Inactivated Influenza Vaccine Efficacy: Diminished Antigenicity of Split-Product Vaccines in Mice

Groups of 60 to 120 mice were given a single intraperitoneal inoculation of varying dilutions of commercially prepared and licensed bivalent (A/England and B/Mass) and monovalent (A/Aichi or B/Hong Kong) inactivated influenza vaccines, and their antibody responses at 14 days were quantitated by hemagglutination inhibition tests. Split-product vaccines prepared by the treatment of A/England, B/Mass, and B/Hong Kong whole virus with Tween-80 and either tributylphosphate or ether produced significantly lower mean antibody titers than did equivalent whole-virus preparations. The rates of seroconversion (<1:8 to >/=1:8) at the various dilutions tested were also significantly reduced when these split-product vaccines were given. When the antigen content of all vaccines was quantitated by the chick cell agglutination test, between 10 and 100 times more split-product antigen than whole-virus antigen was required to produce seroconversion in 50% of the mice tested. Differences between split-product and whole-virus A/Aichi vaccines were less marked. These data point out the need to consider factors other than hemagglutinin content alone in determining the immunogenicity of inactivated influenza vaccines.     

Comparative Immunogenicity of Heat-Killed and Living Oral Salmonella Vaccines

CD-1 mice were vaccinated intragastrically or intramuscularly with one or two doses of 200 mug of heat-killed Salmonella enteritidis 5694. Control mice were vaccinated with sublethal doses of living S. enteritidis Se795. The mice were challenged intragastrically with approximately 10(6)S. enteritidis 5694 SM(R) 7 to 14 days later, and the growth of the challenge population in the liver, spleen, mesenteric lymph nodes, lungs, and intestine was measured quantitatively. Mice receiving two doses of heat-killed vaccine by mouth were able to delay the systemic emergence of a gastrically introduced salmonella infection by 1 to 2 days. The corresponding liver and spleen populations were slightly lower than those seen in the normal controls. On the other hand, mice receiving the living, attenuated vaccine (either intravenously or intragastrically) developed an effective anti-salmonella immunity against subsequent reinfection.     

Immunogenicity and Efficacy of Flagellin-Envelope Fusion Dengue Vaccines in Mice and Monkeys

The envelope (E) protein of flaviviruses includes three domains, EI, EII, and EIII, and is the major protective antigen. Because EIII is rich in type-specific and subcomplex-specific neutralizing epitopes and is easy to express, it is particularly attractive as a recombinant vaccine antigen. VaxInnate has developed a vaccine platform that genetically links vaccine antigens to bacterial flagellin, a Toll-like receptor 5 ligand. Here we report that tetravalent dengue vaccines (TDVs) consisting of four constructs, each containing two copies of EIII fused to flagellin (R3.2x format), elicited robust and long-lived neutralizing antibodies (geometric mean titers of 200 to 3,000), as measured with a 50% focus reduction neutralization test (FRNT₅₀). In an immunogenicity study, rhesus macaques (n = 2) immunized subcutaneously with 10 μg or 90 μg of TDV three or four times, at 4- to 6-week intervals, developed neutralizing antibodies to four dengue virus (DENV) serotypes (mean post-dose 3 FRNT₅₀ titers of 102 to 601). In an efficacy study, rhesus macaques (n = 4) were immunized intramuscularly with 16 μg or 48 μg of TDV or a placebo control three times, at 1-month intervals. The animals that received 48-μg doses of TDV developed neutralizing antibodies against the four serotypes (geometric mean titers of 49 to 258) and exhibited reduced viremia after DENV-2 challenge, with a group mean viremia duration of 1.25 days and 2 of 4 animals being completely protected, compared to the placebo-treated animals, which all developed viremia, with a mean duration of 4 days. In conclusion, flagellin-EIII fusion vaccines are immunogenic and partially protective in a nonhuman primate model.     

