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Jaishwal P, Jha K, Singh SP. Revisiting the dimensions of universal vaccine with special focus on COVID-19: Efficacy versus methods of designing. Int J Biol Macromol 2024; 277:134012. [PMID: 39048013 DOI: 10.1016/j.ijbiomac.2024.134012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 05/28/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Even though the use of SARS-CoV-2 vaccines during the COVID-19 pandemic showed unprecedented success in a short time, it also exposed a flaw in the current vaccine design strategy to offer broad protection against emerging variants of concern. However, developing broad-spectrum vaccines is still a challenge for immunologists. The development of universal vaccines against emerging pathogens and their variants appears to be a practical solution to mitigate the economic and physical effects of the pandemic on society. Very few reports are available to explain the basic concept of universal vaccine design and development. This review provides an overview of the innate and adaptive immune responses generated against vaccination and essential insight into immune mechanisms helpful in designing universal vaccines targeting influenza viruses and coronaviruses. In addition, the characteristics, safety, and factors affecting the efficacy of universal vaccines have been discussed. Furthermore, several advancements in methods worthy of designing universal vaccines are described, including chimeric immunogens, heterologous prime-boost vaccines, reverse vaccinology, structure-based antigen design, pan-reactive antibody vaccines, conserved neutralizing epitope-based vaccines, mosaic nanoparticle-based vaccines, etc. In addition to the several advantages, significant potential constraints, such as defocusing the immune response and subdominance, are also discussed.
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Affiliation(s)
- Puja Jaishwal
- Department of Biotechnology, Mahatma Gandhi Central University, Motihari, India
| | - Kisalay Jha
- Department of Biotechnology, Mahatma Gandhi Central University, Motihari, India
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2
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Rappuoli R, Alter G, Pulendran B. Transforming vaccinology. Cell 2024; 187:5171-5194. [PMID: 39303685 DOI: 10.1016/j.cell.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/24/2024] [Accepted: 07/12/2024] [Indexed: 09/22/2024]
Abstract
The COVID-19 pandemic placed the field of vaccinology squarely at the center of global consciousness, emphasizing the vital role of vaccines as transformative public health tools. The impact of vaccines was recently acknowledged by the award of the 2023 Nobel Prize in Physiology or Medicine to Katalin Kariko and Drew Weissman for their seminal contributions to the development of mRNA vaccines. Here, we provide a historic perspective on the key innovations that led to the development of some 27 licensed vaccines over the past two centuries and recent advances that promise to transform vaccines in the future. Technological revolutions such as reverse vaccinology, synthetic biology, and structure-based design transformed decades of vaccine failures into successful vaccines against meningococcus B and respiratory syncytial virus (RSV). Likewise, the speed and flexibility of mRNA vaccines profoundly altered vaccine development, and the advancement of novel adjuvants promises to revolutionize our ability to tune immunity. Here, we highlight exciting new advances in the field of systems immunology that are transforming our mechanistic understanding of the human immune response to vaccines and how to predict and manipulate them. Additionally, we discuss major immunological challenges such as learning how to stimulate durable protective immune response in humans.
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Affiliation(s)
| | - Galit Alter
- Moderna Therapeutics, Cambridge, MA 02139, USA.
| | - Bali Pulendran
- Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Department of Pathology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
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3
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Booth JS, Rapaka RR, McArthur MA, Fresnay S, Darton TC, Blohmke CJ, Jones C, Waddington CS, Levine MM, Pollard AJ, Sztein MB. Role of circulating T follicular helper subsets following Ty21a immunization and oral challenge with wild type S. Typhi in humans. Front Immunol 2024; 15:1384642. [PMID: 39328410 PMCID: PMC11424897 DOI: 10.3389/fimmu.2024.1384642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 08/16/2024] [Indexed: 09/28/2024] Open
Abstract
Despite decades of intense research, our understanding of the correlates of protection against Salmonella Typhi (S. Typhi) infection and disease remains incomplete. T follicular helper cells (TFH), an important link between cellular and humoral immunity, play an important role in the development and production of high affinity antibodies. While traditional TFH cells reside in germinal centers, circulating TFH (cTFH) (a memory subset of TFH) are present in blood. We used specimens from a typhoid controlled human infection model whereby participants were immunized with Ty21a live attenuated S. Typhi vaccine and then challenged with virulent S. Typhi. Some participants developed typhoid disease (TD) and some did not (NoTD), which allowed us to assess the association of cTFH subsets in the development and prevention of typhoid disease. Of note, the frequencies of cTFH were higher in NoTD than in TD participants, particularly 7 days after challenge. Furthermore, the frequencies of cTFH2 and cTFH17, but not cTFH1 subsets were higher in NoTD than TD participants. However, we observed that ex-vivo expression of activation and homing markers were higher in TD than in NoTD participants, particularly after challenge. Moreover, cTFH subsets produced higher levels of S. Typhi-specific responses (cytokines/chemokines) in both the immunization and challenge phases. Interestingly, unsupervised analysis revealed unique clusters with distinct signatures for each cTFH subset that may play a role in either the development or prevention of typhoid disease. Importantly, we observed associations between frequencies of defined cTFH subsets and anti-S. Typhi antibodies. Taken together, our results suggest that circulating TFH2 and TFH17 subsets might play an important role in the development or prevention of typhoid disease. The contribution of these clusters was found to be distinct in the immunization and/or challenge phases. These results have important implications for vaccines aimed at inducing long-lived protective T cell and antibody responses.
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Affiliation(s)
- Jayaum S Booth
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rekha R Rapaka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Monica A McArthur
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
- Global Clinical Development, Sanofi, Swiftwater, PA, United States
| | - Stephanie Fresnay
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
- Rockville Center for Vaccine Research, GlaxsoSmithKline (GSK), Rockville, MD, United States
| | - Thomas C Darton
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, and the National Institute for Health and Care Research (NIHR), Oxford Biomedical Research Centre, Oxford, United Kingdom
- Clinical Infection Research Group, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, and the National Institute for Health and Care Research (NIHR), Sheffield Biomedical Research Centre, Sheffield, United Kingdom
| | - Christoph J Blohmke
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, and the National Institute for Health and Care Research (NIHR), Oxford Biomedical Research Centre, Oxford, United Kingdom
- GlaxsoSmithKline (GSK) Vaccines, London, United Kingdom
| | - Claire Jones
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, and the National Institute for Health and Care Research (NIHR), Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Claire S Waddington
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, and the National Institute for Health and Care Research (NIHR), Oxford Biomedical Research Centre, Oxford, United Kingdom
- Department of Infection, Imperial College Healthcare, National Health Service (NHS) Trust, London, United Kingdom
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Myron M Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, and the National Institute for Health and Care Research (NIHR), Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Marcelo B Sztein
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Tumor Immunology and Immunotherapy Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, United States
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4
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McCann N, Paganotti Vicentine M, Kim YC, Pollard AJ. The use of controlled human infection models to identify correlates of protection for invasive Salmonella vaccines. Front Immunol 2024; 15:1457785. [PMID: 39257585 PMCID: PMC11385307 DOI: 10.3389/fimmu.2024.1457785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/08/2024] [Indexed: 09/12/2024] Open
Abstract
Controlled human infection model (CHIM) studies, which involve deliberate exposure of healthy human volunteers to an infectious agent, are recognised as important tools to advance vaccine development. These studies not only facilitate estimates of vaccine efficacy, but also offer an experimental approach to study disease pathogenesis and profile vaccine immunogenicity in a controlled environment, allowing correlation with clinical outcomes. Consequently, the data from CHIMs can be used to identify immunological correlates of protection (CoP), which can help accelerate vaccine development. In the case of invasive Salmonella infections, vaccination offers a potential instrument to prevent disease. Invasive Salmonella disease, caused by the enteric fever pathogens Salmonella enterica serovar Typhi (S. Typhi) and S. Paratyphi A, B and C, and nontyphoidal Salmonella (iNTS), remains a significant cause of mortality and morbidity in low- and middle-income countries, resulting in over 200,000 deaths and the loss of 15 million DALYs annually. CHIM studies have contributed to the understanding of S. Typhi infection and provided invaluable insight into the development of vaccines and CoP following vaccination against S. Typhi. However, CoP are less well understood for S. Paratyphi A and iNTS. This brief review focuses on the contribution of vaccine-CHIM trials to our understanding of the immune mechanisms associated with protection following vaccines against invasive Salmonella pathogens, particularly in relation to CoP.
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Affiliation(s)
- Naina McCann
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Margarete Paganotti Vicentine
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Young Chan Kim
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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5
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Zhu H, Chelysheva I, Pollard AJ, O'Connor D. Spotlight on systems vaccinology: a novel approach to elucidate correlates of protection. Genes Immun 2024; 25:336-337. [PMID: 38148341 PMCID: PMC11327098 DOI: 10.1038/s41435-023-00247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Henderson Zhu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Irina Chelysheva
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Daniel O'Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
- NIHR Oxford Biomedical Research Centre, Oxford, UK.
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McCann N, Vicentine MP, Pollard AJ. Towards paratyphoid control: the vital role of the challenge model. Lancet 2024; 403:2780-2781. [PMID: 38944518 DOI: 10.1016/s0140-6736(24)01025-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 07/01/2024]
Affiliation(s)
- Naina McCann
- Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford OX3 7LE, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Margarete Paganotti Vicentine
- Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford OX3 7LE, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford OX3 7LE, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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Allen T, Castellanos ME, Giacomin P, Karunaweera ND, Kupz A, Lol JC, Sharma D, Sikder S, Tedla B, van Eijk L, Vojisavljevic D, Zhao G, Pai S. Next-generation vaccines for tropical infectious diseases. Int J Infect Dis 2024; 143:107014. [PMID: 38499058 DOI: 10.1016/j.ijid.2024.107014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024] Open
Abstract
Tropical infectious diseases inflict an unacceptable burden of disease on humans living in developing countries. Although anti-pathogenic drugs have been widely used, they carry a constant threat of selecting for resistance. Vaccines offer a promising means by which to enhance the global control of tropical infectious diseases; however, these have been difficult to develop, mostly because of the complex nature of the pathogen lifecycles. Here, we present recently developed vaccine candidates for five tropical infectious diseases in the form of a catalog that have either entered clinical trials or have been licensed for use. We deliberate on recently licensed dengue vaccines, provide evidence why combination vaccination could have a synergistic impact on schistosomiasis, critically appraise the value of typhoid conjugate vaccines, and discuss the potential of vaccines in the efforts to eliminate vivax malaria and hookworms.
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Affiliation(s)
- Tammy Allen
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Maria Eugenia Castellanos
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Paul Giacomin
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | | | - Andreas Kupz
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Juan Carlos Lol
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Dileep Sharma
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia; College of Medicine & Dentistry, James Cook University, Cairns, Australia; School of Health Sciences, College of Health Medicine and Wellbeing, The University of Newcastle, Ourimbah, Australia
| | - Suchandan Sikder
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Bemnet Tedla
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Liza van Eijk
- Department of Psychology, James Cook University, Townsville, Australia
| | - Danica Vojisavljevic
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Guangzu Zhao
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Saparna Pai
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia.
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8
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Weyant C, Hooda Y, Munira SJ, Lo NC, Ryckman T, Tanmoy AM, Kanon N, Seidman JC, Garrett D, Saha SK, Goldhaber-Fiebert JD, Saha S, Andrews JR. Cost-effectiveness and public health impact of typhoid conjugate vaccine introduction strategies in Bangladesh. Vaccine 2024; 42:2867-2876. [PMID: 38531727 PMCID: PMC11033679 DOI: 10.1016/j.vaccine.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Typhoid fever causes substantial morbidity and mortality in Bangladesh. The government of Bangladesh plans to introduce typhoid conjugate vaccines (TCV) in its expanded program on immunization (EPI) schedule. However, the optimal introduction strategy in addition to the costs and benefits of such a program are unclear. METHODS We extended an existing mathematical model of typhoid transmission to integrate cost data, clinical incidence data, and recently conducted serosurveys in urban, semi-urban, and rural areas. In our primary analysis, we evaluated the status quo (i.e., no vaccination) and eight vaccine introduction strategies including routine and 1-time campaign strategies, which differed by age groups targeted and geographic focus. Model outcomes included clinical incidence, seroincidence, deaths, costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for each strategy. We adopted a societal perspective, 10-year model time horizon, and 3 % annual discount rate. We performed probabilistic, one-way, and scenario sensitivity analyses including adopting a healthcare perspective and alternate model time horizons. RESULTS We projected that all TCV strategies would be cost saving compared to the status quo. The preferred strategy was a nationwide introduction of TCV at 9-12 months of age with a single catch-up campaign for children ages 1-15, which was cost saving compared to all other strategies and the status quo. In the 10 years following implementation, we projected this strategy would avert 3.77 million cases (95 % CrI: 2.60 - 5.18), 11.31 thousand deaths (95 % CrI: 3.77 - 23.60), and save $172.35 million (95 % CrI: -14.29 - 460.59) compared to the status quo. Our findings were broadly robust to changes in parameter values and willingness-to-pay thresholds. CONCLUSIONS We projected that nationwide TCV introduction with a catch-up campaign would substantially reduce typhoid incidence and very likely be cost saving in Bangladesh.
