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Live Attenuated Influenza Vaccine Enhances Colonization of Streptococcus pneumoniae and Staphylococcus aureus in Mice

tetano

Editor, Senior Moderator
MBio. 2014 Feb 18;5(1). pii: e01040-13. doi: 10.1128/mBio.01040-13.
Live Attenuated Influenza Vaccine Enhances Colonization of Streptococcus pneumoniae and Staphylococcus aureus in Mice.
Mina MJ, McCullers JA, Klugman KP.
Abstract

ABSTRACT Community interactions at mucosal surfaces between viruses, like influenza virus, and respiratory bacterial pathogens are important contributors toward pathogenesis of bacterial disease. What has not been considered is the natural extension of these interactions to live attenuated immunizations, and in particular, live attenuated influenza vaccines (LAIVs). Using a mouse-adapted LAIV against influenza A (H3N2) virus carrying the same mutations as the human FluMist vaccine, we find that LAIV vaccination reverses normal bacterial clearance from the nasopharynx and significantly increases bacterial carriage densities of the clinically important bacterial pathogens Streptococcus pneumoniae (serotypes 19F and 7F) and Staphylococcus aureus (strains Newman and Wright) within the upper respiratory tract of mice. Vaccination with LAIV also resulted in 2- to 5-fold increases in mean durations of bacterial carriage. Furthermore, we show that the increases in carriage density and duration were nearly identical in all aspects to changes in bacterial colonizing dynamics following infection with wild-type (WT) influenza virus. Importantly, LAIV, unlike WT influenza viruses, had no effect on severe bacterial disease or mortality within the lower respiratory tract. Our findings are, to the best of our knowledge, the first to demonstrate that vaccination with a live attenuated viral vaccine can directly modulate colonizing dynamics of important and unrelated human bacterial pathogens, and does so in a manner highly analogous to that seen following wild-type virus infection. IMPORTANCE Following infection with an influenza virus, infected or recently recovered individuals become transiently susceptible to excess bacterial infections, particularly Streptococcus pneumoniae and Staphylococcus aureus. Indeed, in the absence of preexisting comorbidities, bacterial infections are a leading cause of severe disease during influenza epidemics. While this synergy has been known and is well studied, what has not been explored is the natural extension of these interactions to live attenuated influenza vaccines (LAIVs). Here we show, in mice, that vaccination with LAIV primes the upper respiratory tract for increased bacterial growth and persistence of bacterial carriage, in a manner nearly identical to that seen following wild-type influenza virus infections. Importantly, LAIV, unlike wild-type virus, did not increase severe bacterial disease of the lower respiratory tract. These findings may have consequences for individual bacterial disease processes within the upper respiratory tract, as well as bacterial transmission dynamics within LAIV-vaccinated populations.

PMID:
24549845
[PubMed - in process]

Free full text

http://www.ncbi.nlm.nih.gov/pubmed/24549845
 
Last edited by a moderator:
Response to above study:

No Clinical Association of Live Attenuated Influenza Virus with Nasal Carriage of Bacteria or Acute Otitis Media
...
In contrast to results obtained with mice, the licensed Ann Arbor strain LAIV did not enhance S. pneumoniae carriage in clinical studies and there was no evidence of an increased risk of bacterial upper respiratory tract disease following vaccination. LAIV has been shown to reduce influenza-associated AOM and all-cause AOM during the influenza season and to reduce the severity of AOM in breakthrough cases (3, 5). As the authors correctly state, vaccines may have unintended consequences on other important human pathogens unrelated to the vaccine target. As a result, it is important that they are carefully studied in clinical trials prior to licensure. The safety of the licensed LAIV has been demonstrated in multiple clinical studies and in the postmarketing setting (6, 7)
http://mbio.asm.org/content/5/3/e01145-14.full

However the original study authors responded with news that the initial Ann Arbor results were disputed:

Reply to ?No Clinical Association of Live Attenuated Influenza Vaccine with Nasal Carriage of Bacteria or Acute Otitis Media?: Specific Recommendations for Future Studies
...
What do the clinical data show? Citing the abstract (7) of a randomized placebo-controlled study of LAIV (n = 151 children) by Thors et al. submitted for presentation at the 2014 International Symposium on Pneumococci and Pneumococcal Disease (ISPPD) in Hyderabad, India, Coelingh and Belshe state that there is no clinical association of LAIV with nasal carriage of bacteria in humans. Based on the initially submitted (and therefore published) abstract detailing the preliminary results of that study, Coelingh and Belshe were correct in their assertion that LAIV was not associated with increased bacterial titers in that study. However, the updated analysis of the results of that trial, which was ultimately presented at the ISPDD in March of 2014 under a title (8) different from that of the published abstract, suggests that the Ann Arbor strain LAIV licensed for use does significantly increase bacterial carriage density.
http://mbio.asm.org/content/5/3/e01173-14.full
 
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