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Katzelnick LC, Ben-Shachar R, Mercado JC, Rodriguez-Barraquer I, Elizondo D, Arguello S, Nuñez A, Ojeda S, Sanchez N, Lopez Mercado B, Gresh L, Burger-Calderon R, Kuan G, Gordon A, Balmaseda A, Harris E. Dynamics and determinants of the force of infection of dengue virus from 1994 to 2015 in Managua, Nicaragua. Proc Natl Acad Sci U S A 2018; 115:10762-10767. [PMID: 30266790 PMCID: PMC6196493 DOI: 10.1073/pnas.1809253115] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dengue virus (DENV) is the most prevalent human vector-borne viral disease. The force of infection (FoI), the rate at which susceptible individuals are infected in a population, is an important metric for infectious disease modeling. Understanding how and why the FoI of DENV changes over time is critical for developing immunization and vector control policies. We used age-stratified seroprevalence data from 12 years of the Pediatric Dengue Cohort Study in Nicaragua to estimate the annual FoI of DENV from 1994 to 2015. Seroprevalence data revealed a change in the rate at which children acquire DENV-specific immunity: in 2004, 50% of children age >4 years were seropositive, but by 2015, 50% seropositivity was reached only by age 11 years. We estimated a spike in the FoI in 1997-1998 and 1998-1999 and a gradual decline thereafter, and children age <4 years experienced a lower FoI. Two hypotheses to explain the change in the FoI were tested: (i) a transition from introduction of specific DENV serotypes to their endemic transmission and (ii) a population demographic transition due to declining birth rates and increasing life expectancy. We used mathematical models to simulate these hypotheses. We show that the initial high FoI can be explained by the introduction of DENV-3 in 1994-1998, and that the overall gradual decline in the FoI can be attributed to demographic shifts. Changes in immunity and demographics strongly impacted DENV transmission in Nicaragua. Population-level measures of transmission intensity are dynamic and thus challenging to use to guide vaccine implementation locally and globally.
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Affiliation(s)
- Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720-3370
| | - Rotem Ben-Shachar
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720-3370
- Department of Integrative Biology, University of California, Berkeley, CA 94720
| | - Juan Carlos Mercado
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua 16064
- Sustainable Sciences Institute, Managua, Nicaragua 14007
| | | | | | - Sonia Arguello
- Sustainable Sciences Institute, Managua, Nicaragua 14007
| | - Andrea Nuñez
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua 16064
- Sustainable Sciences Institute, Managua, Nicaragua 14007
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua 14007
| | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua 14007
| | | | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua 14007
| | - Raquel Burger-Calderon
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720-3370
- Sustainable Sciences Institute, Managua, Nicaragua 14007
| | - Guillermina Kuan
- Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua 12014
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109
| | - Angel Balmaseda
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua 16064
- Sustainable Sciences Institute, Managua, Nicaragua 14007
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720-3370;
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Dorigatti I, Donnelly CA, Laydon DJ, Small R, Jackson N, Coudeville L, Ferguson NM. Refined efficacy estimates of the Sanofi Pasteur dengue vaccine CYD-TDV using machine learning. Nat Commun 2018; 9:3644. [PMID: 30194294 PMCID: PMC6128884 DOI: 10.1038/s41467-018-06006-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/03/2018] [Indexed: 01/08/2023] Open
Abstract
CYD-TDV is the first licensed dengue vaccine for individuals 9-45 (or 60) years of age. Using 12% of the subjects enroled in phase-2b and phase-3 trials for which baseline serostatus was measured, the vaccine-induced protection against virologically confirmed dengue during active surveillance (0-25 months) was found to vary with prior exposure to dengue. Because age and dengue exposure are highly correlated in endemic settings, refined insight into how efficacy varies by serostatus and age is essential to understand the increased risk of hospitalisation observed among vaccinated individuals during the long-term follow-up and to develop safe and effective vaccination strategies. Here we apply machine learning to impute the baseline serostatus for subjects with post-dose 3 titres but missing baseline serostatus. We find evidence for age dependence in efficacy independent of serostatus and estimate that among 9-16 year olds, CYD-TDV is protective against serotypes 1, 3 and 4 regardless of baseline serostatus.
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Affiliation(s)
- I Dorigatti
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London,, W2 1PG, UK.
| | - C A Donnelly
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London,, W2 1PG, UK
| | - D J Laydon
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London,, W2 1PG, UK
| | - R Small
- Sanofi Pasteur, 2501 Discovery Dr, Orlando, FL, 32826, USA
| | - N Jackson
- Sanofi Pasteur, 1541 Avenue Marcel Mérieux, 69280, Marcy l'Étoile, France
| | - L Coudeville
- Sanofi Pasteur, 14, Espace Henry Vallee, 690077, Lyon, France
| | - N M Ferguson
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London,, W2 1PG, UK
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103
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Tang B, Huo X, Xiao Y, Ruan S, Wu J. A conceptual model for optimizing vaccine coverage to reduce vector-borne infections in the presence of antibody-dependent enhancement. Theor Biol Med Model 2018; 15:13. [PMID: 30173664 PMCID: PMC6120075 DOI: 10.1186/s12976-018-0085-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Many vector-borne diseases co-circulate, as the viruses from the same family are also transmitted by the same vector species. For example, Zika and dengue viruses belong to the same Flavivirus family and are primarily transmitted by a common mosquito species Aedes aegypti. Zika outbreaks have also commonly occurred in dengue-endemic areas, and co-circulation and co-infection of both viruses have been reported. As recent immunological cross-reactivity studies have confirmed that convalescent plasma following dengue infection can enhance Zika infection, and as global efforts of developing dengue and Zika vaccines are intensified, it is important to examine whether and how vaccination against one disease in a large population may affect infection dynamics of another disease due to antibody-dependent enhancement. Methods Through a conceptual co-infection dynamics model parametrized by reported dengue and Zika epidemic and immunological cross-reactivity characteristics, we evaluate impact of a hypothetical dengue vaccination program on Zika infection dynamics in a single season when only one particular dengue serotype is involved. Results We show that an appropriately designed and optimized dengue vaccination program can not only help control the dengue spread but also, counter-intuitively, reduce Zika infections. We identify optimal dengue vaccination coverages for controlling dengue and simultaneously reducing Zika infections, as well as the critical coverages exceeding which dengue vaccination will increase Zika infections. Conclusion This study based on a conceptual model shows the promise of an integrative vector-borne disease control strategy involving optimal vaccination programs, in regions where different viruses or different serotypes of the same virus co-circulate, and convalescent plasma following infection from one virus (serotype) can enhance infection against another virus (serotype). The conceptual model provides a first step towards well-designed regional and global vector-borne disease immunization programs.