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Affiliation(s)
- Christopher Weyant
- Department of Health Policy and Center for Health Policy, Stanford School of Medicine and Freeman Spogli Institute, Stanford University, Stanford, CA, United States.
| | - Yogesh Hooda
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Theresa Ryckman
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Naito Kanon
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh; Department of Microbiology, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Jeremy D Goldhaber-Fiebert
- Department of Health Policy and Center for Health Policy, Stanford School of Medicine and Freeman Spogli Institute, Stanford University, Stanford, CA, United States
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
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Agarwal N, Gupta N, Nishant, H S S, Dutta T, Mahajan M. Typhoid Conjugate Vaccine: A Boon for Endemic Regions. Cureus 2024; 16:e56454. [PMID: 38650789 PMCID: PMC11034893 DOI: 10.7759/cureus.56454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/25/2024] Open
Abstract
Typhoid fever has the highest disease burden in countries in low- and middle-income countries, primarily located in Asia and Sub-Saharan Africa. Previous typhoid vaccines such as the live attenuated typhoid (Ty21a) vaccine and Vi (virulence) capsular polysaccharide vaccine had the limitation that they could not be administered with other standard childhood immunizations and were ineffective in children under two years of age. To address these shortcomings of the previous vaccines, typhoid conjugate vaccines (TCVs) were developed and prequalified by the World Health Organization. Cross-reacting material and tetanus toxoid are widely used as carrier proteins in TCVs. According to various studies, TCV has higher efficacy, has a more extended protection period, and is safe and immunogenic in infants as young as six months. This review article aims to comprehensively appraise the data available on TCVs' efficacy, duration of protection, safety, and immunogenicity in endemic regions.
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Affiliation(s)
- Nitesh Agarwal
- Department of Pediatrics, Southern Gem Hospital, Hyderabad, IND
| | - Naveen Gupta
- Department of Pediatrics, Happy Family Hospital, Karnal, IND
| | - Nishant
- Department of Pediatrics, Nihan Medical Children Hospital, Patna, IND
| | - Surendra H S
- Department of Pediatrics, Natus Women and Children Hospital, Bengaluru, IND
| | - Trayambak Dutta
- Department of Infectious Disease, Zydus Lifesciences, Ahmedabad, IND
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Smith C, Smith E, Rydlova A, Varro R, Hinton JCD, Gordon MA, Choy RKM, Liu X, Pollard AJ, Chiu C, Cooke GS, Gibani MM. Protocol for the challenge non-typhoidal Salmonella (CHANTS) study: a first-in-human, in-patient, double-blind, randomised, safety and dose-escalation controlled human infection model in the UK. BMJ Open 2024; 14:e076477. [PMID: 38199617 PMCID: PMC10806722 DOI: 10.1136/bmjopen-2023-076477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Invasive non-typhoidal Salmonella (iNTS) serovars are a major cause of community-acquired bloodstream infections in sub-Saharan Africa (SSA). In this setting, Salmonella enterica serovar Typhimurium accounts for two-thirds of infections and is associated with an estimated case fatality rate of 15%-20%. Several iNTS vaccine candidates are in early-stage assessment which-if found effective-would provide a valuable public health tool to reduce iNTS disease burden. The CHANTS study aims to develop a first-in-human Salmonella Typhimurium controlled human infection model, which can act as a platform for future vaccine evaluation, in addition to providing novel insights into iNTS disease pathogenesis. METHODS AND ANALYSIS This double-blind, safety and dose-escalation study will randomise 40-80 healthy UK participants aged 18-50 to receive oral challenge with one of two strains of S. Typhimurium belonging to the ST19 (strain 4/74) or ST313 (strain D23580) lineages. 4/74 is a global strain often associated with diarrhoeal illness predominantly in high-income settings, while D23580 is an archetypal strain representing invasive disease-causing isolates found in SSA. The primary objective is to determine the minimum infectious dose (colony-forming unit) required for 60%-75% of participants to develop clinical or microbiological features of systemic salmonellosis. Secondary endpoints are to describe and compare the clinical, microbiological and immunological responses following challenge. Dose escalation or de-escalation will be undertaken by continual-reassessment methodology and limited within prespecified safety thresholds. Exploratory objectives are to describe mechanisms of iNTS virulence, identify putative immune correlates of protection and describe host-pathogen interactions in response to infection. ETHICS AND DISSEMINATION Ethical approval has been obtained from the NHS Health Research Authority (London-Fulham Research Ethics Committee 21/PR/0051; IRAS Project ID 301659). The study findings will be disseminated in international peer-reviewed journals and presented at national/international stakeholder meetings. Study outcome summaries will be provided to both funders and participants. TRIAL REGISTRATION NUMBER NCT05870150.
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Affiliation(s)
- Christopher Smith
- Department of Infectious Disease, Imperial College London, London, UK
| | - Emma Smith
- Department of Infectious Disease, Imperial College London, London, UK
| | - Anna Rydlova
- Department of Infectious Disease, Imperial College London, London, UK
| | - Robert Varro
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jay C D Hinton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Melita A Gordon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
| | | | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, Oxford University, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, Oxford University, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, UK
| | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, London, UK
| | - Malick M Gibani
- Department of Infectious Disease, Imperial College London, London, UK
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Chaudhary S, Shah GS, Bhatta NK, Poudel P, Rai B, Uranw S, Tripathi PM, Khanal B, Ghimire A, Rai N, Gupta BP, Vemula S, Wartel TA, Sahastrabuddhe S, Saluja T. A randomized, observer-blind, controlled phase III clinical trial assessing safety and immunological non-inferiority of Vi-diphtheria toxoid versus Vi-tetanus toxoid typhoid conjugate vaccine in healthy volunteers in eastern Nepal. Hum Vaccin Immunother 2023; 19:2203634. [PMID: 37128723 PMCID: PMC10142305 DOI: 10.1080/21645515.2023.2203634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Typhoid remains one of the major serious health concerns for children in developing countries. With extremely drug-resistant cases emerging, preventative measures like sanitation and vaccination, including typhoid conjugate vaccines (TCV) remain the mainstay in its prevention and control. Different types of TCVs are being developed to meet the global demand. This report outlines the results from a study done to assess the immunogenicity and safety of Vi-Diphtheria toxoid (Vi-DT) TCV in Nepal. The study was a randomized, active-controlled, immunological non-inferiority and safety study. Eligible participants from Sunsari and Morang districts of eastern Nepal were randomized into 4 study groups (A-D) within 3 age strata (6 months to <2 years, 2 to <18 years, and 18 to 45 years). Groups A to C received a single dose (25 μg) of Vi-DT test vaccine from any of the 3 lots, while group D received the comparator, Typbar-TCV®, Vi-tetanus toxoid (Vi-TT) vaccine (25 μg) in 1:1:1:1 ratio and evaluated at 4 weeks postvaccination with 6 months follow-up. Amongst 400 randomized participants, anti-Vi-IgG seroconversion rates for all age strata in Vi-DT pooled groups (A+B+C) were 100.00% (97.5% CI 98.34-100.00) vs 98.99% (97.5% CI 93.99-99.85) in Vi-TT group (D) at 4 weeks. Comparable safety events were reported between the groups. Three serious adverse events (1 in Vi-DT; 2 in Vi-TT group) were reported during the 6 months follow-up, none being related to the investigational product. Thus, Vi-DT vaccine is safe, immunogenic, and immunologically non-inferior to Vi-TT when analyzed at 4 weeks postvaccination.
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Affiliation(s)
- Shipra Chaudhary
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | | | | | - Prakash Poudel
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Basant Rai
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Surendra Uranw
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | | | - Basudha Khanal
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Anup Ghimire
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Nikita Rai
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | | | | | - T Anh Wartel
- International Vaccine Institute (IVI), Seoul, Korea
| | | | - Tarun Saluja
- International Vaccine Institute (IVI), Seoul, Korea
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12
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Tadesse BT, Keddy KH, Rickett NY, Zhusupbekova A, Poudyal N, Lawley T, Osman M, Dougan G, Kim JH, Lee JS, Jeon HJ, Marks F. Vaccination to Reduce Antimicrobial Resistance Burden-Data Gaps and Future Research. Clin Infect Dis 2023; 77:S597-S607. [PMID: 38118013 PMCID: PMC10732565 DOI: 10.1093/cid/ciad562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Antimicrobial resistance (AMR) poses an immediate danger to global health. If unaddressed, the current upsurge in AMR threatens to reverse the achievements in reducing the infectious disease-associated mortality and morbidity associated with antimicrobial treatment. Consequently, there is an urgent need for strategies to prevent or slow the progress of AMR. Vaccines potentially contribute both directly and indirectly to combating AMR. Modeling studies have indicated significant gains from vaccination in reducing AMR burdens for specific pathogens, reducing mortality/morbidity, and economic loss. However, quantifying the real impact of vaccines in these reductions is challenging because many of the study designs used to evaluate the contribution of vaccination programs are affected by significant background confounding, and potential selection and information bias. Here, we discuss challenges in assessing vaccine impact to reduce AMR burdens and suggest potential approaches for vaccine impact evaluation nested in vaccine trials.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Trevor Lawley
- Wellcome Sanger Institute and Microbiotica, Cambridge, United Kingdom
| | - Majdi Osman
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
- Seoul National University, College of Natural Sciences, Seoul, Republic of Korea
| | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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13
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Meiring JE, Khanam F, Basnyat B, Charles RC, Crump JA, Debellut F, Holt KE, Kariuki S, Mugisha E, Neuzil KM, Parry CM, Pitzer VE, Pollard AJ, Qadri F, Gordon MA. Typhoid fever. Nat Rev Dis Primers 2023; 9:71. [PMID: 38097589 DOI: 10.1038/s41572-023-00480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Abstract
Typhoid fever is an invasive bacterial disease associated with bloodstream infection that causes a high burden of disease in Africa and Asia. Typhoid primarily affects individuals ranging from infants through to young adults. The causative organism, Salmonella enterica subsp. enterica serovar Typhi is transmitted via the faecal-oral route, crossing the intestinal epithelium and disseminating to systemic and intracellular sites, causing an undifferentiated febrile illness. Blood culture remains the practical reference standard for diagnosis of typhoid fever, where culture testing is available, but novel diagnostic modalities are an important priority under investigation. Since 2017, remarkable progress has been made in defining the global burden of both typhoid fever and antimicrobial resistance; in understanding disease pathogenesis and immunological protection through the use of controlled human infection; and in advancing effective vaccination programmes through strategic multipartner collaboration and targeted clinical trials in multiple high-incidence priority settings. This Primer thus offers a timely update of progress and perspective on future priorities for the global scientific community.
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Affiliation(s)
- James E Meiring
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Farhana Khanam
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Richelle C Charles
- Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Mugisha
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher M Parry
- Department of Clinical Sciences and Education, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modelling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Firdausi Qadri
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
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14
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Maharjan A, Park JH. Cell-free protein synthesis system: A new frontier for sustainable biotechnology-based products. Biotechnol Appl Biochem 2023; 70:2136-2149. [PMID: 37735977 DOI: 10.1002/bab.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
Cell-free protein synthesis (CFPS) system is an innovative technology with a wide range of potential applications that could challenge current thinking and provide solutions to environmental and health issues. CFPS system has been demonstrated to be a successful way of producing biomolecules in a variety of applications, including the biomedical industry. Although there are still obstacles to overcome, its ease of use, versatility, and capacity for integration with other technologies open the door for it to continue serving as a vital instrument in synthetic biology research and industry. In this review, we mainly focus on the cell-free based platform for various product productions. Moreover, the challenges in the bio-therapeutic aspect using cell-free systems and their future prospective for the improvement and sustainability of the cell free systems.
