51
|
Plotkin SA. Dengue vaccines: the road to failure or to success? Hum Vaccin Immunother 2020; 16:2677-2679. [DOI: 10.1080/21645515.2020.1733367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Stanley A. Plotkin
- Department of Pediatrics, University of Pennsylvania, Vaxconsult, Doylestown, PA, USA
- Vaxconsult, Doylestown, PA, USA
| |
Collapse
|
52
|
Durbin AP. Historical discourse on the development of the live attenuated tetravalent dengue vaccine candidate TV003/TV005. Curr Opin Virol 2020; 43:79-87. [PMID: 33164790 DOI: 10.1016/j.coviro.2020.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Dengue is the most important arboviral disease world-wide with an estimated 400 million annual infections. Dengvaxia™ is a live attenuated tetravalent vaccine recently licensed for dengue seropositive individuals aged 9-45 years. There is great need for a dengue vaccine that could be given to dengue-naïve individuals and very young children. To that end, the U.S. NIH developed a live attenuated tetravalent dengue vaccine using an iterative approach evaluating the safety, infectivity, and immunogenicity of different candidates. This approach identified poor candidates who were then discarded from further evaluation. Each of the components of the tetravalent vaccine formulation is able to replicate to very low titer, inducing a homotypic immune response to each. The immune response elicited by the tetravalent vaccine is balanced, without immunodominance of one component. The vaccine was licensed by several manufacturers for development, including the Instituto Butantan which initiated a Phase 3 efficacy trial.
Collapse
MESH Headings
- Dengue/history
- Dengue/immunology
- Dengue/prevention & control
- Dengue/virology
- Dengue Vaccines/administration & dosage
- Dengue Vaccines/genetics
- Dengue Vaccines/history
- Dengue Vaccines/immunology
- Dengue Virus/genetics
- Dengue Virus/immunology
- Drug Development/history
- History, 20th Century
- History, 21st Century
- Humans
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/genetics
- Vaccines, Attenuated/history
- Vaccines, Attenuated/immunology
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/genetics
- Vaccines, Combined/history
- Vaccines, Combined/immunology
Collapse
Affiliation(s)
- Anna P Durbin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
| |
Collapse
|
53
|
Chis Ster I, Rodriguez A, Romero NC, Lopez A, Chico M, Montgomery J, Cooper P. Age-dependent seroprevalence of dengue and chikungunya: inference from a cross-sectional analysis in Esmeraldas Province in coastal Ecuador. BMJ Open 2020; 10:e040735. [PMID: 33067302 PMCID: PMC7569951 DOI: 10.1136/bmjopen-2020-040735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES There are few population-based estimates for prevalence of past exposure to dengue and chikungunya viruses despite common epidemiological features. Here, we have developed a novel statistical method to study patterns of age-dependent prevalence of immunity in a population following exposures to two viruses which share similar epidemiological features including mode of transmission and induction of long-lasting immunity. This statistical technique accounted for sociodemographic characteristics associated with individuals and households. SETTINGS The data consist of a representative sample from an ongoing longitudinal birth cohort set-up in a tropical district in coastal Ecuador (Esmeraldas). PARTICIPANTS We collected data and blood samples from 319 individuals belonging to 152 households following epidemics of the infections in 2015 in Latin America. PRIMARY OUTCOME Plasma was tested for the presence of specific IgG antibodies to dengue and chikungunya viruses by commercial ELISA and defined a bivariate binary outcome indicating individuals' past exposure status to dengue and chikungunya (ie, presence/absence of IgG antibodies to dengue or chikungunya or both). RESULTS Dengue seroprevalence increased rapidly with age reaching 97% (95% credible interval (CrI): 93%-99%) by 60 years. Chikungunya seroprevalence peaked at 42% (95% CrI: 18%-66%) around 9 years of age and averaged 27% (95% CrI: 8.7%-51.6%) for all ages. Rural areas were more likely to be associated with dengue-only exposure while urban areas and shorter distance to the nearest household were associated with exposures to both. Women living in urban settings were more likely to be chikungunya seropositive while rural men were more likely to be dengue seropositive. CONCLUSION Dengue seroprevalence was strongly age dependent consistent with endemic exposure while that of chikungunya peaked in childhood consistent with the recent emergence of the virus in the study area. Our findings will inform control strategies for the two arboviruses in Ecuador including recommendations by the WHO on dengue vaccination.
Collapse
Affiliation(s)
- Irina Chis Ster
- Institute of Infection and Immunity, St George's University of London, London, UK
| | | | | | - Andrea Lopez
- International University of Ecuador, Quito, Ecuador
| | - Martha Chico
- International University of Ecuador, Quito, Ecuador
| | | | - Philip Cooper
- Institute of Infection and Immunity, St George's University of London, London, UK
- International University of Ecuador, Quito, Ecuador
| |
Collapse
|
54
|
Walters M, Perkins TA. Hidden heterogeneity and its influence on dengue vaccination impact. Infect Dis Model 2020; 5:783-797. [PMID: 33102984 PMCID: PMC7558830 DOI: 10.1016/j.idm.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022] Open
Abstract
The CYD-TDV vaccine was recently developed to combat dengue, a mosquito-borne viral disease that afflicts millions of people each year throughout the tropical and subtropical world. Its rollout has been complicated by recent findings that vaccinees with no prior exposure to dengue virus (DENV) experience an elevated risk of severe disease in response to their first DENV infection subsequent to vaccination. As a result of these findings, guidelines for use of CYD-TDV now require serological screening prior to vaccination to establish that an individual does not fall into this high-risk category. These complications mean that the public health impact of CYD-TDV vaccination is expected to be higher in areas with higher transmission. One important practical difficulty with tailoring vaccination policy to local transmission contexts is that DENV transmission is spatially heterogeneous, even at the scale of neighborhoods or blocks within a city. This raises the question of whether models based on data that average over spatial heterogeneity in transmission could fail to capture important aspects of CYD-TDV impact in spatially heterogeneous populations. We explored this question with a deterministic model of DENV transmission and CYD-TDV vaccination in a population comprised of two communities with differing transmission intensities. Compared to the full model, a version of the model based on the average of the two communities failed to capture benefits of targeting the intervention to the high-transmission community, which resulted in greater impact in both communities than we observed under even coverage. In addition, the model based on the average of the two communities substantially overestimated impact among vaccinated individuals in the low-transmission community. In the event that the specificity of serological screening is not high, this result suggests that models that ignore spatial heterogeneity could overlook the potential for harm to this segment of the population.
Collapse
Affiliation(s)
- Magdalene Walters
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - T Alex Perkins
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, 46556, USA
| |
Collapse
|
55
|
Immune Response Persistence and Safety of a Booster Dose of the Tetravalent Dengue Vaccine in Adolescents and Adults Who Previously Completed the 3-dose Schedule 4-5 Years Earlier in Latin America: A Randomized Placebo-controlled Trial. Pediatr Infect Dis J 2020; 39:961-968. [PMID: 32932330 DOI: 10.1097/inf.0000000000002830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND We previously described an increased immune response 28 days after a booster dose of the live, attenuated, tetravalent dengue vaccine (CYD-TDV) in healthy adolescents and adults in Latin America (CYD64, NCT02623725). This follow-up study evaluated immune response persistence and safety of a CYD-TDV booster dose up to Month (M) 24 post-booster. METHODS This study included 250 participants who previously received 3 primary doses of CYD-TDV in the CYD13 (NCT00993447) and CYD30 (NCT01187433) studies, and who were randomized 4-5 years later to receive a CYD-TDV booster or placebo (3:1). Dengue neutralizing antibodies against the parental dengue virus strains were assessed using the plaque reduction neutralization test (PRNT50) at M6, M12, and M24 post-booster. Post-booster memory B-cell responses were assessed in a subset of participants using the FluoroSpot assay up to M12 post-booster. RESULTS In the CYD-TDV group (n = 187), dengue neutralizing antibody geometric mean titers (GMTs) declined from the peak at day 28 through to M24 for all serotypes. GMTs at M24 were similar to those at pre-booster among baseline dengue seropositives. A similar trend was observed for baseline dengue seronegatives, albeit at a lower magnitude. Previous vaccination-induced detectable B-cell memory responses in seropositives and seronegatives that decreased to pre-booster levels at M12 post-booster. The CYD-TDV booster dose was well-tolerated. CONCLUSIONS In baseline dengue seropositives, following a CYD-TDV booster dose administered 4-5 years after primary immunization, dengue neutralizing antibody GMTs and B-cell memory responses peaked in the short-term before gradually decreasing over time. A CYD-TDV booster dose could improve protection against dengue during outbreak periods.
Collapse
|
56
|
Cattarino L, Rodriguez-Barraquer I, Imai N, Cummings DAT, Ferguson NM. Mapping global variation in dengue transmission intensity. Sci Transl Med 2020; 12:12/528/eaax4144. [PMID: 31996463 DOI: 10.1126/scitranslmed.aax4144] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/12/2019] [Accepted: 01/02/2020] [Indexed: 12/28/2022]
Abstract
Intervention planning for dengue requires reliable estimates of dengue transmission intensity. However, current maps of dengue risk provide estimates of disease burden or the boundaries of endemicity rather than transmission intensity. We therefore developed a global high-resolution map of dengue transmission intensity by fitting environmentally driven geospatial models to geolocated force of infection estimates derived from cross-sectional serological surveys and routine case surveillance data. We assessed the impact of interventions on dengue transmission and disease using Wolbachia-infected mosquitoes and the Sanofi-Pasteur vaccine as specific examples. We predicted high transmission intensity in all continents straddling the tropics, with hot spots in South America (Colombia, Venezuela, and Brazil), Africa (western and central African countries), and Southeast Asia (Thailand, Indonesia, and the Philippines). We estimated that 105 [95% confidence interval (CI), 95 to 114] million dengue infections occur each year with 51 (95% CI, 32 to 66) million febrile disease cases. Our analysis suggests that transmission-blocking interventions such as Wolbachia, even at intermediate efficacy (50% transmission reduction), might reduce global annual disease incidence by up to 90%. The Sanofi-Pasteur vaccine, targeting only seropositive recipients, might reduce global annual disease incidence by 20 to 30%, with the greatest impact in high-transmission settings. The transmission intensity map presented here, and made available for download, may help further assessment of the impact of dengue control interventions and prioritization of global public health efforts.
