The Possible Impact of Vaccination for Seasonal Influenza on Emergence of Pandemic Influenza via Reassortment
Identifieur interne : 000B86 ( Pmc/Curation ); précédent : 000B85; suivant : 000B87The Possible Impact of Vaccination for Seasonal Influenza on Emergence of Pandemic Influenza via Reassortment
Auteurs : Xu-Sheng Zhang [Royaume-Uni] ; Richard Pebody [Royaume-Uni] ; Daniela De Angelis [Royaume-Uni] ; Peter J. White [Royaume-Uni] ; Andre Charlett [Royaume-Uni] ; John W. Mccauley [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
One pathway through which pandemic influenza strains might emerge is reassortment from coinfection of different influenza A viruses. Seasonal influenza vaccines are designed to target the circulating strains, which intuitively decreases the prevalence of coinfection and the chance of pandemic emergence due to reassortment. However, individual-based analyses on 2009 pandemic influenza show that the previous seasonal vaccination may increase the risk of pandemic A(H1N1) pdm09 infection. In view of pandemic influenza preparedness, it is essential to understand the overall effect of seasonal vaccination on pandemic emergence via reassortment.
In a previous study we applied a population dynamics approach to investigate the effect of infection-induced cross-immunity on reducing such a pandemic risk. Here the model was extended by incorporating vaccination for seasonal influenza to assess its potential role on the pandemic emergence via reassortment and its effect in protecting humans if a pandemic does emerge. The vaccination is assumed to protect against the target strains but only partially against other strains. We find that a universal seasonal vaccine that provides full-spectrum cross-immunity substantially reduces the opportunity of pandemic emergence. However, our results show that such effectiveness depends on the strength of infection-induced cross-immunity against any novel reassortant strain. If it is weak, the vaccine that induces cross-immunity strongly against non-target resident strains but weakly against novel reassortant strains, can further depress the pandemic emergence; if it is very strong, the same kind of vaccine increases the probability of pandemic emergence.
Two types of vaccines are available: inactivated and live attenuated, only live attenuated vaccines can induce heterosubtypic immunity. Current vaccines are effective in controlling circulating strains; they cannot always help restrain pandemic emergence because of the uncertainty of the oncoming reassortant strains, however. This urges the development of universal vaccines for prevention of pandemic influenza.
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DOI: 10.1371/journal.pone.0114637
PubMed: 25494180
PubMed Central: 4262424
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Possible Impact of Vaccination for Seasonal Influenza on Emergence of Pandemic Influenza via Reassortment</title><author><name sortKey="Zhang, Xu Sheng" sort="Zhang, Xu Sheng" uniqKey="Zhang X" first="Xu-Sheng" last="Zhang">Xu-Sheng Zhang</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London</wicri:regionArea></affiliation></author><author><name sortKey="Pebody, Richard" sort="Pebody, Richard" uniqKey="Pebody R" first="Richard" last="Pebody">Richard Pebody</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation></author><author><name sortKey="De Angelis, Daniela" sort="De Angelis, Daniela" uniqKey="De Angelis D" first="Daniela" last="De Angelis">Daniela De Angelis</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Medical Research Council Biostatistics Unit, University Forvie Site, Cambridge, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Biostatistics Unit, University Forvie Site, Cambridge</wicri:regionArea></affiliation></author><author><name sortKey="White, Peter J" sort="White, Peter J" uniqKey="White P" first="Peter J." last="White">Peter J. White</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London</wicri:regionArea></affiliation></author><author><name sortKey="Charlett, Andre" sort="Charlett, Andre" uniqKey="Charlett A" first="Andre" last="Charlett">Andre Charlett</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation></author><author><name sortKey="Mccauley, John W" sort="Mccauley, John W" uniqKey="Mccauley J" first="John W." last="Mccauley">John W. Mccauley</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Medical Research Council National Institute for Medical Research, Mill Hill, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council National Institute for Medical Research, Mill Hill, London</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25494180</idno><idno type="pmc">4262424</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262424</idno><idno type="RBID">PMC:4262424</idno><idno type="doi">10.1371/journal.pone.0114637</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000B86</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000B86</idno><idno type="wicri:Area/Pmc/Curation">000B86</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000B86</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Possible Impact of Vaccination for Seasonal Influenza on Emergence of Pandemic Influenza via Reassortment</title><author><name sortKey="Zhang, Xu Sheng" sort="Zhang, Xu Sheng" uniqKey="Zhang X" first="Xu-Sheng" last="Zhang">Xu-Sheng