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Affiliation(s)
- Anoth Maharjan
- Bio-Evaluation Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju 28116, Republic of Korea
| | - Jung-Ho Park
- Bio-Evaluation Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju 28116, Republic of Korea
- Department of Biosystems and Bioengineering, KRIBB School of Biotechnology, Korea University of Science and Technology (UST), Daejeon, Republic of Korea
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15
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Abo YN, Jamrozik E, McCarthy JS, Roestenberg M, Steer AC, Osowicki J. Strategic and scientific contributions of human challenge trials for vaccine development: facts versus fantasy. THE LANCET. INFECTIOUS DISEASES 2023; 23:e533-e546. [PMID: 37573871 DOI: 10.1016/s1473-3099(23)00294-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 08/15/2023]
Abstract
The unprecedented speed of delivery of SARS-CoV-2 pandemic vaccines has redefined the limits for all vaccine development. Beyond the aspirational 100-day timeline for tomorrow's hypothetical pandemic vaccines, there is a sense of optimism that development of other high priority vaccines can be accelerated. Early in the COVID-19 pandemic, an intense and polarised academic and public discourse arose concerning the role of human challenge trials for vaccine development. A case was made for human challenge trials as a powerful tool to establish early proof-of-concept of vaccine efficacy in humans, inform vaccine down selection, and address crucial knowledge gaps regarding transmission, pathogenesis, and immune protection. We review the track record of human challenge trials contributing to the development of vaccines for 19 different pathogens and discuss relevant limitations, barriers, and pitfalls. This Review also highlights opportunities for efforts to broaden the scope and boost the effects of human challenge trials, to accelerate all vaccine development.
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Affiliation(s)
- Yara-Natalie Abo
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
| | - Euzebiusz Jamrozik
- Ethox and Pandemic Sciences Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Monash-WHO Collaborating Centre for Bioethics, Monash University, Melbourne, VIC, Australia
| | - James S McCarthy
- Department of Infectious Diseases, The University of Melbourne, Parkville, VIC, Australia; Victorian Infectious Diseases Services, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Meta Roestenberg
- Controlled Human Infections Center, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Joshua Osowicki
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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16
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Wang X, Su H, Wallach JB, Wagner JC, Braunecker B, Gardner M, Guinn KM, Klevorn T, Lin K, Liu YJ, Liu Y, Mugahid D, Rodgers M, Sixsmith J, Wakabayashi S, Zhu J, Zimmerman M, Dartois V, Flynn JL, Lin PL, Ehrt S, Fortune SM, Rubin EJ, Schnappinger D. Development of an Engineered Mycobacterium tuberculosis Strain for a Safe and Effective Tuberculosis Human Challenge Model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.19.567569. [PMID: 38014062 PMCID: PMC10680849 DOI: 10.1101/2023.11.19.567569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Human challenge experiments could greatly accelerate the development of a tuberculosis (TB) vaccine. Human challenge for tuberculosis requires a strain that can both replicate in the host and be reliably cleared. To accomplish this, we designed Mycobacterium tuberculosis (Mtb) strains featuring up to three orthogonal kill switches, tightly regulated by exogenous tetracyclines and trimethoprim. The resultant strains displayed immunogenicity and antibiotic susceptibility similar to wild-type Mtb under permissive conditions. In the absence of supplementary exogenous compounds, the strains were rapidly killed in axenic culture, mice and nonhuman primates. Notably, the strain that contained three kill switches had an escape rate of less than 10 -10 per genome per generation and displayed no relapse in a SCID mouse model. Collectively, these findings suggest that this engineered Mtb strain could be a safe and effective candidate for a human challenge model.
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17
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Soukavong M, Luangasanatip N, Chanthavilay P, Teerawattananon Y, Dabak SV, Pan-Ngum W, Roberts T, Ashley EA, Mayxay M. Cost-effectiveness analysis of typhoid vaccination in Lao PDR. BMC Public Health 2023; 23:2270. [PMID: 37978481 PMCID: PMC10656839 DOI: 10.1186/s12889-023-17221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Typhoid vaccination has been shown to be an effective intervention to prevent enteric fever and is under consideration for inclusion in the national immunization program in Lao PDR. METHODS A cost-utility analysis was performed using an age-structured static decision tree model to estimate the costs and health outcomes of introducing TCV. Vaccination strategies combined with five delivery approaches in different age groups compared to no vaccination were considered from the societal perspective, using the Gavi price of 1.5 USD per dose. The vaccination program was considered to be cost-effective if the incremental cost-effectiveness ratio was less than a threshold of 1 GDP per capita for Lao PDR, equivalent to USD 2,535 in 2020. RESULTS In the model, we estimated 172.2 cases of enteric fever, with 1.3 deaths and a total treatment cost of USD 7,244, based on a birth cohort of 164,662 births without TCV vaccination that was followed over their lifetime. To implement a TCV vaccination program over the lifetime horizon, the estimated cost of the vaccine and administration costs would be between USD 470,934 and USD 919,186. Implementation of the TCV vaccination program would prevent between 14 and 106 cases and 0.1 to 0.8 deaths. None of the vaccination programs appeared to be cost-effective. CONCLUSIONS Inclusion of TCV in the national vaccination program in Lao PDR would only be cost-effective if the true typhoid incidence is 25-times higher than our current estimate.
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Affiliation(s)
- Mick Soukavong
- Faculty of Medicine, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | | | - Phetsavanh Chanthavilay
- Unit for Health Evidence and Policy, Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Wirichada Pan-Ngum
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tamalee Roberts
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Elizabeth A Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Mayfong Mayxay
- Unit for Health Evidence and Policy, Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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18
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Barton A, Hill J, O'Connor D, Jones C, Jones E, Camara S, Shrestha S, Jin C, Gibani MM, Dobinson HC, Waddington C, Darton TC, Blohmke CJ, Pollard AJ. Early transcriptional responses to human enteric fever challenge. Infect Immun 2023; 91:e0010823. [PMID: 37725060 PMCID: PMC10581002 DOI: 10.1128/iai.00108-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/29/2023] [Indexed: 09/21/2023] Open
Abstract
Enteric fever, caused by oral infection with typhoidal Salmonella serovars, presents as a non-specific febrile illness preceded by an incubation period of 5 days or more. The enteric fever human challenge model provides a unique opportunity to investigate the innate immune response during this incubation period, and how this response is altered by vaccination with the Vi polysaccharide or conjugate vaccine. We find that on the same day as ingestion of typhoidal Salmonella, there is already evidence of an immune response, with 199 genes upregulated in the peripheral blood transcriptome 12 hours post-challenge (false discovery rate <0.05). Gene sets relating to neutrophils, monocytes, and innate immunity were over-represented (false discovery rate <0.05). Estimating cell proportions from gene expression data suggested a possible increase in activated monocytes 12 hours post-challenge (P = 0.036, paired Wilcoxon signed-rank test). Furthermore, plasma TNF-α rose following exposure (P = 0.011, paired Wilcoxon signed-rank test). There were no significant differences in gene expression (false discovery rate <0.05) in the 12 hours response between those who did and did not subsequently develop clinical or blood culture confirmed enteric fever or between vaccination groups. Together, these results demonstrate early perturbation of the peripheral blood transcriptome after enteric fever challenge and provide initial insight into early mechanisms of protection.
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Affiliation(s)
- Amber Barton
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Jennifer Hill
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Daniel O'Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Claire Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Elizabeth Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Susana Camara
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Sonu Shrestha
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Celina Jin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Department of Pathology, Royal Melbourne Hospital, Melbourne, Australia
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Malick M. Gibani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Hazel C. Dobinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Claire Waddington
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Thomas C. Darton
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease and The Florey Institute for Host-Pathogen Interactions, University of Sheffield, Sheffield, United Kingdom
| | - Christoph J. Blohmke
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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19
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Ouedraogo A, Diarra A, Nébié I, Barry N, Kabore JM, Tiono AB, Datta S, Liang Y, Mayo I, Oshinsky JJ, Tracy JK, Girmay T, Pasetti MF, Jamka LP, Neuzil KM, Sirima SB, Laurens MB. Durable Anti-Vi IgG and IgA Antibody Responses in 15-Month-Old Children Vaccinated With Typhoid Conjugate Vaccine in Burkina Faso. J Pediatric Infect Dis Soc 2023; 12:513-518. [PMID: 37589596 PMCID: PMC10533206 DOI: 10.1093/jpids/piad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/15/2023] [Indexed: 08/18/2023]
Abstract
We assessed anti-Vi IgG/IgA responses to typhoid conjugate vaccine (TCV) in children enrolled in a double-blind randomized controlled, phase 2 trial in Burkina Faso. Anti-Vi IgG seroconversion and anti-Vi IgA titers were higher in TCV than control recipients at 30-35 months post-vaccination. TCV induces durable immunity in Burkinabe children vaccinated at 15 months.
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Affiliation(s)
| | - Amidou Diarra
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Issa Nébié
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Nouhoun Barry
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | | | - Alfred B Tiono
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Shrimati Datta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yuanyuan Liang
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ifayet Mayo
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer J Oshinsky
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J Kathleen Tracy
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tsion Girmay
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marcela F Pasetti
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Leslie P Jamka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Matthew B Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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20
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Smith C, Smith E, Chiu C, Hinton J, Perez Sepulveda B, Gordon M, Choy RK, Hill PW, Meiring JE, Darton TC, Carey ME, Cooke G, Gibani MM. The Challenge Non-Typhoidal Salmonella (CHANTS) Consortium: Development of a non-typhoidal Salmonella controlled human infection model: Report from a consultation group workshop, 05 July 2022, London, UK. Wellcome Open Res 2023; 8:111. [PMID: 37808389 PMCID: PMC10558987 DOI: 10.12688/wellcomeopenres.19012.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Invasive non-typhoidal Salmonella disease (iNTS) is a major cause of morbidity and mortality globally, particularly as a cause of bloodstream infection in children and immunocompromised adults in sub-Saharan Africa. Vaccines to prevent non-typhoidal Salmonella (NTS) would represent a valuable public health tool in this setting to avert cases and prevent expansion of antimicrobial resistance. Several NTS and combination typhoidal-NTS vaccine candidates are in early-stage development, although the pathway to licensure is unclear due to challenges in conducting large phase III field trials. Controlled human infection models (CHIM) present an opportunity to accelerate vaccine development for a range of enteric pathogens. Several recent typhoidal Salmonella CHIMs have been conducted safely and have played pivotal roles in progressing vaccine candidates to pre-qualification and licensure. The Challenge Non-Typhoidal Salmonella (CHANTS) consortium has been formed with funding from the Wellcome Trust, to deliver the first NTS CHIM, which can act as a platform for future vaccine evaluation. This paper reports the conclusions of a consultation group workshop convened with key stakeholders. The aims of this meeting were to: (1) define the rationale for an NTS CHIM (2) map the NTS vaccine pipeline (3) refine study design and (4) establish potential future use cases.
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Affiliation(s)
- Christopher Smith
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - Emma Smith
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - Jay Hinton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Blanca Perez Sepulveda
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Melita Gordon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Peter W.S. Hill
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - James E. Meiring
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2TN, UK
| | - Thomas C. Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2TN, UK
| | - Megan E. Carey
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Graham Cooke
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - Malick M. Gibani
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - CHANTS Consortium
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- PATH, Seattle, Washington, 98121, USA
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2TN, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
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21
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Smith C, Smith E, Chiu C, Hinton J, Perez Sepulveda B, Gordon M, Choy RK, Hill PW, Meiring JE, Darton TC, Carey ME, Cooke G, Gibani MM. The Challenge Non-Typhoidal Salmonella (CHANTS) Consortium: Development of a non-typhoidal Salmonella controlled human infection model: Report from a consultation group workshop, 05 July 2022, London, UK. Wellcome Open Res 2023; 8:111. [PMID: 37808389 PMCID: PMC10558987 DOI: 10.12688/wellcomeopenres.19012.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 04/21/2024] Open
Abstract
Invasive non-typhoidal Salmonella disease (iNTS) is a major cause of morbidity and mortality globally, particularly as a cause of bloodstream infection in children and immunocompromised adults in sub-Saharan Africa. Vaccines to prevent non-typhoidal Salmonella (NTS) would represent a valuable public health tool in this setting to avert cases and prevent expansion of antimicrobial resistance. Several NTS and combination typhoidal-NTS vaccine candidates are in early-stage development, although the pathway to licensure is unclear due to challenges in conducting large phase III field trials. Controlled human infection models (CHIM) present an opportunity to accelerate vaccine development for a range of enteric pathogens. Several recent typhoidal Salmonella CHIMs have been conducted safely and have played pivotal roles in progressing vaccine candidates to pre-qualification and licensure. The Challenge Non-Typhoidal Salmonella (CHANTS) consortium has been formed with funding from the Wellcome Trust, to deliver the first NTS CHIM, which can act as a platform for future vaccine evaluation. This paper reports the conclusions of a consultation group workshop convened with key stakeholders. The aims of this meeting were to: (1) define the rationale for an NTS CHIM (2) map the NTS vaccine pipeline (3) refine study design and (4) establish potential future use cases.
