{"id":2596,"date":"2016-07-07T19:25:51","date_gmt":"2016-07-07T23:25:51","guid":{"rendered":"http:\/\/allphasepharma.com\/dir\/?p=2596"},"modified":"2025-09-20T19:21:31","modified_gmt":"2025-09-21T01:21:31","slug":"is-laiv-dead-or-just-on-laiv-support","status":"publish","type":"post","link":"https:\/\/allphasepharma.com\/dir\/2016\/07\/07\/2596\/is-laiv-dead-or-just-on-laiv-support\/","title":{"rendered":"Is LAIV Dead or Just on LAIV-Support?"},"content":{"rendered":"<p><a href=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-slider.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-2609 aligncenter\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-slider.jpg?resize=530%2C149&#038;ssl=1\" alt=\"VE slider\" width=\"530\" height=\"149\" srcset=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-slider.jpg?w=640&amp;ssl=1 640w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-slider.jpg?resize=300%2C84&amp;ssl=1 300w\" sizes=\"auto, (max-width: 530px) 100vw, 530px\" \/><\/a><\/p>\n<p>Very recently we came across several studies in which small differences in design\u00a0had a major\u00a0impact on outcomes. A blog\u00a0is not a good\u00a0place\u00a0to dig deeply into the minutiae of study design as the discussion\u00a0becomes quickly very dry and quite\u00a0technical. However, readers and clinicians are often unaware how a seemingly small change in design can affect results, thinking that reported outcomes\u00a0are robust enough to be affected little by somewhat\u00a0different &#8216;real world&#8217;\u00a0conditions. As clinicians we are used to extrapolating from idealized study populations to other groups of patients, a practice so common that we accept B-III category recommendations in\u00a0Guidelines, which are no longer\u00a0data-driven but rather opinion-based.<\/p>\n<p>This is an area rarely\u00a0discussed but consequential for drug developers and regulators; it has not attracted\u00a0much attention in\u00a0the literature to the best of my knowledge. Hence we will provide\u00a0a mini-series and start today with an example from the world of vaccine trials.<\/p>\n<p><u><strong>Case #1: LAIV Influenza Vaccine<\/strong><br \/>\n<\/u>The news releases from CDC and ACIP this week give us the following information on vaccine effectiveness (VE):<\/p>\n<ul>\n<li><strong>2015 \/ 2016:<\/strong><br \/>\nSeasonal Flu Vaccine VE Network, preliminary study data <a href=\"#_ftn1\" name=\"_ftnref1\">[1]<\/a><br \/>\n<span style=\"color: #ff0000;\">LAIV:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0 3% (CI: -49%, 37%) \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0age 2-17<\/span><br \/>\nIIV:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 63% (CI: 52%, 72%) \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0age 2-17<br \/>\nnon-CDC studies: similar lower VE with LAIV compared to IIV<\/li>\n<li><strong>2014 \/ 2015:<\/strong><br \/>\nSeasonal\u00a0Flu Vaccine VE Network<br \/>\nactivity against H3N2<br \/>\n<span style=\"color: #ff0000;\">LAIV:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 -23% (CI: -90%, 21%) \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0age 2-8<\/span><br \/>\nIIV: \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a015% (CI: -20%, 40%)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 age 2-8<\/li>\n<li><strong>2013\/ 1 4:<\/strong><br \/>\nACIP data review:<br \/>\nactivity against H1N1<br \/>\n<span style=\"color: #ff0000;\">LAIV: \u00a0 \u00a0 \u00a0 \u00a0 no measurable effectiveness for LAIV against influenza A (H1N1)<\/span><br \/>\nIIV: \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a060% (mid-point estimate)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 age 2-8<\/li>\n<\/ul>\n<p>Over the last 12 years, the weight-adjusted average VE for flu vaccination was a respectable 45%. While there were big swings in VE from year to year, please let us be mindful of how difficult the forecasting process is for next season&#8217;s influenza strains. Selection of vaccine strains is based on many assumptions, which may or may not come true; it is a time-critical process in which decisions have to be made early each year to allow for sufficient vaccine production time.