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Published online 12 May 2009 | Nature | doi:10.1038/459144a
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Vaccine decisions loom for new flu strain
World Health Organization considers live attenuated vaccines for swine-associated H1N1 outbreak.
Faced with the prospect of an influenza pandemic, the World Health Organization (WHO) is weighing up its options for advising manufacturers and governments on developing vaccines. With current manufacturing capabilities, there will be enough vaccine for only a fraction of the world's population, and not before six months from now.
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the article states: "MedImmune's FluMist is approved for use in the United States for those aged 2-49 years old; older people have been exposed to past pandemic viruses, and their immune systems therefore kill the live vaccine for current circulating strains." I and my wife are 75. where would we find a list of the flu viruses our immune systems kill? We assume H1N1, being new, is not one of them.
We should initiate research into a modern epitope vaccine that do not carry the risk of reverting into the wild type virus and thereby further spreading the disease. This would also be easier from a regulatory point of view.
Unlike the subunit virus vaccines, which modestly boost circulating antibody responses (of which IgG is the only relevant class for the lung), FluMist is able to elicit CD4+ and CD8+ CTLs and also local mucosal IgA immunity in the upper respiratory tree as well as serum IgG. Since CTLs are both MHC1-restricted/CD8+ effectors [which are most-often directed at internal viral proteins] as well as MHC II-restricted CD4+ effectors [which include both internal and glycoprotein targets], FluMist (if including the 5 swine-origin segments in addition to the 3 cold-adapted vRNA segments] is likely to elicit broader immunity which will promote more rapid recovery, should infection be established because of insufficient nAb -- or drift of the seasonal virus by winter 2009/10 in the Northern Hemisphere. I would strongly support the live attenuated cold-adapted formulation. I would also urge the FDA to expand the licensing age range for the vaccine. Alternatively, physicians could use their discretion in off-label administration.