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Following the demonstration of the strong adjuvant effect of whole-cell DTP vaccine (wDTP) on the immune responses to influenza subunit vaccine, studies were undertaken to identify the component of wDTP responsible for the adjuvant effect, and to determine if acellular DTP (aDTP) vaccine was as effective since it is less reactogenic and likely to replace wDTP for primary or secondary immunisation. In addition, wDTP and aDTP were directly compared in a dose-response study. Experiments in mice indicated that the adjuvant effect of wDTP resided in the LPS component of B. pertussis, since purified LPS enhanced the IgG antibody response, the IgG subclass response and protection to the same level as wDTP. An adjuvant effect was detected using aDTP, but was statistically less pronounced than wDTP by a factor of some 100-fold. These results suggest that immunisation against influenza in infants and young children can be achieved combining small amounts of influenza antigen with wDTP or LPS, and to a lesser extent by combining vaccine with aDTP. However, these results were obtained in mice and should be confirmed in man since species vary considerably in response to adjuvant.

The total and subclass antibody responses of mice and protection of these animals against live influenza A/Sichuan/2/87 virus challenge infection were determined after immunisation with homologous A/Sichuan/87 aqueous or ISCOM-formulated surface glycoprotein subunit antigens administered by either the oral or intramuscular routes. The results show that the greatest systemic and local antibody responses were elicited in mice immunised with A/Sichuan ISCOMs by the intramuscular route; protection against homologous virus challenge was also effective in these animals, particularly after two doses of the vaccine. However, relatively high immune responses and protection were also elicited by the A/Sichuan/87 ISCOM vaccine administered orally. Immunisation of mice by the intramuscular route resulted in levels of serum IgG2a subclass antibody significantly greater than those induced by the same preparation given by the oral route, or by the aqueous A/Sichuan/87 subunit antigen preparation administered by either route. The findings indicate that the ISCOM delivery system can be used for immunisation by the oral route, although in mice, under the conditions used, this strategy compares unfavourably with the intramuscular route in terms of both local and systemic immune responses and protection against homologous challenge virus infection.

The serum total IgG and IgG subclass and nasal wash IgA and IgG antibody responses of mice to influenza virus A/Hong Kong/68 (H3N2) subunit preparations administered parenterally as a single dose, incorporated either in immune stimulatory compounds (ISCOMs) or liposomes with Freund's Complete Adjuvant, or as an aqueous material, as well as to live, infectious virus were measured by ELISA at 10 days and 3, 5, 7 and 22 weeks after immunisation. The protection of the upper and lower respiratory tracts provided by these preparations against homologous and heterologous challenge infection was assessed. Of the four variously-presented subunit preparations, influenza subunit ISCOMs induced relatively high and persisting levels of each of the different IgG subclasses, particularly IgG2a, throughout the study, and most nearly approached those observed after intranasal infection of mice with infectious virus. Furthermore, nasal wash IgA and IgG antibody levels, particularly at 5 or 7 weeks after immunisation, were also significantly greater in mice given the subunit ISCOM preparation than those induced by other subunit preparations with adjuvant or subunits given alone, and provided protection of both the upper and lower respiratory tracts against challenge as similar to that elicited by infectious virus.

The immunogenicity and protective efficacy of an influenza A subunit vaccine preparation administered to mice in an aqueous form, or presented as immunostimulatory complexes (ISCOMs), liposomes or with Freund's complete adjuvant (FCA), were assessed in comparative studies with live infectious virus. Both intranasal and parenteral routes of administration were assessed. An enzyme-linked immunosorbent assay (ELISA) was used to measure nasal wash and serum antibody responses in groups of unprimed mice, while protection was determined by the recovery of homologous influenza virus from mouse nasal washes and lung homogenates following challenge infection by the intranasal route. The results showed that parenteral administration of the influenza antigen preparations induced variable levels of both local and systemic antibodies at weeks 3, 7 and 22 postimmunization. Although the overall greatest levels of antibody and protection were elicited in mice following live virus infection, formulation of influenza surface haemagglutinin (HA) and neuraminidase (NA) proteins into ISCOMs elicited high and persistent antibody responses and provided relatively good protection of the upper and lower respiratory tracts of these animals. The results also show a relatively poor effect of the subunit antigen preparations in promoting humoral immune responses and protection irrespective of the nature of their presentation, when given by the intranasal route.

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.