<\/p>\n<figure id=\"attachment_2605\" aria-describedby=\"caption-attachment-2605\" style=\"width: 267px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Adjusted-VE-by-vaccine-2014-season-childrenadolescents-cropped.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"wp-image-2605\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Adjusted-VE-by-vaccine-2014-season-childrenadolescents-cropped.jpg?resize=267%2C289&#038;ssl=1\" alt=\"Adjusted VE by vaccine 2014 season children+adolescents cropped\" width=\"267\" height=\"289\" srcset=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Adjusted-VE-by-vaccine-2014-season-childrenadolescents-cropped.jpg?w=838&amp;ssl=1 838w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Adjusted-VE-by-vaccine-2014-season-childrenadolescents-cropped.jpg?resize=277%2C300&amp;ssl=1 277w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Adjusted-VE-by-vaccine-2014-season-childrenadolescents-cropped.jpg?resize=768%2C831&amp;ssl=1 768w\" sizes=\"auto, (max-width: 267px) 100vw, 267px\" \/><\/a><figcaption id=\"caption-attachment-2605\" class=\"wp-caption-text\">Adjusted VE by influenza type\/subtype and vaccine type for vaccinated children age &#8211; US Flu VE Network, 2014-2015<\/figcaption><\/figure>\n<p>It would be unfair to blame poor protection in any single year on the vaccine without considering how well\u00a0the\u00a0vaccine strains\u00a0matched the flu strains actually circulating in the following\u00a0respiratory season. Comparisons between different vaccines deployed during the same influenza season are more meaningful than point estimates; only parallel (i.e., contemporaneous) comparisons can truly give reliable\u00a0insights into performance characteristics and the VE of different vaccines.<\/p>\n<p>With that in mind and the data shown above, it is not difficult to understand why the CDC \/ ACIP decided to withdraw its recommendation for LAIV, the only available live attenuated non-injectable vaccine for influenza\u00a0prophylaxis.\u00a0 LAIV clearly had a disappointingly poor track record for several respiratory seasons in a row compared to IIV, the injectable inactivated flu virus vaccine.<\/p>\n<p><strong>Why then is AstraZeneca claiming the exact opposite:<\/strong> In a press release, they quote excellent VE during the last years of LAIV deployment stating that \u201cstudies by AstraZeneca as well as preliminary independent findings by public health authorities in other countries \u2026 demonstrate FluMist\u00a0Quadrivalent\u00a0was 46-58% effective overall against the circulating influenza strains during the 2015-2016 season\u201d.<a href=\"#_ftn2\" name=\"_ftnref2\">[2]<\/a><\/p>\n<p>What is going on? \u00a0Are we missing something here?<\/p>\n<p>Let\u2019s have a closer look at the 2 references quoted by AstraZeneca in support of LAIV effectiveness:<\/p>\n<p>The first reference<\/p>\n<ul>\n<li>is not a publication at all but a slide set from THL, the Finnish Department of Health Protection <a href=\"#_ftn3\" name=\"_ftnref3\"><sup>[3]<\/sup><\/a>. For full disclosure, THL is collaborating with vaccine manufacturers in a \u201cpublic-private partnership\u201d.<\/li>\n<li>LAIV was only recently introduced in Finland. It seems that only a small fraction of flu vaccine recipients in the Finnish 2015\/16 flu season received LAIV: compared to 1.3 million doses of the trivalent inactivated vaccine (TIV), but only a measly 22,500 doses of LAIV were delivered to Finland. Therefore, very few Fins were vaccinated with LAIV compared to TIV.<br \/>\n<figure id=\"attachment_2614\" aria-describedby=\"caption-attachment-2614\" style=\"width: 233px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Finland-flu-doses.