Influenza Vaccine Composition For 2020-21
The WHO recommendation on vaccine composition is based on the year-round activity of the WHO Global Influenza Surveillance and Response System (GISRS). From September 2019 to January 2020 GISRS reported that the influenza A(H1N1)pdm09, A(H3N2), and both lineages of influenza B viruses are co-circulating among peoples (February et al. 2017).
Based on WHOs recommendations the quadrivalent vaccines for use in the 2020 – 2021 northern hemisphere influenza season contain the following:
Egg-based Vaccines
- an A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus;
- an A/Hong Kong/2671/2019 (H3N2)-like virus;
- a B/Washington/02/2019 (B/Victoria lineage)-like virus; and
- a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.
Cell or recombinant-based Vaccines
- an A/Hawaii/70/2019 (H1N1)pdm09-like virus;
- an A/Hong Kong/45/2019 (H3N2)-like virus;
- a B/Washington/02/2019 (B/Victoria lineage)-like virus; and
- a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.
Based on WHOs recommendations the trivalent influenza vaccines for use in the 2020 – 2021 northern hemisphere influenza season contain the following:
Egg-based Vaccines
- an A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus;
- an A/Hong Kong/2671/2019 (H3N2)-like virus; and
- a B/Washington/02/2019 (B/Victoria lineage)-like virus.
Cell or recombinant based Vaccines
- an A/Hawaii/70/2019 (H1N1)pdm09-like virus;
- an A/Hong Kong/45/2019 (H3N2)-like virus; and
- a B/Washington/02/2019 (B/Victoria lineage)-like virus (Asia and Asia 2018)
Based on WHOs recommendations the quadrivalent vaccines for use in the 2020 southern hemisphere influenza season contain the following:
- an A/Brisbane/02/2018 (H1N1)pdm09-like virus;
- an A/South Australia/34/2019 (H3N2)-like virus;
- a B/Washington/02/2019-like (B/Victoria lineage) virus; and
- a B/Phuket/3073/2013-like (B/Yamagata lineage) virus.
Based on WHOs recommendations the trivalent influenza vaccines for use in the 2020 southern hemisphere influenza season contain the following:
- an A/Brisbane/02/2018 (H1N1)pdm09-like virus;
- an A/South Australia/34/2019 (H3N2)-like virus; and
- a B/Washington/02/2019-like (B/Victoria lineage) virus.
Type of Adjuvants use
An adjuvant is an ingredient used in some vaccines that helps create a stronger immune response in people receiving the vaccine (Tregoning, Russell, and Kinnear 2018). Alum is the most common adjuvant used in influenza vaccines (Marrack, McKee, and Munks 2009). The other adjuvants are virosomes (Inflexal V), MF59 (FluAd), AS03 (Pandemrix) also used (Garçon, Vaughn, and Didierlaurent 2012; Higgins, Carlson, and Van Nest 1996; Moser et al. 2013). AF03 was licensed as part of Humenza, but this product was never marketed. Some vaccines (killed or weakened virus) have naturally occurring adjuvants and help the body produce a strong protective immune response.
FLUAD is a standard-dose, trivalent inactivated flu vaccine, manufactured by Seqirus that contains the MF59 adjuvant. The MF59 is an oil-in-water emulsion containing squalene oil. It is manufactured using an egg-based process (like most flu vaccines) (Higgins, Carlson, and Van Nest 1996). AS03 is an oil-in-water adjuvant containing squalene, montane 80, and eumulgin b1 ph (Garçon, Vaughn, and Didierlaurent 2012). Inflexal V uses virosomes in its formulation. Virosomes also called liposomes are based on phospholipids (Moser et al. 2013).
The Possible Side Effect of Influenza Vaccine
In general, adjuvanted vaccines can cause local site symptoms (such as redness, swelling, and pain at the injection site) and more systemic reactions (such as fever, chills, and body aches) than non-adjuvanted vaccines.
AS03 adjuvanted H5N1 vaccine enhanced local and general symptoms like pain, fatigue, headache, and myalgia. According to the Vaccine Adverse Event Reporting System (VAERS), the seasonal influenza vaccines like trivalent inactivated influenza, quadrivalent inactivated influenza, live attenuated influenza-IIV, IIV3, IIV4, RIV3, ccIIV3, LAIV4 may produce anaphylaxis or anaphylactic shock (7 days), shoulder Injury related to vaccine administration (7 days), vasovagal syncope (7 days), Guillain-Barré Syndrome (42 days), any acute complication or sequelae (including death) of above events. (Stratton et al. 2012; VAERS – About Us n.d.).
Annual Selection of Vaccine Strain
If we want to make the conventional influenza vaccines to be maximally effective, then the vaccine viruses have to be antigenically matched to the influenza viruses circulating in humans. The most appropriate way to identify the vaccine strains is an extensive and complex global surveillance system that is coordinated by the World Health Organization (WHO) through its Global Influenza Surveillance and Response System (GISRS) network. This network comprises 6 WHO collaborating centres (CCs), 4 WHO essential regulatory laboratories, and 141 national influenza centres (NICs) in 111 of its member states (To et al. 2017). They updated the composition of influenza vaccines (both TIV and LAIV) every year.
The activities of WHO GISRS include the collection and analysis of influenza virus samples from around the world on a regular basis. Every year they collect more than 500,000 virological samples that screened at these NICs, of which approximately 8,000 samples are sent to the regional CCs for detailed genetic and antigenic analysis. There are about 3 types of data generated and used to assess the relationship between the circulating strains and vaccine components and hence inform vaccine strain selection (Wong and Webby 2013).
These data are interpreted and presented during strain selection meetings held twice a year before the start of the winter seasons for the northern (February) and southern (September) hemispheres. This forms the basis for the annual recommendation for vaccine strains. This recommendation needs to be made at least 6 months prior to the season. They are also working for other zoonotic diseases vaccine from 2004.
Every year, WHO changed one or more components of the vaccine designated for the coming influenza season in the northern and southern hemispheres to reflect the most frequent and recent circulating influenza A and B viruses found in their report (WHO/Europe | Types of seasonal influenza vaccine n.d.).
Production of Influenza Vaccine
Finally, once the viruses are selected for the new formulation, private manufacturers start to produce the vaccine. This usually takes almost 6 months for the production of influenza vaccine after submission of the report of WHO GISRS. The production is based on viral propagation in embryonated eggs, cell cultures, or by using recombinant technology. After production, the manufacture will test by a successful trial and then they will release and distribute the influenza vaccine to save the people.
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