不同表型的双价痢疾菌苗的滴鼻免疫研究

为了探讨滴鼻免疫不同表型的双价痢疾菌苗的免疫效果 ,应用FSM 2 117(Ipa )及FS 5 40 2 (Ipa+)、FS 5 411(Ipa+)、FS 5 414(Ipa+)、FS 5 416 (Ipa+) 5株菌苗株分别滴鼻免疫小鼠 ,4× 10 7CFU/只 ,间隔 14d ,3次免疫后第 7天收集血清和小肠、鼻咽、肺、阴道冲洗液 ,ELISA法检测其中特异性福氏、宋内LPSIgA和IgG抗体水平 ,发现滴鼻免疫能够诱生血清中的双价IgA、IgG抗体显著升高 ,Ipa+株较Ipa 株升高显著 (P <0 0 1)。同时诱生鼻咽、肺、小肠内特异性抗体升高 ,尤其是生殖道冲冼液内抗体升高极为明显。表明鼻粘膜免疫不仅诱导多个粘膜部位 (特别是生殖道 )的抗体反应 ,且能诱导系统免疫反应 ,是一个安全有效的免疫途径。研究中发现侵袭蛋白表达在鼻粘膜部位能够显著加强系统特异性抗体生成。     

Comparison of the Long-Term Immunogenicity of Two Pandemic Influenza A/H1N1 2009 Vaccines,the MF59-Adjuvanted and Unadjuvanted Vaccines,in Adults

Since the first reports of the A/H1N1 virus in April 2009, the pandemic influenza virus spread globally and circulated for a long time. The primary method for the control of influenza is vaccination, but levels of influenza vaccine-induced antibody are known to decline rapidly during a 6-month period. In adults aged 18 to 64 years, we compared the long-term immunogenicity of two of the influenza A/H1N1 2009 monovalent vaccines, 3.75-μg MF59-adjuvanted vaccine and 15-μg unadjuvanted vaccine. The serum hemagglutinin inhibition (HI) titers were determined prevaccination and at 1, 6, and 10 months after vaccination. One hundred six (88.3%) of the 120 subjects were monitored for the entire 10-month period after receiving the influenza A/H1N1 2009 monovalent vaccine. There were 60 patients who received the unadjuvanted vaccine and 46 patients who received the MF59-adjuvanted vaccine. The seroprotection rates, seroconversion rates, and the geometric mean titer (GMT) folds fulfilled the criteria of the European Medicines Agency (EMA) for influenza A/California/7/2009 (H1N1) at 1 month after vaccination irrespective of the vaccine composition. Although the GMTs at 1 month postvaccination were somewhat higher in the unadjuvanted vaccine recipients than in the MF59-adjuvanted vaccine recipients, the difference was not significant (P = 0.29). The seroprotection rates at 6 and 10 months postvaccination were preserved above 70% but only in the MF59-adjuvanted vaccine recipients. In conclusion, low-dose MF59-adjuvanted influenza vaccine, even with 3.75 μg hemagglutinin antigen, might induce excellent long-term immunity that is comparable to the conventional dose of unadjuvanted vaccine among healthy adults aged 18 to 64 years.     

Comparative Efficacy of Two Leading Candidate Ricin Toxin A Subunit Vaccines in Mice

The two leading ricin toxin vaccine candidates, RVEc and RiVax, are recombinant derivatives of the toxin''s 267-amino-acid enzymatic A chain (RTA). RVEc is truncated at the C terminus (residues 199 to 267) to improve protein thermostability, while RiVax has two point mutations (V76M and Y80A) that eliminate the RNA N-glycosidase activity of RTA, as well as its ability to induce vascular leak syndrome. The two vaccines have never been directly compared in terms of their ability to stimulate RTA-specific antibodies (Abs), toxin-neutralizing activity (TNA), or protective immunity. To address this issue, groups of female BALB/c mice were immunized two or three times with Alhydrogel-adsorbed RiVax or RVEc at a range of doses (0.3 to 20 μg) and then challenged with 10 50% lethal doses (LD₅₀s) of ricin. We found that the vaccines were equally effective at eliciting protective immunity at the doses tested. There were, however, quantitative differences in the antibody responses. RVEc tended to elicit higher levels of ricin-specific RTA IgG and TNA than did RiVax. Pepscan analysis revealed that serum Abs elicited by RVEc were skewed toward a solvent-exposed immunodominant α-helix known to be the target of potent toxin-neutralizing Abs. Finally, immunodepletion experiments suggest that the majority of toxin-neutralizing Abs elicited by RiVax were confined to residues 1 to 198, possibly explaining the equal effectiveness of RVEc as a vaccine.     