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"wp-image-2614\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Finland-flu-doses.jpg?resize=233%2C105&#038;ssl=1\" alt=\"Finland flu doses\" width=\"233\" height=\"105\" srcset=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Finland-flu-doses.jpg?w=855&amp;ssl=1 855w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Finland-flu-doses.jpg?resize=300%2C135&amp;ssl=1 300w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/Finland-flu-doses.jpg?resize=768%2C347&amp;ssl=1 768w\" sizes=\"auto, (max-width: 233px) 100vw, 233px\" \/><\/a><figcaption id=\"caption-attachment-2614\" class=\"wp-caption-text\">From: Ref [3]<\/figcaption><\/figure><\/li>\n<li>The slides mention that\u00a0VE was\u00a051-60% and 51%-54% for children and elderly, respectively. \u00a0 As these percentages were based on a\u00a0\u201cNumber vaccinated\u201d far greater than all the doses of LAIV delivered, we might have to assume that these VE rates are averages across all vaccines, and thus predominantly rather reflect TIV effectiveness. Sadly, the authors do not report VE of the individual vaccines administered in Finland.<\/li>\n<li>Note: there was a good match between vaccine strains and circulating flu virus.<\/li>\n<\/ul>\n<p>In conclusion, these data do not support AZ\u2019s claim of LAIV effectiveness. The data sets reviewed by CDC are not only larger but also comparative in nature. AZ or THL may have more detailed information on file but this is what could be found in the public domain.<\/p>\n<p>The second reference<\/p>\n<ul>\n<li>provided by AZ comes from pre-Brexit Great Britain <a href=\"#_ftn4\" name=\"_ftnref4\"><sup>[4]<\/sup><\/a>. In a cohort of 729 children studied with LAIV, the preliminary VE was 57.6% (CI: 25%, 76%). These results are very different from the CDC data listed above and in favor of LAIV effectiveness.<\/li>\n<li>Like in the CDC trial, the British study used the TND approach to determine VE, a commonly used methodology. It is based on a retrospective analysis of patients coming to medical attention for a respiratory illness at certain centers that are proficient in influenza lab testing.<\/li>\n<li>In the British study the size of the LAIV study population was quite small (N=729). We are not provided data from an age-matched comparison group.<\/li>\n<li>By contrast, the CDC study cohort is 10x larger (N=7563); in addition, a direct comparison was made between LAIV and the injectable inactivated flu vaccine in the same population and the same season.<\/li>\n<\/ul>\n<p><figure id=\"attachment_2603\" aria-describedby=\"caption-attachment-2603\" style=\"width: 373px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/UK-study-VE.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"wp-image-2603\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/UK-study-VE.jpg?resize=373%2C174&#038;ssl=1\" alt=\"UK study VE\" width=\"373\" height=\"174\" \/><\/a><figcaption id=\"caption-attachment-2603\" class=\"wp-caption-text\">From: Ref\u00a0[4]<\/figcaption><\/figure>So, there is no argument that the CDC data is better in quality and quantity. In light of the huge discrepancy\u00a0of results between 2 studies using very similar methodology, we need to be concerned about the inherent shortcomings of TND (Test-Negative Design).<\/p>\n<p>TND does not match RCT in quality and scientific rigor, not even closely. For that reason, TND\u00a0results are not referred to as &#8216;efficacy&#8217; but \u2018effectiveness\u2019. TND is neither randomized nor prospectively controlled. It is basically a case control design with its\u00a0major appeal being\u00a0expediency.\u00a0While some believe that TND results compare favorably with those from RCTs,<a href=\"#_ftn5\" name=\"_ftnref5\"><sup>[5]<\/sup><\/a> this view can be challenged <a href=\"#_ftn5\" name=\"_ftnref5\"><sup>[6]<\/sup><\/a>\u00a0.<\/p>\n<p><figure id=\"attachment_2612\" aria-describedby=\"caption-attachment-2612\" style=\"width: 278px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-Bias-Canada.