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Affiliation(s)
- Christopher Smith
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - Emma Smith
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - Jay Hinton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Blanca Perez Sepulveda
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Melita Gordon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Peter W.S. Hill
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - James E. Meiring
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2TN, UK
| | - Thomas C. Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2TN, UK
| | - Megan E. Carey
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Graham Cooke
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - Malick M. Gibani
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
| | - CHANTS Consortium
- Department of Infectious Disease, Imperial College London, London, W2 1PG, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- PATH, Seattle, Washington, 98121, USA
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, S10 2TN, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
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22
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Drewett GP. The Case for Human Challenge Trials in COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2023:10.1007/s11673-023-10309-9. [PMID: 37721594 DOI: 10.1007/s11673-023-10309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/12/2023] [Indexed: 09/19/2023]
Abstract
The COVID-19 pandemic has necessitated rapid research to aid in the understanding of the disease and the development of novel therapeutics. One option is to conduct controlled human infection trials (CHITs). In this article I examine the history of deliberate human infection and CHITs and their utilization prior to the COVID-19 pandemic, key ethical considerations of CHITs in the COVID-19 setting, an analysis of the World Health Organization's (WHO) Key criteria for the ethical acceptability of COVID-19 human challenge studies, and a review of the two COVID-19 CHITs that have already commenced, their compliance with the WHO criteria and other ethical considerations.
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Affiliation(s)
- George P Drewett
- Melbourne Law School, University of Melbourne, Parkville, VIC, Australia.
- The Northern Hospital, Epping, VIC, Australia.
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23
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Imdad MJ, Khan MN, Alam HS, Khan AB, Mirani ZA, Khan A, Ahmed F. Design and in silico analysis of mRNA vaccine construct against Salmonella. J Biomol Struct Dyn 2023; 41:7248-7264. [PMID: 36093938 DOI: 10.1080/07391102.2022.2119280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
Salmonella infections are continuously growing. Causative serovars have gained enhanced drug resistance and virulence. Current vaccines have fallen short of providing sufficient protection. mRNA vaccines have come up with huge success against SARS-CoV-2; Pfizer-BioNTech and Moderna vaccines have resulted in >90% efficacy with efficient translocation, expression, and presentation of antigen to the host immune system. Herein, based on the same approach a mRNA vaccine construct has been designed and analyzed against Salmonella by joining regions of genes of outer membrane proteins C and F of S. Typhi through a flexible linker. Construct was flanked by regulatory regions that have previously shown better expression and translocation of encoded protein. GC content of the construct was improved to attain structural and thermodynamic stability and smooth translation. Sites of strong binding miRNAs were removed through codon optimization. Protein encoded by this construct is structurally plausible, highly antigenic, non-allergen to humans, and does not cross-react to the human proteome. It is enriched in potent, highly antigenic, and conserved linear and conformational epitopes. Most conserved conformational epitopes of core protein lie on extended beta hairpins exposed to the cellular exterior. Stability and thermodynamic attributes of the final construct were found highly comparable to the Pfizer-BioNTech vaccine construct. Both contain a stable stem-loop structure downstream of the start codon and do not offer destabilizing secondary structures upstream of the start codon. Given structural and thermodynamic stability, effective immune response, and epitope composition the construct is expected to provide broad-spectrum protection against clinically important Salmonella serovars.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Muhammad Janees Imdad
- Department of Microbiology, University of Karachi, Karachi, Pakistan
- Microbiology Section, FMRRC, Pakistan Council of Scientific and Industrial Research Laboratories Complex, Karachi, Pakistan
| | - Muhammad Naseem Khan
- Microbiology Section, FMRRC, Pakistan Council of Scientific and Industrial Research Laboratories Complex, Karachi, Pakistan
| | | | - Abdul Basit Khan
- Microbiology Section, FMRRC, Pakistan Council of Scientific and Industrial Research Laboratories Complex, Karachi, Pakistan
| | - Zulfiqar Ali Mirani
- Microbiology Section, FMRRC, Pakistan Council of Scientific and Industrial Research Laboratories Complex, Karachi, Pakistan
| | - Adnan Khan
- Department of Microbiology, University of Karachi, Karachi, Pakistan
| | - Faraz Ahmed
- Microbiology Section, FMRRC, Pakistan Council of Scientific and Industrial Research Laboratories Complex, Karachi, Pakistan
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24
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Zhu H, Chelysheva I, Cross DL, Blackwell L, Jin C, Gibani MM, Jones E, Hill J, Trück J, Kelly DF, Blohmke CJ, Pollard AJ, O’Connor D. Molecular correlates of vaccine-induced protection against typhoid fever. J Clin Invest 2023; 133:e169676. [PMID: 37402153 PMCID: PMC10425215 DOI: 10.1172/jci169676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUNDTyphoid fever is caused by the Gram-negative bacterium Salmonella enterica serovar Typhi and poses a substantial public health burden worldwide. Vaccines have been developed based on the surface Vi-capsular polysaccharide of S. Typhi; these include a plain-polysaccharide-based vaccine, ViPS, and a glycoconjugate vaccine, ViTT. To understand immune responses to these vaccines and their vaccine-induced immunological protection, molecular signatures were analyzed using bioinformatic approaches.METHODSBulk RNA-Seq data were generated from blood samples obtained from adult human volunteers enrolled in a vaccine trial, who were then challenged with S. Typhi in a controlled human infection model (CHIM). These data were used to conduct differential gene expression analyses, gene set and modular analyses, B cell repertoire analyses, and time-course analyses at various post-vaccination and post-challenge time points between participants receiving ViTT, ViPS, or a control meningococcal vaccine.RESULTSTranscriptomic responses revealed strong differential molecular signatures between the 2 typhoid vaccines, mostly driven by the upregulation in humoral immune signatures, including selective usage of immunoglobulin heavy chain variable region (IGHV) genes and more polarized clonal expansions. We describe several molecular correlates of protection against S. Typhi infection, including clusters of B cell receptor (BCR) clonotypes associated with protection, with known binders of Vi-polysaccharide among these.CONCLUSIONThe study reports a series of contemporary analyses that reveal the transcriptomic signatures after vaccination and infectious challenge, while identifying molecular correlates of protection that may inform future vaccine design and assessment.TRIAL REGISTRATIONClinicalTrials.gov NCT02324751.
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Affiliation(s)
- Henderson Zhu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Irina Chelysheva
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Deborah L. Cross
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Luke Blackwell
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Celina Jin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Malick M. Gibani
- Department of Infectious Disease, Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Elizabeth Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jennifer Hill
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Johannes Trück
- Division of Immunology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Dominic F. Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christoph J. Blohmke
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Daniel O’Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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25
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Das S, Howlader DR, Lu T, Whittier SK, Hu G, Sharma S, Dietz ZK, Ratnakaram SSK, Varisco DJ, Ernst RK, Picking WD, Picking WL. Immunogenicity and protective efficacy of nanoparticle formulations of L-SseB against Salmonella infection. Front Immunol 2023; 14:1208848. [PMID: 37457702 PMCID: PMC10347375 DOI: 10.3389/fimmu.2023.1208848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Salmonella enterica, a Gram-negative pathogen, has over 2500 serovars that infect a wide range of hosts. In humans, S. enterica causes typhoid or gastroenteritis and is a major public health concern. In this study, SseB (the tip protein of the Salmonella pathogenicity island 2 type III secretion system) was fused with the LTA1 subunit of labile-toxin from enterotoxigenic E. coli to make the self-adjuvanting antigen L-SseB. Two unique nanoparticle formulations were developed to allow multimeric presentation of L-SseB. Mice were vaccinated with these formulations and protective efficacy determined via challenging the mice with S. enterica serovars. The polysaccharide (chitosan) formulation was found to elicit better protection when compared to the squalene nanoemulsion. When the polysaccharide formulation was used to vaccinate rabbits, protection from S. enterica challenge was elicited. In summary, L-SseB in a particulate polysaccharide formulation appears to be an attractive candidate vaccine capable of broad protection against S. enterica.
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Affiliation(s)
- Sayan Das
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
| | - Debaki R. Howlader
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
| | - Ti Lu
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
| | - Sean K. Whittier
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
| | - Gang Hu
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
| | - Simran Sharma
- Department of Veterinary Pathobiology and Bond Life Science Center, University of Missouri, Columbia, MO, United States
| | - Zackary K. Dietz
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
| | - Siva S. K. Ratnakaram
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
| | - David J. Varisco
- Department of Microbial Pathogenesis, University of Maryland, Baltimore, MD, United States
| | - Robert K. Ernst
- Department of Microbial Pathogenesis, University of Maryland, Baltimore, MD, United States
| | - William D. Picking
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
| | - Wendy L. Picking
- Department of Pharmaceutical Chemistry, University of Kansas, Lawrence, KS, United States
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26
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Morrison H, Jackson S, McShane H. Controlled human infection models in COVID-19 and tuberculosis: current progress and future challenges. Front Immunol 2023; 14:1211388. [PMID: 37304270 PMCID: PMC10248465 DOI: 10.3389/fimmu.2023.1211388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Controlled Human Infection Models (CHIMs) involve deliberately exposing healthy human volunteers to a known pathogen, to allow the detailed study of disease processes and evaluate methods of treatment and prevention, including next generation vaccines. CHIMs are in development for both tuberculosis (TB) and Covid-19, but challenges remain in their ongoing optimisation and refinement. It would be unethical to deliberately infect humans with virulent Mycobacteria tuberculosis (M.tb), however surrogate models involving other mycobacteria, M.tb Purified Protein Derivative or genetically modified forms of M.tb either exist or are under development. These utilise varying routes of administration, including via aerosol, per bronchoscope or intradermal injection, each with their own advantages and disadvantages. Intranasal CHIMs with SARS-CoV-2 were developed against the backdrop of the evolving Covid-19 pandemic and are currently being utilised to both assess viral kinetics, interrogate the local and systemic immunological responses post exposure, and identify immune correlates of protection. In future it is hoped they can be used to assess new treatments and vaccines. The changing face of the pandemic, including the emergence of new virus variants and increasing levels of vaccination and natural immunity within populations, has provided a unique and complex environment within which to develop a SARS-CoV-2 CHIM. This article will discuss current progress and potential future developments in CHIMs for these two globally significant pathogens.
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27
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McCann N, Emary K, Singh N, Mclean F, Camara S, Jones E, Kim YC, Liu X, Greenland M, Conlin K, Hill J, Verheul M, Robinson H, Angus B, Ramasamy MN, Levine MM, Pollard AJ. Accelerating clinical development of a live attenuated vaccine against Salmonella Paratyphi A (VASP): study protocol for an observer-participant-blind randomised control trial of a novel oral vaccine using a human challenge model of Salmonella Paratyphi A infection in healthy adult volunteers. BMJ Open 2023; 13:e068966. [PMID: 37225278 DOI: 10.1136/bmjopen-2022-068966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION This is the first efficacy study of an oral live attenuated vaccine against Salmonella Paratyphi A using a human challenge model of paratyphoid infection. S. Paratyphi A is responsible for 3.3 million cases of enteric fever every year, with over 19 000 deaths. Although improvements to sanitation and access to clean water are vital to reduce the burden of this condition, vaccination offers a cost-effective, medium-term solution. Efficacy trials of potential S. Paratyphi vaccine candidates in the field are unlikely to be feasible given the large number of participants required. Human challenge models therefore offer a unique, cost-effective solution to test efficacy of such vaccines. METHODS AND ANALYSIS This is an observer-blind, randomised, placebo-controlled trial phase I/II of the oral live-attenuated vaccine against S. Paratyphi A, CVD 1902. Volunteers will be randomised 1:1 to receive two doses of CVD 1902 or placebo, 14 days apart. One month following second vaccination all volunteers will ingest S. Paratyphi A bacteria with a bicarbonate buffer solution. They will be reviewed daily in the following 14 days and diagnosed with paratyphoid infection if the predefined microbiological or clinical diagnostic criteria are met. All participants will be treated with antibiotics on diagnosis, or at day 14 postchallenge if not diagnosed. The vaccine efficacy will be determined by comparing the relative attack rate, that is, the proportion of those diagnosed with paratyphoid infection, in the vaccine and placebo groups. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the Berkshire Medical Research Ethics Committee (REC ref 21/SC/0330). The results will be disseminated via publication in a peer-reviewed journal and presentation at international conferences. TRIAL REGISTRATION NUMBER ISRCTN15485902.
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Affiliation(s)
- Naina McCann
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Katherine Emary
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nisha Singh
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Florence Mclean
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susana Camara
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Elizabeth Jones
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Young Chan Kim
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Xinxue Liu
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Melanie Greenland
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Kerry Conlin
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jennifer Hill
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Marije Verheul
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Hannah Robinson
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Brian Angus
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Maheshi N Ramasamy
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Myron M Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew J Pollard
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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28
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Chen J, Long JE, Vannice K, Shewchuk T, Kumar S, Duncan Steele A, Zaidi AKM. Taking on Typhoid: Eliminating Typhoid Fever as a Global Health Problem. Open Forum Infect Dis 2023; 10:S74-S81. [PMID: 37274535 PMCID: PMC10236514 DOI: 10.1093/ofid/ofad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Typhoid fever is a significant global health problem that impacts people living in areas without access to clean water and sanitation. However, collaborative international partnerships and new research have improved both knowledge of the burden in countries with endemic disease and the tools for improved surveillance, including environmental surveillance. Two typhoid conjugate vaccines (TCVs) have achieved World Health Organization prequalification, with several more in the development pipeline. Despite hurdles posed by the coronavirus disease 2019 pandemic, multiple TCV efficacy trials have been conducted in high-burden countries, and data indicate that TCVs provide a high degree of protection from typhoid fever, are safe to use in young children, provide lasting protection, and have the potential to combat typhoid antimicrobial resistance. Now is the time to double down on typhoid control and elimination by sustaining progress made through water, sanitation, and hygiene improvements and accelerating TCV introduction in high-burden locations.