Analysis of the antigenic structure of influenza A/USSR/90/77 virus hemagglutinin

Evolution of the antigenic structure of influenza virus hemagglutinin with the antigenic formula HA1 was studied by the determination of the capacity for interaction with monoclonal antibody and aminoacid substitutions in the protein. Consecutive changes in protein epitopes were found in isolates accumulating from the time of isolation of H1 influenza viruses in 1977.     

Effects of Low- and High-Passage Influenza Virus Infection in Normal and Nude Mice

A human isolate of type A Hong Kong influenza virus (H3N2) was adapted to mice by serial passage. Lung homogenates from mice who received low passage levels contained about the same quantity of virus (10^6.2−6.95 50% tissue culture infective doses/ml) as those from mice who received high passage levels (10^5.95−6.45 50% tissue culture infective doses/ml); however, death occurred only in animals given high-passage virus. Passage 3 (P3) and passage 9 (P9) viruses were selected as representative of low-passage and high-passage viruses, respectively. Although minimal differences were detected in infectivity for rhesus monkey kidney tissue cultures and mice, P9 virus was at least 10,000 times more lethal for mice (mean lethal dose = 10^4.2). Infection with P3 virus was accompanied by minimal bronchitis and bronchiolitis only, whereas P9-infected animals exhibited marked bronchitis, bronchiolitis, and pneumonia. Striking thymic cortical atrophy was also demonstrable in the P9-infected animals and, although virus was more commonly recovered from thymuses from these animals, immunofluorescent studies revealed only a few cells containing influenza virus antigens. To further explore the participation of thymus-derived lymphocytes in influenza, athymic nude mice and furred immunocompetent littermates were given 500 50% mouse infectious doses of P9 virus. Nude mice exhibited an increased survival time and, in contrast to the extensive lung pathology seen in furred littermates, manifested minimal cellular infiltration and no tissue destruction in lungs. Brains from nude mice exhibited encephalomalacia with lymphocytic perivascular cuffing, which was not seen in furred animals. Virus was recovered from brains of 6 of 13 nude mice and 1 of 10 furred animals. The contrasting models suggest that thymus-dependent cells play a significant role in the inflammatory response to influenza virus infection and should prove useful for probing host-virus interactions which characterize influenza virus virulence.     

Reappraisal of the Immunogenicity and Safety of Three Hepatitis A Vaccines in Adolescents

Although the overall incidence of hepatitis A in Korea has been decreasing, adolescents remain highly vulnerable to its outbreaks. This study was conducted to compare the immunogenicity and safety of three hepatitis A vaccines in Korean adolescents. Healthy anti-hepatitis A virus seronegative subjects aged 13 to 19 yr were randomized in three equal groups to receive two doses of Avaxim™, Epaxal®, or Havrix®, 6 to 12 months apart. Seroconversion rates one month after the first dose were 98%, 95%, and 93% for Avaxim™, Epaxal®, and Havrix®, respectively. Seroconversion rates reached 100% for all vaccine groups one month after the second dose. Anti-HAV geometric mean concentrations (GMCs) were 7,207.7 mIU/mL (95% CI, 6023.1-8684.7), 1,750.5 mIU/mL (95% CI, 1362.9-2248.3), and 1,953.5 mIU/mL (95% CI, 1459.4-2614.7) after two doses of Avaxim™, Epaxal®, and Havrix® respectively. Avaxim™ was significantly more immunogenic than Epaxal® and Havrix®, whereas there were no significant differences in antibody responses between Epaxal® and Havrix®. Local and systemic solicited adverse events (AEs) were mostly of mild-to-moderate intensity and resolved within 5 days. No serious AEs were reported. In conclusion, all three vaccines are highly immunogenic and well-tolerated in Korean adolescents. (Clinical Trial Registry NCT00483470)     

