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Avian influenza vaccines

Iain Stephenson, MD, FRCP
Section Editor
Martin S Hirsch, MD
Deputy Editor
Anna R Thorner, MD


There have been five influenza pandemics during the past 100 years, and each has been caused by the emergence of a novel virus. In the 1957 and 1968 pandemics, the new viruses contained components of previous human as well as avian influenza viruses. The origin of the influenza virus responsible for the 1918 pandemic, which killed more people in a single year than the bubonic plague, remains uncertain, but it appears to have been an adapted avian influenza strain. The emergence of a novel H1N1 human-swine-avian reassortant virus in 2009 in North America resulted in a new pandemic. (See "Epidemiology of pandemic H1N1 influenza ('swine influenza')".)

Sporadic transmission of avian influenza H5N1 to more than 840 humans since 2003 has prompted concerns that conditions are suitable for emergence of a pandemic H5 influenza virus [1]. Two features of avian influenza H5N1 outbreaks are striking: the predominance of children and young adults, and the high mortality rate [2,3]. However, seroprevalence studies have found that some exposed individuals may have had a subclinical or mild infection, suggesting that the reported case-fatality rate may be an overestimate.

Issues related to avian influenza vaccines will be reviewed here. Treatment and prevention of avian influenza (other than vaccination) and the epidemiology, transmission, pathogenesis, clinical manifestations, and diagnosis of avian influenza are discussed separately. (See "Treatment and prevention of avian influenza" and "Epidemiology, transmission, and pathogenesis of avian influenza" and "Clinical manifestations and diagnosis of avian influenza".)


Immunization against avian influenza is an active area of research. A non-adjuvanted subvirion H5N1 avian influenza vaccine was approved by the US Food and Drug Administration in 2007 [4]. An oil-in-water emulsion (AS03)-adjuvanted subvirion H5N1 avian influenza vaccine was approved for pre-pandemic use in the European Union in 2008 and in the United States in 2013 [5,6]. (See 'Studies in humans' below.)

Production of H5N1 vaccines by conventional means has been hampered by technical manufacturing difficulties and modest immunogenicity in immunologically naïve humans, potentially requiring the administration of several doses of vaccine to induce seroprotection. As pandemics occur unpredictably and evolve rapidly, high-priority research goals include improving production speed and increasing the quantity of vaccine that can be produced rapidly. Areas of research include use of cell culture systems, dose-sparing approaches (eg, whole-virion formulation, intradermal administration), and use of adjuvants and live attenuated viruses to induce more robust immune responses with lower quantities of antigen [7].

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Literature review current through: Dec 2017. | This topic last updated: Jan 24, 2017.
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