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Affiliation(s)
- Biao Tang
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.,Centre for Disease Modelling, Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, Canada
| | - Xi Huo
- Centre for Disease Modelling, Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, Canada.,Department of Mathematics, University of Miami, Coral Gables, 33146, USA
| | - Yanni Xiao
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Shigui Ruan
- Department of Mathematics, University of Miami, Coral Gables, 33146, USA
| | - Jianhong Wu
- Centre for Disease Modelling, Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, Canada.
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104
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Mishra AC, Arankalle VA, Gadhave SA, Mahadik PH, Shrivastava S, Bhutkar M, Vaidya VM. Stratified sero-prevalence revealed overall high disease burden of dengue but suboptimal immunity in younger age groups in Pune, India. PLoS Negl Trop Dis 2018; 12:e0006657. [PMID: 30080850 PMCID: PMC6095695 DOI: 10.1371/journal.pntd.0006657] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 08/16/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In India, dengue disease is emerging as the most important vector borne public health problem due to rapid and unplanned urbanization, high human density and week management of the disease. Clinical cases are grossly underreported and not much information is available on prevalence and incidence of the disease. METHODOLOGY A cross sectional, stratified, facility based, multistage cluster sampling was conducted between May 4 and June 27, 2017 in Pune city. A total of 1,434 participants were enrolled. The serum samples were tested for detection of historical dengue IgG antibodies by ELISA using the commercial Panbio Dengue IgG Indirect ELISA kit. Anti-dengue IgG-capture Panbio ELISA was used for detection of high titered antibodies to detect recent secondary infection. We used this data to estimate key transmission parameters like force of infection and basic reproductive number. A subset of 120 indirect ELISA positive samples was also tested for Plaque Reduction Neutralizing Antibodies for determining serotype-specific prevalence. FINDINGS Overall, 81% participants were infected with dengue virus (DENV) at least once if not more. The positivity was significantly different in different age groups. All the adults above 70 years were positive for DENV antibodies. Over 69% participants were positive for neutralizing antibodies against all 4 serotypes suggesting intense transmission of all DENV serotypes in Pune. Age-specific seroprevalence was consistent with long-term, endemic circulation of DENV. There was an increasing trend with age, from 21.6% among <36 months to 59.4% in age group 10-12 years. We estimate that 8.68% of the susceptible population gets infected by DENV each year resulting into more than 3,00,000 infections and about 47,000 to 59,000 cases per year. This transmission intensity is similar to that reported from other known hyper-endemic settings in Southeast Asia and the Americas but significantly lower than report from Chennai. CONCLUSIONS Our study suggests that Pune city has high disease burden, all 4 serotypes are circulating, significant spatial heterogeneity in seroprevalence and suboptimal immunity in younger age groups. This would allow informed decisions to be made on management of dengue and introduction of upcoming dengue vaccines in the city.
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Affiliation(s)
- Akhilesh C. Mishra
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Katraj, Pune, India
| | - Vidya A. Arankalle
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Katraj, Pune, India
| | - Swapnil A. Gadhave
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Katraj, Pune, India
| | - Pritam H. Mahadik
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Katraj, Pune, India
| | - Shubham Shrivastava
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Katraj, Pune, India
| | - Mandar Bhutkar
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Katraj, Pune, India
| | - Varsha M. Vaidya
- Department Community Medicine, Medical College, Bharati Vidyapeeth (Deemed to be University), Katraj, Pune, India
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105
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Coudeville L, Baurin N, Olivera-Botello G. Assessment of benefits and risks associated with dengue vaccination at the individual and population levels: a dynamic modeling approach. Expert Rev Vaccines 2018; 17:753-763. [PMID: 30063839 DOI: 10.1080/14760584.2018.1503955] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND A case-cohort study, using a novel assay and data from three dengue vaccine efficacy trials, highlighted differences in vaccination outcomes according to baseline serostatus. Based on these results, we explored, with a model, the benefits and risks associated with vaccination. RESEARCH DESIGN AND METHODS Parameters of a previously developed transmission model were estimated with subject-level data from a case-cohort study. The model was used to assess vaccination outcomes for a range of transmission settings over 5-30 years, with or without indirect protection. MAIN OUTCOME MEASURES Symptomatic dengue cases, dengue hospitalizations, and severe dengue cases. RESULTS The model is consistent with previous results indicating a transitory period at increased risk for dengue-seronegative vaccine recipients (setting-dependent duration) and long-term benefits for dengue-seropositive recipients. At the population level, benefits to seropositive individuals over 10 years outweighed the risk to those seronegative in moderate to high transmission settings (≥50% seropositivity at age 9), especially in high transmission settings (no excess hospitalizations in dengue-seronegative for ≥80% seropositivity at age 9). Results were more favorable when longer time horizons or indirect protection were considered. CONCLUSIONS Results indicate a public health benefit associated with dengue vaccination especially in high-transmission settings, even with the initial excess risks to dengue-seronegative patients which diminish over time.
