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Vaccine Failure and
Severe H1N1 Cases in Wyoming
Unlike Barron’s employee, Benefiel had been vaccinated, friends said. Despite the vaccination, Benefiel contracted severe pneumonia as a result of H1N1 and had to be transported from St. John’s Medical Center in Jackson to Utah.
The above comments describe two of three Wyoming residents who contracted a severe form of H1N1 which required transfer to Utah. At least one was said to have been vaccinated, raising concerns that the H1N1 has evolved away from the current vaccine. Prior sequences from Utah included one fatal case with an HA sequence, A/Utah/42/2009, that had D225G and D225N. Another sequence, A/Utah/20/2009, was designated as a low reactor, while a third isolate, A/Utah/34/2009, had H274Y.
The presence of “low reactors” in Utah raises concerns of immunological escape from the current vaccine. In addition to designating Utah/20 a low reactor, the CDC tested a D225G positive clone from Utah/42 but did not designate it as a low reactor. Similarly, a D225G positive clone from Ukraine was also not designated a low reactor, although Mill Hill tested an isolate from the same patient and did designate it as a low reactor, suggesting Mill Hill and CDC were using different anti-sera in the characterization test.
Although both labs presumably used an anti-sera directed against Califirnia-7, the original isolate produced mix signals. Reassortants were generated with and without D225G for the killed vaccine as well as the attenuated live vaccine. However, the commercial killed vaccine shot did not have D225G, while the attenuated live nasal spray did. Thus, the selection of the influenza-like target could affect titers in antigen characterization tests.
The Mill Hill low reactor designation for H1N1 with D225G raises concerns that a vaccine lacking D225G, as well as natural immunity to an infection by wild type H1N,1 will generate a response with reduced activity against D225G variants, which are linked to severe and fatal H1N1 infections.
This week the WHO is selecting the vaccine target for the 2010/2011 season, and WHO reports have significantly downplayed the role of D225G in fatal case, raising concerns that this week’s recommendation will be to use the same California/7 target as used for the current season in the northern hemisphere and the upcoming season in the southern hemisphere, which would lead to use of current stocks and further scale up of the current target, which lack D225G.
The descriptions in the WHO Dec 28 report on D225G were obsolete by the time the report came out, and was further discounted by sequences that became public just before and after the Jan 21 mailing. Since the Jan 21 e-mailing and WER publication represents the last official comment on D225G, there is concern that the obsolete and thoroughly discounted data will be used to recommend continued use of the California/7-like target, and the use of a target without D225G will be hazardous to the world’s health.