Collapse
Affiliation(s)
- Lorenzo Cattarino
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
| | | | - Natsuko Imai
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Derek A T Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, P. O. Box 100009, Gainesville, FL 32610, USA
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| |
Collapse
|
57
|
Wilder-Smith A. Dengue vaccine development by the year 2020: challenges and prospects. Curr Opin Virol 2020; 43:71-78. [PMID: 33086187 PMCID: PMC7568693 DOI: 10.1016/j.coviro.2020.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/29/2022]
Abstract
The first licensed dengue vaccine led to considerable controversy, and to date, no dengue vaccine is in widespread use. All three leading dengue vaccine candidates are live attenuated vaccines, with the main difference between them being the type of backbone and the extent of chimerization. While CYD-TDV (the first licensed dengue vaccine) does not include non-structural proteins of dengue, TAK-003 contains the dengue virus serotype 2 backbone, and the Butantan/Merck vaccine contains three full-genomes of the four dengue virus serotypes. While dengue-primed individuals can already benefit from vaccination against all four serotypes with the first licensed dengue vaccine CYD-TDV, the need for dengue-naive population has not yet been met. To improve tetravalent protection, sequential vaccination should be considered in addition to a heterologous prime-boost approach.
Collapse
Affiliation(s)
- Annelies Wilder-Smith
- London School of Hygiene and Tropical Medicine, UK; Heidelberg Institute of Global Health, University of Heidelberg, Germany.
| |
Collapse
|
58
|
Jamrozik E, Selgelid MJ. COVID-19 human challenge studies: ethical issues. THE LANCET. INFECTIOUS DISEASES 2020; 20:e198-e203. [PMID: 32479747 PMCID: PMC7259898 DOI: 10.1016/s1473-3099(20)30438-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
Abstract
COVID-19 poses an extraordinary threat to global public health and an effective vaccine could provide a key means of overcoming this crisis. Human challenge studies involve the intentional infection of research participants and can accelerate or improve vaccine development by rapidly providing estimates of vaccine safety and efficacy. Human challenge studies of low virulence coronaviruses have been done in the past and human challenge studies with severe acute respiratory syndrome coronavirus 2 have been proposed. These studies of coronaviruses could provide considerable benefits to public health; for instance, by improving and accelerating vaccine development. However, human challenge studies of severe acute respiratory syndrome coronavirus 2 in particular might be controversial, in part, for ethical reasons. The ethical issues raised by such studies thus warrant early consideration involving, for example, broad consultation with the community. This Personal View provides preliminary analyses of relevant ethical considerations regarding human challenge studies of severe acute respiratory syndrome coronavirus 2, including the potential benefits to public health and to participants, the risks and uncertainty for participants, and the third-party risks (ie, to research staff and the wider community). We argue that these human challenge studies can reasonably be considered ethically acceptable insofar as such studies are accepted internationally and by the communities in which they are done, can realistically be expected to accelerate or improve vaccine development, have considerable potential to directly benefit participants, are designed to limit and minimise risks to participants, and are done with strict infection control measures to limit and reduce third-party risks.
Collapse
Affiliation(s)
- Euzebiusz Jamrozik
- Monash Bioethics Centre and WHO Collaborating Centre for Bioethics, Monash University, Melbourne, VIC, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
| | - Michael J Selgelid
- Monash Bioethics Centre and WHO Collaborating Centre for Bioethics, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
59
|
Halstead SB, Katzelnick LC, Russell PK, Markoff L, Aguiar M, Dans LR, Dans AL. Ethics of a partially effective dengue vaccine: Lessons from the Philippines. Vaccine 2020; 38:5572-5576. [PMID: 32654899 PMCID: PMC7347470 DOI: 10.1016/j.vaccine.2020.06.079] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
Dengvaxia, a chimeric yellow fever tetravalent dengue vaccine developed by SanofiPasteur is widely licensed in dengue-endemic countries. In a large cohort study Dengvaxia was found to partially protect children who had prior dengue virus (DENV) infections but sensitized seronegative children to breakthrough DENV disease of enhanced severity. In 2019, the European Medicines Agency and the US FDA issued licenses that reconciled safety issues by restricting vaccine to individuals with prior dengue infections. Using revised Dengvaxia efficacy and safety data we sought to estimate hospitalized and severe dengue cases among the more than 800,000 9 year-old children vaccinated in the Philippines. Despite an overall vaccine efficacy of 69% during 4 years post-vaccination we project there will be more than one thousand vaccinated seronegative and seropositive children hospitalized for severe dengue. Assisting these children through a program of enhanced surveillance leading to improved care deserves widespread support. Clinical responses observed during breakthrough dengue infections in vaccinated individuals counsel prudence in design of vaccine policies. Recommendations concerning continued use of this dengue vaccine are: (1) obtain a better definition of vaccine efficacy and safety through enhanced phase 4 surveillance, (2) obtain a valid, accessible, sensitive, specific and affordable serological test that identifies past wild-type dengue virus infection and (3) clarify safety and efficacy of Dengvaxia in flavivirus immunes. In the absence of an acceptable serological screening test these unresolved ethical issues suggest Dengvaxia be given only to those signing informed consent.
Collapse
Affiliation(s)
- Scott B Halstead
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, United States.
| | - Leah C Katzelnick
- Research Associate, Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; Department of Biology, University of Florida, Gainesville, FL 32611, United States
| | - Philip K Russell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Lewis Markoff
- Consultant, 6908 Nevis Road, Bethesda MD 20817, United States
| | - Maira Aguiar
- Dipartimento di Matematica, Università degli Studi di Trento, Via Sommarive 14, 38123 Povo Trento, Italy; Basque Center for Applied Mathematics (BCAM), Alameda Mazarredo, 14, 48009 Bilbao, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Leonila R Dans
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila, 547 Pedro Gil Street, Ermita, Manila 1000, Philippines
| | - Antonio L Dans
- Department of Medicine, College of Medicine, University of the Philippines, Manila 547 Pedro Gil Streeet, Ermita, Manila 1000, Philippines
| |
Collapse
|
60
|
Coates SJ, Norton SA. The effects of climate change on infectious diseases with cutaneous manifestations. Int J Womens Dermatol 2020; 7:8-16. [PMID: 32838014 PMCID: PMC7373693 DOI: 10.1016/j.ijwd.2020.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background Anthropogenic climate change affects the burden of infectious diseases via several interconnected mechanisms. In recent years, there has been greater awareness of the ways in which climate-sensitive infectious diseases pose a growing threat to global public health. Objective This study aimed to categorize and describe the effects of climate change on infectious diseases with skin manifestations. Methods A scoping review of the MEDLINE and PubMed online databases for climate-sensitive infections was performed in February and March 2020. A representative selection of conditions with skin manifestations was included in this review. Results Several representative climate-sensitive infectious diseases were identified in each of the following categories: vector-borne infectious diseases, infectious diseases associated with extreme weather events, and infectious diseases linked to human migration. Conclusion Climate variables directly influence the survival and reproduction of infectious microorganisms, their vectors, and their animal reservoirs. Due to sustained warmer temperatures at higher latitudes, climate change has expanded the geographic range of certain pathogenic microbes. More frequent climate change-related extreme weather events create circumstances where existing infectious microorganisms flourish and novel infections emerge. Climate instability is linked to increased human migration, which disrupts health care infrastructure as well as the habitats of microbes, vectors, and animal reservoirs and leads to widespread poverty and overcrowding. Dermatologists should understand that climate change will affect the burden and geographic distribution of infectious diseases, many of which have cutaneous signs and might be encountered in their regular practice.
Collapse
Affiliation(s)
- Sarah J Coates
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Scott A Norton
- Dermatology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States
| |
Collapse
|
61
|
Zhang M, Sun J, Li M, Jin X. Modified mRNA-LNP Vaccines Confer Protection against Experimental DENV-2 Infection in Mice. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 18:702-712. [PMID: 32913878 PMCID: PMC7452130 DOI: 10.1016/j.omtm.2020.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
Dengue virus (DENV) infection is a major global public health concern, and there is no effective vaccine for it. In this study, we describe the design and characterization of three nucleotide-modified mRNA vaccines (prME-mRNA, E80-mRNA, and NS1-mRNA) for DENV-2. Our results showed that vaccination with E80-mRNA alone or a combination of E80-mRNA and NS1-mRNA can induce high levels of neutralizing antibodies and antigen-specific T cell responses; furthermore, these vaccines confer complete protection against DENV-2 challenge in immunocompetent mice. These data provide foundations for further development of a tetravalent DENV vaccine based on nucleotide-modified mRNA.
Collapse
Affiliation(s)
- Mengling Zhang
- Viral Disease and Vaccine Translational Research Unit, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China.,University of Chinese Academy of Sciences, Beijing, China.,Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jin Sun
- Viral Disease and Vaccine Translational Research Unit, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Min Li
- Viral Disease and Vaccine Translational Research Unit, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Xia Jin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| |
Collapse
|
62
|
Risk factors and biomarkers of severe dengue. Curr Opin Virol 2020; 43:1-8. [PMID: 32688269 DOI: 10.1016/j.coviro.2020.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
Dengue virus infects several million people each year. Although usually a self-limiting disease, some patients can develop life-threatening severe complications, characterized by plasma leakage, hemorrhaging, and shock. The signs and symptoms of severe disease usually arise late in the disease course when patients are recovering and fever has subsided, making it difficult to predict. Efforts are underway to identify risk factors and biomarkers that can accurately predict disease severity in the acute febrile phase of the disease, facilitating early intervention and treatment strategies for those at greatest risk. In this review we discuss recent advancements in identifying risk factors and biomarkers for the prognosis of severe dengue.