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"wp-image-2612\" src=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-Bias-Canada.jpg?resize=278%2C203&#038;ssl=1\" alt=\"VE Bias -Canada\" width=\"278\" height=\"203\" srcset=\"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-Bias-Canada.jpg?w=1648&amp;ssl=1 1648w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-Bias-Canada.jpg?resize=300%2C219&amp;ssl=1 300w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-Bias-Canada.jpg?resize=768%2C561&amp;ssl=1 768w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-Bias-Canada.jpg?resize=1024%2C747&amp;ssl=1 1024w, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-Bias-Canada.jpg?w=1590&amp;ssl=1 1590w\" sizes=\"auto, (max-width: 278px) 100vw, 278px\" \/><\/a><figcaption id=\"caption-attachment-2612\" class=\"wp-caption-text\">From: Ref [6]<\/figcaption><\/figure>AstraZeneca is probably not amused with this recent CDC assessment of the LAIV\u00a0vaccine\u00a0\u2013 its MedImmune subsidiary is already in a tight spot. MedImmune\u2019s infectious disease franchise had been exceptionally unlucky \/ unsuccessful \/ unproductive in recent years and kept on being a drag on profitability. Its infectious disease portfolio has shrunk and now only lists an RSV compound and antibodies against S. aureus and P. aeruginosa, all problematic projects for their own individual and very specific reasons.<\/p>\n<hr \/>\n<p><strong><span style=\"color: #800000;\">PS:<\/span><\/strong> <span style=\"color: #800000;\">We just learned (10\/1\/16) that the H1N1 component of the LAIV vaccine may be the culprit; according to MedImmune, it\u00a0is not replicating as well as it should.<\/span> <a href=\"#_ftn5\" name=\"_ftnref5\"><sup>[7]<\/sup><\/a><\/p>\n<p><strong>Abbreviations:<br \/>\n<\/strong>ACIP\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Advisory Committee on Immunization Practices<br \/>\nAZ\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 AstraZeneca<br \/>\nIIV\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 injectable influenza vaccine<br \/>\nLAIV \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 life-attenuated influenza vaccine<br \/>\nRCT \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 randomized controlled trial<br \/>\nRSV \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 respiratory syncytial virus<br \/>\nTND\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Test-Negative Design<br \/>\nVE\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vaccine effectiveness<\/p>\n<p><strong>References:<\/strong><\/p>\n<p><a href=\"#_ftnref1\" name=\"_ftn1\">[1]<\/a> http:\/\/www.cdc.gov\/media\/releases\/2015\/s0226-acip.html<br \/>\n<a href=\"#_ftnref2\" name=\"_ftn2\">[2]<\/a> https:\/\/www.astrazeneca.com\/media-centre\/press-releases\/2016\/astrazeneca-provides-update-on-flumist-quadrivalent-vaccine-in-the-us-for-the-2016-17-influenza-season-23062016.html<br \/>\n<a href=\"#_ftnref3\" name=\"_ftn3\">[3]<\/a> H Nohynek for the THL Influenza Research Team. Nordic Vaccine Meeting April 2016 Reykjavik Iceland.\u00a0 Nohynek_NorVac_influenzaLessonsNohynek_short<br \/>\n<a href=\"#_ftnref4\" name=\"_ftn4\">[4]<\/a>\u00a0Public Health England. Influenza Vaccine Effectiveness in adults and children in primary care in the UK: provisional end-of-season results 2015-16. Influenza_vaccine_effectiveness_in_primary_care_in_children.pdf<br \/>\n<a href=\"#_ftnref5\" name=\"_ftn5\">[5]<\/a> G De Serres. Eurosurveillance, 18: 2013<br \/>\n<a href=\"#_ftnref5\" name=\"_ftn5\">[6]<\/a>\u00a0S McNeill. Overview of Vaccine Efficacy and Vaccine Effectiveness. Canadian Center for Vaccinology.\u00a0https:\/\/www.google.com\/url?sa=t&amp;rct=j&amp;q=&amp;esrc=s&amp;source=web&amp;cd=1&amp;cad=rja&amp;uact=8&amp;ved=0ahUKEwit4Lml4-DNAhVJXh4KHcZHCVoQFgghMAA&amp;url=http%3A%2F%2Fwww.who.int%2Finfluenza_vaccines_plan%2Fresources%2FSession4_VEfficacy_VEffectiveness.PDF&amp;usg=AFQjCNGoJd1GV_b-ivAFuqv0JA86sTHatA&amp;sig2=RXBFfS3c70GhfgBs-psJPw&amp;bvm=bv.126130881,d.dmo<br \/>\n<a href=\"#_ftnref5\" name=\"_ftn5\">[7]<\/a> http:\/\/www.medscape.com\/viewarticle\/869537?nlid=109590_3901&amp;src=wnl_newsalrt_160929_MSCPEDIT&amp;uac=75802SR&amp;impID=1206767&amp;faf=1<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Very recently we came across several studies in which small differences in design\u00a0had a major\u00a0impact on outcomes. A blog\u00a0is not a good\u00a0place\u00a0to dig deeply into the minutiae of study design as the discussion\u00a0becomes quickly very dry and quite\u00a0technical. However, readers and clinicians are often unaware how a seemingly small change <a class=\"more-link\" href=\"https:\/\/allphasepharma.com\/dir\/2016\/07\/07\/2596\/is-laiv-dead-or-just-on-laiv-support\/\">Continue reading <span class=\"screen-reader-text\">  Is LAIV Dead or Just on LAIV-Support?