Immunogenicity of Living and Heat-Killed Salmonella pullorum Vaccines

Specific pathogen-free CD-1 and C57Bl mice were infected in a hind footpad with 5 x 10(4) viable Salmonella enteritidis cells or 10(7) viable S. pullorum cells. The resulting bacterial growth within the footpad, the draining lymph nodes, and the liver and spleen was followed for 14 days. Mice vaccinated with live S. enteritidis rapidly developed an effective antibacterial resistance to both intravenous and intragastric challenge with S. enteritidis SM(R). The viable inoculum of S. pullorum was rapidly eliminated from the normal mouse tissues and failed to induce a detectable anti-Salmonella resistance to parenteral or oral challenge with S. enteritidis. Heat-killed saline suspensions (200 mug, dry wt) of S. enteritidis or S. pullorum were unable to induce an effective antimicrobial resistance against a subsequent virulent Salmonella challenge. However, when the organisms were suspended in Freund complete adjuvant, both vaccines induced an antibacterial resistance to intravenous and intragastric challenge. Reduction of the antigenic dose from 200 to 40 mug did not greatly affect the protective value of the two killed vaccines against an intravenous challenge, but the level of protection observed with two 40-mug doses of S. pullorum was considerably reduced when the animals were infected intragastrically, suggesting that some quantitative differences existed between the sensitizing antigenic contents of the two test organisms.     

Further Studies of the Neuraminidase Content of Inactivated Influenza Vaccines and the Neuraminidase Antibody Responses After Vaccination of Immunologically Primed and Unprimed Populations

Purified concentrates of influenza A/USSR/90/77(H1N1)-like, A/Texas/1/77 (H3N2)-like, and B/Hong Kong/5/72-like viruses used for preparation of investigational and licensed vaccines in 1978 to 1979 were tested for their content of neuraminidase enzyme activity. Concentrates of H1N1 virus used to prepare vaccines for clinical investigations performed in the spring of 1978 had neuraminidase activity at that time which decreased during storage to almost undetectable levels (three lots) or by 50% (one lot) by the winter of 1978. Several other lots of concentrates prepared with H1N1 virus and used for vaccine formulation had no detectable neuraminidase enzyme activity when tested in the winter of 1978, at a time when they would be administered in vaccines. The range of specific activity for different lots of concentrates was about 40-fold for A/Texas/1/77, B/Hong Kong/5/72, and A/USSR/90/77 neuraminidases. Immunogenicity of investigational vaccines prepared with tested concentrates and administered between April and July 1978 was measured in volunteers aged 13 to >50 years. Frequency of neuraminidase antibody rises to two doses of H1N1-containing vaccine was 10% in unprimed subjects aged <26 years and about 18 to 36% in older persons. The frequency of neuraminidase antibody rises to one dose of H3N2-containing vaccine varied from 0 to 32% in different groups (mean, 18%). The frequencies of neuraminidase antibody responses were always much lower than the frequencies of hemagglutinin antibody responses. These observations confirm the existence of practical difficulties in achieving uniformity of the neuraminidase content in influenza vaccines and of ensuring good immunogenicity of vaccine neuraminidase even in primed populations.     

Comparison of the Immunogenicity and Safety of the Conventional Subunit,MF59-Adjuvanted,and Intradermal Influenza Vaccines in the Elderly

The influenza vaccination is known as the most effective method for preventing influenza infection and its complications in the elderly. Conventional subunit (Agrippal S1; Novartis), MF59-adjuvanted (Fluad; Novartis), and intradermal (IDflu15; Sanofi Pasteur) influenza vaccines are widely used throughout South Korea. However, few comparative studies evaluating the safety and immunogenicity of these vaccines are available. Prior to the beginning of the 2011-2012 influenza season, 335 healthy elderly volunteers randomly received one of three seasonal trivalent influenza vaccines, the conventional subunit, MF59-adjuvanted, or intradermal influenza vaccine. Serum hemagglutination-inhibiting antibody levels were measured at the time of vaccination and at 1 and 6 months after vaccination. Adverse events were recorded prospectively. A total of 113 conventional subunit, 111 MF59-adjuvanted, and 111 intradermal influenza vaccine volunteers were followed up during a 6-month postvaccination period. One month after vaccination, all three vaccines satisfied Committee for Medical Products for Human Use (CHMP) immunogenicity criteria for the A/H1N1 and A/H3N2 strains but not for the B strain. Compared with the subunit vaccine, the intradermal vaccine exhibited noninferiority, while the MF59-adjuvanted vaccine exhibited superiority. Furthermore, the MF59-adjuvanted vaccine was more immunogenic against the A/H3N2 strain than was the subunit vaccine up to 6 months postvaccination. The most common local and systemic reactions to the conventional subunit, MF59-adjuvanted, and intradermal influenza vaccines were pain at the injection site (7.1%, 10.8%, and 6.3%, respectively) and generalized myalgia (0.9%, 8.1%, and 5.4%, respectively). Local and systemic reactions were similar among the three vaccine groups. MF59-adjuvanted vaccine exhibited superior immunogenicity compared with a conventional subunit vaccine and had a comparable safety profile. For older adults, the MF59-adjuvanted vaccine is preferable for providing superior immunogenicity.     