Collapse
|
63
|
Fischer C, de Oliveira-Filho EF, Drexler JF. Viral emergence and immune interplay in flavivirus vaccines. THE LANCET. INFECTIOUS DISEASES 2020; 20:15-17. [PMID: 31876486 DOI: 10.1016/s1473-3099(19)30697-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Carlo Fischer
- Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Virology, Berlin, Germany
| | - Edmilson F de Oliveira-Filho
- Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Virology, Berlin, Germany
| | - Jan Felix Drexler
- Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Virology, Berlin, Germany; German Centre for Infection Research (DZIF), Helmut-Ruska-Haus, Institute of Virology, Campus Charité Mitte, Berlin, Germany.
| |
Collapse
|
64
|
Kallas EG, Precioso AR, Palacios R, Thomé B, Braga PE, Vanni T, Campos LMA, Ferrari L, Mondini G, da Graça Salomão M, da Silva A, Espinola HM, do Prado Santos J, Santos CLS, Timenetsky MDCST, Miraglia JL, Gallina NMF, Weiskopf D, Sette A, Goulart R, Salles RT, Maestri A, Sallum AME, Farhat SCL, Sakita NK, Ferreira JCOA, Silveira CGT, Costa PR, Raw I, Whitehead SS, Durbin AP, Kalil J. Safety and immunogenicity of the tetravalent, live-attenuated dengue vaccine Butantan-DV in adults in Brazil: a two-step, double-blind, randomised placebo-controlled phase 2 trial. THE LANCET. INFECTIOUS DISEASES 2020; 20:839-850. [PMID: 32220283 DOI: 10.1016/s1473-3099(20)30023-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/17/2019] [Accepted: 01/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Butantan Institute has manufactured a lyophilised tetravalent live-attenuated dengue vaccine Butantan-DV, which is analogous to the US National Institutes of Health (NIH) TV003 admixture. We aimed to assess the safety and immunogenicity of Butantan-DV. METHODS We did a two-step, double-blind, randomised placebo-controlled phase 2 trial at two clinical sites in São Paulo, Brazil. We recruited healthy volunteers aged 18-59 years; pregnant women, individuals with a history of neurological, heart, lung, liver or kidney disease, diabetes, cancer, or autoimmune diseases, and individuals with HIV or hepatitis C were excluded. Step A was designed as a small bridge-study between Butantan-DV and TV003 in DENV-naive participants. In step A, we planned to randomly assign 50 dengue virus (DENV)-naive individuals to receive two doses of Butantan-DV, TV003, or placebo, given 6 months apart. In step B, we planned to randomly assign 250 participants (DENV-naive and DENV-exposed) to receive one dose of Butantan-DV or placebo. Participants were randomly assigned, by computer-generated block randomisation (block sizes of five); participants in step A were randomly assigned (2:2:1) to receive Butantan-DV, TV003, or placebo and participants in step B were randomly assigned (4:1) to receive Butantan-DV or placebo. Participants and study staff were unaware of treatment allocation. The primary safety outcome was the frequency of solicited and unsolicited local and systemic adverse reactions within 21 days of the first vaccination, analysed by intention to treat. The primary immunogenicity outcome was seroconversion rates of the DENV-1-4 serotypes measured 91 days after the first vaccination, analysed in the per-protocol population, which included all participants in step A, and all participants included in step B who completed all study visits with serology sample collection. This trial is registered with ClinicalTrials.gov, NCT01696422. FINDINGS Between Nov 5, 2013, and Sept 21, 2015, 300 individuals were enrolled and randomly assigned: 155 (52%) DENV-naive participants and 145 (48%) DENV-exposed participants. Of the 155 DENV-naive participants, 97 (63%) received Butantan-DV, 17 (11%) received TV003, and 41 (27%) received placebo. Of the 145 DENV-exposed participants, 113 (78%) received Butantan-DV, three (2%) received TV003, and 29 (20%) received placebo. Butantan-DV and TV003 were both immunogenic, well-tolerated, and no serious adverse reactions were observed. In step A, rash was the most frequent adverse event (16 [845] of 19 participants in the Butantan-DV group and 13 [76%] of 17 participants in the TV003 group). Viraemia was similar between the Butantan-DV and TV003 groups. Of the 85 DENV-naive participants in the Butantan-DV group who attended all visits for sample collection for seroconversion analysis and thus were included in the per-protocol analysis population, 74 (87%) achieved seroconversion to DENV-1, 78 (92%) to DENV-2, 65 (76%) to DENV-3, and 76 (89%) to DENV-4. Of the 101 DENV-exposed participants in the Butantan-DV group who attended all visits for sample collection for seroconversion analysis, 82 (81%) achieved seroconversion to DENV-1, 79 (78%) to DENV-2, 83 (82%) to DENV-3, and 78 (77%) to DENV-4. INTERPRETATION Butantan-DV and TV003 were safe and induced robust, balanced neutralising antibody responses against the four DENV serotypes. Efficacy evaluation of the Butantan-DV vaccine is ongoing. FUNDING Intramural Research Program US NIH National Institute of Allergy and Infectious Diseases, Brazilian National Bank for Economic and Social Development, Fundação de Amparo à Pesquisa do Estado de São Paulo, and Fundação Butantan.
Collapse
Affiliation(s)
- Esper G Kallas
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alexander Roberto Precioso
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil; Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil.
| | - Ricardo Palacios
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Beatriz Thomé
- Preventive Medicine Department, Federal University of São Paulo, São Paulo, Brazil
| | - Patrícia Emília Braga
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Tazio Vanni
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Lúcia M A Campos
- Department of Pediatrics, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lilian Ferrari
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Gabriella Mondini
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Maria da Graça Salomão
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Anderson da Silva
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Heloisa M Espinola
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Joane do Prado Santos
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | | | | | - João Luiz Miraglia
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Neuza M F Gallina
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Daniela Weiskopf
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, San Diego, CA, USA
| | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology, San Diego, CA, USA
| | - Raphaella Goulart
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rafael Tavares Salles
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alvino Maestri
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Neusa K Sakita
- Department of Pediatrics, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Juliana C O A Ferreira
- Department of Pediatrics, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Cassia G T Silveira
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Priscilla R Costa
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Isaias Raw
- Division of Clinical Trials and Pharmacovigilance, Instituto Butantan, São Paulo, Brazil
| | - Stephen S Whitehead
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Anna P Durbin
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jorge Kalil
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
65
|
Pinheiro-Michelsen JR, Souza RDSO, Santana IVR, da Silva PDS, Mendez EC, Luiz WB, Amorim JH. Anti-dengue Vaccines: From Development to Clinical Trials. Front Immunol 2020; 11:1252. [PMID: 32655561 PMCID: PMC7325986 DOI: 10.3389/fimmu.2020.01252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022] Open
Abstract
Dengue Virus (DENV) is an arbovirus (arthropod-borne virus). Four serotypes of DENV are responsible for the infectious disease called dengue that annually affects nearly 400 million people worldwide. Although there is only one vaccine formulation licensed for use in humans, there are other vaccine formulations under development that apply different strategies. In this review, we present information about anti-dengue vaccine formulations regarding development, pre-clinical tests, and clinical trials. The improvement in vaccine development against dengue is much needed, but it should be considered that the correlate of protection is still uncertain. Neutralizing antibodies have been proposed as a correlate of protection, but this ignores the key role of T-cell mediated immunity in controlling DENV infection. It is important to confirm the accurate correlate of protection against DENV infection, and also to have other anti-dengue vaccine formulations licensed for use.
Collapse
Affiliation(s)
- Josilene Ramos Pinheiro-Michelsen
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Rayane da Silva Oliveira Souza
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
| | - Itana Vivian Rocha Santana
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
| | - Patrícia de Souza da Silva
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Erick Carvalho Mendez
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Wilson Barros Luiz
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Jaime Henrique Amorim
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| |
Collapse
|
66
|
Wilken L, Rimmelzwaan GF. Adaptive Immunity to Dengue Virus: Slippery Slope or Solid Ground for Rational Vaccine Design? Pathogens 2020; 9:pathogens9060470. [PMID: 32549226 PMCID: PMC7350362 DOI: 10.3390/pathogens9060470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022] Open
Abstract
The four serotypes of dengue virus are the most widespread causes of arboviral disease, currently placing half of the human population at risk of infection. Pre-existing immunity to one dengue virus serotype can predispose to severe disease following secondary infection with a different serotype. The phenomenon of immune enhancement has complicated vaccine development and likely explains the poor long-term safety profile of a recently licenced dengue vaccine. Therefore, alternative vaccine strategies should be considered. This review summarises studies dissecting the adaptive immune responses to dengue virus infection and (experimental) vaccination. In particular, we discuss the roles of (i) neutralising antibodies, (ii) antibodies to non-structural protein 1, and (iii) T cells in protection and pathogenesis. We also address how these findings could translate into next-generation vaccine approaches that mitigate the risk of enhanced dengue disease. Finally, we argue that the development of a safe and efficacious dengue vaccine is an attainable goal.
Collapse
|
67
|
Tenth Scientific Biennial Meeting of the Australasian Virology Society-AVS10 2019. Viruses 2020; 12:v12060621. [PMID: 32517260 PMCID: PMC7354434 DOI: 10.3390/v12060621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
The Australasian Virology Society (AVS) aims to promote, support and advocate for the discipline of virology in the Australasian region. The society was incorporated in 2011 after 10 years operating as the Australian Virology Group (AVG) founded in 2001, coinciding with the inaugural biennial scientific meeting. AVS conferences aim to provide a forum for the dissemination of all aspects of virology, foster collaboration, and encourage participation by students and post-doctoral researchers. The tenth Australasian Virology Society (AVS10) scientific meeting was held on 2–5 December 2019 in Queenstown, New Zealand. This report highlights the latest research presented at the meeting, which included cutting-edge virology presented by our international plenary speakers Ana Fernandez-Sesma and Benjamin tenOever, and keynote Richard Kuhn. AVS10 honoured female pioneers in Australian virology, Lorena Brown and Barbara Coulson. We report outcomes from the AVS10 career development session on “Successfully transitioning from post-doc to lab head”, winners of best presentation awards, and the AVS gender equity policy, initiated in 2013. Plans for the 2021 meeting are underway which will celebrate the 20th anniversary of AVS where it all began, in Fraser Island, Queensland, Australia.
Collapse
|
68
|
Bosch I, Reddy A, de Puig H, Ludert JE, Perdomo-Celis F, Narváez CF, Versiani A, Fandos D, Nogueira ML, Singla M, Lodha R, Medigeshi GR, Lorenzana I, Ralde HV, Gélvez-Ramírez M, Villar LA, Hiley M, Mendoza L, Salcedo N, Herrera BB, Gehrke L. Serotype-specific detection of dengue viruses in a nonstructural protein 1-based enzyme-linked immunosorbent assay validated with a multi-national cohort. PLoS Negl Trop Dis 2020; 14:e0008203. [PMID: 32579555 PMCID: PMC7351204 DOI: 10.1371/journal.pntd.0008203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 07/10/2020] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dengue virus (DENV) infections pose one of the largest global barriers to human health. The four serotypes (DENV 1-4) present different symptoms and influence immune response to subsequent DENV infections, rendering surveillance, risk assessments, and disease control particularly challenging. Early diagnosis and appropriate clinical management is critical and can be achieved by detecting DENV nonstructural protein 1 (NS1) in serum during the acute phase. However, few NS1-based tests have been developed that are capable of differentiating DENV serotypes and none are currently commercially available. METHODOLOGY/PRINCIPLE FINDINGS We developed an enzyme-linked immunosorbent assay (ELISA) to distinguish DENV-1-4 NS1 using serotype-specific pairs of monoclonal antibodies. A total of 1,046 antibodies were harvested from DENV-immunized mice and screened for antigen binding affinity. ELISA clinical performance was evaluated using 408 polymerase chain reaction-confirmed dengue samples obtained from patients in Brazil, Honduras, and India. The overall sensitivity of the test for pan-DENV was 79.66% (325/408), and the sensitivities for DENV-1-4 serotyping were 79.1% (38/48), 80.41% (78/97), 100% (45/45), and 79.6% (98/123), respectively. Specificity reached 94.07-100%. SIGNIFICANCE Our study demonstrates a robust antibody screening strategy that enabled the development of a serotype NS1-based ELISA with maximized specific and sensitive antigen binding. This sensitive and specific assay also utilized the most expansive cohort to date, and of which about half are from Latin America, a geographic region severely underrepresented in previous similar studies. This ELISA test offers potential enhanced diagnostics during the acute phase of infection to help guide patient care and disease control. These results indicate that this ELISA is a promising aid in early DENV-1-4 diagnosis and surveillance in regions of endemicity in addition to offer convenient monitoring for future vaccine interventions.
