Vaccines for seasonal and pandemic influenza
Vaccines for seasonal and pandemic influenza
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DOI：
10.1086/507544
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发表时间：
2006-11-01
影响因子：
6.4
通讯作者：
Treanor, John J.
中科院分区：
文献类型：
--
作者：
Nichol, Kristin L.;Treanor, John J.
季节性流感继续在美国产生巨大的年度影响，导致数千万人患病，数十万人过度住院，数万人过度死亡。预防流感的主要方法仍然是接种疫苗。在美国，目前有两种类型的流感疫苗获得许可：三价灭活流感疫苗和减毒活流感疫苗。两者在批准使用的人群中均安全有效。儿童、65岁以下的成年人和老年人都能从疫苗接种中获得实质性的健康益处。此外，在所有年龄段，接种疫苗似乎具有成本效益，即使不能节省成本。尽管长期以来一直建议对高优先群体的人进行常规疫苗接种，但美国所有年龄组的疫苗接种率仍然太低。需要解决的重要问题包括改进向现有和扩大的目标群体提供疫苗的工作，确保及时提供充足的疫苗供应，以及开发更有效的疫苗。开发针对潜在大流行毒株的疫苗是控制和预防大流行爆发战略的重要组成部分。利用现有的流感疫苗生产技术将是最直接的办法，因为这些技术是商业上可以获得的，而且许可证发放将相对简单。目前正在测试的方法包括亚病毒灭活疫苗和冷适应性减毒活疫苗。初步结果表明，对于某些大流行抗原，特别是H5，亚病毒体灭活疫苗的免疫原性较差，原因尚不清楚。大流行性流感活疫苗的评价数据尚待获得。旨在以较低剂量提供改善的免疫应答的第二代方法集中在佐剂上，如明矾和MF 59，目前已被许可用于流感或其他疫苗。需要更多的实验方法来实现季节性和大流行性流感预防的最终目标，即在人类中产生广泛交叉反应和持久保护的能力。
Seasonal influenza continues to have a huge annual impact in the United States, accounting for tens of millions of illnesses, hundreds of thousands of excess hospitalizations, and tens of thousands of excess deaths. Vaccination remains the mainstay for the prevention of influenza. In the United States, 2 types of influenza vaccine are currently licensed: trivalent inactivated influenza vaccine and live attenuated influenza vaccine. Both are safe and effective in the populations for which they are approved for use. Children, adults < 65 years of age, and the elderly all receive substantial health benefits from vaccination. In addition, vaccination appears to be cost-effective, if not cost saving, across the age spectrum. Despite long-standing recommendations for the routine vaccination of persons in high-priority groups, US vaccination rates remain too low across all age groups. Important issues to be addressed include improving vaccine delivery to current and expanded target groups, ensuring timely availability of adequate vaccine supply, and development of even more effective vaccines. Development of a vaccine against potentially pandemic strains is an essential part of the strategy to control and prevent a pandemic outbreak. The use of existing technologies for influenza vaccine production would be the most straightforward approach, because these technologies are commercially available and licensing would be relatively simple. Approaches currently being tested include subvirion inactivated vaccines and cold-adapted, live attenuated vaccines. Preliminary results have suggested that, for some pandemic antigens, particularly H5, subvirion inactivated vaccines are poorly immunogenic, for reasons that are not clear. Data from evaluation of live pandemic vaccines are pending. Second-generation approaches designed to provide improved immune responses at lower doses have focused on adjuvants such as alum and MF59, which are currently licensed for influenza or other vaccines. Additional experimental approaches are required to achieve the ultimate goal for seasonal and pandemic influenza prevention-namely, the ability to generate broadly cross-reactive and durable protection in humans.