Human Influenza. Dr. Sina Soleimani. Human Viral Vaccine Quality Control 89/2/29. November 2, 2011 HVVQC ١

Transcription

1 Human Influenza Dr. Sina Soleimani Human Viral Vaccine Quality Control 89/2/29 November 2, 2011 HVVQC ١

2 Presentation outline 1. Introduction 2. Virology 3. Classification 4. Hosts 5. Antigenic Specifications 6. Epidemiology 7. Pandemics 8. Disease 9. Vaccines 10. Quality Control November 2, 2011 HVVQC ٢

3 Introduction Influenza commonly referred to as the flu An infectious disease caused by RNA viruses family Orthomyxoviridae Affects birds and mammals The name influenza is Italian and means "influence" of Stars (Latin: influentia) November 2, 2011 HVVQC ٣

4 Virology Virus first isolated in Orthomyxoviridae - Negative single stranded RNA viruse - Envelop - 3 Immunologic Types: A, B & C - A and B: 8 separate gene segments -C: 7 separate gene segments(-na Gene) -Antigenic Recombinant November 2, 2011 HVVQC ۴

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6 Viral Proteins Influenza A genome:11 genes on eight pieces of RNA encoding for 11 proteins: Hemagglutinin (HA) Sub Types of HA: 15 Sub types: H1- H15(16) Neuraminidase (NA) Sub Types of NA: 9 Sub types: N1- N9 (Antibodies to 2 surface proteins provide immunity) Nucleoprotein (NP) M1, M2, NS1 NS2(NEP) PA, PB1, PB1-F2 and PB2 November 2, 2011 HVVQC ۶

7 Nucleocapsid (RNA fragments wrapped in protein) Envelope haemagglutinin and neuraminidase spikes In envelope 100 nm November 2, 2011 HVVQC ٧

8 Haemagglutinin and sialic acid on receptor Neuraminidase HA N active site receptor binding site variable loops variable loops November 2, 2011 HVVQC ٨

9 Influenza Virus Replication HA cleaved by proteases HA binds to receptor lowered ph, HA fuses membranes RNA released virus in phagolysosome virus buds N releases virus November 2, 2011 HVVQC ٩

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11 Type A Classification Primary cause of influenza morbidity and mortality Is found in birds and mammals Famous for causing many pandemics with high mortality Type B Epidemics typically observed among children Perhaps milder illness in adults A and B differ in expression of Matrix (M) gene and Neuroamidase (NA) gene Key difference at NS1 protein. - Type C Mild Disease in Human November 2, 2011 HVVQC ١١

12 Flu Hosts Influenza virus A humans horses pigs Dogs? birds Cat marine mammals Influenza virus B Influenza virus C humans Humans & Pigs November 2, 2011 HVVQC ١٢

13 Natural hosts of influenza viruses Haemagglutinin subtype Neuraminidase subtype H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 November 2, 2011 HVVQC ١٣ N1 N2 N3 N4 N5 N6 N7 N8 N9

14 Antigenic Recombinant Antigenic drift Point mutations in viral RNA encoding HA and NA Continual process Results in yearly epidemics Vaccine updated yearly Creates influenza viruses with slightly modified antigens Antigenic shift Replacement of HA or HA + NA (i.e. new subtype) Sporadic event Can result in a pandemic -generates viruses with entirely novel antigens November 2, 2011 HVVQC ١۴

15 Antigenic Drift Mutations accumulated during virus replication Minor changes that can make antigens Ineffectual Point November 2, 2011 HVVQC ١۵

16 Antigenic shift Mixing of different strains of influenza viruses in the same intermediate host gives rise to new virus The new subtype can be more harmful than the first two strands due to the lack of prior familiarity/immunity November 2, 2011 HVVQC ١۶

17 Influenza Epidemiology November 2, 2011 HVVQC ١٧

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19 Pandemic history of influenza Recorded human pandemic influenza (early sub-types inferred) H2N2 H3N8 H1N1 H2N2 H3N2 H1N1 Pandemic H1N Russian influenza H2N Old Hong Kong influenza H3N Spanish influenza H1N1 Recorded new avian influenzas 1957 Asian influenza H2N Hong Kong influenza H3N2 H H9 * H Pandemic influenza H1N November 2, 2011 HVVQC ١٩

20 Latest flu pandemics Name of pandemic Date Deaths Sub type involved Asiatic(Russia n) Flu milion H2N2 Spanish Flu milion H1N1 Asian Flu milion H2N2 Hong kong Flu milion H3N2 Swine Flu 2009? Novel H1N1 November 2, 2011 HVVQC ٢٠

21 World flue Pandemic in 20 Century 1918 Spanish Flu 1957 Asian Flu 1968 Hong Kong Flu A(H1N1) A(H2N2) A(H3N2) November 2, 2011 HVVQC ٢١

22 Seasonal Influenza: Clinical Features Typical incubation 2 days (range 1-4 days) Viral shedding Can begin 1 day before symptom onset Peak shedding first 3 days of illness Correlates with temperature Can be 10+ days in children Abrupt onset Fever and constitutional symptoms: Body aches, Headaches, Fatigue Cough, Rhinitis, Sore throat GI symptoms and Myositis, particularly among young children Complications: Viral and Bacterial Pneumonia Cardiomyopathy, Encephalopathy/Encephalitis November 2, 2011 HVVQC ٢٢

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24 H1N1 Influenza: Clinical Features Fever higher than 37.8 oc Rhinorrhea Cough Sore throat Other possible symptoms: Headache, Dyspnoea, Myalgia, Joint pain, Vomiting and Diarrhoea November 2, 2011 HVVQC ٢۴

