibody levels, but the relative distribution of anti-influenzal antibody among the IgG subclasses was unchanged. Mice primed with HANA-flu prior to infection with mouse-adapted virus, produced high IgG2a, moderate IgG1, and low IgG2b and IgG3 levels of serum antibody. These data indicate that the physical form in which viral protein antigens are presented to the immune system can influence the subclass distribution of antibodies produced during primary immune responses and that once priming has occurred, responses to antigen presented in a different form are altered.

Pulmonary and serum isotypic antibody responses of mice to live and inactivated influenza virus.

Primary and secondary immunoglobulin class-specific antibody responses in serum and pulmonary lavage fluids of mice were studied after respiratory infection and intramuscular vaccination with influenza virus. Infection and vaccination with inactivated virus vaccine induced primary IgM and IgG antibody responses in the serum and pulmonary lavage fluids (PLF). Neither immunizing method induced detectable serum IgA antibodies, and only infection generated IgA antibodies in PLF. The major portion of antibodies in PLF was derived from serum, but local synthesis of IgG and IgA antibodies was detected after virus infection. Vaccination of infection-primed mice boosted the IgM and IgG antibody concentrations in serum and PLF but had no effect on IgA antibody concentrations. Nonlethal infection of vaccine-primed mice generated secondary IgM and IgG antibody responses in serum and PLF and an IgA antibody response in PLF. Again, most of the antibody detected in PLF was derived from serum, but low concentrations of IgA and IgG were synthesized locally after infection. Although mice immunized with inactivated vaccine lacked the capacity to synthesize IgA antibody, they were protected from severe pulmonary disease when challenged with lethal influenza virus. These data support the concept that serum IgG antibodies are sufficient for prevention of severe pulmonary disease.