Advances in Predicting and Manipulating the Immunogenicity of Biotherapeutics and Vaccines

Therapeutic proteins are vital to the future of human health provision and the survival and profitability of the global pharmaceutical industry. Returns from protein therapeutics are experiencing unprecedented growth: both their number and their economic dividend have increased by an order of magnitude in the last 10 years. The potential immunogenicity of protein therapeutics raises many clinical and safety concerns. Many poorly understood factors relating to both product and host affect immune responses. Available laboratory measurement of immunogenicity is of little utility for predicting the clinical properties of biotherapeutics. Coupled with assay variability and standardization issues, this precludes adequate prediction of the biological or clinical responses of therapeutic proteins, arguing for the utilization of informatic strategies in the analysis and prediction of protein immunogenicity. Currently, many unresolved issues must be addressed and thus circumvented before effective prediction can become routine.     

Immunogenicity of influenza A/USSR (H1N1) subunit vaccine in unprimed young adults

Purified subunit vaccines (HANAflu) containing 20 /xg of hemagglutinin of influenza A/USSR/90/77 (H1N1) alone or with 1–5% whole virus were compared to commercially available vaccines for reactogenicity and immunogenicity in unprimed young adults. Reactions to all vaccines were minimal. Sera from volunteers who received two intramuscular doses of vaccine or placebo were tested by hemagglutination-inhibition and neutralization tests. HANAflu with 1 m?g (5%) whole virus added was not different in immunogenicity from commercial vaccine. Both commercial vaccine and HANAflu with 1 m?g whole virus added gave higher seroconversion rates and more neutralization titers ≥ 4 log₂ than HANAflu alone and HANAflu + 0.2 m?g (1%) whole virus. Thus, the HANAflu subunit vaccine alone was less immunogenic than commercial vaccine in unprimed persons. However, addition of 1 m?g (5%) whole virus, but not 0.2 m?g (1%), eliminated this difference. There may be a role for addition of small amounts of whole virus to subunit influenza vaccines to overcome lower immunogenicity in unprimed populations.     

Immunity to Influenza in Ferrets X. Intranasal Immunization of Ferrets with Inactivated Influenza A Virus Vaccines

The response of ferrets after intranasal inoculation of inactivated A/Hong Kong/68 (H3N2) influenza virus vaccines is reported. Normal ferrets given either saline vaccine in drops or freeze-dried vaccine in an aerosol intranasally did not produce detectable serum or nasal hemagglutination inhibiting antibody and were found to be completely susceptible to challenge infection with A/Hong Kong/68 virus. Intranasal saline vaccine did not produce an additive effect on the response of ferrets simultaneously given the same vaccine intramuscularly with adjuvant. Ferrets primed by previous infection with A/PR/8/34 (H0N1) influenza virus, however, responded to intranasal immunization with saline A/Hong Kong/68 virus vaccine and produced serum and nasal antibody. These animals were found to be partially resistant to challenge infection, in contrast to similar animals given saline vaccine intramuscularly which were completely resistant to challenge infection. Primed ferrets did not respond after immunization with the freeze-dried aerosol vaccine, but this may have been due to a failure of the aerosol to be inhaled satisfactorily.     

Aventis Pasteur Vaccines Containing Inactivated Hepatitis A Virus: A Compilation of Immunogenicity Data

Inactivated hepatitis A vaccines were developed in the 1980s and were introduced during the early 1990s. The Aventis Pasteur (AvP) inactivated hepatitis A virus antigen is used in several different vaccine formulations licensed for adults and children. Presented here are the immunogenicity results compiled from 37 clinical trials performed in 20 different countries between 1991 and 2001 in which these vaccines were administered to adults (16 years of age and over), children (aged 12 months–17 years), and infants (younger than 12 months). The accumulated clinical experience with these hepatitis A virus-containing vaccines demonstrates the excellent immunogenicity of this antigen in a wide range of situations. As with other licensed inactivated hepatitis A vaccines, immunological priming is achieved in virtually all vaccinees after a single-dose primary immunization, and it may be reinforced by a booster vaccination administered 6–36 months after the primary vaccination.     

