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Commentary


H1N1 Vaccine Breakthrough Sequences
Recombinomics Commentary 21:15
February 23, 2011

The United States DoD-GEIS Flu Program at Brooks Air Force base released a series of partial HA sequences largely from samples collected in December, 2010 or January, 2011 from DoD beneficiary populations.  17 of the sequences were from vaccinated patients and therefore represented vaccine breakthroughs (see list below).  11 of the 17 were the sub-clade with S188T, including one sample, A/Korea/AF21790/2011, which also had S186P.  These sequences also had A200T. Four additional sequences were from the S186P sub-clade, while the two sequences without S188T or S186P had A189T.  Thus, all 17 sequences had at least one change at positions 186, 188, or 189 and those with S188T also had A200T.

These sequences from vaccine breakthrough patients provide additional data indicating the current vaccine no longer offers significant protection from the H1N1 currently in circulation.  The S188T sub-clade is the dominant clade in the northern hemisphere represented by 11 of the 17 breakthrough sequences, signaling widespread vaccine failure. 

This failure is largely missed by the antigen chacterization assay, which has failed to identify these sequences as low reactors (only the sequence from India with S188T and S186P was designated a low reactor).  The assay has been used to claim that these common sequences were antigenically indistinguishable from the current H1N1 vaccine target, A/California/7/2009, which was used to justify the decision to keep the vaccine target unchanged.

The vaccine breakthrough sequences are consistent with the UK data which showed that the H1N1 vaccine only protected 50% of recipients in the first half of the 2011/2012 season.  This rate is probably low because the S188T sub-clade is becoming increasingly dominant throughout the northern hemisphere.

These data and sequences demonstrate the fatal flaw in the current antigen characterization assay and the recommendation to leave the target unchanged.

The vaccine target recommendation should be re-evaluated by an independent scientific committee, and the current WHO influenza consultants, who comprise latest committee, should be removed.

S188T
A/Korea/AF21778/2010
A/Korea/AF21780/2010
A/Korea/AF21783/2010
A/Japane/AF21777/2011
A/Korea/AF21784/2011
A/Korea/AF21785/2011
A/Korea/AF21786/2011
A/Korea/AF21787/2011
A/Korea/AF21788/2011
A/Korea/AF21789/2011
A/Korea/AF21790/2011

S186P
A/Korea/AF21779/2010
A/Korea/AF21781/2010
A/Korea/AF21782/2010
A/North Carolina/AF21797/2011

A189T
A/Arizona/AF21768/2011
A/New Jersey/AF21791/2011


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