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Affiliation(s)
| | - Nicolas Baurin
- a Vaccination Value Modelling , Sanofi Pasteur , Lyon , France
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106
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Sridhar S, Luedtke A, Langevin E, Zhu M, Bonaparte M, Machabert T, Savarino S, Zambrano B, Moureau A, Khromava A, Moodie Z, Westling T, Mascareñas C, Frago C, Cortés M, Chansinghakul D, Noriega F, Bouckenooghe A, Chen J, Ng SP, Gilbert PB, Gurunathan S, DiazGranados CA. Effect of Dengue Serostatus on Dengue Vaccine Safety and Efficacy. N Engl J Med 2018; 379:327-340. [PMID: 29897841 DOI: 10.1056/nejmoa1800820] [Citation(s) in RCA: 485] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In efficacy trials of a tetravalent dengue vaccine (CYD-TDV), excess hospitalizations for dengue were observed among vaccine recipients 2 to 5 years of age. Precise risk estimates according to observed dengue serostatus could not be ascertained because of the limited numbers of samples collected at baseline. We developed a dengue anti-nonstructural protein 1 (NS1) IgG enzyme-linked immunosorbent assay and used samples from month 13 to infer serostatus for a post hoc analysis of safety and efficacy. METHODS In a case-cohort study, we reanalyzed data from three efficacy trials. For the principal analyses, we used baseline serostatus determined on the basis of measured (when baseline values were available) or imputed (when baseline values were missing) titers from a 50% plaque-reduction neutralization test (PRNT50), with imputation conducted with the use of covariates that included the month 13 anti-NS1 assay results. The risk of hospitalization for virologically confirmed dengue (VCD), of severe VCD, and of symptomatic VCD according to dengue serostatus was estimated by weighted Cox regression and targeted minimum loss-based estimation. RESULTS Among dengue-seronegative participants 2 to 16 years of age, the cumulative 5-year incidence of hospitalization for VCD was 3.06% among vaccine recipients and 1.87% among controls, with a hazard ratio (vaccine vs. control) through data cutoff of 1.75 (95% confidence interval [CI], 1.14 to 2.70). Among dengue-seronegative participants 9 to 16 years of age, the cumulative incidence of hospitalization for VCD was 1.57% among vaccine recipients and 1.09% among controls, with a hazard ratio of 1.41 (95% CI, 0.74 to 2.68). Similar trends toward a higher risk among seronegative vaccine recipients than among seronegative controls were also found for severe VCD. Among dengue-seropositive participants 2 to 16 years of age and those 9 to 16 years of age, the cumulative incidence of hospitalization for VCD was 0.75% and 0.38%, respectively, among vaccine recipients and 2.47% and 1.88% among controls, with hazard ratios of 0.32 (95% CI, 0.23 to 0.45) and 0.21 (95% CI, 0.14 to 0.31). The risk of severe VCD was also lower among seropositive vaccine recipients than among seropositive controls. CONCLUSIONS CYD-TDV protected against severe VCD and hospitalization for VCD for 5 years in persons who had exposure to dengue before vaccination, and there was evidence of a higher risk of these outcomes in vaccinated persons who had not been exposed to dengue. (Funded by Sanofi Pasteur; ClinicalTrials.gov numbers, NCT00842530 , NCT01983553 , NCT01373281 , and NCT01374516 .).
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Affiliation(s)
- Saranya Sridhar
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Alexander Luedtke
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Edith Langevin
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Ming Zhu
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Matthew Bonaparte
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Tifany Machabert
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Stephen Savarino
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Betzana Zambrano
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Annick Moureau
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Alena Khromava
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Zoe Moodie
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Ted Westling
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Cesar Mascareñas
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Carina Frago
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Margarita Cortés
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Danaya Chansinghakul
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Fernando Noriega
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Alain Bouckenooghe
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Josh Chen
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Su-Peing Ng
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Peter B Gilbert
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Sanjay Gurunathan
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Carlos A DiazGranados
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
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107
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Challenges and opportunities in controlling mosquito-borne infections. Nature 2018; 559:490-497. [PMID: 30046071 DOI: 10.1038/s41586-018-0318-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/24/2018] [Indexed: 11/08/2022]
Abstract
Mosquito-borne diseases remain a major cause of morbidity and mortality across the tropical regions. Despite much progress in the control of malaria, malaria-associated morbidity remains high, whereas arboviruses-most notably dengue-are responsible for a rising burden of disease, even in middle-income countries that have almost completely eliminated malaria. Here I discuss how new interventions offer the promise of considerable future reductions in disease burden. However, I emphasize that intervention programmes need to be underpinned by rigorous trials and quantitative epidemiological analyses. Such analyses suggest that the long-term goal of elimination is more feasible for dengue than for malaria, even if malaria elimination would offer greater overall health benefit to the public.
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108
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Masala GL, Lipsitch M, Bottomley C, Flasche S. Exploring the role of competition induced by non-vaccine serotypes for herd protection following pneumococcal vaccination. J R Soc Interface 2018; 14:rsif.2017.0620. [PMID: 29093131 PMCID: PMC5721164 DOI: 10.1098/rsif.2017.0620] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/11/2017] [Indexed: 02/02/2023] Open
Abstract
The competitive pressure from non-vaccine serotypes may have helped pneumococcal conjugate vaccines (PCVs) to limit vaccine-type (VT) serotype prevalence. We aimed to investigate if, consequently, the indirect protection of vaccines targeting most pneumococcal serotypes could fall short of the profound effects of current formulations. We compared three previously described pneumococcal models harmonized to simulate 20 serotypes with a combined pre-vaccination prevalence in children younger than 5-years-old of 40%. We simulated vaccines of increasing valency by adding serotypes in order of their competitiveness and explored their ability to reduce VT carriage by 95% within 10 years after introduction. All models predicted that additional valency will reduce indirect vaccine effects and hence the overall vaccine impact on carriage both in children and adults. Consequently, the minimal effective coverage (efficacy against carriage×vaccine coverage) needed to eliminate VT carriage increased with increasing valency. One model predicted this effect to be modest, while the other two predicted that high-valency vaccines may struggle to eliminate VT pneumococci unless vaccine efficacy against carriage can be substantially improved. Similar results were obtained when settings of higher transmission intensity and different PCV formulations were explored. Failure to eliminate carriage as a result of increased valency could lead to overall decreased impact of vaccination if the disease burden caused by the added serotypes is low. Hence, a comparison of vaccine formulations of varying valency, and pan-valent formulations in particular, should consider the invasiveness of targeted serotypes, as well as efficacy against carriage.
