Division of Cellular and Gene Therapies, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland.
Am J Epidemiol. 2018 Dec 1;187(12):2603-2614. doi: 10.1093/aje/kwy145.
Despite all we have learned since 1918 about influenza virus and immunity, available influenza vaccines remain inadequate to control outbreaks of unexpected strains. Universal vaccines not requiring strain matching would be a major improvement. Their composition would be independent of predicting circulating viruses and thus potentially effective against unexpected drift or pandemic strains. This commentary explores progress with candidate universal vaccines based on various target antigens. Candidates include vaccines based on conserved viral proteins such as nucleoprotein and matrix, on the conserved hemagglutinin (HA) stem, and various combinations. Discussion covers the differing evidence for each candidate vaccine demonstrating protection in animals against influenza viruses of widely divergent HA subtypes and groups; durability of protection; routes of administration, including mucosal, providing local immunity; and reduction of transmission. Human trials of some candidate universal vaccines have been completed or are underway. Interestingly, the HA stem, like nucleoprotein and matrix, induces immunity that permits some virus replication and emergence of escape mutants fit enough to cause disease. Vaccination with multiple target antigens will thus have advantages over use of single antigens. Ultimately, a universal vaccine providing long-term protection against all influenza virus strains might contribute to pandemic control and routine vaccination.
尽管自 1918 年以来,我们已经对流感病毒和免疫有了很多了解,但现有的流感疫苗仍然不足以控制意外出现的病毒株的爆发。不需要匹配病毒株的通用疫苗将是一个重大的改进。它们的组成将不依赖于预测流行的病毒,因此有可能对意外的漂移或大流行病毒株有效。本评论探讨了基于各种靶抗原的候选通用疫苗的进展。候选疫苗包括基于保守的病毒蛋白(如核蛋白和基质)、保守的血凝素(HA)茎以及各种组合的疫苗。讨论涵盖了每个候选疫苗在动物中针对具有广泛不同 HA 亚型和组的流感病毒的保护作用的不同证据;保护的持久性;包括粘膜在内的给药途径,提供局部免疫;以及减少传播。一些候选通用疫苗的人体试验已经完成或正在进行中。有趣的是,HA 茎与核蛋白和基质一样,诱导的免疫可以允许一些病毒复制,并出现足够适应引起疾病的逃逸突变体。因此,使用多种靶抗原进行疫苗接种将优于使用单一抗原。最终,一种提供针对所有流感病毒株的长期保护的通用疫苗可能有助于控制大流行和常规接种。
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