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Affiliation(s)
- Jessie Chen
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Jessica E Long
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Kirsten Vannice
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Tanya Shewchuk
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Supriya Kumar
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Anita K M Zaidi
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
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29
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MacLennan CA, Stanaway J, Grow S, Vannice K, Steele AD. Salmonella Combination Vaccines: Moving Beyond Typhoid. Open Forum Infect Dis 2023; 10:S58-S66. [PMID: 37274529 PMCID: PMC10236507 DOI: 10.1093/ofid/ofad041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
There is now a robust pipeline of licensed and World Health Organization (WHO)-prequalified typhoid conjugate vaccines with a steady progression of national introductions. However, typhoid fever is responsible for less than half the total global burden of Salmonella disease, and even less among children aged <5 years. Invasive nontyphoidal Salmonella disease is the dominant clinical presentation of Salmonella in Africa, and over a quarter of enteric fever in Asia is due to paratyphoid A. In this article, we explore the case for combination Salmonella vaccines, review the current pipeline of these vaccines, and discuss key considerations for their development, including geographies of use, age of administration, and pathways to licensure. While a trivalent typhoid/nontyphoidal Salmonella vaccine is attractive for Africa, and a bivalent enteric fever vaccine for Asia, a quadrivalent vaccine covering the 4 main disease-causing serovars of Salmonella enterica would provide a single vaccine option for global Salmonella coverage.
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Affiliation(s)
- Calman A MacLennan
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Jeffrey Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Stephanie Grow
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Kirsten Vannice
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
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30
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John J, Bavdekar A, Rongsen-Chandola T, Dutta S, Gupta M, Kanungo S, Sinha B, Srinivasan M, Shrivastava A, Bansal A, Singh A, Koshy RM, Jinka DR, Thomas MS, Alexander AP, Thankaraj S, Ebenezer SE, Karthikeyan AS, Kumar D, Njarekkattuvalappil SK, Raju R, Sahai N, Veeraraghavan B, Murhekar MV, Mohan VR, Natarajan SK, Ramanujam K, Samuel P, Lo NC, Andrews J, Grassly NC, Kang G. Burden of Typhoid and Paratyphoid Fever in India. N Engl J Med 2023; 388:1491-1500. [PMID: 37075141 PMCID: PMC10116367 DOI: 10.1056/nejmoa2209449] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND In 2017, more than half the cases of typhoid fever worldwide were projected to have occurred in India. In the absence of contemporary population-based data, it is unclear whether declining trends of hospitalization for typhoid in India reflect increased antibiotic treatment or a true reduction in infection. METHODS From 2017 through 2020, we conducted weekly surveillance for acute febrile illness and measured the incidence of typhoid fever (as confirmed on blood culture) in a prospective cohort of children between the ages of 6 months and 14 years at three urban sites and one rural site in India. At an additional urban site and five rural sites, we combined blood-culture testing of hospitalized patients who had a fever with survey data regarding health care use to estimate incidence in the community. RESULTS A total of 24,062 children who were enrolled in four cohorts contributed 46,959 child-years of observation. Among these children, 299 culture-confirmed typhoid cases were recorded, with an incidence per 100,000 child-years of 576 to 1173 cases in urban sites and 35 in rural Pune. The estimated incidence of typhoid fever from hospital surveillance ranged from 12 to 1622 cases per 100,000 child-years among children between the ages of 6 months and 14 years and from 108 to 970 cases per 100,000 person-years among those who were 15 years of age or older. Salmonella enterica serovar Paratyphi was isolated from 33 children, for an overall incidence of 68 cases per 100,000 child-years after adjustment for age. CONCLUSIONS The incidence of typhoid fever in urban India remains high, with generally lower estimates of incidence in most rural areas. (Funded by the Bill and Melinda Gates Foundation; NSSEFI Clinical Trials Registry of India number, CTRI/2017/09/009719; ISRCTN registry number, ISRCTN72938224.).
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Affiliation(s)
- Jacob John
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ashish Bavdekar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Temsunaro Rongsen-Chandola
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Shanta Dutta
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Madhu Gupta
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Suman Kanungo
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Bireshwar Sinha
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Manikandan Srinivasan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ankita Shrivastava
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Adarsh Bansal
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ashita Singh
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Roshine M Koshy
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Dasharatha R Jinka
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Mathew S Thomas
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Anna P Alexander
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Shajin Thankaraj
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Sheena E Ebenezer
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Arun S Karthikeyan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Dilesh Kumar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Swathi K Njarekkattuvalappil
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Reshma Raju
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nikhil Sahai
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Balaji Veeraraghavan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Manoj V Murhekar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Venkata R Mohan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Sindhu K Natarajan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Karthikeyan Ramanujam
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Prasanna Samuel
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nathan C Lo
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Jason Andrews
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nicholas C Grassly
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Gagandeep Kang
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
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31
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Jossi SE, Arcuri M, Alshayea A, Persaud RR, Marcial-Juárez E, Palmieri E, Di Benedetto R, Pérez-Toledo M, Pillaye J, Channell WM, Schager AE, Lamerton RE, Cook CN, Goodall M, Haneda T, Bäumler AJ, Jackson-Jones LH, Toellner KM, MacLennan CA, Henderson IR, Micoli F, Cunningham AF. Vi polysaccharide and conjugated vaccines afford similar early, IgM or IgG-independent control of infection but boosting with conjugated Vi vaccines sustains the efficacy of immune responses. Front Immunol 2023; 14:1139329. [PMID: 37033932 PMCID: PMC10076549 DOI: 10.3389/fimmu.2023.1139329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Vaccination with Vi capsular polysaccharide (Vi-PS) or protein-Vi typhoid conjugate vaccine (TCV) can protect adults against Salmonella Typhi infections. TCVs offer better protection than Vi-PS in infants and may offer better protection in adults. Potential reasons for why TCV may be superior in adults are not fully understood. Methods and results Here, we immunized wild-type (WT) mice and mice deficient in IgG or IgM with Vi-PS or TCVs (Vi conjugated to tetanus toxoid or CRM197) for up to seven months, with and without subsequent challenge with Vi-expressing Salmonella Typhimurium. Unexpectedly, IgM or IgG alone were similarly able to reduce bacterial burdens in tissues, and this was observed in response to conjugated or unconjugated Vi vaccines and was independent of antibody being of high affinity. Only in the longer-term after immunization (>5 months) were differences observed in tissue bacterial burdens of mice immunized with Vi-PS or TCV. These differences related to the maintenance of antibody responses at higher levels in mice boosted with TCV, with the rate of fall in IgG titres induced to Vi-PS being greater than for TCV. Discussion Therefore, Vi-specific IgM or IgG are independently capable of protecting from infection and any superior protection from vaccination with TCV in adults may relate to responses being able to persist better rather than from differences in the antibody isotypes induced. These findings suggest that enhancing our understanding of how responses to vaccines are maintained may inform on how to maximize protection afforded by conjugate vaccines against encapsulated pathogens such as S. Typhi.
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Affiliation(s)
- Siân E. Jossi
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Melissa Arcuri
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- GSK Vaccines Institute for Global Health SRL, Siena, Italy
| | - Areej Alshayea
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Ruby R. Persaud
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Edith Marcial-Juárez
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Elena Palmieri
- GSK Vaccines Institute for Global Health SRL, Siena, Italy
| | | | - Marisol Pérez-Toledo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Jamie Pillaye
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Will M. Channell
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Anna E. Schager
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Rachel E. Lamerton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Charlotte N. Cook
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Margaret Goodall
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Takeshi Haneda
- Laboratory of Microbiology, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Andreas J. Bäumler
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, CA, United States
| | - Lucy H. Jackson-Jones
- Division of Biomedical and Life Sciences, Lancaster University, Lancaster, United Kingdom
| | - Kai-Michael Toellner
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Calman A. MacLennan
- Bill & Melinda Gates Foundation, London, United Kingdom
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ian R. Henderson
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | | | - Adam F. Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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Ok Baik Y, Lee Y, Lee C, Kyung Kim S, Park J, Sun M, Jung D, Young Jang J, Jun Yong T, Woo Park J, Jeong S, Lim S, Hyun Han S, Keun Choi S. A Phase II/III, Multicenter, Observer-blinded, Randomized, Non-inferiority and Safety, study of typhoid conjugate vaccine (EuTCV) compared to Typbar-TCV® in healthy 6 Months-45 years aged participants. Vaccine 2023; 41:1753-1759. [PMID: 36774331 DOI: 10.1016/j.vaccine.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 02/11/2023]
Abstract
The typhoid conjugate vaccine (TCV) ensures a long-lasting protective immune response, requires fewer doses and is fit for children under 2 years of age. From Phase I study, EuTCV displayed considerable immunogenicity and reliable safety, thus endorsing further examination in Phase II/III trials. Therefore, a clinical Phase II/III study (NCT04830371) was conducted to evaluate its efficacy in healthy Filipino participants aged 6 months to 45 years through administration of the test vaccine (Arm A, B, and C) or comparator vaccine Typbar-TCV® (Arm D). Sera samples were collected pre-vaccination (Visit 1) and post-vaccination (Visit 4, Day 28) to assess the immunogenicity of EuTCV and Typbar-TCV®. During the study, participants were regularly monitored through scheduled visits to the clinic to report any adverse events associated with the vaccine. For vaccine safety, the proportion of solicited and unsolicited Treatment-Emergent Adverse Events was all comparable between EuTCV and Typbar-TCV® groups. A single dose of EuTCV produced seroconversion in 99.4% of treated participants, with seroconversion rates non-inferior to that of Typbar-TCV®. Batch-to-batch consistency was concluded based on the 90% Confidence Interval of the geometric mean ratio (EuTCV Arm A, B, and C) at Week 4, lying within the equivalence margin of 0.5 to 2.0 for all batches. Results from this Phase II/III clinical trial of EuTCV in healthy volunteers show comparable safety and considerable immunogenicity, compared to Typbar-TCV®, meeting the objectives of this pivotal study. ClinicalTrials.gov registration number: NCT04830371.
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Affiliation(s)
| | | | - Chankyu Lee
- R&D Center, EuBiologics Co., Ltd., Chuncheon, Republic of Korea
| | - Soo Kyung Kim
- R&D Center, EuBiologics Co., Ltd., Chuncheon, Republic of Korea
| | | | - Meixiang Sun
- R&D Center, EuBiologics Co., Ltd., Chuncheon, Republic of Korea
| | - DaYe Jung
- EuBiologics Co., Ltd., Seoul, Republic of Korea
| | - Jin Young Jang
- R&D Center, EuBiologics Co., Ltd., Chuncheon, Republic of Korea
| | - Tae Jun Yong
- R&D Center, EuBiologics Co., Ltd., Chuncheon, Republic of Korea
| | - Jeong Woo Park
- Department of Oral Microbiology and Immunology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sungho Jeong
- Department of Oral Microbiology and Immunology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Suwon Lim
- Department of Oral Microbiology and Immunology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Seung Hyun Han
- Department of Oral Microbiology and Immunology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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33
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Sharma A, Apte A, Rajappa M, Vaz M, Vaswani V, Goenka S, Malhotra S, Sangoram R, Lakshminarayanan S, Jayaram S, Mathaiyan J, Farseena K, Mukerjee P, Jaswal S, Dongre A, Timms O, Shafiq N, Aggarwal R, Kaur M, Juvekar S, Sekhar A, Kang G. Perceptions about controlled human infection model (CHIM) studies among members of ethics committees of Indian medical institutions: A qualitative exploration. Wellcome Open Res 2023; 7:209. [PMID: 36969719 PMCID: PMC10031138 DOI: 10.12688/wellcomeopenres.17968.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/04/2023] Open
Abstract
Introduction: Controlled Human Infection Model (CHIM) studies provide a unique platform for studying the pathophysiology of infectious diseases and accelerated testing of vaccines and drugs in controlled settings. However, ethical issues shroud them as the disease-causing pathogen is intentionally inoculated into healthy consenting volunteers, and effective treatment may or may not be available. We explored the perceptions of the members of institutional ethics committees (IECs) in India about CHIM studies. Methods: This qualitative exploratory study, conducted across seven sites in India, included 11 focused group discussions (FGD) and 31 in-depth interviews (IDI). A flexible approach was used with the aid of a topic guide. The data were thematically analyzed using grounded theory and an inductive approach. Emerging themes and sub-themes were analyzed, and major emergent themes were elucidated. Results: Seventy-two IEC members participated in the study including 21 basic medical scientists, 29 clinicians, 9 lay people, 6 legal experts and 7 social scientists. Three major themes emerged from this analysis—apprehensions about conduct of CHIM studies in India, a perceived need for CHIM studies in India and risk mitigation measures needed to protect research participants and minimize the associated risks. Conclusion: Development of a specific regulatory and ethical framework, training of research staff and ethics committee members, and ensuring specialized research infrastructure along with adequate community sensitization were considered essential before initiation of CHIM studies in India.