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Affiliation(s)
- G L Masala
- Centre for Mathematical Modelling and Infectious Diseases, Department of Infectious disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.,School of Computing, Electronics and Mathematics, University of Plymouth, Plymouth, UK
| | - M Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - C Bottomley
- Centre for Mathematical Modelling and Infectious Diseases, Department of Infectious disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - S Flasche
- Centre for Mathematical Modelling and Infectious Diseases, Department of Infectious disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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109
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Dengue virus serotype distribution based on serological evidence in pediatric urban population in Indonesia. PLoS Negl Trop Dis 2018; 12:e0006616. [PMID: 29953438 PMCID: PMC6040755 DOI: 10.1371/journal.pntd.0006616] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/11/2018] [Accepted: 06/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dengue is a febrile illness transmitted by mosquitoes, causing disease across the tropical and sub-tropical world. Antibody prevalence data and serotype distributions describe population-level risk and inform public health decision-making. METHODOLOGY/PRINCIPAL FINDINGS In this cross-sectional study we used data from a pediatric dengue seroprevalence study to describe historical dengue serotype circulation, according to age and geographic location. A sub-sample of 780 dengue IgG-positive sera, collected from 30 sites across urban Indonesia in 2014, were tested by the plaque reduction neutralization test (PRNT) to measure the prevalence and concentration of serotype-specific neutralizing antibodies according to subject age and geography. PRNT results were obtained from 776 subjects with mean age of 9.6 years. 765 (98.6%) neutralized one or more dengue serotype at a threshold of >10 (1/dil). Multitypic profiles were observed in 50.9% of the samples; a proportion which increased to 63.1% in subjects aged 15-18 years. Amongst monotypic samples, the highest proportion was reactive against DENV-2, followed by DENV-1, and DENV-3, with some variation across the country. DENV-4 was the least common serotype. The highest anti-dengue antibody titers were recorded against DENV-2, and increased with age to a geometric mean of 516.5 [1/dil] in the oldest age group. CONCLUSIONS/SIGNIFICANCE We found that all four dengue serotypes have been widely circulating in most of urban Indonesia, and more than half of children had already been exposed to >1 dengue serotype, demonstrating intense transmission often associated with more severe clinical episodes. These data will help inform policymakers and highlight the importance of dengue surveillance, prevention and control.
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110
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Transmission-clearance trade-offs indicate that dengue virulence evolution depends on epidemiological context. Nat Commun 2018; 9:2355. [PMID: 29907741 PMCID: PMC6003961 DOI: 10.1038/s41467-018-04595-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
An extensive body of theory addresses the topic of pathogen virulence evolution, yet few studies have empirically demonstrated the presence of fitness trade-offs that would select for intermediate virulence. Here we show the presence of transmission-clearance trade-offs in dengue virus using viremia measurements. By fitting a within-host model to these data, we further find that the interaction between dengue and the host immune response can account for the observed trade-offs. Finally, we consider dengue virulence evolution when selection acts on the virus’s production rate. By combining within-host model simulations with empirical findings on how host viral load affects human-to-mosquito transmission success, we show that the virus’s transmission potential is maximized at production rates associated with intermediate virulence and that the optimal production rate critically depends on dengue’s epidemiological context. These results indicate that long-term changes in dengue’s global distribution impact the invasion and spread of virulent dengue virus genotypes. Theory predicts that pathogens will evolve towards intermediate virulence, yet the necessary trade-offs invoked by this theory have rarely been demonstrated empirically. Here, the authors show that dengue virus dynamics exhibit a trade-off between transmission and clearance rates.
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111
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Vannice KS, Wilder-Smith A, Barrett ADT, Carrijo K, Cavaleri M, de Silva A, Durbin AP, Endy T, Harris E, Innis BL, Katzelnick LC, Smith PG, Sun W, Thomas SJ, Hombach J. Clinical development and regulatory points for consideration for second-generation live attenuated dengue vaccines. Vaccine 2018; 36:3411-3417. [PMID: 29525283 PMCID: PMC6010224 DOI: 10.1016/j.vaccine.2018.02.062] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/05/2018] [Accepted: 02/15/2018] [Indexed: 01/05/2023]
Abstract
Licensing and decisions on public health use of a vaccine rely on a robust clinical development program that permits a risk-benefit assessment of the product in the target population. Studies undertaken early in clinical development, as well as well-designed pivotal trials, allow for this robust characterization. In 2012, WHO published guidelines on the quality, safety and efficacy of live attenuated dengue tetravalent vaccines. Subsequently, efficacy and longer-term follow-up data have become available from two Phase 3 trials of a dengue vaccine, conducted in parallel, and the vaccine was licensed in December 2015. The findings and interpretation of the results from these trials released both before and after licensure have highlighted key complexities for tetravalent dengue vaccines, including concerns vaccination could increase the incidence of dengue disease in certain subpopulations. This report summarizes clinical and regulatory points for consideration that may guide vaccine developers on some aspects of trial design and facilitate regulatory review to enable broader public health recommendations for second-generation dengue vaccines.
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Affiliation(s)
- Kirsten S Vannice
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland
| | - Annelies Wilder-Smith
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland; Lee Kong Chian School of Medicine, Singapore
| | - Alan D T Barrett
- Sealy Center for Vaccine Development and World Health Organization Collaborating Center for Vaccine Research, Evaluation and Training for Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA
| | - Kalinka Carrijo
- Brazilian Health Regulatory Agency - Anvisa, Brasília, DF, Brazil
| | | | - Aravinda de Silva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Anna P Durbin
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tim Endy
- State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Bruce L Innis
- Respiratory Infections and Maternal Immunizations, PATH Center for Vaccine Innovation and Access, Washington, DC, USA
| | - Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Stephen J Thomas
- State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Joachim Hombach
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland.