Collapse
Affiliation(s)
- Irene Bosch
- E25Bio, Cambridge, Massachusetts, United States of America
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Ankita Reddy
- E25Bio, Cambridge, Massachusetts, United States of America
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Helena de Puig
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Wyss Institute for Biologically Inspired Engineering, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Juan E. Ludert
- Departamento de Infectómica y Patogénesis Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | | | - Carlos F. Narváez
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Colombia
| | - Alice Versiani
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina de São José do Rio Preto, SP, Brazil
| | - Diana Fandos
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Institut Químic de Sarrià, Universitat Ramon Llull, Barcelona, Spain
| | - Mauricio L. Nogueira
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
| | - Mohit Singla
- Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rakesh Lodha
- Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | | | - Ivette Lorenzana
- Instituto de Investigación en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Hugo Vicente Ralde
- Facultad de Medicina, Universidad Autónoma de Guadalajara, Guadalajara, Mexico
| | | | - Luis A. Villar
- Universidad Industrial de Santander and AEDES Network, Bucaramanga, Santander, Colombia
| | - Megan Hiley
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Laura Mendoza
- E25Bio, Cambridge, Massachusetts, United States of America
| | - Nol Salcedo
- E25Bio, Cambridge, Massachusetts, United States of America
| | - Bobby Brooke Herrera
- E25Bio, Cambridge, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lee Gehrke
- E25Bio, Cambridge, Massachusetts, United States of America
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
69
|
Elenga N, Nacher M, Trehan I. The Imperative of Dengue Vaccination for Children with Sickle Cell Disease. J Trop Pediatr 2020; 66:245-247. [PMID: 32357242 DOI: 10.1093/tropej/fmaa021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Narcisse Elenga
- Department of Pediatrics, Service de Médecine et Chirurgie Pédiatrique, Centre Hospitalier de Cayenne, Centre de Référence de la Drépanocytose aux Antilles-Guyane, BP 6006- 97306 Cayenne Cedex, French Guiana
| | - Mathieu Nacher
- Department of Epidemiology and Public Health, Centre d'Investigation Clinique Antilles-Guyane, Inserm CIC 1424, Centre Hospitalier de Cayenne, BP 6006-97306 Cayenne Cedex, French Guiana
| | - Indi Trehan
- Departments of Pediatrics and Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
70
|
Cannalire R, Ki Chan KW, Burali MS, Gwee CP, Wang S, Astolfi A, Massari S, Sabatini S, Tabarrini O, Mastrangelo E, Barreca ML, Cecchetti V, Vasudevan SG, Manfroni G. Pyridobenzothiazolones Exert Potent Anti-Dengue Activity by Hampering Multiple Functions of NS5 Polymerase. ACS Med Chem Lett 2020; 11:773-782. [PMID: 32435384 DOI: 10.1021/acsmedchemlett.9b00619] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/19/2020] [Indexed: 01/23/2023] Open
Abstract
Treatment of dengue virus (DENV) and other flavivirus infections is an unmet medical need. The highly conserved flaviviral NS5 RNA-dependent RNA polymerase (RdRp) is an attractive antiviral target that interacts with NS3 and viral RNA within the replication complex assembly. Biochemical and cell-based evidence indicate that targeting cavity B may lead to dual RdRp and NS5-NS3 interaction inhibitors. By ligand-based design around 1H-pyrido[2,1-b][1,3]benzothiazol-1-one (PBTZ) 1, we identified new potent and selective DENV inhibitors that exert dual inhibition of NS5 RdRp and NS3-NS5 interaction, likely through binding cavity B. Resistance studies with compound 4 generated sequence variants in the 3'-untranslated region of RNA while further biochemical experiments demonstrated its ability to block also RNA-NS5 interaction, required for correct RNA synthesis in cells. These findings shed light on the potential mechanism of action for this class of compounds, underlying how PBTZs are very promising lead candidates for further evaluation.
Collapse
Affiliation(s)
- Rolando Cannalire
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| | - Kitti Wing Ki Chan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore 169857
| | - Maria Sole Burali
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| | - Chin Piaw Gwee
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore 169857
| | - Sai Wang
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore 169857
| | - Andrea Astolfi
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| | - Serena Massari
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| | - Stefano Sabatini
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| | - Oriana Tabarrini
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| | - Eloise Mastrangelo
- Dipartimento di Bioscienze, Università di Milano, Via Celoria 26, I-20133 Milano, Italy
- CNR-IBF, Consiglio Nazionale delle Ricerche, Istituto di Biofisica, Via Celoria 26, I-20133 Milano, Italy
| | - Maria Letizia Barreca
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| | - Violetta Cecchetti
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| | - Subhash G. Vasudevan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8 College Road, Singapore 169857
- Department of Microbiology and Immunology, National University of Singapore, 5 Science Drive 2, Singapore 117545
- Institute for Glycomics, Griffith University, Gold Coast Campus, Queensland 4022, Australia
| | - Giuseppe Manfroni
- Dipartimento di Scienze Farmaceutiche, Università degli Studi di Perugia, Via del Liceo, 1-06123 Perugia, Italy
| |
Collapse
|
71
|
Plotkin SA. Dengue Vaccine, A Double-Edged Sword. J Pediatric Infect Dis Soc 2020; 9:107-109. [PMID: 30657941 DOI: 10.1093/jpids/piy140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Stanley A Plotkin
- Emeritus Professor of Pediatrics, University of Pennsylvania, Vaxconsult, Doylestown, Pennsylvania
| |
Collapse
|
72
|
Gore MM. Vaccines Against Dengue and West Nile Viruses in India: The Need of the Hour. Viral Immunol 2020; 33:423-433. [PMID: 32320353 DOI: 10.1089/vim.2019.0122] [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: 11/12/2022] Open
Abstract
The circulation of flaviviruses, dengue (DEN), Japanese encephalitis (JE) and West Nile (WN) viruses, and others, is generating a major concern in many countries. Both JE along with DEN have been endemic in large regions of India. WN virus infection, although circulating in southern regions for many years, in recent years, WN encephalitis patients have been demonstrated. While vaccines against JE have been developed and decrease outbreaks, in case of DEN and WN, vaccines are still in developing level, especially, it has been difficult to achieve the long-term protective immune response. The first licensed DEN vaccine, which is a live attenuated vaccine, was administered in countries where the virus is endemic, and has a potential to cause serious side effects, especially when administered to younger population as observed in the Philippines vaccination drive. In the case of WN, although the purified inactivated virion-based vaccine worked effectively as a veterinary vaccine for horses, no effective vaccine has yet been licensed for humans. The induction of CD4+ and CD8+ T cell responses is essential to complete protection by these viruses, as evidenced by responses to asymptomatic infections. Many studies have shown that neutralizing antibody (NAb) response is against surface structural proteins; CD4+ and CD8+ responses are mainly directed against nonstructural proteins rather than NAb response. New data suggest that encapsulating virus vaccines in nanoparticles (NPs) will direct antigen in cytoplasmic compartment by antigen-presenting cells, which will improve presentation to CD4+ and CD8+ T cells. Since tissue culture-derived, purified inactivated viruses are easier to manufacture and safer than developing live virus vaccines, inclusion of NP provides an attractive alternative for generating robust flaviviral vaccines that are affordable with long-lived protection.
Collapse
Affiliation(s)
- Milind M Gore
- Emeritus Scientist, ICMR-National Institute of Virology, Pune, India
| |
Collapse
|
73
|
Rajarethinam J, Ong J, Neo ZW, Ng LC, Aik J. Distribution and seasonal fluctuations of Ae. aegypti and Ae. albopictus larval and pupae in residential areas in an urban landscape. PLoS Negl Trop Dis 2020; 14:e0008209. [PMID: 32310960 PMCID: PMC7192508 DOI: 10.1371/journal.pntd.0008209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/30/2020] [Accepted: 03/11/2020] [Indexed: 01/21/2023] Open
Abstract
Dengue, a vector-borne disease spread by Aedes mosquitoes, is a global threat. In the absence of an efficacious dengue vaccine, vector control is the key intervention tool in Singapore. A good understanding of vector habitats is essential to formulate operational strategies. We examined the distribution, long-term trend and seasonality of Aedes data collected during regulatory inspections in residences and public areas from 2008 to 2017. We also studied the seasonality of climate factors to understand their influence on the detection of Aedes-positive containers. The most frequently reported Aedes-positive containers were domestic containers, drains, discarded receptacles, ornamental containers, flower pot plates/trays, plants, gully traps, canvas/plastic sheet, bins, ground puddle, inspection chambers and roof tops/gutters. We found more Ae. aegypti and Ae. albopictus-positive containers per inspection in residences and public areas, respectively. The seasonality of Ae. aegypti-positive containers in residences and public areas coincided with that of mean temperature. However, the seasonality of Ae. albopictus-positive containers lagged by one month compared to that of mean temperature. Our study demonstrates the seasonal fluctuations of Aedes-positive containers in an urban environment. Understanding the distribution and seasonality of Aedes breeding helps to facilitate resource planning and community awareness to moderate dengue transmission.