The persistence and extrapulmonary spread of three strains of influenza virus, the mouse neuro-adapted A/NWS virus, the wild-type strain A/Victoria/75, and a recombinant virus RIT4050, bearing surface antigens derived from A/Victoria/75, were studied in both normal and cyclophosphamide-treated CBA mice following either intranasal or intracerebral inoculation. All three viruses showed increased lethality in mice in the presence of cyclophosphamide but exhibited distinctive patterns of replication and spread. The recombinant virus RIT4050 showed a reduced ability to replicate, persist, and spread in CBA mice compared to either A/NWS or A/Victoria/75 viruses, and in general, the A/NWS virus persisted to a greater extent than the A/Victoria/75 virus in both normal and treated mice. However, in the presence of cyclophosphamide, no extrapulmonary spread of A/NWS virus was observed. The reasons for the differences are discussed.

The growth characteristics of a series of influenza A viruses in the turbinates and lungs of hamsters was measured: in addition, the susceptibility of hamsters to infection by these viruses was also determined. These two criteria were used to give estimates of the growth potential of influenza viruses in hamsters, and the results were related to the incidence of transmission of virus from inoculated hamsters to cage-contacts. The results showed that strains of influenza virus reported as virulent for man tended to grow to higher titres in hamster nasal washings and lungs; were more infective for hamsters when inoculated by the intranasal route; and showed a high incidence of spread to cage-contacts. The methods could provide valuable measurements of virus attenuation and transmissibility for man, and the further exploitation of these techniques could facilitate the production and licensing of live, attenuated influenza virus vaccines.

Previous studies of boys at Christ's Hospital school have indicated that annual immunization with influenza virus vaccines did not significantly reduce the total incidence of influenza infection compared to unimmunized subjects. In view of the implications of this result, a similar study was conducted in ferrets to clarify these findings. Groups of ferrets were immunized or infected with a series of influenza A (H3N2) viruses over an 18-month period, and the immunity to subsequent live virus challenge was measured after each virus or vaccine exposure. The results indicated that live virus infection gave a more solid immunity than immunization with inactivated vaccine; and the serum haemagglutination-inhibiting antibody response was greater following immunization than following infection. In addition, differences in immunity could not be explained by measurements of cross-reacting and specific antibody, since the incidence of these antibodies was similar in both infected and immunized animals. The results do not suggest an explanation for the different levels of immunity induced following infection or immunization or the results obtained from the Christ's Hospital study. However, the relative contribution of various immune responses to virus or virus antigen is discussed, and it is suggested that the difference in immunity may lie in the ability of live virus infection to stimulate local antibody.

The antibody response and immunity to challenge infection were determined in ferrets immunized with inactivated influenza vaccine in saline or adjuvant. Adjuvanated vaccines induced variable titres of serum antibody, and the degree of immunity to challenge infection was directly related to the titre of serum HI antibody induced by these vaccines. Conventional doses of saline vaccine did not induce serum HI antibody, and the ferrets were completely susceptible to challenge infection. Infection with live virus produced a more solid immunity to challenge infection than immunization with a adjuvant vaccines, even though immunization induced higher titres of serum HI antibody. Ferrets previously infected with a heterotypic influenza A virus, but not other viruses, produced serum HI antibody in response to subsequent immunization with inactivated influenza vaccine. Similar results were obtained in hamsters and mice. Thus, the failure of animals to produce antibody in response to immunization with saline inactivated vaccines was due to the absence of a previous priming infection; this prior experience would be a feature of most volunteers. Live virus infection produced nasal antibody in ferrets, but inactivated vaccines only induced serum antibody. This may explain the more solid immunity observed following infection; however, at the time of challenge infection, no nasal wash antibody could be detected. Immunization with inactivated vaccine in Freund's complete adjuvant and influenza virus infection both produced a cell-mediated immune response; thus, the difference in the degree of immunity induced by these two immunization procedures are probably not due to differences in the cell-mediated immune response. However, cell-mediated immunity was measured by skin tests and by macrophage migration inhibition tests with spleen cells; the reaction of cells from the respiratory tract may be more important, but was not measured in these studies.

Hamsters were used to examine the role of serum antibody in protection against influenza virus infection. Following intranasal instillation, influenza viruses replicated well in these animals, and high, reproducible amounts of virus could be subsequently recovered from nasal washings and lung suspensions. A specific serum antibody response to the infecting virus was also observed; but no local antibody production was detected. The passive transfer of serum antibody gave some measurable protection, against homologous influenza virus challenge, to recipient hamsters. However, evidence that protection can occur in the absence of detectable serum antibody in individual hamsters, is also presented.

