Abstract
The National Institute of Allergy and Infectious Diseases recently published a strategic plan for the development of a universal influenza vaccine. This plan focuses on improving understanding of influenza infection, the development of influenza immunity, and rational design of new vaccines. Epidemiological studies such as prospective, longitudinal cohort studies are essential to the completion of these objectives. In this review, we discuss the contributions of epidemiological studies to our current knowledge of vaccines and correlates of immunity, and how they can contribute to the development and evaluation of the next generation of influenza vaccines. These studies have been critical in monitoring the effectiveness of current influenza vaccines, identifying issues such as low vaccine effectiveness, reduced effectiveness among those who receive repeated vaccination, and issues related to egg adaptation during the manufacturing process. Epidemiological studies have also identified population-level correlates of protection that can inform the design and development of next generation influenza vaccines. Going forward, there is an enduring need for epidemiological studies to continue advancing knowledge of correlates of protection and the development of immunity, to evaluate and monitor the effectiveness of next generation influenza vaccines, and to inform recommendations for their use.
Highlights
With recent publication of their strategic plan for the development of a universal influenza vaccine, the National Institute of Allergy and Infectious Diseases (NIAID) has clarified the criteria that a universal vaccine should meet and has prioritized research to fill the gaps in knowledge required to successfully develop and implement such a vaccine [1]
Whether NA will be a target of next-generation influenza vaccines or a universal influenza vaccine remains an open question, epidemiological evidence suggests that the inclusion of NA in seasonal influenza vaccines could be beneficial
Immune histories shaped by past infection and vaccination influence individuals’ response to subsequent vaccination. This has affected the performance of current influenza vaccines, and will likely affect the generation of influenza vaccines, in the likely case that more than a single dose is needed in a lifetime
Summary
The minimal desired characteristics of a universal vaccine are that it be ≥75% effective in preventing symptomatic influenza infection, that it provides broad protection against hemagglutinin (HA) group I and II influenza A viruses, and that it provides protection that persists for at least one year These desired characteristics provide clear goals for development of new vaccines, and highlight current gaps in knowledge and areas where our understanding of current influenza vaccines will be important. Going forward, there is a continued need for epidemiological studies to understand influenza transmission and natural history of infection, to characterize the development of immunity following natural infection and vaccination, to evaluate and monitor the effectiveness of generation influenza vaccines, and to inform recommendations for their use
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