Collapse
Affiliation(s)
| | - Janet Ong
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Zhi-Wei Neo
- Environmental Public Health Operations, National Environment Agency, Singapore, Singapore
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore
- * E-mail:
| | - Joel Aik
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Level 3, Samuels Building, Botany Road, Keningston, New South Wales, Australia
| |
Collapse
|
74
|
Secondary Analysis of the Efficacy and Safety Trial Data of the Tetravalent Dengue Vaccine in Children and Adolescents in Colombia. Pediatr Infect Dis J 2020; 39:e30-e36. [PMID: 32040014 PMCID: PMC7182239 DOI: 10.1097/inf.0000000000002580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The efficacy of the recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV) against virologically-confirmed dengue (VCD) has been documented in a phase 3 trial in Latin America (CYD15, NCT01374516). This is a descriptive secondary analysis of the efficacy and safety of CYD-TDV in participants from Colombia. METHODS Data from 9740 Colombian participants 9-16 years of age who were randomized 2:1 to receive CYD-TDV or placebo were assessed to describe the vaccine efficacy of CYD-TDV against VCD and severe VCD. Estimation was made of the relative risk (RR) for hospitalized VCD cases and severe hospitalized VCD cases after the first dose of CYD-TDV, as well as a description of the incidence of hospitalized dengue from the start of the study and per year of the study until study completion. RESULTS During the active phase of the trial in Colombia, the efficacy of CYD-TDV was 67.5% [95% confidence interval (CI): 58.3-74.7] against symptomatic VCD due to any serotype from injection 1 (month 0) to 25 months postinjection 1. Over 6 years, the RR across all 4 serotypes was 0.166 (95% CI: 0.09-0.29) in hospitalized VCD patients and 0.154 (95% CI: 0.04-0.50) in patients with severe hospitalized VCD. CONCLUSIONS Analysis of the data from Colombia mimics the efficacy observed in CYD15 during the active surveillance follow-up (25 months), but with a sustained beneficial RR for dengue hospitalizations on the subsequent years of follow-up. In Colombia, where seroprevalence has been demonstrated to be high in several regions of the country, CYD-TDV is a useful tool to consider as part of an integrated control strategy against endemic dengue, a disease with a high economic impact on the health system.
Collapse
|
75
|
Zhou Y, Chen D, Yang L, Zou W, Duan Z, Zhang Y, Wen J. Dengue virus envelope protein domain III-elicited antibodies mediate cross-protection against Zika virus in a mouse model. Virus Res 2020; 278:197882. [DOI: 10.1016/j.virusres.2020.197882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 01/01/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
|
76
|
|
77
|
Hladish TJ, Pearson CAB, Toh KB, Rojas DP, Manrique-Saide P, Vazquez-Prokopec GM, Halloran ME, Longini IM. Designing effective control of dengue with combined interventions. Proc Natl Acad Sci U S A 2020; 117:3319-3325. [PMID: 31974303 PMCID: PMC7022216 DOI: 10.1073/pnas.1903496117] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Viruses transmitted by Aedes mosquitoes, such as dengue, Zika, and chikungunya, have expanding ranges and seem unabated by current vector control programs. Effective control of these pathogens likely requires integrated approaches. We evaluated dengue management options in an endemic setting that combine novel vector control and vaccination using an agent-based model for Yucatán, Mexico, fit to 37 y of data. Our intervention models are informed by targeted indoor residual spraying (TIRS) experiments; trial outcomes and World Health Organization (WHO) testing guidance for the only licensed dengue vaccine, CYD-TDV; and preliminary results for in-development vaccines. We evaluated several implementation options, including varying coverage levels; staggered introductions; and a one-time, large-scale vaccination campaign. We found that CYD-TDV and TIRS interfere: while the combination outperforms either alone, performance is lower than estimated from their separate benefits. The conventional model hypothesized for in-development vaccines, however, performs synergistically with TIRS, amplifying effectiveness well beyond their independent impacts. If the preliminary performance by either of the in-development vaccines is upheld, a one-time, large-scale campaign followed by routine vaccination alongside aggressive new vector control could enable short-term elimination, with nearly all cases avoided for a decade despite continuous dengue reintroductions. If elimination is impracticable due to resource limitations, less ambitious implementations of this combination still produce amplified, longer-lasting effectiveness over single-approach interventions.
Collapse
Affiliation(s)
- Thomas J Hladish
- Department of Biology, University of Florida, Gainesville, FL 32611;
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611
| | - Carl A B Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa 7600
| | - Kok Ben Toh
- School of Natural Resources and Environment, University of Florida, Gainesville, FL 32611
| | - Diana Patricia Rojas
- Department of Biostatistics, University of Florida, Gainesville, FL 32611
- Division of Public Health and Tropical Medicine, James Cook University, Townsville QLD 4814, Australia
| | - Pablo Manrique-Saide
- Collaborative Unit for Entomological Bioassays, Universidad Autónoma de Yucatán, Mérida, Mexico 9700
| | | | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA 98109
- Department of Biostatistics, University of Washington, Seattle, WA 98195
| | - Ira M Longini
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611
- Department of Biostatistics, University of Florida, Gainesville, FL 32611
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA 98109
| |
Collapse
|
78
|
Tozan Y, Headley TY, Sewe MO, Schwartz E, Shemesh T, Cramer JP, Eberhardt KA, Ramharter M, Harrison N, Leder K, Angheben A, Hatz C, Neumayr A, Chen LH, De Pijper CA, Grobusch MP, Wilder-Smith A. A Prospective Study on the Impact and Out-of-Pocket Costs of Dengue Illness in International Travelers. Am J Trop Med Hyg 2020; 100:1525-1533. [PMID: 30994088 DOI: 10.4269/ajtmh.18-0780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Although the costs of dengue illness to patients and households have been extensively studied in endemic populations, international travelers have not been the focus of costing studies. As globalization and human travel activities intensify, travelers are increasingly at risk for emerging and reemerging infectious diseases, such as dengue. This exploratory study aims to investigate the impact and out-of-pocket costs of dengue illness among travelers. We conducted a prospective study in adult travelers with laboratory-confirmed dengue and recruited patients at travel medicine clinics in eight different countries from December 2013 to December 2015. Using a structured questionnaire, we collected information on patients and their health-care utilization and out-of-pocket expenditures, as well as income and other financial losses they incurred because of dengue illness. A total of 90 patients participated in the study, most of whom traveled for tourism (74%) and visited countries in Asia (82%). Although 22% reported hospitalization and 32% receiving ambulatory care while traveling, these percentages were higher at 39% and 71%, respectively, after returning home. The out-of-pocket direct and indirect costs of dengue illness were US$421 (SD 744) and US$571 (SD 1,913) per episode, respectively, averaging to a total out-of-pocket cost of US$992 (SD 2,052) per episode. The study findings suggest that international travelers incur important direct and indirect costs because of dengue-related illness. This study is the first to date to investigate the impact and out-of-pocket costs of travel-related dengue illness from the patient's perspective and paves the way for future economic burden studies in this population.
Collapse
Affiliation(s)
- Yesim Tozan
- New York University College of Global Public Health, New York, New York.,New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Tyler Y Headley
- New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Maquines Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Eli Schwartz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tamar Shemesh
- Sheba Medical Center, Institute of Tropical and Travel Medicine, Ramat-Gan, Israel
| | - Jakob P Cramer
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten A Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Harrison
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrea Angheben
- Centre for Tropical Diseases, IRCCS Hospital Sacro Cuore-Don Calabria, Verona, Italy
| | - Christoph Hatz
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lin Hwei Chen
- Mount Auburn Hospital, Cambridge, and Harvard Medical School, Boston, Massachusetts
| | - Cornelis A De Pijper
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Martin P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Heidelberg Global Health Institute, University of Heidelberg, Heidelberg, Germany.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| |
Collapse
|
79
|
Wilder-Smith A. Dengue vaccine development: status and future. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:40-44. [PMID: 31784763 PMCID: PMC7224137 DOI: 10.1007/s00103-019-03060-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dengue, the most common arbovirus, represents an increasingly significant cause of morbidity worldwide, including in travelers. After decades of research, the first dengue vaccine was licensed in 2015: CYD-TDV, a tetravalent live attenuated vaccine with a yellow fever vaccine backbone. Recent analyses have shown that vaccine performance is dependent on serostatus. In those who have had a previous dengue infection, i.e., who are seropositive, the efficacy is high and the vaccine is safe. However, in seronegative vaccinees, approximately 3 years after vaccination the vaccine increases the risk of developing severe dengue when the individual experiences a natural dengue infection. The World Health Organization recommends that this vaccine be administered only to seropositive individuals. Current efforts are underway to develop rapid diagnostic tests to facilitate prevaccination screening. Two second-generation dengue vaccine candidates, both also live attenuated recombinant vaccines in late-stage development, may not present the same limitations because of differences in the backbone used, but results of phase 3 trials need to be available before firm conclusions can be drawn. Dengue is increasingly frequent in travelers, but the only licensed dengue vaccine to date can be used only in seropositive individuals. However, the vast majority of travelers are seronegative. Furthermore, the primary series of three doses given 6 months apart renders this vaccine difficult in the travel medicine context.
Collapse
Affiliation(s)
- Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, WC1E 7HT, London, UK. .,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| |
Collapse
|
80
|
Hooft van Huijsduijnen R, Kojima S, Carter D, Okabe H, Sato A, Akahata W, Wells TNC, Katsuno K. Reassessing therapeutic antibodies for neglected and tropical diseases. PLoS Negl Trop Dis 2020; 14:e0007860. [PMID: 31999695 PMCID: PMC6991954 DOI: 10.1371/journal.pntd.0007860] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In the past two decades there has been a significant expansion in the number of new therapeutic monoclonal antibodies (mAbs) that are approved by regulators. The discovery of these new medicines has been driven primarily by new approaches in inflammatory diseases and oncology, especially in immuno-oncology. Other recent successes have included new antibodies for use in viral diseases, including HIV. The perception of very high costs associated with mAbs has led to the assumption that they play no role in prophylaxis for diseases of poverty. However, improvements in antibody-expression yields and manufacturing processes indicate this is a cost-effective option for providing protection from many types of infection that should be revisited. Recent technology developments also indicate that several months of protection could be achieved with a single dose. Moreover, new methods in B cell sorting now enable the systematic identification of high-quality antibodies from humanized mice, or patients. This Review discusses the potential for passive immunization against schistosomiasis, fungal infections, dengue, and other neglected diseases.