Zhang</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London</wicri:regionArea></affiliation></author><author><name sortKey="Pebody, Richard" sort="Pebody, Richard" uniqKey="Pebody R" first="Richard" last="Pebody">Richard Pebody</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation></author><author><name sortKey="De Angelis, Daniela" sort="De Angelis, Daniela" uniqKey="De Angelis D" first="Daniela" last="De Angelis">Daniela De Angelis</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Medical Research Council Biostatistics Unit, University Forvie Site, Cambridge, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Biostatistics Unit, University Forvie Site, Cambridge</wicri:regionArea></affiliation></author><author><name sortKey="White, Peter J" sort="White, Peter J" uniqKey="White P" first="Peter J." last="White">Peter J. White</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London</wicri:regionArea></affiliation></author><author><name sortKey="Charlett, Andre" sort="Charlett, Andre" uniqKey="Charlett A" first="Andre" last="Charlett">Andre Charlett</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London</wicri:regionArea></affiliation></author><author><name sortKey="Mccauley, John W" sort="Mccauley, John W" uniqKey="Mccauley J" first="John W." last="Mccauley">John W. Mccauley</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Medical Research Council National Institute for Medical Research, Mill Hill, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council National Institute for Medical Research, Mill Hill, London</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>One pathway through which pandemic influenza strains might emerge is reassortment from coinfection of different influenza A viruses. Seasonal influenza vaccines are designed to target the circulating strains, which intuitively decreases the prevalence of coinfection and the chance of pandemic emergence due to reassortment. However, individual-based analyses on 2009 pandemic influenza show that the previous seasonal vaccination may increase the risk of pandemic A(H1N1) pdm09 infection. In view of pandemic influenza preparedness, it is essential to understand the overall effect of seasonal vaccination on pandemic emergence via reassortment.</p></sec><sec><title>Methods and Findings</title><p>In a previous study we applied a population dynamics approach to investigate the effect of infection-induced cross-immunity on reducing such a pandemic risk. Here the model was extended by incorporating vaccination for seasonal influenza to assess its potential role on the pandemic emergence via reassortment and its effect in protecting humans if a pandemic does emerge. The vaccination is assumed to protect against the target strains but only partially against other strains. We find that a universal seasonal vaccine that provides full-spectrum cross-immunity substantially reduces the opportunity of pandemic emergence. However, our results show that such effectiveness depends on the strength of infection-induced cross-immunity against any novel reassortant strain. If it is weak, the vaccine that induces cross-immunity strongly against non-target resident strains but weakly against novel reassortant strains, can further depress the pandemic emergence; if it is very strong, the same kind of vaccine increases the probability of pandemic emergence.</p></sec><sec><title>Conclusions</title><p>Two types of vaccines are available: inactivated and live attenuated, only live attenuated vaccines can induce heterosubtypic immunity. Current vaccines are effective in controlling circulating strains; they cannot always help restrain pandemic emergence because of the uncertainty of the oncoming reassortant strains, however. This urges the development of universal vaccines for prevention of pandemic influenza.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Klimov, Ai" uniqKey="Klimov A">AI Klimov</name></author><author><name sortKey="Garten, R" uniqKey="Garten R">R Garten</name></author><author><name sortKey="Russell, C" uniqKey="Russell C">C Russell</name></author><author><name sortKey="Barr, Ig" uniqKey="Barr I">IG Barr</name></author><author><name sortKey="Besselaar, Tg" uniqKey="Besselaar T">TG Besselaar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Neumann, G" uniqKey="Neumann G">G Neumann</name></author><author><name sortKey="Noda, T" uniqKey="Noda T">T Noda</name></author><author><name sortKey="Kawaoka, Y" uniqKey="Kawaoka Y">Y Kawaoka</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khiabanian, H" uniqKey="Khiabanian H">H Khiabanian</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25494180</article-id><article-id pub-id-type="pmc">4262424</article-id><article-id pub-id-type="publisher-id">PONE-D-14-20271</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0114637</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biology and Life Sciences</subject><subj-group><subject>Immunology</subject></subj-group><subj-group><subject>Population Biology</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Computer and Information Sciences</subject><subj-group><subject>Computerized Simulations</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Epidemiology</subject></subj-group><subj-group><subject>Infectious Diseases</subject></subj-group></subj-group></article-categories><title-group><article-title>The Possible Impact of Vaccination for Seasonal Influenza on Emergence of Pandemic Influenza via Reassortment</article-title><alt-title alt-title-type="running-head">Seasonal Vaccination and Pandemic Influenza Emergence</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Zhang</surname><given-names>Xu-Sheng</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pebody</surname><given-names>Richard</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>De Angelis</surname><given-names>Daniela</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>White</surname><given-names>Peter J.