Safety and Immunogenicity of a Subvirion Monovalent Unadjuvanted Inactivated Influenza A(H3N2) Variant Vaccine in Healthy Persons ≥18 Years Old

Keitel, Wendy A.; Jackson, Lisa A.; Edupuganti, Srilatha; Winokur, Patricia L.; Mulligan, Mark J.; Thornburg, Natalie J.; Patel, Shital M.; Rouphael, Nadine G.; Lai, Lilin; Bangaru, Sandhya; McNeal, Monica M.; Bellamy, Abbie R.; Hill, Heather R.; Bond, Nanette; Bosworth, Kathy; Brown, Janet; Banay, Jess; Cheesman, Coni; Lanford, Tracey; Munoz, Flor; Wells, Janet; Carste, Barb; Dunstan, Maya; Mathis, Angel; Parikh, Mihir; Phillips, C. Hallie; Spingola, Alyssa; Starkovich, Pat; Suyehira, Janice; Beck, Allison; Mask, Karen; Bower, Mary; Osinski, Eileen; Rimann, Nayoka; Turner, Pamela; Wang, DongLi; Stapleton, Jack; Won, Regina; Wagner, Nancy; Dull, Geraldine; Gerot, Necole; Reidy, Mary; Zhao, Dan; Segar, Ellen; Slaughter, James C.; McDonough, Megan; He, Fenhua; Salata, Robert; Meissner, Cody; Sheffield, Jeanne; Spigarelli, Michael; Greenberg, Stephen; Agrawal, Anoop; Dublin, Sascha; Arterburn, David; Rimland, David; Ribner, Bruce; Meier, Jeff; Buchanan, Wendy; Chang, Soju; Lambert, Linda; Murray, Suzanne; Riddle, Valerie; Spiro, David

BACKGROUND: Variant influenza A(H3N2) viruses (H3N2v) have transmitted recently from pigs to humans in the United States. Vaccines strategies are needed. METHODS: Healthy adults received 2 doses of subvirion H3N2v vaccine (15 µg of hemagglutinin/dose) 21 days apart in this open-label trial. Serum hemagglutination inhibition (HAI) and neutralizing (Neut) antibody (Ab) titers were measured before and 8 and 21 days after each dose. Memory B-cell (MBC) responses were assessed. RESULTS: Vaccine was well tolerated. A total of 40% of subjects had an HAI Ab titer of ≥40 before vaccination. Eight-seven percent (95% confidence interval [CI], 79%–93%) and 73% (95% CI, 63%–81%) of subjects 18–64 years old (98 subjects) and ≥65 years old (90 subjects), respectively, had an HAI titer of ≥40 21 days after dose 1 (P = .01); 51% (95% CI, 41%–61%) and 52% (95% CI, 41%–62%) of younger and older subjects, respectively, developed ≥4-fold rises in titer (P = not significant). Neut Ab response patterns were similar. Geometric mean titers were higher in younger subjects. Dose 2 provided no significant enhancement in responses. Cross-reactive MBCs were detected before vaccination and expanded after vaccination. Preexisting H3N2v-specific MBCs positively correlated with early increases in vaccine-induced Ab. CONCLUSIONS: In most healthy adults, one 15-µg dose of vaccine elicited levels of HAI Abs associated with protection. Studies in children and elderly individuals are indicated to define the immunization needs of these groups. CLINICAL TRIALS REGISTRATION: NCT01746082.