25 Influenza Clinical Diagnosis Clinical symptoms non-specific Symptoms overlap with many pathogens Coupling with laboratory data to verify diagnosis Influenza Laboratory Testing Viral culture Gold standard but results take 7+ days usually Influenza isolates for yearly vaccine development Point-of-care tests Generally 70+% sensitive, 90+% specific Can provide results <30 minutes Immunofluorescence Requires intact cells and laboratory skill/experience Serology Must used paired serum samples >2 week delay for results RT-PCR Most sensitive Becoming more widely available November 2, 2011 HVVQC ٢۵

26 Three Viral Types Distinguish Type A Host Humans, birds, horses, other mammals Clinical Importance Moderate to severe disease B Humans Moderate to severe disease C Humans and swine Mild disease Pattern of Occurrence Sporadic, epidemics, pandemics Sporadic, epidemics Sporadic, localized outbreaks Subtypes Yes H1-H15 N1-N9 No 2 lineages co-circulate No November 2, 2011 HVVQC ٢۶

27 Influenza Antiviral Medications 1. Prevent membrane fusion M2 inhibitors (Adamantanes) Rimantadine(Flumadine) Amantadine(Symmetrel) Not effective against influenza B 2. Neuraminidase inhibitors Oseltamivir(Tamiflu) Oral medication licensed for use in persons 1 year and older Zanamivir (Relenza) - Laninamivir - Peramivir Supportive care Antibiotic November 2, 2011 HVVQC ٢٧

28 Influenza Vaccine Production: types of vaccines Influenza vaccines: Trivalent inactivated virus strains, either whole viruses or parts or subunits of them. 1. Whole inactivated viruses 2. Split inactivated virus particles disrupted (detergent treatment) 3. Subunit or surface antigen: purified hemagglutinin and neuraminidase 4. Live attenuated whole virus (cold-adapted & weakened/nonpathogenic).

29 Influenza vaccine 1. Live Vaccine Live, attenuated, intranasal spray (LAIV) Live vaccine stimulate mucosal immunity May be more effective at limiting shedding 2. Inactivated Vaccine Inactivated, for intramuscular injection (TIV) Both contain 3 virus strains (2 strains of influenza A [subtypes H1N1 and H3N2] and 1 strain of influenza B) selected each year based on viruses anticipated to be circulating during the upcoming influenza season November 2, 2011 HVVQC ٢٩

30 Influenza vaccine 1. Egg Base Vaccine 2. Cell culture Vaccine 3. Reverse genetics Vaccine Manipulate the genomes of influenza viruses and to transfer genes between viral strains November 2, 2011 HVVQC ٣٠

31 Influenza Vaccines: production procedures

32 Flu vaccine development by Reverse Genetics techniques November 2, 2011 HVVQC ٣٢

33 Flue Vaccine Production Timing November 2, 2011 HVVQC ٣٣

34 Production of Influenza Vaccine November 2, 2011 HVVQC ٣۴ Ref. WHO

35 Vaccine Production Capacity November 2, 2011 HVVQC ٣۵

36 Famous Flue Vaccine Manufacturers Producer Country Brand Name 1 Sanofi pasteur USA- France Fluzone(TIV) 2 Novartis UK- Germany-Italy Fluvirin(TIV) 3 Med Immune USA FluMist (LAIV) 4 CSL Australia Afluria(TIV) 5 GSK Belgium Fluarix(TIV) 6 Solvay Healthcare Netherlands Influvac 7 Berna- Crucell Switzerland Inflexal V 8 ID Biomedical Canada FluLaval(TIV) November 2, 2011 HVVQC ٣۶

37 Vaccine Consumption منبع : WHOبرنامه جهانی ا نفلوا نزا November 2, 2011 HVVQC ٣٧

38 "People need to understand that this vaccine is safe," President Obama said".michelle and I just got the shots ourselves... we wanted to make sure nationwide that children were getting it before adults did. And now there's enough vaccine so that adults should get it as well ". November 2, 2011 HVVQC ٣٨

39 Inactivated Influenza Vaccine Adverse Reactions Local reactions 15%-20% Fever, malaise not common Allergic reactions rare Neurological very rare reactions November 2, 2011 HVVQC ٣٩

40 Live Attenuated Influenza Vaccine Adverse Reactions Children no significant increase in fever, or other systemic symptoms significantly increased risk of asthma or reactive airways disease in children months of age Adults significantly increased rate of cough, runny nose, nasal congestion, sore throat, and chills reported among vaccine recipients no increase in the occurrence of fever No serious adverse reactions identified November 2, 2011 HVVQC ۴٠

41 Influenza Quality Control Tests November 2, 2011 HVVQC ۴١

42 1-HAConcentration: SingleRadial Immunodiffusion(SRID) 2- Sucrose: Thin Layer Chromatography 3- Ovalbumin Test : ELISA 4- Residual Infectious Virus: Egg Test 5- Beta Propiolactone: Colorimetric assay November 2, 2011 HVVQC ۴٢

43 6- Neuraminidase Test : Neuraminidase Activity 7-NeuraminidaseInhibitionTest: Inhibition Test 8- EID50 Test: Titration 9- Haemagglutination Inhibition: Haemagglutination November 2, 2011 HVVQC ۴٣

44 10- Endotoxin Test: Gel Clot 11- Bioburden Test: Milipore Filtration 12- Sterility Test: Direct & Filtration November 2, 2011 HVVQC ۴۴

45 13- Mycobacteria & Mycoplasma 14- Extraneous Agent : 5-1- Extraneous Agent in Suckling mice 5-2- Extraneous Agent in adult mice 5-3- Extraneous Agent in guinea pigs 5-4- Extraneous Agent in cell culture 15- Total Protein 16- ph November 2, 2011 HVVQC ۴۵