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Affiliation(s)
- Abhishek Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Aditi Apte
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Medha Rajappa
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manjulika Vaz
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Vina Vaswani
- Yenepoya University, Mangalore, Karnataka, 575018, India
| | - Shifalika Goenka
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Samir Malhotra
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rashmi Sangoram
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Subitha Lakshminarayanan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Suganya Jayaram
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Jayanthi Mathaiyan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | | | - Prarthna Mukerjee
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Surinder Jaswal
- Tata Institute of Social Sciences, Mumbai, Maharashtra, 400088, India
| | - Amol Dongre
- Pramukhswami Medical College, Karamsad, Gujarat, 388325, India
| | - Olinda Timms
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Amrita Sekhar
- Translational Health Science and Technology Institute, Faridabad, Haryana, 101213, India
| | - Gagandeep Kang
- Christian Medical College, Vellore, Tamil Nadu, 632004, India
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34
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Adams-Phipps J, Toomey D, Więcek W, Schmit V, Wilkinson J, Scholl K, Jamrozik E, Osowicki J, Roestenberg M, Manheim D. A Systematic Review of Human Challenge Trials, Designs, and Safety. Clin Infect Dis 2023; 76:609-619. [PMID: 36219704 PMCID: PMC9938741 DOI: 10.1093/cid/ciac820] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have assessed participant safety in human challenge trials (HCTs). Key questions regarding HCTs include how risky such trials have been, how often adverse events (AEs) and serious adverse events (SAEs) occur, and whether risk mitigation measures have been effective. METHODS A systematic search of PubMed and PubMed Central for articles reporting on results of HCTs published between 1980 and 2021 was performed and completed by 7 October 2021. RESULTS Of 2838 articles screened, 276 were reviewed in full. A total of 15 046 challenged participants were described in 308 studies that met inclusion criteria; 286 (92.9%) of these studies reported mitigation measures used to minimize risk to the challenge population. Among 187 studies that reported on SAEs, 0.2% of participants experienced at least 1 challenge-related SAE. Among 94 studies that graded AEs by severity, challenge-related AEs graded "severe" were reported by between 5.6% and 15.8% of participants. AE data were provided as a range to account for unclear reporting. Eighty percent of studies published after 2010 were registered in a trials database. CONCLUSIONS HCTs are increasingly common and used for an expanding list of diseases. Although AEs occur, severe AEs and SAEs are rare. Reporting has improved over time, though not all papers provide a comprehensive report of relevant health impacts. We found very few severe symptoms or SAEs in studies that reported them, but many HCTs did not report relevant safety data. This study was preregistered on PROSPERO as CRD42021247218.
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Affiliation(s)
| | - Danny Toomey
- 1Day Sooner Research Team, Lewes, Delaware, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | | | | | - Keller Scholl
- RAND Corporation, Pardee RAND Graduate School, Santa Monica, California, USA
| | - Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and the Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Monash Bioethics Centre, Monash University, Clayton, VIC, Australia
- Royal Melbourne Hospital Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Joshua Osowicki
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Meta Roestenberg
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, ZAThe Netherlands
| | - David Manheim
- 1Day Sooner Research Team, Lewes, Delaware, USA
- Technion, Israel Institute of Technology, Haifa, Israel
- ALTER, Association for Long Term Existence and Resilience, Rehovot, Israel
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35
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Li K, Dodds M, Spreng RL, Abraha M, Huntwork RHC, Dahora LC, Nyanhete T, Dutta S, Wille-Reece U, Jongert E, Ewer KJ, Hill AVS, Jin C, Hill J, Pollard AJ, Munir Alam S, Tomaras GD, Dennison SM. A tool for evaluating heterogeneity in avidity of polyclonal antibodies. Front Immunol 2023; 14:1049673. [PMID: 36875126 PMCID: PMC9978818 DOI: 10.3389/fimmu.2023.1049673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/18/2023] [Indexed: 02/18/2023] Open
Abstract
Diversity in specificity of polyclonal antibody (pAb) responses is extensively investigated in vaccine efficacy or immunological evaluations, but the heterogeneity in antibody avidity is rarely probed as convenient tools are lacking. Here we have developed a polyclonal antibodies avidity resolution tool (PAART) for use with label-free techniques, such as surface plasmon resonance and biolayer interferometry, that can monitor pAb-antigen interactions in real time to measure dissociation rate constant (kd ) for defining avidity. PAART utilizes a sum of exponentials model to fit the dissociation time-courses of pAb-antigens interactions and resolve multiple kd contributing to the overall dissociation. Each kd value of pAb dissociation resolved by PAART corresponds to a group of antibodies with similar avidity. PAART is designed to identify the minimum number of exponentials required to explain the dissociation course and guards against overfitting of data by parsimony selection of best model using Akaike information criterion. Validation of PAART was performed using binary mixtures of monoclonal antibodies of same specificity but differing in kd of the interaction with their epitope. We applied PAART to examine the heterogeneity in avidities of pAb from malaria and typhoid vaccinees, and individuals living with HIV-1 that naturally control the viral load. In many cases, two to three kd were dissected indicating the heterogeneity of pAb avidities. We showcase examples of affinity maturation of vaccine induced pAb responses at component level and enhanced resolution of heterogeneity in avidity when antigen-binding fragments (Fab) are used instead of polyclonal IgG antibodies. The utility of PAART can be manifold in examining circulating pAb characteristics and could inform vaccine strategies aimed to guide the host humoral immune response.
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Affiliation(s)
- Kan Li
- Center for Human Systems Immunology, Duke University, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
| | - Michael Dodds
- Integrated Drug Development, Certara, Seattle, WA, United States
| | - Rachel L. Spreng
- Duke Human Vaccine Institute, Duke University, Durham, NC, United States
| | - Milite Abraha
- Center for Human Systems Immunology, Duke University, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
| | - Richard H. C. Huntwork
- Center for Human Systems Immunology, Duke University, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
| | - Lindsay C. Dahora
- Center for Human Systems Immunology, Duke University, Durham, NC, United States
- Department of Immunology, Duke University, Durham, NC, United States
| | - Tinashe Nyanhete
- Center for Human Systems Immunology, Duke University, Durham, NC, United States
- Department of Immunology, Duke University, Durham, NC, United States
| | - Sheetij Dutta
- Structural Vaccinology Lab, Malaria Biologics Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Ulrike Wille-Reece
- PATH's Center for Vaccine Innovation and Access, Washington, DC, United States
| | | | - Katie J. Ewer
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Adrian V. S. Hill
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Center, Oxford, United Kingdom
| | - Celina Jin
- Oxford Vaccine Group and Department of Pediatrics, University of Oxford, Oxford, United Kingdom
| | - Jennifer Hill
- Oxford Vaccine Group and Department of Pediatrics, University of Oxford, Oxford, United Kingdom
| | - Andrew J. Pollard
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Center, Oxford, United Kingdom
- Oxford Vaccine Group and Department of Pediatrics, University of Oxford, Oxford, United Kingdom
| | - S. Munir Alam
- Duke Human Vaccine Institute, Duke University, Durham, NC, United States
- Department of Pathology, Duke University, Durham, NC, United States
| | - Georgia D. Tomaras
- Center for Human Systems Immunology, Duke University, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
- Duke Human Vaccine Institute, Duke University, Durham, NC, United States
- Department of Immunology, Duke University, Durham, NC, United States
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States
| | - S. Moses Dennison
- Center for Human Systems Immunology, Duke University, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
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Warfel K, Williams A, Wong DA, Sobol SE, Desai P, Li J, Chang YF, DeLisa MP, Karim AS, Jewett MC. A Low-Cost, Thermostable, Cell-Free Protein Synthesis Platform for On-Demand Production of Conjugate Vaccines. ACS Synth Biol 2023; 12:95-107. [PMID: 36548479 PMCID: PMC9872175 DOI: 10.1021/acssynbio.2c00392] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Indexed: 12/24/2022]
Abstract
Cell-free protein synthesis systems that can be lyophilized for long-term, non-refrigerated storage and transportation have the potential to enable decentralized biomanufacturing. However, increased thermostability and decreased reaction cost are necessary for further technology adoption. Here, we identify maltodextrin as an additive to cell-free reactions that can act as both a lyoprotectant to increase thermostability and a low-cost energy substrate. As a model, we apply optimized formulations to produce conjugate vaccines for ∼$0.50 per dose after storage at room temperature (∼22 °C) or 37 °C for up to 4 weeks, and ∼$1.00 per dose after storage at 50 °C for up to 4 weeks, with costs based on raw materials purchased at the laboratory scale. We show that these conjugate vaccines generate bactericidal antibodies against enterotoxigenic Escherichia coli (ETEC) O78 O-polysaccharide, a pathogen responsible for diarrheal disease, in immunized mice. We anticipate that our low-cost, thermostable cell-free glycoprotein synthesis system will enable new models of medicine biosynthesis and distribution that bypass cold-chain requirements.
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Affiliation(s)
- Katherine
F. Warfel
- Department
of Chemical and Biological Engineering, Northwestern University, 2145 Sheridan Road, Technological Institute E136, Evanston, Illinois 60208, United States
- Chemistry
of Life Processes Institute, Northwestern
University, 2170 Campus
Drive, Evanston, Illinois 60208, United States
- Center
for Synthetic Biology, Northwestern University, 2145 Sheridan Road, Technological
Institute E136, Evanston, Illinois 60208, United States
| | - Asher Williams
- Robert
Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York 14853 United States
| | - Derek A. Wong
- Department
of Chemical and Biological Engineering, Northwestern University, 2145 Sheridan Road, Technological Institute E136, Evanston, Illinois 60208, United States
- Chemistry
of Life Processes Institute, Northwestern
University, 2170 Campus
Drive, Evanston, Illinois 60208, United States
- Center
for Synthetic Biology, Northwestern University, 2145 Sheridan Road, Technological
Institute E136, Evanston, Illinois 60208, United States
| | - Sarah E. Sobol
- Department
of Chemical and Biological Engineering, Northwestern University, 2145 Sheridan Road, Technological Institute E136, Evanston, Illinois 60208, United States
- Chemistry
of Life Processes Institute, Northwestern
University, 2170 Campus
Drive, Evanston, Illinois 60208, United States
- Center
for Synthetic Biology, Northwestern University, 2145 Sheridan Road, Technological
Institute E136, Evanston, Illinois 60208, United States
| | - Primit Desai
- Biochemistry,
Molecular & Cell Biology, Cornell University, Ithaca, New York 14853 United States
| | - Jie Li
- Department
of Population Medicine and Diagnostic Sciences, College of Veterinary
Medicine, Cornell University, Ithaca, New York 14853, United States
| | - Yung-Fu Chang
- Department
of Population Medicine and Diagnostic Sciences, College of Veterinary
Medicine, Cornell University, Ithaca, New York 14853, United States
| | - Matthew P. DeLisa
- Robert
Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, New York 14853 United States
- Biochemistry,
Molecular & Cell Biology, Cornell University, Ithaca, New York 14853 United States
- Cornell
Institute of Biotechnology, Cornell University, Ithaca, New York 14853 United States
| | - Ashty S. Karim
- Department
of Chemical and Biological Engineering, Northwestern University, 2145 Sheridan Road, Technological Institute E136, Evanston, Illinois 60208, United States
- Chemistry
of Life Processes Institute, Northwestern
University, 2170 Campus
Drive, Evanston, Illinois 60208, United States
- Center
for Synthetic Biology, Northwestern University, 2145 Sheridan Road, Technological
Institute E136, Evanston, Illinois 60208, United States
| | - Michael C. Jewett
- Department
of Chemical and Biological Engineering, Northwestern University, 2145 Sheridan Road, Technological Institute E136, Evanston, Illinois 60208, United States
- Chemistry
of Life Processes Institute, Northwestern
University, 2170 Campus
Drive, Evanston, Illinois 60208, United States
- Center
for Synthetic Biology, Northwestern University, 2145 Sheridan Road, Technological
Institute E136, Evanston, Illinois 60208, United States
- Robert
H. Lurie Comprehensive Cancer Center, Northwestern
University, 676 North
Saint Clair Street, Suite 1200, Chicago, Illinois 60611, United States
- Simpson
Querrey Institute, Northwestern University, 303 East Superior Street, Suite
11-131, Chicago, Illinois 60611, United States
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Vij S, Thakur R, Rishi P. Reverse engineering approach: a step towards a new era of vaccinology with special reference to Salmonella. Expert Rev Vaccines 2022; 21:1763-1785. [PMID: 36408592 DOI: 10.1080/14760584.2022.2148661] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Salmonella is responsible for causing enteric fever, septicemia, and gastroenteritis in humans. Due to high disease burden and emergence of multi- and extensively drug-resistant Salmonella strains, it is becoming difficult to treat the infection with existing battery of antibiotics as we are not able to discover newer antibiotics at the same pace at which the pathogens are acquiring resistance. Though vaccines against Salmonella are available commercially, they have limited efficacy. Advancements in genome sequencing technologies and immunoinformatics approaches have solved the problem significantly by giving rise to a new era of vaccine designing, i.e. 'Reverse engineering.' Reverse engineering/vaccinology has expedited the vaccine identification process. Using this approach, multiple potential proteins/epitopes can be identified and constructed as a single entity to tackle enteric fever. AREAS COVERED This review provides details of reverse engineering approach and discusses various protein and epitope-based vaccine candidates identified using this approach against typhoidal Salmonella. EXPERT OPINION Reverse engineering approach holds great promise for developing strategies to tackle the pathogen(s) by overcoming the limitations posed by existing vaccines. Progressive advancements in the arena of reverse vaccinology, structural biology, and systems biology combined with an improved understanding of host-pathogen interactions are essential components to design new-generation vaccines.
