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Administration of Vaccines: Current Process, New Technologies and Adjuvants

  • Giuseppe Del GiudiceEmail author
  • Alberta Di Pasquale
Chapter
Part of the Practical Issues in Geriatrics book series (PIG)

Abstract

Vaccine formulations and administration have travelled a long path since the first vaccines were developed. Progress in pharmaceutical science has taught us a lot about tailoring vaccine formulations and routes for administration in order to obtain effective immune responses. Indeed, there is an age-related decline in immune function that impairs the response to infection and vaccination in older adults. Therefore, specialized solutions are warranted to achieve better vaccine immunogenicity and efficacy among these populations. Vaccine coverage is also suboptimal, meaning that target groups may not be sufficiently well protected. High coverage is essential to maintain health in the population, and there is value in using even those vaccines that appear less than optimal since the impact of vaccination is substantial in terms of death and hospitalization avoided. Strategies to enhance immunization performed are discussed here, including achieving high coverage, development of new formulations with higher antigen content or alternative delivery routes or adjuvants. New technologies are revolutionizing the field of vaccine development; their ability to make possible new and more effective vaccines will further increase benefits of vaccinations in the years to come.

Keywords

Vaccine Administration Coverage Adjuvants 

Notes

Acknowledgements

This work was sponsored by GlaxoSmithKline Biologicals SA. Giuseppe Del Giudice and Alberta Di Pasquale are employees of the GSK Group of Companies.

