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Immunogenicity and Safety of H5N1 A/Vietnam/1194/2004 (Clade 1) AS03-Adjuvanted Prepandemic Candidate Influenza Vaccines in Children Aged 3 to 9 Years: A Phase II, Randomized, Open, Controlled Study

Díez-Domingo, Javier MD, PhD*; Garcés-Sanchez, Maria MD, PhD; Baldó, José-María MD; Planelles, María Victoria MD§; Ubeda, Isabel MD, PhD; JuBert, Angels MD; Marés, Josep MD**; Moris, Philippe MS††; Garcia-Corbeira, Pilar MD‡‡; Dramé, Mamadou MD††; Gillard, Paul MD††

The Pediatric Infectious Disease Journal: June 2010 - Volume 29 - Issue 6 - p e35-e46
doi: 10.1097/INF.0b013e3181daf921
Online-Only: Original Studies

Background: The development of vaccines against pandemic influenza viruses for use in children is a public health priority.

Methods: In this phase II, randomized, open study, the immunogenicity and reactogenicity of H5N1 A/Vietnam/1194/2004 (NIBRG-14) (clade 1) prepandemic influenza vaccine were assessed in children aged 3 to 5 and 6 to 9 years. Children were randomized to receive 2 doses, given 21 days apart, of A/Vietnam/1194/2004 vaccine containing 1.9 μg or 3.75 μg hemagglutinin antigen (HA), adjuvanted with a tocopherol-based oil-in-water emulsion (AS03) containing 11.86 mg (AS03A) or 5.93 mg (AS03B) tocopherol. Control groups received 2 doses of trivalent influenza vaccine (TIV). Humoral immune responses, reactogenicity, and safety were the primary outcome measures; cross-reactivity and cell-mediated responses were also assessed (NCT00502593).

Results: Between 49 and 51 children in each age stratum (aged 3–5 and 6–9 years) received H5N1 vaccine, and between 17 and 18 children in each age stratum received TIV. After the second dose, recipients of H5N1 vaccine (1.9 μg HA/AS03B, 3.75 μg HA/AS03B, and 3.75 μg HA/AS03A) achieved humoral antibody titers against the vaccine-homologous strain, which fulfilled the United States influenza vaccines licensure criteria for immunogenicity. With the exception of 1 child, there were no H5N1 immune responses in children who received TIV. The most frequent injection-site event was pain in all groups, and the H5N1 vaccine had a clinically acceptable reactogenicity and safety profile. Exploratory analyses in children aged 3 to 5 years indicated that the induction of CD4+ T-cell responses polarized in favor of a T-helper 1 profile.

Conclusions: The results showed that 2 doses of AS03-adjuvanted H5N1 influenza vaccine at antigen-sparing doses of 1.9 μg or 3.75 μg HA elicited broad and persistent immune responses with acceptable reactogenicity, and without safety concerns, in children aged 3 to 9 years.

From the *Centro Superior de Investigación en Salud Pública (CSISP), Valencia, Spain; †Centro de Salud Guillem de Castro, Valencia, Spain; ‡Centro de Salud Quart de Poblet, Valencia, Spain; §Centro de Salud Paiporta, Valencia, Spain; ¶Centro de Salud La Eliana, Valencia, Spain; ∥Centro de Salud Malvarrosa, Valencia, Spain; **Institut Pediatric Marés Riera, Gerona, Spain; ††GlaxoSmithKline Biologicals, Rixensart, Belgium; and ‡‡GlaxoSmithKline, Madrid, Spain.

Accepted for publication February 18, 2010.

Address for correspondence: Javier Diez Domingo, CSISP, Centro Superior de Investigación en Salud Pública (Centre for Public Health Research), Area de investigación en Vacunas, Avda Catalunya 21, 46020 Valencia, Spain. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.