Guinea pigs were inoculated by intranasal inoculation with unadapted, influenza virus A/England/42/72, and virus was recovered from nasal washings between 3 and 10 days post-inoculation. Infected animals did not exhibit a febrile response to infection, did not produce local antibody and produced only relatively low levels of serum antibody. However, they developed delayed-type hypersensitivity to influenza virus, demonstrable by both skin tests and macrophage migration inhibition tests, which was similar to that of man. The relevance of the influenza virus specific delayed hypersensitivity in immunity to infection was examined in this model. Guinea pigs previously infected with virus or passively immunized with hyperimmune serum were relatively resistant to reinfection with influenza virus A/England/42/72. Inoculation of guinea pigs with spleen cells from immune donor animals, together with or without immune serum, did not give or enhance resistance to challenge virus infection. The results do not suggest a role for delayed hypersensitivity response in immunity to influenza virus infection.

Infant rats were infected intranasally with wild influenza virus strains, attenuated strain A/Okuda/57 or recombinants prepared from these parents. The growth of viruses in the turbinates or lungs, and the ability of virus infections to potentiate subsequent bacterial infection by Haemophilus influenzae (HIb) were measured. The two wild strains of virus and a recombinant strain WRL105, known to be virulent for man, reached titres of 10(5.1)--10(6.5) EBID50/ml in the turbinates of infant rats 48 h after infections; infection by these viruses was followed by HIb bacteraemia in 77--92% and meningitis in 58--75% of animals. In contrast, virus strains known to be attenuated for man grew to lower titres in infant-rat turbinates and promoted a lower incidence of systemic infection by HIb than the virulent strains. A comparison of the various results of infection of infant rats with influenza virus strains of known pathogenicity for man indicated that the subsequent incidence of HIb bacteraemia was the most discriminating measurement of virus virulence; the range of yields of attenuated virus in rat turbinates overlapped that of virulent strains. These results, together with those of previous studies, indicate that the behaviour of influenza viruses in infant rats is an indication of virus virulence for man, and could provide a test of virulence that would facilitate the development of live attenuated virus vaccines for human use.

Hamsters previously infected by influenza viruses, have been shown to have a cell-mediated immune response, as measured by the macrophage migration inhibition test. The participation of spleen cells in the protection of recipients against homologous influenza virus infection was also demonstrated using adoptive transfer experiments. However, the protection achieved by spleen cell transfer was marginal and not observed in every animal. The time at which the spleen cells were transferred following infection, and their number, affected the outcome. Evidence suggesting that transferred spleen cells protected recipient hamsters through specific antibody is presented.

The degree of immunity due to cross-reactions between antibody to influenza virus A/Hong Kong/1/68 and A/England/42/72 was studied in ferrets. Ferrets were immunized with the viruses by either live infection or by inoculation with inactivated virus vaccines. The vaccines were given with Freund's incomplete adjuvant or were given to ferrets previously infected with influenza virus A/PR/8/34. As a result of these immunizations the animals all produced similar titres of serum HI antibody to the immunizing virus, although the degree of cross-reaction with the other virus strain was variable. After immunization the animals were challenged by infection with an A/Eng/42/72-like virus and their degree of immunity was measured. It was found that the greatest immunity was in ferrets previously infected with the homologous A/Eng/42/72 virus. Animals previously infected with A/HK/68 virus also showed a measurable degree of immunity to A/Eng/42/72 infection, and this was greater than that found in animals given inactivated virus vaccines. The immunity produced by the vaccines was approximately equal, regardless of which vaccine or method of immunization was used. Thus, live infection produced a more effective, broader immunity than did the use of inactivated virus vaccines.

Hamsters previously infected with influenza virus A1/FM/1/47 produced serum hemagglutination inhibition (HI) antibody in response to 1/100 the antigenic dose of inactivated influenza virus A2/Hong Kong vaccine necessary to induce antibody in normal animals. This priming effect was believed to be due to the virus infection which caused an immune response to a virus antigen common to both the infecting virus and the virus vaccine; this antigen acted as a carrier for the specific vaccine virus hemagglutinin and potentiated the immune response to the new antigen. This theory, which has been established in other immune systems, was tested, and the results obtained did not contradict the conditions imposed in the above explanation. Thus, the priming effect could be transferred to normal hamsters by inoculation of spleen cells from virus-infected animals, and the HI antibody response to the virus vaccine was characteristic of a secondary response. The theory also required that the new antigen be coupled to the carrier protein; however, primed hamsters produced serum HI antibody after inoculation with ether-Tween-split virus vaccine, but there was no proof that this vaccine was completely dissociated.