Symptoms associated with influenza vaccination and experimental human pneumococcal colonisation of the nasopharynx

•The timing and route of influenza vaccines effect symptom reporting in healthy adults.•Symptoms experienced by healthy adults were further affected by the presence of S. pneumoniae.•LAIV vaccination prior to S. pneumoniae exposure/colonisation led to reduced symptoms.•TIV vaccination prior to S. pn...

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Bibliographic Details
Published in:	Vaccine 2020-02, Vol.38 (10), p.2298-2306
Main Authors:	Hales, Caz, Jochems, Simon P., Robinson, Rachel, Solórzano, Carla, Carniel, Beatriz, Pojar, Sherin, Reiné, Jesús, German, Esther L., Nikolaou, Elissavet, Mitsi, Elena, Hyder-Wright, Angela D., Hill, Helen, Adler, Hugh, Connor, Victoria, Zaidi, Seher, Lowe, Catherine, Fan, Xiaojing, Wang, Duolao, Gordon, Stephen B., Rylance, Jamie, Ferreira, Daniela M.
Format:	Article
Language:	eng
Subjects:	Adult Antibiotics Bacteria Coinfection - microbiology Coinfection - virology Colonization Controlled human infection challenge model Data analysis Double-Blind Method Epidemics Humans Immune response Immunization Infections Influenza Influenza vaccination Influenza Vaccines - administration & dosage Influenza Vaccines - classification Influenza, Human - prevention & control Inoculation Live attenuated influenza vaccine Nasopharynx Nasopharynx - microbiology Nose Pathogens Pneumococcal inoculation Pneumococcus colonisation Pneumonia Questionnaires Streptococcus infections Streptococcus pneumoniae Streptococcus pneumoniae - pathogenicity Studies Symptoms Time Factors Vaccination Vaccines Vaccines, Attenuated - administration & dosage Vaccines, Inactivated - administration & dosage Viral infections Viruses
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Summary:	•The timing and route of influenza vaccines effect symptom reporting in healthy adults.•Symptoms experienced by healthy adults were further affected by the presence of S. pneumoniae.•LAIV vaccination prior to S. pneumoniae exposure/colonisation led to reduced symptoms.•TIV vaccination prior to S. pneumoniae exposure/colonisation led to increased nasal symptoms compared to LAIV. Nasopharyngeal colonisation by S. pneumoniae is a prerequisite for invasive pneumococcal infections. Influenza co-infection leads to increased susceptibility to secondary pneumonia and mortality during influenza epidemics. Increased bacterial load and impaired immune responses to pneumococcus caused by influenza play a role in this increased susceptibility. Using an Experimental Human Challenge Model and influenza vaccines, we examined symptoms experienced by healthy adults during nasal co-infection with S. pneumoniae and live attenuated influenza virus. Randomised, blinded administration of Live Attenuated Influenza Vaccine (LAIV) or Tetravalent Inactivated Influenza Vaccine (TIV) either preceded bacterial inoculation or followed it, separated by a 3-day interval. The presence and density of S. pneumoniae was determined from nasal washes. Participants completed a symptom questionnaire from the first intervention until 6 days post second intervention. The timing and type of influenza vaccination and presence of S. pneumoniae in the nasopharynx significantly affected symptom reporting. In the study where influenza vaccination preceded bacterial inoculation: nasal symptoms were less common in the LAIV group than the TIV group (OR 0.57, p
ISSN:	0264-410X 1873-2518