<\/span><span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":2609,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[227,3],"tags":[1695,1696,1271,403,585,639,1691,1690,1689,1583,1687,986,1694,1686,1180,1683,744,38,500,1684,1688,1685,992,1692,1693],"class_list":["post-2596","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-recent_literature","category-the_news","tag-acip","tag-advisory-committee-on-immunization-practices","tag-allphase-pharma-consulting","tag-antibiotic-blog","tag-astrazeneca","tag-cdc","tag-effectiveness-vs-efficacy","tag-finland","tag-flumist","tag-harald-reinhart","tag-iiv","tag-influenza-vaccine","tag-injectable-influenza-vaccine","tag-laiv","tag-medimmune","tag-p-aeruginosa-s-aureus","tag-randomized-controlled-trial","tag-rct","tag-rsv","tag-test-negative-design","tag-tiv","tag-tnd","tag-vaccine-effectiveness","tag-vaccine-efficacy","tag-ve"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/07\/VE-slider.jpg?fit=640%2C180&ssl=1","jetpack_shortlink":"https:\/\/wp.me\/p4KWFr-FS","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":5948,"url":"https:\/\/allphasepharma.com\/dir\/2025\/12\/15\/5948\/influenza-vaccination-in-the-elderly\/","url_meta":{"origin":2596,"position":0},"title":"INFLUENZA VACCINATION IN THE ELDERLY","author":"Harald","date":"December 15, 2025","format":false,"excerpt":"In 2024, the ECDC published a detailed review of flu vaccine studies [1].\u00a0 In particular, the report examined published trials of newer flu vaccines.\u00a0 As is well known, the older vaccines provide significant protection, but efficacy is diminished in certain populations.\u00a0 Especially the elderly are at an increased risk of\u2026","rel":"","context":"In &quot;Recent Literature&quot;","block_context":{"text":"Recent Literature","link":"https:\/\/allphasepharma.com\/dir\/category\/recent_literature\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/12\/image.png?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/12\/image.png?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/12\/image.png?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/12\/image.png?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/12\/image.png?resize=1050%2C600&ssl=1 3x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2025\/12\/image.png?resize=1400%2C800&ssl=1 4x"},"classes":[]},{"id":1470,"url":"https:\/\/allphasepharma.com\/dir\/2015\/05\/21\/1470\/vaccine-mismatch-the-influenza-season-2014-2015\/","url_meta":{"origin":2596,"position":1},"title":"Vaccine Mismatch \u2013 The Influenza Season 2014 \/ 2015","author":"Harald","date":"May 21, 2015","format":false,"excerpt":"PLEASE SHARE YOUR OPINION AND VOTE\u00a0BELOW \u00a0 It has\u00a0always been a bit of a gamble: Predicting the main circulating flu types and subtypes for the next season based on information from the previous season is an educated guess. \u00a0It works well most of the time but fails when there is\u2026","rel":"","context":"In &quot;Recent Literature&quot;","block_context":{"text":"Recent Literature","link":"https:\/\/allphasepharma.com\/dir\/category\/recent_literature\/"},"img":{"alt_text":"2003 Vaccine Effectiveness","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/05\/2003-Vaccine-Effectiveness.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":577,"url":"https:\/\/allphasepharma.com\/dir\/2014\/07\/11\/577\/bacterial-vaccine-targets\/","url_meta":{"origin":2596,"position":2},"title":"Bacterial Vaccine Targets","author":"Harald","date":"July 11, 2014","format":false,"excerpt":"A recent publication [1] from the team which brought us the Meningococcal B vaccine is of interest from the perspective of vaccine development strategy and feasibility.