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Affiliation(s)
- Shania Vij
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Reena Thakur
- Department of Microbiology, Panjab University, Chandigarh, India
| | - Praveen Rishi
- Department of Microbiology, Panjab University, Chandigarh, India
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Fazaludeen Koya S, Hasan Farooqui H, Mehta A, Selvaraj S, Galea S. Quantifying antibiotic use in typhoid fever in India: a cross-sectional analysis of private sector medical audit data, 2013-2015. BMJ Open 2022; 12:e062401. [PMID: 36253043 PMCID: PMC9577907 DOI: 10.1136/bmjopen-2022-062401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To estimate the antibiotic prescription rates for typhoid in India. DESIGN Cross-sectional study. SETTING Private sector primary care clinicians in India. PARTICIPANTS The data came from prescriptions of a panel of 4600 private sector primary care clinicians selected through a multistage stratified random sampling accounting for the region, specialty type and patient turnover. The data had 671 million prescriptions for antibiotics extracted from the IQVIA database for the years 2013, 2014 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Mean annual antibiotic prescription rates; sex-specific and age-specific prescription rates; distribution of antibiotic class. RESULTS There were 8.98 million antibiotic prescriptions per year for typhoid, accounting for 714 prescriptions per 100 000 population. Children 10-19 years of age represented 18.6% of the total burden in the country in absolute numbers, 20-29 year age group had the highest age-specific rate, and males had a higher average rate (844/100 000) compared with females (627/100 000). Ten different antibiotics accounted for 72.4% of all prescriptions. Cefixime-ofloxacin combination was the preferred drug of choice for typhoid across all regions except the south. Combination antibiotics are the preferred choice of prescribers for adult patients, while cephalosporins are the preferred choice for children and young age. Quinolones were prescribed as monotherapy in 23.0% of cases. CONCLUSIONS Nationally representative private sector antibiotic prescription data during 2013-2015 indicate a higher disease burden of typhoid in India than previously estimated. The total prescription rate shows a declining trend. Young adult patients account for close to one-third of the cases and children less than 10 years account for more than a million cases annually.
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Affiliation(s)
| | | | - Aashna Mehta
- Health Economics, Financing and Policy Division, Public Health Foundation of India, New Delhi, India
| | - Sakthivel Selvaraj
- Health Economics, Financing and Policy Division, Public Health Foundation of India, New Delhi, India
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW Momentum for achieving widespread control of typhoid fever has been growing over the past decade. Typhoid conjugate vaccines represent a potentially effective tool to reduce the burden of disease in the foreseeable future and new data have recently emerged to better frame their use-case. RECENT FINDINGS We describe how antibiotic resistance continues to pose a major challenge in the treatment of typhoid fever, as exemplified by the emergence of azithromycin resistance and the spread of Salmonella Typhi strains resistant to third-generation cephalosporins. We review efficacy and effectiveness data for TCVs, which have been shown to have high-level efficacy (≥80%) against typhoid fever in diverse field settings. Data from randomized controlled trials and observational studies of TCVs are reviewed herein. Finally, we review data from multicountry blood culture surveillance studies that have provided granular insights into typhoid fever epidemiology. These data are becoming increasingly important as countries decide how best to introduce TCVs into routine immunization schedules and determine the optimal delivery strategy. SUMMARY Continued advocacy is needed to address the ongoing challenge of typhoid fever to improve child health and tackle the rising challenge of antimicrobial resistance.
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40
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Britto C, Alter G. The next frontier in vaccine design: blending immune correlates of protection into rational vaccine design. Curr Opin Immunol 2022; 78:102234. [PMID: 35973352 PMCID: PMC9612370 DOI: 10.1016/j.coi.2022.102234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 07/13/2022] [Indexed: 02/02/2023]
Abstract
Despite the extraordinary speed and success in SARS-Cov-2 vaccine development, the emergence of variants of concern perplexed the vaccine development community. Neutralizing antibodies waned antibodies waned and were evaded by viral variants, despite the preservation of protection against severe disease and death across vaccinated populations. Similar to other vaccine design efforts, the lack of mechanistic correlates of immunity against Coronavirus Disease 2019, raised questions related to the need for vaccine redesign and boosting. Hence, our limited understanding of mechanistic correlates of immunity - across pathogens - remains a major obstacle in vaccine development. The identification and incorporation of mechanistic correlates of immunity are key to the accelerated design of highly impactful globally relevant vaccines. Systems-biology tools can be applied strategically to define a complete understanding of mechanistic correlates of immunity. Embedding immunological dissection and target immune profile identification, beyond canonical antibody binding and neutralization, may accelerate the design and success of durable protective vaccines.
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Affiliation(s)
- Carl Britto
- Department of Pediatrics, Boston Children's Hospital, USA; Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA.
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Choy RKM, Bourgeois AL, Ockenhouse CF, Walker RI, Sheets RL, Flores J. Controlled Human Infection Models To Accelerate Vaccine Development. Clin Microbiol Rev 2022; 35:e0000821. [PMID: 35862754 PMCID: PMC9491212 DOI: 10.1128/cmr.00008-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The timelines for developing vaccines against infectious diseases are lengthy, and often vaccines that reach the stage of large phase 3 field trials fail to provide the desired level of protective efficacy. The application of controlled human challenge models of infection and disease at the appropriate stages of development could accelerate development of candidate vaccines and, in fact, has done so successfully in some limited cases. Human challenge models could potentially be used to gather critical information on pathogenesis, inform strain selection for vaccines, explore cross-protective immunity, identify immune correlates of protection and mechanisms of protection induced by infection or evoked by candidate vaccines, guide decisions on appropriate trial endpoints, and evaluate vaccine efficacy. We prepared this report to motivate fellow scientists to exploit the potential capacity of controlled human challenge experiments to advance vaccine development. In this review, we considered available challenge models for 17 infectious diseases in the context of the public health importance of each disease, the diversity and pathogenesis of the causative organisms, the vaccine candidates under development, and each model's capacity to evaluate them and identify correlates of protective immunity. Our broad assessment indicated that human challenge models have not yet reached their full potential to support the development of vaccines against infectious diseases. On the basis of our review, however, we believe that describing an ideal challenge model is possible, as is further developing existing and future challenge models.
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Affiliation(s)
- Robert K. M. Choy
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | - A. Louis Bourgeois
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | | | - Richard I. Walker
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | | | - Jorge Flores
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
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Sztein MB, Booth JS. Controlled human infectious models, a path forward in uncovering immunological correlates of protection: Lessons from enteric fevers studies. Front Microbiol 2022; 13:983403. [PMID: 36204615 PMCID: PMC9530043 DOI: 10.3389/fmicb.2022.983403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Enteric infectious diseases account for more than a billion disease episodes yearly worldwide resulting in approximately 2 million deaths, with children under 5 years old and the elderly being disproportionally affected. Enteric pathogens comprise viruses, parasites, and bacteria; the latter including pathogens such as Salmonella [typhoidal (TS) and non-typhoidal (nTS)], cholera, Shigella and multiple pathotypes of Escherichia coli (E. coli). In addition, multi-drug resistant and extensively drug-resistant (XDR) strains (e.g., S. Typhi H58 strain) of enteric bacteria are emerging; thus, renewed efforts to tackle enteric diseases are required. Many of these entero-pathogens could be controlled by oral or parenteral vaccines; however, development of new, effective vaccines has been hampered by lack of known immunological correlates of protection (CoP) and limited knowledge of the factors contributing to protective responses. To fully comprehend the human response to enteric infections, an invaluable tool that has recently re-emerged is the use of controlled human infection models (CHIMs) in which participants are challenged with virulent wild-type (wt) organisms. CHIMs have the potential to uncover immune mechanisms and identify CoP to enteric pathogens, as well as to evaluate the efficacy of therapeutics and vaccines in humans. CHIMs have been used to provide invaluable insights in the pathogenesis, host-pathogen interaction and evaluation of vaccines. Recently, several Oxford typhoid CHIM studies have been performed to assess the role of multiple cell types (B cells, CD8+ T, Tregs, MAIT, Monocytes and DC) during S. Typhi infection. One of the key messages that emerged from these studies is that baseline antigen-specific responses are important in that they can correlate with clinical outcomes. Additionally, volunteers who develop typhoid disease (TD) exhibit higher levels and more activated cell types (e.g., DC and monocytes) which are nevertheless defective in discrete signaling pathways. Future critical aspects of this research will involve the study of immune responses to enteric infections at the site of entry, i.e., the intestinal mucosa. This review will describe our current knowledge of immunity to enteric fevers caused byS. Typhi and S. Paratyphi A, with emphasis on the contributions of CHIMs to uncover the complex immunological responses to these organisms and provide insights into the determinants of protective immunity.
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Affiliation(s)
- Marcelo B. Sztein
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- *Correspondence: Marcelo B. Sztein,
| | - Jayaum S. Booth
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
- Jayaum S. Booth,
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Deen J, Clemens JD. Vaccine clinical trials in low- and middle-income countries: a brief review of standard, newer and proposed approaches. Expert Rev Vaccines 2022; 21:1595-1602. [DOI: 10.1080/14760584.2022.2126357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Pedro Gil Street, Ermita, Manila 1000, Philippines
| | - John D Clemens
- International Vaccine Institute, SNU Research Park, Gwanak-gu, Seoul, 08826 Korea
- UCLA Fielding School of Public Health, 650 Charles E Young Drive South, Los Angeles, California 90095-1772, USA
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Saluja T, Rai GK, Chaudhary S, Kanodia P, Giri BR, Kim DR, Yang JS, Park IY, Kyung SE, Vemula S, Reddy E J, Kim B, Gupta BP, Jo SK, Ryu JH, Park HK, Shin JH, Lee Y, Kim H, Kim JH, Mojares ZR, Wartel TA, Sahastrabuddhe S. Immune non-interference and safety study of Vi-DT typhoid conjugate vaccine with a measles, mumps and rubella containing vaccine in 9-15 months old Nepalese infants. Vaccine 2022; 40:5828-5834. [PMID: 36064672 DOI: 10.1016/j.vaccine.2022.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 07/06/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Typhoid fever is a common disease in developing countries especially in the Indian subcontinent and Africa. The available typhoid conjugate vaccines (TCV) have been found to be highly immunogenic in infants and children less than 2 years of age. Many countries are planning to adopt TCV in their routine EPI programs around 9 months of age when measles containing vaccines are given. Therefore, Vi-DT TCV was tested in 9-15 months aged healthy infants in Nepal to demonstrate non-interference with a measles containing vaccine. METHODS This was a randomized, open label, phase III study to assess the immune non-interference, safety, and reactogenicity of Vi-DT typhoid conjugate vaccine when given concomitantly with measles, mumps and rubella (MMR) vaccine. A total of 360 participants aged 9-15 months were enrolled and randomized equally into Vi-DT + MMR (180 participants) or MMR alone (180 participants) group and were evaluated for immunogenicity and safety 28 days post vaccination. RESULTS Using the immunogenicity set, difference between proportions (95% CI) of the Vi-DT + MMR group vs MMR alone group were -2.73% (-8.85, 3.38), -3.19% (-11.25, 4.88) and 2.91% (-3.36, 9.18) for sero-positivity rate of anti-measles, anti-mumps and anti- rubella, respectively. Only the lower bound of the range in difference of the proportions for sero-positivity rate of anti-mumps did not satisfy the non-inferiority criteria as it was above the -10% limit, which may not be of clinical significance. These results were confirmed in the per protocol set. There were no safety concerns reported from the study and both Vi-DT + MMR and MMR alone groups were comparable in terms of solicited and unsolicited adverse events . CONCLUSIONS Results indicated that there is non-interference of MMR vaccine with Vi-DT and Vi-DT conjugate vaccine could be considered as an addition to the EPI schedule among children at risk of contracting typhoid.
