Pandemic influenza: its origin and control

A "new" influenza virus will appear at some time in the future. This virus will arise by natural processes, which we do not fully understand, or it might be created by some bioterrorist. The world's population will have no immunity to the new virus, which will spread like wild-fire, causing much misery, economic disruption and many deaths. Vaccines will take time to develop and the only means of control, at least in the early stages of the epidemic, are anti-viral drugs, of which the neuraminidase inhibitors currently seem the most effective.     

The role of health care workers and antiviral drugs in the control of pandemic influenza

Until a vaccine against the new strain becomes available, the response to newly emerged pandemic influenza will consist of the use of antiviral drugs and measures that limit exposure to infectious individuals. These first-line defence measures include isolating cases upon diagnosis, reducing close contacts, the use of personal protective equipment and hygiene, and using antiviral drugs for treatment and prophylaxis. There are significant 'costs' associated with control measures, so to justify such interventions it is important to assess their potential to reduce transmission. In this paper, we determine the effect that a number of different antiviral interventions have on the reproduction number of infectives and the probability that an imported infection fades out, and determine parameter scenarios for which these interventions are able to eliminate an emerging pandemic of influenza. We also assess the role that health care workers play in transmission and the extent to which providing them with antiviral prophylaxis and personal protective equipment modifies this role. Our results indicate that this class requires protection to avoid a greatly disproportionate contribution to early infective numbers, and for the maintenance of a stable health care system. Further, we show that the role children play in increasing transmission is moderate, in spite of closer mixing with other children.     

Carbohydrate based meningococcal vaccines: past and present overview

Glycoconjugate Journal - Neisseria meningitidis is a major cause of bacterial meningitidis worldwide. Children less than five years and adolescents are particularly affected. Nearly all invasive...     

Susceptibility of antiviral drugs against 2009 influenza A (H1N1) virus

The recent outbreak of the novel strain of influenza A (H1N1) virus has raised a global concern of the future risk of a pandemic. To understand at the molecular level how this new H1N1 virus can be inhibited by the current anti-influenza drugs and which of these drugs it is likely to already be resistant to, homology modeling and MD simulations have been applied on the H1N1 neuraminidase complexed with oseltamivir, and the M2-channel with adamantanes bound. The H1N1 virus was predicted to be susceptible to oseltamivir, with all important interactions with the binding residues being well conserved. In contrast, adamantanes are not predicted to be able to inhibit the M2 function and have completely lost their binding with the M2 residues. This is mainly due to the fact that the M2 transmembrane of the new H1N1 strain contains the S31N mutation which is known to confer resistance to adamantanes.     

Liposomes for drugs and vaccines

Application of drugs in therapeutic and preventive medicine is marred by indiscriminate drug action and inability of drugs to reach areas in need of treatment. On the other hand, development of new, more selective drugs is very expensive, lengthy and often uncertain. Recently, much attention has been given to an alternative approach, namely the use of drug delivery systems which are expected to optimize the action of drugs already in existence. One of the more promising systems is liposomes, microscopic spheres made of natural materials (lipids) and able to accommodate large amounts of drug. Fifteen years of liposome research have produced a great deal of knowledge of how the carrier interacts with the biological milieu. In turn, such knowledge has helped us to optimize liposomal drug action in situations as diverse as cancer and microbial therapy, vaccines, oral therapy and medical diagnostics. Some of these applications, especially those involving the phagocytic cells (e.g. antimicrobial therapy and vaccines) seem realistic enough to warrant extensive support from industry.     

Research and development of universal influenza vaccines

The continuous threat of influenza pandemics determines the urgency and necessity to develop safe and effective vaccines against divergent influenza viruses. This review describes the advancements in the research and development of universal influenza vaccines based on the relatively conserved sequences of M2e, HA, and other proteins of influenza viruses.     

Soluble recombinant influenza vaccines.

Soluble, recombinant forms of influenza A virus haemagglutinin and neuraminidase have been produced in cells of lower eukaryotes, and shown in a mouse model to induce complete protective immunity against a lethal virus challenge. Soluble neuraminidase, produced in a baculovirus system, consisted of tetramers, dimers and monomers. Only the tetramers were enzymatically active. The immunogenicity decreased very considerably in the order tetra > di > mono. Therefore, we fused the head part of the neuraminidase gene to a tetramerizing leucine zipper sequence; the resulting product was enzymatically active, tetrameric neuraminidase. The protective immunity induced by this engineered neuraminidase, however, remained fairly strain-specific. A third influenza A virus protein, the M2 protein, has only 23 amino acids exposed on the outer membrane surface. This extracellular part, M2e, has been remarkably conserved in all human influenza A strains since 1933. By fusing the M2e sequence to hepatitis B virus core protein, we could obtain highly immunogenic particles that induced complete, strain-independent, long-lasting protection in mice against a lethal viral challenge. Native M2 is a tetrameric protein and this conformation of the M2e part can also be mimicked by fusing this sequence to a tetramerizing leucine zipper. The potential of the resulting protein as a vaccine candidate remains to be evaluated.     

Development of mucosal influenza inactivated vaccines

In this review recent data on the development of mucosal influenza inactivated vaccines with the use of mucosoadhesive adjuvants are presented. After the intranasal administration of such vaccines the formation of not only systemic, but also local immunity (IgA antibodies), as well as cross protection against the variants of influenza virus within its serotype, can be observed. Some mucosal influenza vaccines have passed clinical tests. Certain drawbacks of Escherichia thermolabile enterotoxin, used as mucosoadhesive adjuvant, and difficulties which may arise in mass immunization with mucosal vaccines due to the necessity of introducing them in two or three intranasal administrations are indicated.     

An overview of influenza haemagglutinin and neuraminidase

This is an overview of the structures of influenza virus haemagglutinin and neuraminidase membrane glycoproteins with particular reference to antibody recognition and antigenic variation.     

Problem of influenza prophylaxis by vaccines

Scientific data is presented and problems of influenza prophylaxis in various age groups are discussed. Influenza prophylaxis in neonates is possible by inducing maternal antibodies, this dictates the necessity of influenza vaccination in pregnancy. Problems of influenza prophylaxis are most pressing in the group of children from 6 months to 2 years of age. More effective vaccines that do not cause adverse reactions are necessary for the children of this age group. Influenza prophylaxis in healthy working adults is most important for reducing economical impact during influenza epidemics. Influenza prophylaxis in the elderly is reasonable by using novel and more effective vaccines with adjuvants. The optimal method for influenza prophylaxis in the population in general is mass vaccination of children (80%), when, besides the induction of protection in children, influenza morbidity may decrease up to 80% in the other age groups of unvaccinated population.