\u00a0 Appropriately, tuberculosis (TB) leads the list of important bacterial targets for vaccine research. Despite numerous attempts, all the vaccines candidate tested so far had\u2026","rel":"","context":"In &quot;Recent Literature&quot;","block_context":{"text":"Recent Literature","link":"https:\/\/allphasepharma.com\/dir\/category\/recent_literature\/"},"img":{"alt_text":"Bacterial Targets","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/07\/Bacterial-Targets-Rappuoli.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":2157,"url":"https:\/\/allphasepharma.com\/dir\/2015\/12\/03\/2157\/there-is-momentum-building-for-rsv-therapeutics\/","url_meta":{"origin":2596,"position":3},"title":"There is Momentum Building for RSV Therapeutics","author":"Harald","date":"December 3, 2015","format":false,"excerpt":"Sometimes \u2013 for no obvious reason \u2013 there is a flurry of publications from a particular area which has been quiet for a long time.\u00a0 RSV is such an area where new drug development had a hard time getting started.\u00a0 There was always the lure of big money: an infection\u2026","rel":"","context":"In &quot;Recent Literature&quot;","block_context":{"text":"Recent Literature","link":"https:\/\/allphasepharma.com\/dir\/category\/recent_literature\/"},"img":{"alt_text":"RSV - banner copy","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/11\/RSV-banner-copy.jpg?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/11\/RSV-banner-copy.jpg?resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/11\/RSV-banner-copy.jpg?resize=525%2C300 1.5x"},"classes":[]},{"id":3550,"url":"https:\/\/allphasepharma.com\/dir\/2020\/02\/09\/3550\/some-thoughts-about-the-new-coronavirus-syndrome-and-its-transmission\/","url_meta":{"origin":2596,"position":4},"title":"Some Thoughts about the New Coronavirus Syndrome and its Transmission","author":"Harald","date":"February 9, 2020","format":false,"excerpt":"First and upfront, let\u2019s call this virus WARS*, which stands for Wuhan Associated Respiratory Syndrome.\u00a0 President Xi Jingping called for a war against the new virus, and a war it is.\u00a0 Therefore our acronym makes intuitive sense.\u00a0 The naming of new viruses is getting politized and silly: yes, we need\u2026","rel":"","context":"In &quot;The News&quot;","block_context":{"text":"The News","link":"https:\/\/allphasepharma.com\/dir\/category\/the_news\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":125,"url":"https:\/\/allphasepharma.com\/dir\/2014\/04\/18\/125\/waraboutdataaccess\/","url_meta":{"origin":2596,"position":5},"title":"The War about Data Access","author":"Harald","date":"April 18, 2014","format":false,"excerpt":"Several articles in the April 7 issue of BMJ were devoted to the epic battle fought by BMJ and Cochrane to gain unfettered access to the Tamiflu\u00ae and Relenza\u00ae data. Not just some data, but all the data. Considering that only 2 out of 10 Tamiflu studies were published in\u2026","rel":"","context":"In &quot;The Viewpoint&quot;","block_context":{"text":"The Viewpoint","link":"https:\/\/allphasepharma.com\/dir\/category\/the_viewpoint\/"},"img":{"alt_text":"Tamiflu tablets","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/04\/Tamiflu-tablets-300x194.jpg?resize=350%2C200","width":350,"height":200},"classes":[]}],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/2596","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/comments?post=2596"}],"version-history":[{"count":19,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/2596\/revisions"}],"predecessor-version":[{"id":2773,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/posts\/2596\/revisions\/2773"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/media\/2609"}],"wp:attachment":[{"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/media?parent=2596"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/categories?post=2596"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/allphasepharma.com\/dir\/wp-json\/wp\/v2\/tags?post=2596"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}