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Affiliation(s)
- Tarun Saluja
- International Vaccine Institute, Seoul, Republic of Korea.
| | | | | | | | | | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Il-Yeon Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Sridhar Vemula
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Bomi Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Sue Kyoung Jo
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Hun Kim
- SK bioscience, Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
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Sharma A, Apte A, Rajappa M, Vaz M, Vaswani V, Goenka S, Malhotra S, Sangoram R, Lakshminarayanan S, Jayaram S, Mathaiyan J, Farseena K, Mukerjee P, Jaswal S, Dongre A, Timms O, Shafiq N, Aggarwal R, Kaur M, Juvekar S, Sekhar A, Kang G. Perceptions about controlled human infection model (CHIM) studies among members of ethics committees of Indian medical institutions: A qualitative exploration. Wellcome Open Res 2022; 7:209. [PMID: 36969719 PMCID: PMC10031138 DOI: 10.12688/wellcomeopenres.17968.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Controlled Human Infection Model (CHIM) studies provide a unique platform for studying the pathophysiology of infectious diseases and accelerated testing of vaccines and drugs in controlled settings. However, ethical issues shroud them as the disease-causing pathogen is intentionally inoculated into healthy consenting volunteers, and effective treatment may or may not be available. We explored the perceptions of the members of institutional ethics committees (IECs) in India about CHIM studies. Methods: This qualitative exploratory study, conducted across seven sites in India, included 11 focused group discussions (FGD) and 31 in-depth interviews (IDI). A flexible approach was used with the aid of a topic guide. The data were thematically analyzed using grounded theory and an inductive approach. Emerging themes and sub-themes were analyzed, and major emergent themes were elucidated. Results: Seventy-two IEC members participated in the study including 21 basic medical scientists, 29 clinicians, 9 lay people, 6 legal experts and 7 social scientists. Three major themes emerged from this analysis—apprehensions about conduct of CHIM studies in India, a perceived need for CHIM studies in India and risk mitigation measures needed to protect research participants and minimize the associated risks. Conclusion: Development of a specific regulatory and ethical framework, training of research staff and ethics committee members, and ensuring specialized research infrastructure along with adequate community sensitization were considered essential before initiation of CHIM studies in India.
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Affiliation(s)
- Abhishek Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Aditi Apte
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Medha Rajappa
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manjulika Vaz
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Vina Vaswani
- Yenepoya University, Mangalore, Karnataka, 575018, India
| | - Shifalika Goenka
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Samir Malhotra
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rashmi Sangoram
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Subitha Lakshminarayanan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Suganya Jayaram
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Jayanthi Mathaiyan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | | | - Prarthna Mukerjee
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Surinder Jaswal
- Tata Institute of Social Sciences, Mumbai, Maharashtra, 400088, India
| | - Amol Dongre
- Pramukhswami Medical College, Karamsad, Gujarat, 388325, India
| | - Olinda Timms
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Amrita Sekhar
- Translational Health Science and Technology Institute, Faridabad, Haryana, 101213, India
| | - Gagandeep Kang
- Christian Medical College, Vellore, Tamil Nadu, 632004, India
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Thobani RS, Yousafzai MT, Sultana S, Kazi AM, Jan M, Rafey A, Khan A, Irfan S, Ujjan IU, Brown N, Mårtensson A, Qamar FN. Field evaluation of typhoid conjugate vaccine in a catch-up campaign among children aged 9 months to 15 years in Sindh, Pakistan. Vaccine 2022; 40:5391-5398. [DOI: 10.1016/j.vaccine.2022.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/10/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
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Lightowler MS, Manangazira P, Nackers F, Van Herp M, Phiri I, Kuwenyi K, Panunzi I, Garone D, Marume F, Tarupiwa A, Ferreras E, Duri C, Luquero FJ. Effectiveness of typhoid conjugate vaccine in Zimbabwe used in response to an outbreak among children and young adults: A matched case control study. Vaccine 2022; 40:4199-4210. [PMID: 35690501 DOI: 10.1016/j.vaccine.2022.04.093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Zimbabwe suffers from regular outbreaks of typhoid fever (TF), worse since 2017. Most cases were in Harare and a vaccination campaign with Typhoid Conjugate Vaccine (TCV) was conducted in March 2019. The vaccine effectiveness (VE) was assessed against culture-confirmed S. Typhi in children six months to 15 years and in individuals six months to 45 years in Harare. METHODS A matched case-control study was conducted in three urban suburbs of Harare targeted by the TCV vaccination campaign. Suspected TF cases were enrolled prospectively in four health facilities and were matched to facility (1:1) and community (1:5) controls. FINDINGS Of 504 suspected cases from July 2019 to March 2020, 148 laboratory-confirmed TF cases and 153 controls confirmed-negative were identified. One hundred and five (47 aged six months to 15 years) cases were age, sex, and residence matched with 105 facility-based controls while 96 cases were matched 1:5 by age, sex, and immediate-neighbour with 229 community controls. The adjusted VE against confirmed TF was 75% (95%CI: 1-94, p = 0.049) compared to facility controls, and 84% (95%CI: 57-94, p < 0.001) compared to community controls in individuals six months to 15 years. The adjusted VE against confirmed TF was 46% (95%CI: 26-77, p = 0.153) compared to facility controls, and 67% (95%CI: 35-83, p = 0.002) compared to community controls six months to 45 years old. INTERPRETATION This study confirms that one vaccine dose of TCV is effective to control TF in children between six months and 15 years old in an African setting.
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Affiliation(s)
| | - Portia Manangazira
- Ministry of Health and Child Welfare, Epidemiology and Disease Control Directorate, Harare, Zimbabwe
| | | | - Michel Van Herp
- Médecins Sans Frontières, Operational Centre Brussels, Belgium
| | - Isaac Phiri
- Ministry of Health and Child Welfare, Epidemiology and Disease Control Directorate, Harare, Zimbabwe
| | - Kuziwa Kuwenyi
- Médecins Sans Frontières, Operational Centre Brussels, Belgium
| | | | - Daniela Garone
- Médecins Sans Frontières, Operational Centre Brussels, Belgium
| | - Farayi Marume
- Médecins Sans Frontières, Operational Centre Brussels, Belgium
| | - Andrew Tarupiwa
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | - Eva Ferreras
- Epicentre, 14-34 Avenue Jean Jaurès, 70519 Paris, France
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Abstract
AB toxins are protein virulence factors secreted by many bacterial pathogens, contributing to the pathogenicity of the cognate bacteria. AB toxins consist of two functionally distinct components: the enzymatic "A" component for pathogenicity and the receptor-binding "B" component for toxin delivery. Consistently, unlike other virulence factors such as effectors, AB toxins do not require additional systems to deliver them to the target host cells. Target host cells are located in the infection site and/or located distantly from infected host cells. The first part of this review discusses the structural and functional features of single-peptide and multiprotein AB toxins in the context of host-microbe interactions, using several well-characterized examples. The second part of this review discusses toxin neutralization strategies, as well as applications of AB toxins relevant to developing intervention strategies against diseases.
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Affiliation(s)
- Jeongmin Song
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY, United States.
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Barnes E, Cooke GS, Lauer GM, Chung RT. Implementation of a controlled human infection model for evaluation of HCV vaccine candidates. Hepatology 2022; 77:1757-1772. [PMID: 35736236 DOI: 10.1002/hep.32632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/08/2022]
Abstract
Hepatitis C virus (HCV) remains a major global health concern. Directly acting antiviral (DAA) drugs have transformed the treatment of HCV. However, it has become clear that, without an effective HCV vaccine, it will not be possible to meet the World Health Organization targets of HCV viral elimination. Promising new vaccine technologies that generate high magnitude antiviral T and B cell immune responses and significant new funding have recently become available, stimulating the HCV vaccine pipeline. In the absence of an immune competent animal model for HCV, the major block in evaluating new HCV vaccine candidates will be the assessment of vaccine efficacy in humans. The development of a controlled human infection model (CHIM) for HCV could overcome this block, enabling the head-to-head assessment of vaccine candidates. The availability of highly effective DAA means that a CHIM for HCV is possible for the first time. In this review, we highlight the challenges and issues with currently available strategies to assess HCV vaccine efficacy including HCV "at-risk" cohorts and animal models. We describe the development of CHIM in other infections that are increasingly utilized by trialists and explore the ethical and safety concerns specific for an HCV CHIM. Finally, we propose an HCV CHIM study design including the selection of volunteers, the development of an infectious inoculum, the evaluation of host immune and viral parameters, and the definition of study end points for use in an HCV CHIM. Importantly, the study design (including number of volunteers required, cost, duration of study, and risk to volunteers) varies significantly depending on the proposed mechanism of action (sterilizing/rapid viral clearance vs. delayed viral clearance) of the vaccine under evaluation. We conclude that an HCV CHIM is now realistic, that safety and ethical concerns can be addressed with the right study design, and that, without an HCV CHIM, it is difficult to envisage how the development of an HCV vaccine will be possible.
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Affiliation(s)
- Eleanor Barnes
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, Oxford, UK
| | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, Oxford, UK
| | - Georg M Lauer
- Liver Center, GI Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond T Chung
- Liver Center, GI Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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50
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Oxford JS, Catchpole A, Mann A, Bell A, Noulin N, Gill D, Oxford JR, Gilbert A, Balasingam S. A Brief History of Human Challenge Studies (1900-2021) Emphasising the Virology, Regulatory and Ethical Requirements, Raison D'etre, Ethnography, Selection of Volunteers and Unit Design. Curr Top Microbiol Immunol 2022. [PMID: 35704095 DOI: 10.1007/82_2022_253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Venetian quarantine 400 years ago was an important public health measure. Since 1900 this has been refined to include "challenge" or deliberate infection with pathogens be they viruses, bacteria, or parasites. Our focus is virology and ranges from the early experiments in Cuba with Yellow Fever Virus to the most widespread pathogen of our current times, COVID-19. The latter has so far caused over four million deaths worldwide and 190 million cases of the disease. Quarantine and challenge were also used to investigate the Spanish Influenza of 1918 which caused over 100 million deaths. We consider here the merits of the approach, that is the speeding up of knowledge in a practical sense leading to the more rapid licensing of vaccines and antimicrobials. At the core of quarantine and challenge initiatives is the design of the unit to allow safe confinement of the pathogen and protection of the staff. Most important though is the safety of volunteers. We can see now, as in 1900, that members of our society are prepared and willing to engage in these experiments for the public good. Our ethnology study, where the investigator observed the experiment from within the quarantine, gave us the first indication of changing attitudes amongst volunteers whilst in quarantine. These quarantine experiments, referred to as challenge studies, human infection studies, or "controlled human infection models" involve thousands of clinical samples taken over two to three weeks and can provide a wealth of immunological and molecular data on the infection itself and could allow the discovery of new targets for vaccines and therapeutics. The Yellow Fever studies from 121 years ago gave the impetus for development of a successful vaccine still used today whilst also uncovering the nature of the Yellow Fever agent, namely that it was a virus. We outline how carefully these experiments are approached and the necessity to have high quality units with self-contained air-flow along with extensive personal protective equipment for nursing and medical staff. Most important is the employment of highly trained scientific, medical and nursing staff. We face a future of emerging pathogens driven by the increasing global population, deforestation, climate change, antibiotic resistance and increased global travel. These emerging pathogens may be pathogens we currently are not aware of or have not caused outbreaks historically but could also be mutated forms of known pathogens including viruses such as influenza (H7N9, H5N1 etc.) and coronaviruses. This calls for challenge studies to be part of future pandemic preparedness as an additional tool to assist with the rapid development of broad-spectrum antimicrobials, immunomodulators and new vaccines.
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Affiliation(s)
- J S Oxford
- Blizzard Institute of Cell and Molecular Science, Queen Mary University of London, London, E1 2AT, UK
| | | | | | | | | | - D Gill
- Blizzard Institute of Cell and Molecular Science, Queen Mary University of London, London, E1 2AT, UK
| | - J R Oxford
- Inveresk Medical Practice, Edinburgh, E21 7BP, UK
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