References

  1. 1.
    World Health Organization. Global and regional immunization profile: European region. 2017. http://www.who.int/immunization/monitoring_surveillance/data/gs_eurprofile.pdf?ua=1. Accessed 24 June 2018.
  2. 2.
    Goodwin K, Viboud C, Simonsen L. Antibody response to influenza vaccination in the elderly: a quantitative review. Vaccine. 2006;24(8):1159–69.CrossRefGoogle Scholar
  3. 3.
    Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson LA. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect Dis. 2007;7(10):658–66.CrossRefGoogle Scholar
  4. 4.
    Kang I, Hong MS, Nolasco H, Park SH, Dan JM, Choi JY, et al. Age-associated change in the frequency of memory CD4+ T cells impairs long term CD4+ T cell responses to influenza vaccine. J Immunol. 2004;173(1):673–81.CrossRefGoogle Scholar
  5. 5.
    Rosenberg C, Bovin NV, Bram LV, Flyvbjerg E, Erlandsen M, Vorup-Jensen T, et al. Age is an important determinant in humoral and T cell responses to immunization with hepatitis B surface antigen. Hum Vaccin Immunother. 2013;9(7):1466–76.CrossRefGoogle Scholar
  6. 6.
    Schenkein JG, Park S, Nahm MH. Pneumococcal vaccination in older adults induces antibodies with low opsonic capacity and reduced antibody potency. Vaccine. 2008;26(43):5521–6.CrossRefGoogle Scholar
  7. 7.
    Williams WW, Lu PJ, O’Halloran A, Kim DK, Grohskopf LA, Pilishvili T, et al. Surveillance of vaccination coverage among adult populations—United States, 2014. MMWR Surveill Summ. 2016;65(1):1–36.CrossRefGoogle Scholar
  8. 8.
    Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(1):36–44.CrossRefGoogle Scholar
  9. 9.
    McElhaney JE. Influenza vaccination in the elderly: seeking new correlates of protection and improved vaccines. Aging Health. 2008;4(6):603–13.CrossRefGoogle Scholar
  10. 10.
    Istituto Superiore di Sanita. Seasonal influenza 2014–2015. Epidemiological surveillance. 2015. http://old.iss.it/binary/iflu/cont/Influnet_stagione_2014_2015.pdf. Accessed 15 Aug 2018.
  11. 11.
    Gangarosa EJ, Galazka AM, Wolfe CR, Phillips LM, Gangarosa RE, Miller E, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet. 1998;351(9099):356–61.CrossRefGoogle Scholar
  12. 12.
    Romanus V, Jonsell R, Bergquist SO. Pertussis in Sweden after the cessation of general immunization in 1979. Pediatr Infect Dis J. 1987;6(4):364–71.CrossRefGoogle Scholar
  13. 13.
    Galazka A. Control of pertussis in the world. World Health Stat Q. 1992;45(2–3):238–47.PubMedGoogle Scholar
  14. 14.
    Filia A, Bella A, Del Manso M, Baggieri M, Magurano F, Rota MC. Ongoing outbreak with well over 4,000 measles cases in Italy from January to end August 2017—what is making elimination so difficult? Euro Surveill. 2017;22(37):30614.CrossRefGoogle Scholar
  15. 15.
    Halloran ME, Longini IM Jr. Public health. Community studies for vaccinating schoolchildren against influenza. Science. 2006;311(5761):615–6.CrossRefGoogle Scholar
  16. 16.
    Charu V, Viboud C, Simonsen L, Sturm-Ramirez K, Shinjoh M, Chowell G, et al. Influenza-related mortality trends in Japanese and American seniors: evidence for the indirect mortality benefits of vaccinating schoolchildren. PLoS One. 2011;6(11):e26282.CrossRefGoogle Scholar
  17. 17.
    Bragazzi NL, Orsi A, Ansaldi F, Gasparini R, Icardi G. Fluzone(R) intra-dermal (Intanza(R)/Istivac(R) Intra-dermal): an updated overview. Hum Vaccin Immunother. 2016;12(10):2616–27.CrossRefGoogle Scholar
  18. 18.
    Robertson CA, Tsang P, Landolfi VA, Greenberg DP. Fluzone(R) Intradermal Quadrivalent Influenza Vaccine. Expert Rev Vaccines. 2016;15(10):1245–53.CrossRefGoogle Scholar
  19. 19.
    Parikh SR, Andrews NJ, Beebeejaun K, Campbell H, Ribeiro S, Ward C, et al. Effectiveness and impact of a reduced infant schedule of 4CMenB vaccine against group B meningococcal disease in England: a national observational cohort study. Lancet. 2016;388(10061):2775–82.CrossRefGoogle Scholar
  20. 20.
    Shrestha SS, Swerdlow DL, Borse RH, Prabhu VS, Finelli L, Atkins CY, et al. Estimating the burden of 2009 pandemic influenza A (H1N1) in the United States (April 2009–April 2010). Clin Infect Dis. 2011;52(Suppl 1):S75–82.CrossRefGoogle Scholar
  21. 21.
    Tizzoni M, Bajardi P, Poletto C, Ramasco JJ, Balcan D, Goncalves B, et al. Real-time numerical forecast of global epidemic spreading: case study of 2009 A/H1N1pdm. BMC Med. 2012;10:165.CrossRefGoogle Scholar
  22. 22.
    Bart SA, Hohenboken M, Della Cioppa G, Narasimhan V, Dormitzer PR, Kanesa-Thasan N. A cell culture-derived MF59-adjuvanted pandemic A/H7N9 vaccine is immunogenic in adults. Sci Transl Med. 2014;6(234):234ra55.CrossRefGoogle Scholar
  23. 23.
    Dormitzer PR, Suphaphiphat P, Gibson DG, Wentworth DE, Stockwell TB, Algire MA, et al. Synthetic generation of influenza vaccine viruses for rapid response to pandemics. Sci Transl Med. 2013;5(185):185ra68.CrossRefGoogle Scholar
  24. 24.
    Galli G, Hancock K, Hoschler K, DeVos J, Praus M, Bardelli M, et al. Fast rise of broadly cross-reactive antibodies after boosting long-lived human memory B cells primed by an MF59 adjuvanted prepandemic vaccine. Proc Natl Acad Sci U S A. 2009;106(19):7962–7.CrossRefGoogle Scholar
  25. 25.