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112
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Hladish TJ, Pearson CAB, Patricia Rojas D, Gomez-Dantes H, Halloran ME, Vazquez-Prokopec GM, Longini IM. Forecasting the effectiveness of indoor residual spraying for reducing dengue burden. PLoS Negl Trop Dis 2018; 12:e0006570. [PMID: 29939983 PMCID: PMC6042783 DOI: 10.1371/journal.pntd.0006570] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/12/2018] [Accepted: 05/30/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Historically, mosquito control programs successfully helped contain malaria and yellow fever, but recent efforts have been unable to halt the spread of dengue, chikungunya, or Zika, all transmitted by Aedes mosquitoes. Using a dengue transmission model and results from indoor residual spraying (IRS) field experiments, we investigated how IRS-like campaign scenarios could effectively control dengue in an endemic setting. METHODS AND FINDINGS In our model, we found that high levels of household coverage (75% treated once per year), applied proactively before the typical dengue season could reduce symptomatic infections by 89.7% (median of 1000 simulations; interquartile range [IQR]:[83.0%, 94.8%]) in year one and 78.2% (IQR: [71.2%, 88.0%]) cumulatively over the first five years of an annual program. Lower coverage had correspondingly lower effectiveness, as did reactive campaigns. Though less effective than preventative campaigns, reactive and even post-epidemic interventions retain some effectiveness; these campaigns disrupt inter-seasonal transmission, highlighting an off-season control opportunity. Regardless, none of the campaign scenarios maintain their initial effectiveness beyond two seasons, instead stabilizing at much lower levels of benefit: in year 20, median effectiveness was only 27.3% (IQR: [-21.3%, 56.6%]). Furthermore, simply ceasing an initially successful program exposes a population with lowered herd immunity to the same historical threat, and we observed outbreaks more than four-fold larger than pre-intervention outbreaks. These results do not take into account evolving insecticide resistance, thus long-term effectiveness may be lower if new, efficacious insecticides are not developed. CONCLUSIONS Using a detailed agent-based dengue transmission model for Yucatán State, Mexico, we predict that high coverage indoor residual spraying (IRS) interventions can largely eliminate transmission for a few years, when applied a few months before the typical seasonal epidemic peak. However, vector control succeeds by preventing infections, which precludes natural immunization. Thus, as a population benefits from mosquito control, it gradually loses naturally acquired herd immunity, and the control effectiveness declines; this occurs across all of our modeled scenarios, and is consistent with other empirical work. Long term control that maintains early effectiveness would require some combination of increasing investment, complementary interventions such as vaccination, and control programs across a broad region to diminish risk of importation.
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Affiliation(s)
- Thomas J. Hladish
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | | | - Diana Patricia Rojas
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Hector Gomez-Dantes
- Health Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Ira M. Longini
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA, USA
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
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113
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Salje H, Cummings DAT, Rodriguez-Barraquer I, Katzelnick LC, Lessler J, Klungthong C, Thaisomboonsuk B, Nisalak A, Weg A, Ellison D, Macareo L, Yoon IK, Jarman R, Thomas S, Rothman AL, Endy T, Cauchemez S. Reconstruction of antibody dynamics and infection histories to evaluate dengue risk. Nature 2018; 557:719-723. [PMID: 29795354 PMCID: PMC6064976 DOI: 10.1038/s41586-018-0157-4] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/24/2018] [Indexed: 11/25/2022]
Abstract
As with many pathogens, most dengue infections are subclinical and therefore unobserved1. Coupled with limited understanding of the dynamical behavior of potential serological markers of infection, this observational problem has wide-ranging implications, including hampering our understanding of individual- and population-level correlates of infection and disease risk and how they change over time, assay interpretation and cohort design. We develop a framework that simultaneously characterizes antibody dynamics and identifies subclinical infections via Bayesian augmentation from detailed cohort data (3,451 individuals with blood draws every 91 days, 143,548 hemagglutination inhibition assay titer measurements)2,3. We identify 1,149 infections (95% CI: 1,135–1,163) that were not detected by active surveillance and estimate that 65% of infections are subclinical. Post infection, individuals develop a stable setpoint antibody load after 1y that places them within or outside a risk window. Individuals with pre-existing titers of ≤1:40 develop hemorrhagic fever 7.4 (95% CI: 2.5–8.2) times as often as naïve individuals compared to 0.0 times for individuals with titers >1:40 (95% CI: 0.0–1.3). PRNT titers ≤1:100 were similarly associated with severe disease. Across the population, variability in the force of infection results in large-scale temporal changes in infection and disease risk that correlate poorly with age.
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Affiliation(s)
- Henrik Salje
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France. .,CNRS UMR2000, Génomique évolutive, modélisation et santé (GEMS), Institut Pasteur, Paris, France. .,Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France. .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Derek A T Cummings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Department of Biology, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | | | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Ananda Nisalak
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Alden Weg
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Damon Ellison
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Louis Macareo
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - In-Kyu Yoon
- International Vaccine Institute, Seoul, South Korea
| | - Richard Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Stephen Thomas
- Department of Medicine, Upstate Medical University of New York, Syracuse, NY, USA
| | - Alan L Rothman
- Institute for Immunology and Informatics, Department of Cell and Molecular Biology, University of Rhode Island, Providence, RI, USA
| | - Timothy Endy
- Department of Medicine, Upstate Medical University of New York, Syracuse, NY, USA
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France.,CNRS UMR2000, Génomique évolutive, modélisation et santé (GEMS), Institut Pasteur, Paris, France.,Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France
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Halstead SB. Safety issues from a Phase 3 clinical trial of a live-attenuated chimeric yellow fever tetravalent dengue vaccine. Hum Vaccin Immunother 2018; 14:2158-2162. [PMID: 29482433 PMCID: PMC6183135 DOI: 10.1080/21645515.2018.1445448] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/21/2018] [Indexed: 11/08/2022] Open
Abstract
A tetravalent live-attenuated 3-dose vaccine composed of chimeras of yellow fever 17D and the four dengue viruses (CYD, also called Dengvaxia) completed phase 3 clinical testing in over 35,000 children leading to a recommendation that vaccine be administered to >/ = 9 year-olds residing in highly dengue- endemic countries. When clinical trial results were assessed 2 years after the first dose, vaccine efficacy among seropositives was high, but among seronegatives efficacy was marginal. Breakthrough dengue hospitalizations of vaccinated children occurred continuously over a period of 4-5 years post 3rd dose in an age distribution suggesting these children had been vaccinated when seronegative. This surmise was validated recently when the manufacturer reported that dengue NS1 IgG antibodies were absent in sera from hospitalized vaccinated children, an observation consistent with their having received Dengvaxia when seronegative. Based upon published efficacy data and in compliance with initial published recommendations by the manufacturer and WHO the Philippine government undertook to vaccinate 800,000-plus 9 year-olds starting in April 2016. Eighteen months later, dengue hospitalizations and a deaths were reported among vaccinated children. The benefits of administering Dengvaxia predicted by the manufacturer, WHO and others derive from scoring dengue hospitalizations of vaccinated children as vaccine failures rather than as vaccine enhanced dengue disease. Recommended regimens for administration of Dengvaxia should have been structured to warn of and avoid serious adverse events.