Collapse
Affiliation(s)
| | | | - Dee Carter
- School of Life and Environmental Sciences and The Marie Bashir Institute, University of Sydney, NSW, Australia
| | | | | | - Wataru Akahata
- VLP Therapeutics, Gaithersburg, Maryland, United States of America
| | | | - Kei Katsuno
- Global Health Innovative Technology Fund, Tokyo, Japan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| |
Collapse
|
81
|
Bonaparte M, Zheng L, Garg S, Guy B, Lustig Y, Schwartz E, DiazGranados CA, Savarino S, Ataman-Önal Y. Evaluation of rapid diagnostic tests and conventional enzyme-linked immunosorbent assays to determine prior dengue infection. J Travel Med 2019; 26:5588085. [PMID: 31616949 DOI: 10.1093/jtm/taz078] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND In September 2018, the World Health Organization recommended that prevaccination screening be used with the tetravalent dengue vaccine (CYD-TDV), to ensure that only individuals with evidence of prior dengue infection (PDI) are vaccinated. Dengue rapid diagnostic tests (RDTs) would offer a potential solution for prevaccination screening at the point-of-care, but data on performance of available RDTs for identifying PDI are limited. We determined the suitability of four dengue RDTs and two conventional enzyme-linked immunosorbent assays (ELISAs) to identify PDI and evaluated cross-reactivity with co-circulating flaviviruses. UNLABELLED Methods: Specificity was assessed using 534 dengue-negative [determined by 50% plaque reduction neutralization test (PRNT50)] serum samples from USA (n = 229) and dengue-endemic regions (n = 305). Sensitivity was assessed using 270 samples from recent (n = 90) or remote (n = 90) virologically confirmed prior dengue cases, and dengue PRNT50-positive samples (n = 90). Cross-reactivity was assessed in dengue-seronegative samples that were seropositive for yellow fever (n = 57), Japanese encephalitis (n = 37), West Nile (n = 59) or Zika (n = 41). UNLABELLED Results: Dengue IgG RDTs and the Panbio ELISA exhibited favourable specificities (99-100%), higher than the Focus ELISA (95%). The RDTs had variable sensitivities (40-70%) that were lower than those of the ELISAs (≥90%). Cross-reactivity to other flaviviruses was low with RDTs (≤7%), but more significant with ELISAs (up to 51% for West Nile and 34% for Zika). No cross-reactivity to any of the four closely related flaviviruses was observed with the CTK Biotech RDT. For each SeroTest, sensitivity appeared similar in samples from individuals with recent (<13 months) vs remote (3-4 years) virologically confirmed PDI. UNLABELLED Conclusions: In general, dengue IgG RDTs were found to be more specific and less cross-reactive than the ELISAs, but the latter were more sensitive for identifying PDI cases. Currently available RDTs could be temporizing tools for rapid and safe prevaccination screening until improved RDTs with increased sensitivity become available.
Collapse
Affiliation(s)
- Matthew Bonaparte
- Global Clinical Immunology, Sanofi Pasteur, 1 Discovery Drive, Swiftwater PA 18370, USA
| | - Lingyi Zheng
- Global Biostatistics, Sanofi Pasteur, 1 Discovery Drive, Swiftwater PA 18370, USA
| | - Sanjay Garg
- Global Clinical Immunology, Sanofi Pasteur, 1 Discovery Drive, Swiftwater PA 18370, USA
| | - Bruno Guy
- Global Research, Sanofi Pasteur, 1541 Avenue Marcel Mérieux, Marcy l'Etoile 69280, France
| | - Yaniv Lustig
- Central Virology Laboratory, Public Health Services, Israel Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eli Schwartz
- Institute of Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carlos A DiazGranados
- Global Clinical Sciences, Sanofi Pasteur, 1 Discovery Drive, Swiftwater PA 18370, USA
| | - Stephen Savarino
- Translational Sciences and Biomarkers, Sanofi Pasteur, 1 Discovery Drive, Swiftwater PA 18370, USA
| | - Yasemin Ataman-Önal
- Translational Sciences and Biomarkers, Sanofi Pasteur, 1541 Avenue Marcel Mérieux, Marcy l'Etoile 69280, France
| |
Collapse
|
82
|
Vekemans J, Snow W, Fast PE, Baggaley R, Chinyenze K, Friede MH, Godfrey-Faussett P, Kaslow DC, Rees H. HIV immunoprophylaxis: preparing the pathway from proof of concept to policy decision and use. Lancet HIV 2019; 7:e141-e148. [PMID: 31786175 DOI: 10.1016/s2352-3018(19)30294-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/03/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022]
Abstract
Various long-awaited efficacy studies of vaccines and broadly neutralising antibodies for prevention of HIV are now well underway in highly endemic settings. One broadly neutralising monoclonal antibody is being assessed for proof of concept, and combinations are in the pipeline. Two multicomponent prime-and-boost vaccine regimens are being evaluated, one of which is designed for global coverage. These multicomponent vaccines present a new level of complexity that will challenge health delivery systems. We recommend that while awaiting the results, which will appear in 2020-22, the target product profiles and full public value proposition for both categories of products should be defined, and the regulatory, policy, and implementation pathways should be prepared. Economic and health benefits, cost of goods, administrative complexity, and user perspectives will be key considerations for the roll-out of effective products. Investments in manufacturing capacity and public-sector delivery systems will be needed to prepare for product introduction and scale-up. We propose a prioritisation of activities on the basis of a broad stakeholder consultation organised by WHO and UNAIDS.
Collapse
Affiliation(s)
| | | | - Patricia E Fast
- International AIDS Vaccine Initiative, New York, NY, USA; School of Medicine, Stanford University, CA, USA
| | | | | | | | | | - David C Kaslow
- Essential Medicines and Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Helen Rees
- Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
83
|
Piot P, Larson HJ, O'Brien KL, N'kengasong J, Ng E, Sow S, Kampmann B. Immunization: vital progress, unfinished agenda. Nature 2019; 575:119-129. [PMID: 31695203 DOI: 10.1038/s41586-019-1656-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/06/2019] [Indexed: 01/02/2023]
Abstract
Vaccination against infectious diseases has changed the future of the human species, saving millions of lives every year, both children and adults, and providing major benefits to society as a whole. Here we show, however, that national and sub-national coverage of vaccination varies greatly and major unmet needs persist. Although scientific progress opens exciting perspectives in terms of new vaccines, the pathway from discovery to sustainable implementation can be long and difficult, from the financing, development and licensing to programme implementation and public acceptance. Immunization is one of the best investments in health and should remain a priority for research, industry, public health and society.
Collapse
Affiliation(s)
- Peter Piot
- Office of the Director, Vaccine Centre and Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, London, UK.
| | - Heidi J Larson
- Office of the Director, Vaccine Centre and Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, London, UK.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Centre for the Evaluation of Vaccination (CEV), University of Antwerp, Antwerp, Belgium
| | - Katherine L O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - John N'kengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Edmond Ng
- Office of the Director, Vaccine Centre and Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, London, UK
| | - Samba Sow
- Center for Vaccine Development, Bamako, Mali
| | - Beate Kampmann
- Office of the Director, Vaccine Centre and Vaccine Confidence Project, London School of Hygiene & Tropical Medicine, London, UK.,MRC Unit The Gambia at the LSHTM, Banjul, The Gambia
| |
Collapse
|
84
|
Flasche S, Wilder-Smith A, Hombach J, Smith PG. Estimating the proportion of vaccine-induced hospitalized dengue cases among Dengvaxia vaccinees in the Philippines. Wellcome Open Res 2019; 4:165. [PMID: 31815190 PMCID: PMC6880258 DOI: 10.12688/wellcomeopenres.15507.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Dengvaxia was used in the Philippines to vaccinate 9-10-year-old school children, living in areas highly endemic for dengue. After about 830,000 had received at least 1 of 3 recommended doses, risks of enhanced disease in dengue-naïve vaccinees were reported. Methods: We used Phase 3 trial data to derive the proportions of cases of hospitalised and severe dengue that might have been prevented by the Philippines vaccination programme and, among those cases that may occur in vaccinees, what proportions are likely to arise in those who were seropositive or seronegative for dengue at the time of first vaccination and what proportion in the latter group may be enhanced disease attributable to the vaccine. Results: Assuming about 15% of vaccinees were dengue naïve at vaccination and the effects of the vaccine are independent of the number of doses received, we estimate that, in the 5 years following vaccination, the number of cases of severe disease in the vaccinated population will be reduced by about 70%. Among vaccinees who do develop severe disease, about half the cases will be due to vaccine breakthrough in seropositive vaccinees, and about a quarter will be excess cases in seronegative vaccinees that will have occurred as a consequence of vaccination. Conclusions: Overall, the Philippine dengue vaccination programme will likely prevent a substantial number of severe dengue cases and, among those that do occur, the majority are likely to be breakthrough disease in seropositive vaccinees and a minority attributable to the excess risk of enhanced disease in seronegative vaccinees.
Collapse
Affiliation(s)
- Stefan Flasche
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Peter G. Smith
- London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
85
|
|
86
|
Durbin AP, Gubler DJ. What is the prospect of a safe and effective dengue vaccine for travellers? J Travel Med 2019; 26:5292564. [PMID: 30657935 DOI: 10.1093/jtm/tay153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Anna P Durbin
- International Health, Johns Hopkins Bloomberg School of Public Health, Global Dengue and Aedes-Transmitted Diseases Consortium (GDAC), Baltimore, MD, USA
| | - Duane J Gubler
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore. Global Dengue and Aedes-Transmitted Diseases Consortium (GDAC)
| |
Collapse
|
87
|
Travelling arboviruses: A historical perspective. Travel Med Infect Dis 2019; 31:101471. [DOI: 10.1016/j.tmaid.2019.101471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022]
|
88
|
Valdés I, Lazo L, Hermida L, Guillén G, Gil L. Can Complementary Prime-Boost Immunization Strategies Be an Alternative and Promising Vaccine Approach Against Dengue Virus? Front Immunol 2019; 10:1956. [PMID: 31507591 PMCID: PMC6718459 DOI: 10.3389/fimmu.2019.01956] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/02/2019] [Indexed: 12/27/2022] Open
Abstract
Dengue is one of the most important diseases transmitted by mosquitoes. Dengvaxia®, a vaccine registered in several countries, cannot be administered to non-immune individuals and children younger than 9 years old, due to safety reasons. There are two vaccine candidates in phase 3 efficacy trials, but their registration date is completely unknown at this moment. So, the development of new vaccines or vaccine strategies continues to be a priority for the WHO. This work reviews some complementary prime-boost immunization studies against important human pathogens. Additionally, it reviews the results obtained using this regimen of immunization against dengue virus as a potential alternative approach for finding a safe and efficient vaccine. Finally, the main elements associated with this strategy are also discussed. The generation of new strategies of vaccination against dengue virus, must be directed to reduce the risk of increasing viral load through sub-neutralizing antibodies and it must be also directed to induce a polyfunctional T cell response. Complementary prime-boost immunization strategies could emerge as an interesting approach to induce solid immunity or at least to reduce viral load after natural infection, avoiding severe dengue. Subunit vaccine could be safe and attractive antigens for this strategy, especially proteins including B, and T-cells epitopes for inducing humoral and cellular immune responses, which can play an important role controlling the disease.
