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Background Analysis: US FDA Advisory Committee to Make Recommendations on Strains for Influenza Virus Vaccine – OCT 3, 2018 (VRBPAC)


The US FDA has scheduled a Vaccines and Related Biological Products Advisory Committee (VRBPAC) meeting for Wednesday, October 3, 2018 to discuss and make recommendations on the selection of strains to be included in an influenza virus vaccine for the 2019 Southern Hemisphere influenza season.

Indication Background

Description of Indication

Influenza is a contagious respiratory illness caused by influenza viruses that infect the respiratory tract. It can cause mild to severe illness, and at times can lead to death. Seasonal influenza is characterized by a sudden onset of high fever, dry cough, headache, sore throat, muscle and joint pain, and severe malaise.

Most people recover within a week without requiring medical attention. However, some people, including older people, young children, and people with certain health conditions, such as chronic heart, lung, kidney, liver, blood or metabolic diseases or weakened immune systems, are at high risk for serious flu complications. Influenza virus infections can cause primary influenza viral pneumonia; exacerbate underlying medical conditions (e.g., pulmonary or cardiac disease); lead to secondary bacterial pneumonia, sinusitis, or otitis media; or contribute to co-infections with other viral or bacterial pathogens. In the United States, on average 5% to 20% of the population gets the flu, and more than 200,000 people are hospitalized from seasonal flu-related complications annually.

There are three types of influenza viruses: A, B and C. Type C infections cause a mild respiratory illness and are not thought to cause epidemics: Human influenza A and B viruses cause seasonal epidemics of disease.

In temperate climates, seasonal epidemics occur mainly during winter months. In the Northern Hemisphere, the flu season can begin as early as October and can last as late as April or May. In the temperate regions of the Southern Hemisphere, influenza activity typically occurs during April – September.

Influenza A viruses are divided into subtypes based on two proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase (N). There are 17 different hemagglutinin subtypes and 10 different neuraminidase subtypes. Influenza A viruses can be further broken down into different strains. Influenza B viruses are not divided into subtypes, but can be further broken down into different strains. Changes in influenza viruses occur in two ways: antigenic drift, small changes that happen continually over time; and antigenic shift, which is an occasional, abrupt, major change in influenza A viruses, resulting in new hemagglutinin and/or new hemagglutinin and neuraminidase proteins. Type A viruses undergo both kinds of changes; influenza type B viruses change only by the more gradual process of antigenic drift.

Product Background

Description of Product

The following injectable vaccines are FDA-approved:

    AFLURIA by Seqirus Pty. Ltd.

    Agriflu by Novartis Vaccines and Diagnostics, Inc.

    FluLaval by ID Biomedical Corporation of Quebec

    Fluarix by GlaxoSmithKline Biologicals

    FluBlok by Protein Sciences Corporation

    Flucelvax by Seqirus, Inc.

    Fluvirin by Seqirus Vaccines Limited

    Fluzone by Sanofi Pasteur, Inc., which also available for intradermal administration

    Fluad (adjuvanted) by Seqirus, Inc

An intranasal vaccine, called FluMist, by Medimmune, LLC, is also FDA-approved.

Regulatory Background

The viruses to be included in the vaccine can change each year, based on international surveillance and scientists’ estimations about which types and strains of viruses will circulate in a given year. Each year, the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) meets once to select the influenza viruses for the composition of the influenza vaccine for the next US influenza season and once to select the influenza virus strains for the next Southern Hemisphere vaccine. During this meeting, the advisory committee reviews and evaluates the surveillance data related to epidemiology and antigenic characteristics of recent influenza isolates, serological responses to previous vaccines, and the availability of candidate strains and reagents. In the past, the committee made recommendations of two A strains, usually A/H1N1, A/H3N2, and one B strain, to be included in a trivalent vaccine. More recently, they have also voted on an additional B strain to be included in a quadrivalent vaccine.

On October 4, 2017, the VRBPAC made recommendations on the selection of strains to be included in the influenza virus vaccine for the 2018 influenza season in the Southern Hemisphere. Committee members agreed with the World Health Organization (WHO) strain recommendations. For trivalent vaccines, they recommended two A strains: an A/Michigan/45/2015 (H1N1)pdm09-like virus and an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus; and one B strain: a B/Phuket/3073/2013-like virus. For quadrivalent vaccines, the Committee unanimously recommended, in addition to the three strains of the trivalent vaccine, the addition of a second B strain: a B/Brisbane/60/2008-like virus. The WHO will have a consultation and informational meeting on the composition of influenza virus vaccines for use in the 2019 Southern Hemisphere influenza season on September 24-27, 2018. Tarius expects that the FDA will review the WHO’s recommendations at the upcoming VRBPAC meeting.

What’s Next? (With Subscription)

Tarius will send a Briefing Summary after briefing materials are posted to FDA’s website (typically within 2 days of the meeting). This report will provide a summary of the FDA briefing materials.

Tarius will send a Results Wire soon after the meeting. This report will include the voting outcomes, if applicable, and key outcomes of the discussion.

METADATA: Sponsor: none Drug Name: none Drug Class: vaccine Indication: influenza

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DISCLAIMER: The information in this document is for informational purposes only. The SAC Tracker Background Analysis contains information from publicly available sources, including FDA, sponsor, scientific, and clinical websites. Tarius A/S assumes no liability for any inaccurate or incomplete information, or for any actions taken in reliance thereon. © Tarius A/S. All rights reserved.