Hong Kong flu, COVID-19 – what to fear? Interview with the Director of the Flu Institute Director of the Flu Institute Lioznov talked about when to expect an increase in flu cases 11/07/2023, 08:00

— What does the picture of flu cases in Russia look like now?

— In general, the situation is calm. We see a seasonal increase in ARVI cases, but nothing dramatic. Very few cases of flu have been recorded so far.

— Were there more flu cases last year?

– In general, yes. In mid-November 2022, flu cases increased rapidly. It is difficult to predict how the situation will develop this season.

— Did the coronavirus that caused the pandemic change the normal circulation of viruses?

– Yes. Before COVID-19, we lived according to certain laws. We had trends and therefore the possibility of making predictions. SARS-CoV-2 caused some changes in circulation. In the first year of the pandemic, we saw almost no flu infections. In the second year we saw the flu, which caused cases to increase, but Omicron intervened. And last year the flu really took hold: the number of cases was quite high and there were many hospitalized cases.

It is not yet clear how we will live this year: according to last year’s scenario or according to the pre-pandemic period? But in general If you look at what is happening in the Southern Hemisphere, we are probably returning to the pre-pandemic period, when ARVI pathogens were circulating as usual and the COVID-19 pathogen was added.

— To understand what we will experience during flu season, would you look to Australia or South America?

– To both continents. However, we focus more on the temperate climate region. We are also watching South Africa. And from what has happened in the Southern Hemisphere this season, we see that there are no extremes; The flu was generally circulating as usual, and there were no flu viruses with special potential to make us cautious.

— How are the viruses that are expected to circulate among us “selected” from the general picture? How are the variants to be used in vaccines determined?

— Our institute conducts year-round surveillance of the circulation of ARVI pathogens. There are more than 140 centers around the world that, like us, are part of the WHO global influenza surveillance program.

These institutions collect morbidity data and isolate and study viruses from patients. This way it is known which variants are in circulation. Then, the properties of these flu viruses are passed on to our colleagues – WHO experts, who, taking into account all the data, make recommendations for the inclusion of four types of flu viruses in vaccines. This happens in February so that flu vaccine manufacturers in the spring and summer have time to produce them in the fall.

— How many types do you choose from?

– These are dozens. You need to choose dominant options from them. Just like races, there are several of them, but each race has millions of representatives with their own unique characteristics, characteristics and characters. However, the WHO expert group still needs to identify the dominant variants that are most likely to circulate in the coming season and make recommendations for inclusion in vaccines.

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Dmitry Lioznov

Alexander Demyanchuk/TASS

— Are viruses also congregating in Russia? How many of these are currently in the database for this season?

— Of course, and this happens regularly. So far their numbers are very small, but new cases are coming every week. However, we can already assume that an increase in flu cases can be expected in late November – early December. Judging by last year’s experience, the influenza A(H3N2) virus will dominate. This virus has been known for a long time. And what is very important is that all of the vaccines we are using this season contain protection against H3N2.

— How is the flu vaccine administered? We have Sovigripp, Ultrix, Grippol, Flu-M. What will you choose? Some vaccines are trivalent (from three viruses), some are quadrivalent (from four viruses).

— Yes, indeed, flu vaccines differ in their ability to protect against the three or four flu viruses. But this year the situation is unique; Actually there is no difference between them. This was due to the disappearance of the Yamagata lineage influenza B virus during the pandemic (in the mid-1980s, group B viruses split into two lines, Yamagata and Victorian). That’s why both trivalent and quadrivalent vaccines “work” this year.

— A vaccine against COVID-19 based on the flu virus has been created at your institute. At what stage is this development?

— This is a vector vaccine; Clinical trials of the second phase have been completed. We are now analyzing these results and preparing a report to submit to regulatory authorities. Since the aim of the first and second phases is to evaluate safety and immunogenicity (the ability to trigger an immune response), it is already clear that the vaccine is safe and immunogenic. The question of its effectiveness is the result of the next, third phase of the study, which should involve a large number of volunteers.

— Is the flu virus in this vaccine expected to change annually?

— Yes, it will change every year. And this is an additional bonus of vaccines based on the flu virus – you and I will receive protection against both COVID-19 and flu.

— Which part of the coronavirus will you use to cause an immune reaction?

— N-protein.

— Do you only make vector vaccines? Not interested in mRNA?

— We produce both vaccines and mRNA medicine against flu. mRNA vaccines have advantages. And if the tests are successful, it will be possible to quickly change the version of the flu virus in them and use them to create vaccines that will prevent other infections. However, for now, the long-term safety of mRNA vaccines still needs to be investigated.

We are also creating a drug to treat flu based on the same mRNA technology. The drug targets antibodies to the influenza virus and is still in development. Successful results will allow this technology to be used in the treatment of other diseases.

— They have been talking about a universal flu vaccine for a long time. How can this be done if the virus is constantly mutating?

— Yes, a universal vaccine is being developed by many research centers, but so far there has been no success in the world. Some even reached the second phase of the study but showed they were ineffective. The most recent study was conducted in Israel in 2021. It was later shown that the prototype created did not work.

But we expect a breakthrough. They are working very hard on this vaccine. Researchers are trying to find the most conservative part of the virus and mount an immune response against it. There is a theoretical justification that such a vaccine might exist today. It should be effective for three to five years.

— Recently, WHO drew attention to another virus, RSV (human respiratory syncytial virus). It causes serious diseases in children and the elderly. Is your institute involved in the RSV surveillance program?

— Yes, we are part of the global surveillance system for RSV infection. In 2017, WHO launched a pilot project for RSV surveillance: two countries were selected in each WHO region. England and Russia were among the European countries. Overall, this highlights the role and authority that the WHO National Influenza Center has at our institute.

— How many such programs does WHO have?

— Actually, if we are talking about pathogens of respiratory infections, the priority is influenza, RSV, SARS-CoV-2.

— Why does WHO attach so much importance to RSV?

“The importance of this virus is increasing year by year. RSV is a rather serious infection in young children, especially weakened children and those with accompanying pathologies. But now it has been revealed that this virus causes serious diseases in the elderly: severe pneumonia, bronchiolitis.

At the beginning of flu season in the United States last year, there was a rapid increase in RSV infection and COVID-19. This is where the term “tridemic” comes from; a significant increase in morbidity caused by three pathogens simultaneously.

— What ways are there to prevent RSV infection today?

— Two strategies have been developed to protect yourself from this virus. This is the vaccination and administration of ready-made monoclonal antibodies to RSV.

Monoclonal antibodies are used on the eve and during the season of an expected increase in the incidence of RSV infection in young children. Two vaccines against RSV were registered this year; One is applied to pregnant women close to birth and aims to protect the newborn with antibodies from the mother, and the other one protects the elderly.

Our institute is also developing an RSV vaccine for the elderly. We have now completed the first phase of clinical trials and hope to begin the second phase by the end of the year.. The vaccine is made using the influenza virus vector and is intended for intranasal use.

— So are you going to drop it into your nose and immediately protect yourself from flu and RSV?

– Yes. First of all, this is protection against RSV and, as an added bonus, protection against flu throughout the season. In my opinion, nasal vaccination against respiratory infections is the best approach because we not only gain systemic immunity, but also immunity at the point of entry of infections.

— Is it possible to get a triple vaccine against flu, RSV and COVID-19?

– Of course its possible. Combination vaccines targeting influenza and Covid-19 are being developed. And this will be done when the need for more value “ripens”.