Collapse
Affiliation(s)
- Iris Valdés
- Vaccine Department, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Laura Lazo
- Vaccine Department, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Lisset Hermida
- Vaccine Department, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Gerardo Guillén
- Vaccine Department, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| | - Lázaro Gil
- Vaccine Department, Center for Genetic Engineering and Biotechnology, Havana, Cuba
| |
Collapse
|
89
|
Galula JU, Salem GM, Chang GJJ, Chao DY. Does structurally-mature dengue virion matter in vaccine preparation in post-Dengvaxia era? Hum Vaccin Immunother 2019; 15:2328-2336. [PMID: 31314657 PMCID: PMC6816432 DOI: 10.1080/21645515.2019.1643676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The unexpectedly low vaccine efficacy of Dengvaxia®, developed by Sanofi Pasteur, and a higher risk of severe diseases after vaccination among dengue-naive children or children younger than 6 years old, have cast skepticism about the safety of dengue vaccination resulting in the suspension of school-based immunization programs in the Philippines. The absence of immune correlates of protection from dengue virus (DENV) infection hampers the development of other potential DENV vaccines. While tetravalent live-attenuated tetravalent vaccines (LATVs), which mimic natural infection by inducing both cellular and humoral immune responses, are still currently favored, developing a vaccine that provides a balanced immunity to all four DENV serotypes remains a challenge. With the recently advanced understanding of virion structure and B cell immune responses from naturally infected DENV patients, two points of view in developing a next-generation dengue vaccine emerged: one is to induce potent, type-specific neutralizing antibodies (NtAbs) recognizing quaternary structure-dependent epitopes by having four components of vaccine strains replicate equivalently; the other is to induce protective and broadly NtAbs against the four serotypes of DENV with a universal vaccine. This article reviews the studies related to these issues and the current knowledge gap that needs to be filled in.
Collapse
Affiliation(s)
- Jedhan Ucat Galula
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University , Taichung , Taiwan
| | - Gielenny M Salem
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University , Taichung , Taiwan
| | - Gwong-Jen J Chang
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services , Fort Collins , CO , USA
| | - Day-Yu Chao
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University , Taichung , Taiwan
| |
Collapse
|
90
|
Halstead SB, Dans LF. Dengue infection and advances in dengue vaccines for children. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:734-741. [PMID: 31378686 DOI: 10.1016/s2352-4642(19)30205-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/23/2019] [Accepted: 06/10/2019] [Indexed: 12/26/2022]
Abstract
Dengue viruses are endemic in most tropical and subtropical countries where they produce disease ranging from a mild fever to a severe, potentially fatal vascular permeability syndrome. We reviewed the status of development and testing in children of three vaccines designed to protect against the four dengue viruses. The first dengue virus vaccine, Dengvaxia, now licensed in 20 endemic countries, the EU and the USA, provides protection against severe dengue in seropositive individuals but increases the risk for naive recipients to develop severe dengue and to be hospitalised. We discuss mechanisms and implications of shortcomings of the licensed vaccine and describe the structure and attributes of two other dengue virus vaccines. Based upon human dengue challenge studies, one of these vaccines promises to deliver solid, long-lasting immunity after a single dose. Because dengue virus infections are ubiquitous in residents and visitors to tropical countries, in the absence of a protective vaccine paediatricians should recognise the early signs and clinical presentation of severe dengue, understand its pathophysiology and appropriate management.
Collapse
Affiliation(s)
- Scott B Halstead
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Leonila F Dans
- Departments of Pediatrics and Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
| |
Collapse
|
91
|
Pearson CAB, Abbas KM, Clifford S, Flasche S, Hladish TJ. Serostatus testing and dengue vaccine cost-benefit thresholds. J R Soc Interface 2019; 16:20190234. [PMID: 31431184 PMCID: PMC6731500 DOI: 10.1098/rsif.2019.0234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The World Health Organization (WHO) currently recommends pre-screening for past infection prior to administration of the only licensed dengue vaccine, CYD-TDV. Using a threshold modelling analysis, we identify settings where this guidance prohibits positive net-benefits, and are thus unfavourable. Generally, however, our model shows test-then-vaccinate strategies can improve CYD-TDV economic viability: effective testing reduces unnecessary vaccination costs while increasing health benefits. With sufficiently low testing cost, those trends outweigh additional screening costs, expanding the range of settings with positive net-benefits. This work highlights two aspects for further analysis of test-then-vaccinate strategies. We found that starting routine testing at younger ages could increase benefits; if real tests are shown to sufficiently address safety concerns, the manufacturer, regulators and WHO should revisit guidance restricting use to 9-years-and-older recipients. We also found that repeat testing could improve return-on-investment (ROI), despite increasing intervention costs. Thus, more detailed analyses should address questions on repeat testing and testing periodicity, in addition to real test sensitivity and specificity. Our results follow from a mathematical model relating ROI to epidemiology, intervention strategy, and costs for testing, vaccination and dengue infections. We applied this model to a range of strategies, costs and epidemiological settings pertinent to CYD-TDV. However, general trends may not apply locally, so we provide our model and analyses as an R package available via CRAN, denvax. To apply to their setting, decision-makers need only local estimates of age-specific seroprevalence and costs for secondary infections.
Collapse
Affiliation(s)
- Carl A. B. Pearson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa,e-mail:
| | - Kaja M. Abbas
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Samuel Clifford
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas J. Hladish
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| |
Collapse
|
92
|
Lam HM, Phuong HT, Thao Vy NH, Le Thanh NT, Dung PN, Ngoc Muon TT, Van Vinh Chau N, Rodríguez-Barraquer I, Cummings DAT, Wills BA, Boni MF, Rabaa MA, Clapham HE. Serological inference of past primary and secondary dengue infection: implications for vaccination. J R Soc Interface 2019; 16:20190207. [PMID: 31362614 PMCID: PMC6685028 DOI: 10.1098/rsif.2019.0207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Owing to the finding that Dengvaxia® (the only licensed dengue vaccine to date) increases the risk of severe illness among seronegative recipients, the World Health Organization has recommended screening individuals for their serostatus prior to vaccination. To decide whether and how to carry out screening, it is necessary to estimate the transmission intensity of dengue and to understand the performance of the screening method. In this study, we inferred the annual force of infection (FOI; a measurement of transmission intensity) of dengue virus in three locations in Vietnam: An Giang (FOI = 0.04 for the below 10 years age group and FOI = 0.20 for the above 10 years age group), Ho Chi Minh City (FOI = 0.12) and Quang Ngai (FOI = 0.05). In addition, we show that using a quantitative approach to immunoglobulin G (IgG) levels (measured by indirect enzyme-linked immunosorbent assays) can help to distinguish individuals with primary exposures (primary seropositive) from those with secondary exposures (secondary seropositive). We found that primary-seropositive individuals—the main targets of the vaccine—tend to have a lower IgG level, and, thus, they have a higher chance of being misclassified as seronegative than secondary-seropositive cases. However, screening performance can be improved by incorporating patient age and transmission intensity into the interpretation of IgG levels.
Collapse
Affiliation(s)
- Ha Minh Lam
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Huynh Thi Phuong
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Nguyen Ha Thao Vy
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Le Thanh
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Pham Ngoc Dung
- Laboratory Department, An Giang Central General Hospital, An Giang, Vietnam
| | - Thai Thi Ngoc Muon
- Department of Biochemistry, Quang Ngai General Hospital, Quang Ngai, Vietnam
| | | | | | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Bridget A Wills
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maciej F Boni
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Biology, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - Maia A Rabaa
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Hannah E Clapham
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
93
|
España G, Yao Y, Anderson KB, Fitzpatrick MC, Smith DL, Morrison AC, Wilder-Smith A, Scott TW, Perkins TA. Model-based assessment of public health impact and cost-effectiveness of dengue vaccination following screening for prior exposure. PLoS Negl Trop Dis 2019; 13:e0007482. [PMID: 31260441 PMCID: PMC6625736 DOI: 10.1371/journal.pntd.0007482] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 07/12/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
The tetravalent dengue vaccine CYD-TDV (Dengvaxia) is the first licensed vaccine against dengue, but recent findings indicate an elevated risk of severe disease among vaccinees without prior dengue virus (DENV) exposure. The World Health Organization currently recommends CYD-TDV only for individuals with serological confirmation of past DENV exposure. Our objective was to evaluate the potential health impact and cost-effectiveness of vaccination following serological screening. To do so, we used an agent-based model to simulate DENV transmission with and without vaccination over a 10-year timeframe. Across a range of values for the proportion of vaccinees with prior DENV exposure, we projected the proportion of symptomatic and hospitalized cases averted as a function of the sensitivity and specificity of serological screening. Scenarios about the cost-effectiveness of screening and vaccination were chosen to be representative of Brazil and the Philippines. We found that public health impact depended primarily on sensitivity in high-transmission settings and on specificity in low-transmission settings. Cost-effectiveness could be achievable from the perspective of a public payer provided that sensitivity and the value of a disability-adjusted life-year were both high, but only in high-transmission settings. Requirements for reducing relative risk and achieving cost-effectiveness from an individual perspective were more restricted, due to the fact that those who test negative pay for screening but receive no benefit. Our results predict that cost-effectiveness could be achieved only in high-transmission areas of dengue-endemic countries with a relatively high per capita GDP, such as Panamá (13,680 USD), Brazil (8,649 USD), México (8,201 USD), or Thailand (5,807 USD). In conclusion, vaccination with CYD-TDV following serological screening could have a positive impact in some high-transmission settings, provided that screening is highly specific (to minimize individual harm), at least moderately sensitive (to maximize population benefit), and sufficiently inexpensive (depending on the setting).