    Galli G, Medini D, Borgogni E, Zedda L, Bardelli M, Malzone C, et al. Adjuvanted H5N1 vaccine induces early CD4+ T cell response that predicts long-term persistence of protective antibody levels. Proc Natl Acad Sci U S A. 2009;106(10):3877–82.CrossRefGoogle Scholar
  26. 26.
    Leroux-Roels G, Bourguignon P, Willekens J, Janssens M, Clement F, Didierlaurent AM, et al. Immunogenicity and safety of a booster dose of an investigational adjuvanted polyprotein HIV-1 vaccine in healthy adults and effect of administration of chloroquine. Clin Vaccine Immunol. 2014;21(3):302–11.CrossRefGoogle Scholar
  27. 27.
    Leroux-Roels G, Van Belle P, Vandepapeliere P, Horsmans Y, Janssens M, Carletti I, et al. Vaccine Adjuvant Systems containing monophosphoryl lipid A and QS-21 induce strong humoral and cellular immune responses against hepatitis B surface antigen which persist for at least 4 years after vaccination. Vaccine. 2015;33(8):1084–91.CrossRefGoogle Scholar
  28. 28.
    Leroux-Roels I, Devaster JM, Leroux-Roels G, Verlant V, Henckaerts I, Moris P, et al. Adjuvant system AS02V enhances humoral and cellular immune responses to pneumococcal protein PhtD vaccine in healthy young and older adults: randomised, controlled trials. Vaccine. 2015;33(4):577–84.CrossRefGoogle Scholar
  29. 29.
    Baras B, Stittelaar KJ, Simon JH, Thoolen RJ, Mossman SP, Pistoor FH, et al. Cross-protection against lethal H5N1 challenge in ferrets with an adjuvanted pandemic influenza vaccine. PLoS One. 2008;3(1):e1401.CrossRefGoogle Scholar
  30. 30.
    Leroux-Roels I, Borkowski A, Vanwolleghem T, Drame M, Clement F, Hons E, et al. Antigen sparing and cross-reactive immunity with an adjuvanted rH5N1 prototype pandemic influenza vaccine: a randomised controlled trial. Lancet. 2007;370(9587):580–9.CrossRefGoogle Scholar
  31. 31.
    Nolan T, Roy-Ghanta S, Montellano M, Weckx L, Ulloa-Gutierrez R, Lazcano-Ponce E, et al. Relative efficacy of AS03-adjuvanted pandemic influenza A(H1N1) vaccine in children: results of a controlled, randomized efficacy trial. J Infect Dis. 2014;210(4):545–57.CrossRefGoogle Scholar
  32. 32.
    Khurana S, Verma N, Yewdell JW, Hilbert AK, Castellino F, Lattanzi M, et al. MF59 adjuvant enhances diversity and affinity of antibody-mediated immune response to pandemic influenza vaccines. Sci Transl Med. 2011;3(85):85ra48.CrossRefGoogle Scholar
  33. 33.
    van der Most RG, Roman FP, Innis B, Hanon E, Vaughn DW, Gillard P, et al. Seeking help: B cells adapting to flu variability. Sci Transl Med. 2014;6(246):246ps8.CrossRefGoogle Scholar
  34. 34.
    Einstein MH, Baron M, Levin MJ, Chatterjee A, Fox B, Scholar S, et al. Comparison of the immunogenicity of the human papillomavirus (HPV)-16/18 vaccine and the HPV-6/11/16/18 vaccine for oncogenic non-vaccine types HPV-31 and HPV-45 in healthy women aged 18–45 years. Hum Vaccin. 2011;7(12):1359–73.CrossRefGoogle Scholar
  35. 35.
    Einstein MH, Baron M, Levin MJ, Chatterjee A, Fox B, Scholar S, et al. Comparative immunogenicity and safety of human papillomavirus (HPV)-16/18 vaccine and HPV-6/11/16/18 vaccine: follow-up from months 12–24 in a Phase III randomized study of healthy women aged 18–45 years. Hum Vaccin. 2011;7(12):1343–58.CrossRefGoogle Scholar
  36. 36.
    Moris P, van der Most R, Leroux-Roels I, Clement F, Drame M, Hanon E, et al. H5N1 influenza vaccine formulated with AS03 A induces strong cross-reactive and polyfunctional CD4 T-cell responses. J Clin Immunol. 2011;31(3):443–54.CrossRefGoogle Scholar
  37. 37.
    Vesikari T, Knuf M, Wutzler P, Karvonen A, Kieninger-Baum D, Schmitt HJ, et al. Oil-in-water emulsion adjuvant with influenza vaccine in young children. N Engl J Med. 2011;365(15):1406–16.CrossRefGoogle Scholar
  38. 38.
    Mannino S, Villa M, Apolone G, Weiss NS, Groth N, Aquino I, et al. Effectiveness of adjuvanted influenza vaccination in elderly subjects in northern Italy. Am J Epidemiol. 2012;176(6):527–33.CrossRefGoogle Scholar
  39. 39.
    Berarducci B, Ikoma M, Stamatis S, Sommer M, Grose C, Arvin AM. Essential functions of the unique N-terminal region of the varicella-zoster virus glycoprotein E ectodomain in viral replication and in the pathogenesis of skin infection. J Virol. 2006;80(19):9481–96.CrossRefGoogle Scholar
  40. 40.
    Berarducci B, Rajamani J, Reichelt M, Sommer M, Zerboni L, Arvin AM. Deletion of the first cysteine-rich region of the varicella-zoster virus glycoprotein E ectodomain abolishes the gE and gI interaction and differentially affects cell-cell spread and viral entry. J Virol. 2009;83(1):228–40.CrossRefGoogle Scholar
  41. 41.
    Malavige GN, Jones L, Black AP, Ogg GS. Varicella zoster virus glycoprotein E-specific CD4+ T cells show evidence of recent activation and effector differentiation, consistent with frequent exposure to replicative cycle antigens in healthy immune donors. Clin Exp Immunol. 2008;152(3):522–31.CrossRefGoogle Scholar
  42. 42.
    Coccia M, Collignon C, Herve C, Chalon A, Welsby I, Detienne S, et al. Cellular and molecular synergy in AS01-adjuvanted vaccines results in an early IFNgamma response promoting vaccine immunogenicity. NPJ Vaccines. 2017;2:25.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.GSKSienaItaly
  2. 2.GSKWavreBelgium

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