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ten Bosch QA, Clapham HE, Lambrechts L, Duong V, Buchy P, Althouse BM, Lloyd AL, Waller LA, Morrison AC, Kitron U, Vazquez-Prokopec GM, Scott TW, Perkins TA. Contributions from the silent majority dominate dengue virus transmission. PLoS Pathog 2018; 14:e1006965. [PMID: 29723307 PMCID: PMC5933708 DOI: 10.1371/journal.ppat.1006965] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 03/09/2018] [Indexed: 02/07/2023] Open
Abstract
Despite estimates that, each year, as many as 300 million dengue virus (DENV) infections result in either no perceptible symptoms (asymptomatic) or symptoms that are sufficiently mild to go undetected by surveillance systems (inapparent), it has been assumed that these infections contribute little to onward transmission. However, recent blood-feeding experiments with Aedes aegypti mosquitoes showed that people with asymptomatic and pre-symptomatic DENV infections are capable of infecting mosquitoes. To place those findings into context, we used models of within-host viral dynamics and human demographic projections to (1) quantify the net infectiousness of individuals across the spectrum of DENV infection severity and (2) estimate the fraction of transmission attributable to people with different severities of disease. Our results indicate that net infectiousness of people with asymptomatic infections is 80% (median) that of people with apparent or inapparent symptomatic infections (95% credible interval (CI): 0–146%). Due to their numerical prominence in the infectious reservoir, clinically inapparent infections in total could account for 84% (CI: 82–86%) of DENV transmission. Of infections that ultimately result in any level of symptoms, we estimate that 24% (95% CI: 0–79%) of onward transmission results from mosquitoes biting individuals during the pre-symptomatic phase of their infection. Only 1% (95% CI: 0.8–1.1%) of DENV transmission is attributable to people with clinically detected infections after they have developed symptoms. These findings emphasize the need to (1) reorient current practices for outbreak response to adoption of pre-emptive strategies that account for contributions of undetected infections and (2) apply methodologies that account for undetected infections in surveillance programs, when assessing intervention impact, and when modeling mosquito-borne virus transmission. Most dengue virus infections result in either no perceptible symptoms or symptoms that are so mild that they go undetected by surveillance systems. It is unclear how much these infections contribute to the overall transmission and burden of dengue. At an individual level, we show that people with asymptomatic infections are approximately 80% as infectious to mosquitoes as their symptomatic counterparts. At a population level, we show that approximately 88% of infections result from people who display no apparent symptoms at the time of transmission. These results suggest that individuals undetected by surveillance systems may be the primary reservoir of dengue virus transmission and that policy for dengue control and prevention must be revised accordingly.
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Affiliation(s)
- Quirine A. ten Bosch
- Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States
- * E-mail: (QAtB); (TAP)
| | - Hannah E. Clapham
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Louis Lambrechts
- Insect-Virus Interactions Group, Department of Genomes and Genetics, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 2000, Paris, France
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Philippe Buchy
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
- GlaxoSmithKline, Vaccines R&D, Singapore
| | - Benjamin M. Althouse
- Institute for Disease Modeling, Bellevue, WA, United States
- Information School, University of Washington, Seattle, WA, United States
- Department of Biology, New Mexico State University, Las Cruces, NM, United States
| | - Alun L. Lloyd
- Department of Mathematics, Biomathematics Graduate Program and Center for Quantitative Sciences in Biomedicine, North Carolina State University, Raleigh, NC, United States
| | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Amy C. Morrison
- Department of Entomology and Nematology, University of California, Davis, CA, United States
| | - Uriel Kitron
- Department of Environmental Sciences, Emory University, Atlanta, GA, United States
| | | | - Thomas W. Scott
- Department of Entomology and Nematology, University of California, Davis, CA, United States
| | - T. Alex Perkins
- Department of Biological Sciences, Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, United States
- * E-mail: (QAtB); (TAP)
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116
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Lourenço J, Tennant W, Faria NR, Walker A, Gupta S, Recker M. Challenges in dengue research: A computational perspective. Evol Appl 2018; 11:516-533. [PMID: 29636803 PMCID: PMC5891037 DOI: 10.1111/eva.12554] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/08/2017] [Indexed: 01/12/2023] Open
Abstract
The dengue virus is now the most widespread arbovirus affecting human populations, causing significant economic and social impact in South America and South-East Asia. Increasing urbanization and globalization, coupled with insufficient resources for control, misguided policies or lack of political will, and expansion of its mosquito vectors are some of the reasons why interventions have so far failed to curb this major public health problem. Computational approaches have elucidated on dengue's population dynamics with the aim to provide not only a better understanding of the evolution and epidemiology of the virus but also robust intervention strategies. It is clear, however, that these have been insufficient to address key aspects of dengue's biology, many of which will play a crucial role for the success of future control programmes, including vaccination. Within a multiscale perspective on this biological system, with the aim of linking evolutionary, ecological and epidemiological thinking, as well as to expand on classic modelling assumptions, we here propose, discuss and exemplify a few major computational avenues-real-time computational analysis of genetic data, phylodynamic modelling frameworks, within-host model frameworks and GPU-accelerated computing. We argue that these emerging approaches should offer valuable research opportunities over the coming years, as previously applied and demonstrated in the context of other pathogens.