Collapse
Affiliation(s)
- Guido España
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| | - Yutong Yao
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| | - Kathryn B. Anderson
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Meagan C. Fitzpatrick
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - David L. Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Amy C. Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA
| | - Annelies Wilder-Smith
- Global Health and Vaccinology Programme, Lee Kong Chian School of Medicine, Singapore
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute of Public Health, University of Heidelberg, Germany
| | - Thomas W. Scott
- Department of Entomology and Nematology, University of California, Davis, CA, United States of America
| | - T. Alex Perkins
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States of America
| |
Collapse
|
94
|
Affiliation(s)
- Lázaro Gil
- Vaccine Department, Center for Genetic Engineering and Biotechnology (CIGB), Havana, Cuba
| | - Laura Lazo
- Vaccine Department, Center for Genetic Engineering and Biotechnology (CIGB), Havana, Cuba
| |
Collapse
|
95
|
Murhekar MV, Kamaraj P, Kumar MS, Khan SA, Allam RR, Barde P, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Sapkal G, Kumar CPG, Sabarinathan R, Kumar VS, Bitragunta S, Grover GS, Lakshmi PVM, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Bhagat A, Srivastava R, Dinesh ER, Karunakaran T, Govindhasamy C, Rajasekar TD, Jeyakumar A, Suresh A, Augustine D, Kumar PA, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM. Burden of dengue infection in India, 2017: a cross-sectional population based serosurvey. LANCET GLOBAL HEALTH 2019; 7:e1065-e1073. [PMID: 31201130 DOI: 10.1016/s2214-109x(19)30250-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/03/2019] [Accepted: 05/01/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The burden of dengue virus (DENV) infection across geographical regions of India is poorly quantified. We estimated the age-specific seroprevalence, force of infection, and number of infections in India. METHODS We did a community-based survey in 240 clusters (118 rural, 122 urban), selected from 60 districts of 15 Indian states from five geographical regions. We enumerated each cluster, randomly selected (with an Andriod application developed specifically for the survey) 25 individuals from age groups of 5-8 years, 9-17 years, and 18-45 years, and sampled a minimum of 11 individuals from each age group (all the 25 randomly selected individuals in each age group were visited in their houses and individuals who consented for the survey were included in the study). Age was the only inclusion criterion; for the purpose of enumeration, individuals residing in the household for more than 6 months were included. Sera were tested centrally by a laboratory team of scientific and technical staff for IgG antibodies against the DENV with the use of indirect ELISA. We calculated age group specific seroprevalence and constructed catalytic models to estimate force of infection. FINDINGS From June 19, 2017, to April 12, 2018, we randomly selected 17 930 individuals from three age groups. Of these, blood samples were collected and tested for 12 300 individuals (5-8 years, n=4059; 9-17 years, n=4265; 18-45 years, n=3976). The overall seroprevalence of DENV infection in India was 48·7% (95% CI 43·5-54·0), increasing from 28·3% (21·5-36·2) among children aged 5-8 years to 41·0% (32·4-50·1) among children aged 9-17 years and 56·2% (49·0-63·1) among individuals aged between 18-45 years. The seroprevalence was high in the southern (76·9% [69·1-83·2]), western (62·3% [55·3-68·8]), and northern (60·3% [49·3-70·5]) regions. The estimated number of primary DENV infections with the constant force of infection model was 12 991 357 (12 825 128-13 130 258) and for the age-dependent force of infection model was 8 655 425 (7 243 630-9 545 052) among individuals aged 5-45 years from 30 Indian states in 2017. INTERPRETATION The burden of dengue infection in India was heterogeneous, with evidence of high transmission in northern, western, and southern regions. The survey findings will be useful in making informed decisions about introduction of upcoming dengue vaccines in India. FUNDING Indian Council of Medical Research.
Collapse
Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India.
| | - P Kamaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | | | - Siraj Ahmed Khan
- ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, India
| | | | - Pradip Barde
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suman Kanungo
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Uday Mohan
- King George's Medical University, Lucknow, India
| | | | - Subarna Roy
- ICMR-National Institute of Traditional Medicine, Belagavi, India
| | - Vivek Sagar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Roshan Kamal Topno
- ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | | | - C P Girish Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - R Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Velusamy Saravana Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | | | | | - P V M Lakshmi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Provash Sadhukhan
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - S K Singh
- King George's Medical University, Lucknow, India
| | | | - Asha Bhagat
- ICMR-National Institute of Virology, Pune, India
| | | | - E Ramya Dinesh
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - T Karunakaran
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - C Govindhasamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - T Daniel Rajasekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A Jeyakumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A Suresh
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D Augustine
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - P Ashok Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Rajesh Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - G S Toteja
- ICMR-Desert Medicine Research Centre, Jodhpur, India
| | - Nivedita Gupta
- Epidemiology and Communicable Diseases Division, ICMR, New Delhi, India
| | | |
Collapse
|
96
|
Wilder-Smith A, Rupali P. Estimating the dengue burden in India. LANCET GLOBAL HEALTH 2019; 7:e988-e989. [PMID: 31201129 DOI: 10.1016/s2214-109x(19)30249-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| | | |
Collapse
|
97
|
Aik J, Neo ZW, Rajarethinam J, Chio K, Lam WM, Ng LC. The effectiveness of inspections on reported mosquito larval habitats in households: A case-control study. PLoS Negl Trop Dis 2019; 13:e0007492. [PMID: 31242192 PMCID: PMC6615626 DOI: 10.1371/journal.pntd.0007492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/09/2019] [Accepted: 05/24/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Dengue is an arboviral disease that imposes substantial health and economic burdens across the globe. Vector control remains a key strategy in settings where Dengvaxia (a dengue vaccine) has not been licenced due to safety concerns and where mass immunization programmes are not cost-effective. Though inspections are used as part of arboviral disease control programmes, evidence of their impact on the entomological activity in households is sparse. METHODOLOGY/PRINCIPAL FINDINGS We analysed nationally representative household inspection data collected from Singapore over a 3-year period, to determine the effect of inspections on reported mosquito larval habitats in households. A case was a household with a positive report of a mosquito larval habitat in its most recent inspection in 2017. A control was a household that was reported free of mosquito larvae in its most recent inspection in 2017. Using multivariable logistic regression, we analysed 3,205 cases and 557,044 controls. Households averaging three inspections per annum were associated with reduced odds of mosquito larval habitat reports [Adjusted Odds Ratio (AOR): 0.49, 95% Confidence Interval (95% CI): 0.38 to 0.63]. The effect of inspections declined with decreasing inspection frequencies but remained protective at lower levels. Longer intervals (30 to 36 months) between the most recent two successive inspections were associated with increased odds of mosquito larval habitat reports (AOR: 1.28, 95% CI: 1.06 to 1.56) compared to those carried out less than 6 months apart. Mosquito larval habitat reports exhibited a dependence on spatial and household-level characteristics such as the location of the community district, housing type and housing floor level. We observed a four-fold increase in the odds of mosquito larval habitat reports in households with an immediate previous report of larval activity compared to those that did not have one (AOR: 4.52, 95% CI: 3.67 to 5.56). CONCLUSIONS/SIGNIFICANCE Our study confirms the protective effect of inspections on reported mosquito larval habitat reporting in households. Spatial, temporal and household-level characteristics should be accounted for in prioritizing vector control resources. Alternative strategies may help address recurrent entomological activity in households.
Collapse
Affiliation(s)
- Joel Aik
- Environmental Health Institute, National Environment Agency, Singapore
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, New South Wales, Australia
| | - Zhi Wei Neo
- Environmental Public Health Operations Department, National Environment Agency, Singapore
| | | | - Kaiyun Chio
- Environmental Public Health Operations Department, National Environment Agency, Singapore
| | - Wing Mun Lam
- Environmental Public Health Operations Department, National Environment Agency, Singapore
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore
| |
Collapse
|
98
|
Wang R, Zheng X, Sun J, Feng K, Gao N, Fan D, Chen H, Jin X, An J. Vaccination With a Single Consensus Envelope Protein Ectodomain Sequence Administered in a Heterologous Regimen Induces Tetravalent Immune Responses and Protection Against Dengue Viruses in Mice. Front Microbiol 2019; 10:1113. [PMID: 31134046 PMCID: PMC6524413 DOI: 10.3389/fmicb.2019.01113] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/01/2019] [Indexed: 12/24/2022] Open
Abstract
The development of a safe and effective tetravalent dengue vaccine that elicits protection against all dengue virus (DENV) serotypes is urgently needed. The consensus sequence of the ectodomain of envelope (E) protein of DENV (cE80) has been examined as an immunogen previously. In the current study, a cE80 DNA (D) vaccine was constructed and evaluated in conjunction with the cE80 protein (P) vaccine to examine whether both vaccines used together can further improve the immune responses. The cE80 DNA vaccine was administrated using either a homologous (DNA alone, DDD) or heterologous (DNA prime-protein boost: DDP or DPP) regimen, and evaluated for immunogenicity and protective efficacy in mice. Among the three DNA-based immunization regimens tested, DDP immunization is the optimal immunization regimen that elicited the greatest systemic immune response and conferred protection against all four DENV serotypes. This work provides innovative ideas for the development of consensus E-based dengue vaccines and the testing of optimal immunization regimens.
Collapse
Affiliation(s)
- Ran Wang
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Xiaoyan Zheng
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, The Second Clinical Medical College of Capital Medical University, Beijing, China
| | - Jin Sun
- Viral Disease and Vaccine Translational Research Unit, CAS Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Kaihao Feng
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Na Gao
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Dongying Fan
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Xia Jin
- Viral Disease and Vaccine Translational Research Unit, CAS Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Jing An
- Department of Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| |
Collapse
|
99
|
Flasche S, Smith PG. Sensitivity and negative predictive value for a rapid dengue test. THE LANCET. INFECTIOUS DISEASES 2019; 19:465-466. [PMID: 31034385 DOI: 10.1016/s1473-3099(19)30167-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/20/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Stefan Flasche
- Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
100
|
Cohen C, Moreira ED, Nañez H, Nachiappan JP, Arvinder-Singh HS, Huoi C, Nealon J, Sarti E, Puentes-Rosas E, Moureau A, Khromava A. Incidence rates of neurotropic-like and viscerotropic-like disease in three dengue-endemic countries: Mexico, Brazil, and Malaysia. Vaccine 2019; 37:1868-1875. [PMID: 30826144 DOI: 10.1016/j.vaccine.2019.01.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The background incidence of viscerotropic- (VLD) and neurotropic-like disease (NLD) unrelated to immunization in dengue-endemic countries is currently unknown. METHODS This retrospective population-based analysis estimated crude and standardized incidences of VLD and NLD in twelve hospitals in Brazil (n = 3), Mexico (n = 3), and Malaysia (n = 6) over a 1-year period before the introduction of the tetravalent dengue vaccine. Catchment areas were estimated using publicly available population census information and administrative data. The denominator population for incidence rates was calculated, and sensitivity analyses assessed the impact of important assumptions. RESULTS Total cases adjudicated as definite VLD were 5, 57, and 56 in Brazil, Mexico, and Malaysia, respectively. Total cases adjudicated as definite NLD were 103, 29, and 26 in Brazil, Mexico, and Malaysia, respectively. Crude incidence rates of cases adjudicated as definite VLD in Brazil, Mexico, and Malaysia were 1.17, 2.60, and 1.48 per 100,000 person-years, respectively. Crude incidence rates of cases adjudicated as definite NLD in Brazil, Mexico, and Malaysia were 4.45, 1.32, and 0.69 per 100,000 person-years, respectively. CONCLUSIONS Background incidence estimates of VLD and NLD obtained in Mexico, Brazil, and Malaysia could provide context for cases occurring after the introduction of the tetravalent dengue vaccine.
Collapse
Affiliation(s)
| | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil.
| | - Homero Nañez
- University Hospital Dr. José E. González, Faculty of Medicine Universidad Autonoma de Nuevo León, Monterrey N.L., Mexico.
| | | | | | | | | | - Elsa Sarti
- Sanofi Pasteur LATAM, Coyoacán, CDMX, Mexico.
| | | | - Annick Moureau
- Clinical Development, Sanofi Pasteur, Marcy l'Etoile, Lyon, France.
| | | | | |
Collapse
|