Egg-free influenza vaccines, specifically cell culture-based inactivated influenza vaccine (ccIIV) and recombinant influenza vaccine (RIV), represent a significant advancement over traditional egg-based inactivated influenza vaccines (IIV), particularly for populations with extensive vaccination histories. This comprehensive immunological study investigated the comparative efficacy of ccIIV, IIV, and RIV in healthcare personnel (HCP) with repeated vaccination histories, examining both cellular and humoral immune responses through multiple analytical approaches. Our investigation employed a multi-faceted analytical framework, combining serological assessments via hemagglutination inhibition (HI) and microneutralization (MN) assays with detailed cellular immune response analysis. We utilized advanced flow cytometry techniques with recombinant hemagglutinin (HA) probes to evaluate both circulating T follicular helper cells (cTfh) and HA-specific B cells, providing a comprehensive view of vaccine-induced immune responses. The results revealed RIV's superior immunogenicity profile, demonstrating significantly elevated levels of both cTfh and HA-specific B cells compared to ccIIV and IIV. RIV's enhanced performance was particularly evident in its response to influenza A components, with notably higher immunogenicity against both A(H3N2) and A(H1N1) strains. This superiority was reflected in elevated HI titers and markedly increased HA-specific B cell induction. While RIV also demonstrated enhanced HA-specific B cell responses against influenza B components compared to ccIIV, interestingly, HI titers remained comparable across all vaccine groups for these strains. These findings underscore the critical importance of comprehensive immune response evaluation in vaccine assessment. The disparity between cellular and serological responses, particularly for influenza HA-specific B cells, highlights that traditional serological measures alone may not fully capture the breadth and depth of vaccine-induced immunity. This study provides compelling evidence for the inclusion of cellular immunity assessments in vaccine evaluation protocols, offering crucial insights into vaccine immunogenicity that may be missed by conventional serological analysis alone.

BACKGROUND: Strategies are needed to improve oral rotavirus vaccine (RV), which provides suboptimal protection in developing countries. Probiotics and zinc supplementation could improve RV immunogenicity by altering the intestinal microbiota and immune function. METHODS: Infants 5weeks old living in urban Vellore, India were enrolled in a randomized, double-blind, placebo-controlled trial with a 4-arm factorial design to assess the effects of daily zinc (5mg), probiotic (1010Lactobacillus rhamnosus GG) or placebo on the immunogenicity of two doses of RV (Rotarix(R), GlaxoSmithKline Biologicals) given at 6 and 10weeks of age. Infants were eligible for participation if healthy, available for the study duration and without prior receipt of RV or oral poliovirus vaccine other than the birth dose. The primary outcome was seroconversion to rotavirus at 14weeks of age based on detection of VP6-specific IgA at ≥20U/ml in previously seronegative infants or a fourfold rise in concentration. RESULTS: The study took place during July 2012 to February 2013. 620 infants were randomized equally between study arms and 551 (88.9%) completed per protocol. Seroconversion was recorded in 54/137 (39.4%), 42/136 (30.9%), 40/143 (28.0%), and 37/135 (27.4%) infants receiving (1) probiotic and zinc, (2) probiotic and placebo, (3) placebo and zinc, (4) two placebos. Seroconversion showed a modest improvement among infants receiving probiotic (difference between groups 1, 2 and 3, 4 was 7.5% (97.5% Confidence Interval (CI): -1.4%, 16.2%), p=0.066) but not zinc (difference between groups 1, 3 and 2, 4 was 4.4% (97.5% CI: -4.4%, 13.2%), p=0.272). 16 serious adverse events were recorded, none related to study interventions. CONCLUSIONS: Zinc or probiotic supplementation did not significantly improve the low immunogenicity of rotavirus vaccine given to infants in a poor urban community in India. A modest effect of combined supplementation deserves further investigation. TRIAL REGISTRATION: The trial was registered in India (CTRI/2012/05/002677).