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Affiliation(s)
| | - Warren Tennant
- Centre for Mathematics and the EnvironmentUniversity of ExeterPenrynUK
| | | | | | | | - Mario Recker
- Centre for Mathematics and the EnvironmentUniversity of ExeterPenrynUK
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117
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Pavía-Ruz N, Diana Patricia Rojas, Salha Villanueva, Granja P, Balam-May A, Longini IM, Halloran ME, Manrique-Saide P, Gómez-Dantés H. Seroprevalence of Dengue Antibodies in Three Urban Settings in Yucatan, Mexico. Am J Trop Med Hyg 2018; 98:1202-1208. [PMID: 29460714 PMCID: PMC5928812 DOI: 10.4269/ajtmh.17-0382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/25/2017] [Indexed: 12/19/2022] Open
Abstract
Dengue transmission in Mexico has become a major public health problem. Few epidemiological studies have examined the seroprevalence of dengue in Mexico, and recent estimates are needed to better understand dengue transmission dynamics. We conducted a dengue seroprevalence survey among 1,668 individuals including all age groups in three urban settings in Yucatan, Mexico. Children (< 19 years old) were selected randomly from schools. The adults (≥ 19 years old) were selected from healthcare facilities. Participants were asked to provide a venous blood sample and to answer a brief questionnaire with demographic information. Previous exposure to dengue was determined using indirect immunoglobulin G enzyme-linked immunosorbent assay. The overall seroprevalence was 73.6%. The age-specific seroprevalence increased with age, going from 51.4% (95% confidence interval [CI] = 45.0-57.9%) in children ≤ 8 years to 72% (95% CI = 66.3-77.2%) in the 9- to 14-years old. The highest seroprevalence was 83.4% (95% CI = 77-82.2%) in adults greater than 50 years. The seroprevalence in Merida was 68.6% (95% CI = 65-72%), in Progreso 68.7% (95% CI = 64.2-72.8%), and in Ticul 85.3% (95% CI = 81.9-88.3%). Ticul had the highest seroprevalence in all age groups. Logistic regression analysis showed that age and city of residence were associated with greater risk of prior dengue exposure. The results highlight the level of past exposure to dengue virus including young children. Similar studies should be conducted elsewhere in Mexico and other endemic countries to better understand the transmission dynamics of dengue.
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Affiliation(s)
- Norma Pavía-Ruz
- Regional Research Center Hideyo Noguchi, Universidad Autonoma de Yucatan, Merida, Mexico
| | - Diana Patricia Rojas
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Salha Villanueva
- State Public Health Laboratory, Ministry of Health, Merida, Mexico
| | - Pilar Granja
- State Public Health Laboratory, Ministry of Health, Merida, Mexico
| | - Angel Balam-May
- Regional Research Center Hideyo Noguchi, Universidad Autonoma de Yucatan, Merida, Mexico
| | - Ira M. Longini
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - M. Elizabeth Halloran
- Center for Inference and Dynamics of Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Pablo Manrique-Saide
- Collaborative Unit for Entomological Bioassays, Universidad Autonoma de Yucatan, Merida, Mexico
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118
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Four-year safety follow-up of the tetravalent dengue vaccine CYD-TDV. Clin Microbiol Infect 2018; 24:680-681. [PMID: 29581052 DOI: 10.1016/j.cmi.2018.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
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119
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Lee JS, Lourenço J, Gupta S, Farlow A. A multi-country study of dengue vaccination strategies with Dengvaxia and a future vaccine candidate in three dengue-endemic countries: Vietnam, Thailand, and Colombia. Vaccine 2018; 36:2346-2355. [PMID: 29573874 DOI: 10.1016/j.vaccine.2018.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/15/2018] [Accepted: 03/01/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The dengue vaccination era began when Dengvaxia (CYD-TDV) became available in 2016. In addition, several second-generation vaccine candidates are currently in phase 3 trials, suggesting that a broader availability of dengue vaccines may be possible in the near future. Advancing on the recent WHO-SAGE recommendations for the safe and effective use of CYD-TDV at the regional level on average, this study investigates the vaccination impacts and cost-effectiveness of CYD-TDV and of a hypothetical new vaccine candidate (NVC) in a country-specific manner for three endemic countries: Vietnam, Thailand, and Colombia. METHODS The vaccination impacts of CYD-TDV and NVC were derived by fitting the empirical seroprevalence rates of 9 year olds into an individual-based meta-population transmission model, previously used for the WHO-SAGE working group. The disability-adjusted life years were estimated by applying country-specific parametric values. The cost-effectiveness analyses of four intervention strategies in combination with routine and catch-up campaigns were compared for both vaccines to inform decision makers regarding the most suitable immunization program in each of the three countries. RESULTS AND CONCLUSION Both CYD-TDV and NVC could be cost-effective at the DALY threshold cost of $2000 depending upon vaccination costs. With CYD-TDV, targeting 9 year olds in routine vaccination programs and 10-29 year olds as a one-off catch-up campaign was the most cost-effective strategy in all three countries. With NVC, while the most cost-effective strategy was to vaccinate 9-29 and 9-18 year olds in Vietnam and Thailand respectively, vaccinating younger age cohorts between 1 and 5 years old in Colombia was more cost-effective than other strategies. Given that three countries will soon face decisions regarding whether and how to incorporate CYD-TDV or future dengue vaccines into their budget-constrained national immunization programs, the current study outcomes can be used to help decision makers understand the expected impacts and cost-effectiveness of such vaccines.