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Charlett</surname><given-names>Andre</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>McCauley</surname><given-names>John W.</given-names></name><xref ref-type="aff" rid="aff7"><sup>7</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></aff><aff id="aff4"><label>4</label><addr-line>Statistics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Medical Research Council Biostatistics Unit, University Forvie Site, Cambridge, United Kingdom</addr-line></aff><aff id="aff6"><label>6</label><addr-line>NIHR Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom</addr-line></aff><aff id="aff7"><label>7</label><addr-line>Medical Research Council National Institute for Medical Research, Mill Hill, London, United Kingdom</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Viboud</surname><given-names>Cecile</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>National Institutes of Health, United States of America</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>xu-sheng.zhang@phe.gov.uk</email></corresp><fn fn-type="COI-statement"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: XZ RP DD PJW AC JWM. Performed the experiments: XZ. Analyzed the data: XZ RP PJW JWM. Contributed reagents/materials/analysis tools: XZ. Wrote the paper: XZ RP PJW JWM.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>10</day><month>12</month><year>2014</year></pub-date><volume>9</volume><issue>12</issue><elocation-id>e114637</elocation-id><history><date date-type="received"><day>6</day><month>5</month><year>2014</year></date><date date-type="accepted"><day>12</day><month>11</month><year>2014</year></date></history><permissions><copyright-statement>© 2014 Zhang et al</copyright-statement><copyright-year>2014</copyright-year><copyright-holder>Zhang et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p></license></permissions><abstract><sec><title>Background</title><p>One pathway through which pandemic influenza strains might emerge is reassortment from coinfection of different influenza A viruses. Seasonal influenza vaccines are designed to target the circulating strains, which intuitively decreases the prevalence of coinfection and the chance of pandemic emergence due to reassortment. However, individual-based analyses on 2009 pandemic influenza show that the previous seasonal vaccination may increase the risk of pandemic A(H1N1) pdm09 infection. In view of pandemic influenza preparedness, it is essential to understand the overall effect of seasonal vaccination on pandemic emergence via reassortment.</p></sec><sec><title>Methods and Findings</title><p>In a previous study we applied a population dynamics approach to investigate the effect of infection-induced cross-immunity on reducing such a pandemic risk. Here the model was extended by incorporating vaccination for seasonal influenza to assess its potential role on the pandemic emergence via reassortment and its effect in protecting humans if a pandemic does emerge. The vaccination is assumed to protect against the target strains but only partially against other strains. We find that a universal seasonal vaccine that provides full-spectrum cross-immunity substantially reduces the opportunity of pandemic emergence. However, our results show that such effectiveness depends on the strength of infection-induced cross-immunity against any novel reassortant strain. If it is weak, the vaccine that induces cross-immunity strongly against non-target resident strains but weakly against novel reassortant strains, can further depress the pandemic emergence; if it is very strong, the same kind of vaccine increases the probability of pandemic emergence.</p></sec><sec><title>Conclusions</title><p>Two types of vaccines are available: inactivated and live attenuated, only live attenuated vaccines can induce heterosubtypic immunity. Current vaccines are effective in controlling circulating strains; they cannot always help restrain pandemic emergence because of the uncertainty of the oncoming reassortant strains, however. This urges the development of universal vaccines for prevention of pandemic influenza.</p></sec></abstract><funding-group><funding-statement>This study was supported by the Public Health England. PJW thanks the MRC for Centre funding [grant number MR/K010174/1], and also thanks the UK National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Modelling Methodology at Imperial College London in partnership with Public Health England (PHE) for funding [grant number HPRU-2012-10080]. JWM was supported by MRC NIMR programme No. u117512723. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, or Public Health England. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="27"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper.</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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