Immunogenicity of Haemophilus influenzae Type b Conjugate Vaccines in Korean Infants: A Meta-analysis

A meta-analysis was performed on the immunogenicity of Haemophilus influenzae type b (Hib) conjugate vaccines after 2 (2 and 4 months) and 3 doses (2, 4, and 6 months) in Korean infants. A database search of MEDLINE, KoreaMed, and Korean Medical Database was done. The primary outcome measure was the proportion of infants with anti-polyribosylribitol phosphate (PRP) concentrations ≥1.0 µg/mL. Eight studies including eleven trials were retrieved. One trial reported on the diphtheria toxoid conjugate vaccine (PRP-D) and 2 trials each on the mutant diphtheria toxin (PRP-CRM) and Neisseria meningitidis outer-membrane protein (PRP-OMP) conjugate vaccine. Heterogeneity in study designs between trials on PRP-CRM was noted and one trial reported on a monovalent and another on a combination PRP-OMP vaccine. Thus, a meta-analysis was conducted only on the tetanus toxoid conjugate vaccine (PRP-T). After a primary series of 2 doses and 3 doses, 80.6% (95% confidence interval [CI]; 76.0-85.1%) and 95.7% (95% CI; 94.0-98.0%) of infants achieved an antibody level ≥1.0 µg/mL, respectively. The immunogenic response to the PRP-T vaccine was acceptable after a primary series of 3 doses and also 2 doses. A reduced number of doses as a primary series could be carefully considered in Korean infants.     

Antigenicity and Immunogenicity of Antigenized Antibodies. Studies on B and T Cells

This laboratory has been testing the possibility of using the complementarity-determining region (CDR) loops of the antibody molecule to express oligopeptide epitopes in an immunologically-accessible and conformationally-suitable way. The new process consists in grafting peptides epitopes derived from antigens other than immunoglobulins into antibody CDR loops [1], This process, “antibody antigenization,” utilizes the immunoglobulin fold as a scaffold to immobilize and present oligopeptide epitopes to the immune system as the integral part of the immunoglobulin molecule. Here we describe some of the initial results with antigenized antibodies (^AgAbs).     

Effects of Different Adjuvants in the Context of Intramuscular and Intranasal Routes on Humoral and Cellular Immune Responses Induced by Detergent-Split A/H3N2 Influenza Vaccines in Mice

Influenza A/H3N2 viruses have caused the most severe epidemics since 1968 despite current immunization programs with inactivated vaccines. We undertook a side-by-side preclinical evaluation of different adjuvants (Alum, AS03, and Protollin) and routes of administration (intramuscular [i.m.] and intranasal [i.n.]) for assessing their effect on the immunogenicity and cross-reactivity of inactivated split vaccines (A/H3N2/New York/55/2004). Humoral and T cell-mediated immune responses against the homologous virus and a heterologous drifted strain (A/H3N2/Wisconsin/67/2005) were measured in BALB/c mice at 2, 6, and 19 weeks postboost. The AS03- and Alum-adjuvanted i.m. vaccines induced at least an 8-fold increase over the nonadjuvanted vaccine in functional antibody titers against both the homotypic and heterotypic strains and low IgG2a and high IgG1 levels, suggesting a mixed Th1/Th2 response with a Th2 trend. The Protollin-adjuvanted i.n. vaccine induced the lowest IgG1/IgG2a ratio, which is indicative of a mixed Th1/Th2-type profile with a Th1 trend. This adjuvanted vaccine was the only vaccine to stimulate a mucosal IgA response. Whatever the timing after the boost, both hemagglutination inhibition (HAI) and microneutralization (MN) titers were higher with the AS03-adjuvanted i.m. vaccine than with the protollin-adjuvanted i.n. vaccine. Finally, the Alum-adjuvanted i.m. vaccine and the lower-dose Protollin-adjuvanted i.n. vaccine elicited significantly higher CD4⁺ Th1 and Th2 responses and more gamma interferon (IFN-γ)-producing CD8⁺ T cells than the nonadjuvanted vaccine. Our data indicate that the adjuvanted vaccines tested in this study can elicit stronger, more persistent, and broader immune responses against A/H3N2 strains than nonadjuvanted inactivated influenza vaccines.