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Affiliation(s)
- Jung-Seok Lee
- Department of Zoology, University of Oxford, Oxford, UK.
| | - José Lourenço
- Department of Zoology, University of Oxford, Oxford, UK
| | - Sunetra Gupta
- Department of Zoology, University of Oxford, Oxford, UK
| | - Andrew Farlow
- Department of Zoology, University of Oxford, Oxford, UK
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120
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Wichmann O, Vannice K, Asturias EJ, de Albuquerque Luna EJ, Longini I, Lopez AL, Smith PG, Tissera H, Yoon IK, Hombach J. Live-attenuated tetravalent dengue vaccines: The needs and challenges of post-licensure evaluation of vaccine safety and effectiveness. Vaccine 2018; 35:5535-5542. [PMID: 28893477 DOI: 10.1016/j.vaccine.2017.08.066] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 11/16/2022]
Abstract
Since December 2015, the first dengue vaccine has been licensed in several Asian and Latin American countries for protection against disease from all four dengue virus serotypes. While the vaccine demonstrated an overall good safety and efficacy profile in clinical trials, some key research questions remain which make risk-benefit-assessment for some populations difficult. As for any new vaccine, several questions, such as very rare adverse events following immunization, duration of vaccine-induced protection and effectiveness when used in public health programs, will be addressed by post-licensure studies and by data from national surveillance systems after the vaccine has been introduced. However, the complexity of dengue epidemiology, pathogenesis and population immunity, as well as some characteristics of the currently licensed vaccine, and potentially also future, live-attenuated dengue vaccines, poses a challenge for evaluation through existing monitoring systems, especially in low and middle-income countries. Most notable are the different efficacies of the currently licensed vaccine by dengue serostatus at time of first vaccination and by dengue virus serotype, as well as the increased risk of dengue hospitalization among young vaccinated children observed three years after the start of vaccination in one of the trials. Currently, it is unknown if the last phenomenon is restricted to younger ages or could affect also seronegative individuals aged 9years and older, who are included in the group for whom the vaccine has been licensed. In this paper, we summarize scientific and methodological considerations for public health surveillance and targeted post-licensure studies to address some key research questions related to live-attenuated dengue vaccines. Countries intending to introduce a dengue vaccine should assess their capacities to monitor and evaluate the vaccine's effectiveness and safety and, where appropriate and possible, enhance their surveillance systems accordingly. Targeted studies are needed, especially to better understand the effects of vaccinating seronegative individuals.
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Affiliation(s)
- Ole Wichmann
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland; Robert Koch Institute, Berlin, Germany
| | - Kirsten Vannice
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland
| | - Edwin J Asturias
- University of Colorado School of Medicine, Aurora, CO, United States; Colorado School of Public Health, Aurora, CO, United States
| | | | - Ira Longini
- University of Florida, Gainesville, FL, United States
| | - Anna Lena Lopez
- University of the Philippines Manila - National Institutes of Health, Manila, Philippines
| | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hasitha Tissera
- National Dengue Control Unit, Ministry of Health, Colombo, Sri Lanka
| | - In-Kyu Yoon
- International Vaccine Institute, Seoul, South Korea
| | - Joachim Hombach
- World Health Organization, Department of Immunizations, Vaccines and Biologicals, Geneva, Switzerland.
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121
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Dorigatti I, McCormack C, Nedjati-Gilani G, Ferguson NM. Using Wolbachia for Dengue Control: Insights from Modelling. Trends Parasitol 2018; 34:102-113. [PMID: 29183717 PMCID: PMC5807169 DOI: 10.1016/j.pt.2017.11.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 12/23/2022]
Abstract
Dengue is the most common arboviral infection of humans, responsible for a substantial disease burden across the tropics. Traditional insecticide-based vector-control programmes have limited effectiveness, and the one licensed vaccine has a complex and imperfect efficacy profile. Strains of the bacterium Wolbachia, deliberately introduced into Aedes aegyptimosquitoes, have been shown to be able to spread to high frequencies in mosquito populations in release trials, and mosquitoes infected with these strains show markedly reduced vector competence. Thus, Wolbachia represents an exciting potential new form of biocontrol for arboviral diseases, including dengue. Here, we review how mathematical models give insight into the dynamics of the spread of Wolbachia, the potential impact of Wolbachia on dengue transmission, and we discuss the remaining challenges in evaluation and development.
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Affiliation(s)
- Ilaria Dorigatti
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK; These authors made equal contributions
| | - Clare McCormack
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK; These authors made equal contributions
| | - Gemma Nedjati-Gilani
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK; These authors made equal contributions
| | - Neil M Ferguson
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK.
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122
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Abstract
PURPOSE OF REVIEW Dengue, the most common arbovirus, is an increasingly significant cause of morbidity worldwide. After decades of research, an approved tetravalent dengue vaccine is finally available. Models constructed using recently available vaccine efficacy data allow for a data-driven discussion of the potential impact of dengue vaccine deployment on global control. RECENT FINDINGS Phase 3 efficacy trials demonstrated that the approved dengue vaccine, chimeric yellow fever-dengue-tetravalent dengue vaccine, has an efficacy of 60% against dengue illness of any severity. However, among dengue unexposed recipients, vaccination offers limited efficacy and may increase dengue severity. The WHO consequently recommends dengue vaccination for populations in which 70% of intended recipients are dengue seropositive. Models predict that routine childhood dengue vaccine may reduce dengue burden, but over time, population-level impact may be limited. Additional vaccine candidates in late-stage development may not suffer from the same limitations as chimeric yellow fever-dengue-tetravalent dengue vaccine. SUMMARY The efficacy and safety profile of the recently approved dengue vaccine is favorable only in previously dengue exposed recipients, which limits its potential for global control. Future work must evaluate the approved vaccine's long-term durability, efficacy of other late phase vaccine candidates, and potential for vector control efforts to work synergistically with vaccine deployment.
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123
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Kraemer MUG, Bisanzio D, Reiner RC, Zakar R, Hawkins JB, Freifeld CC, Smith DL, Hay SI, Brownstein JS, Perkins TA. Inferences about spatiotemporal variation in dengue virus transmission are sensitive to assumptions about human mobility: a case study using geolocated tweets from Lahore, Pakistan. EPJ DATA SCIENCE 2018; 7:16. [PMID: 30854281 PMCID: PMC6404370 DOI: 10.1140/epjds/s13688-018-0144-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/31/2018] [Indexed: 05/14/2023]
Abstract
UNLABELLED Billions of users of mobile phones, social media platforms, and other technologies generate an increasingly large volume of data that has the potential to be leveraged towards solving public health challenges. These and other big data resources tend to be most successful in epidemiological applications when utilized within an appropriate conceptual framework. Here, we demonstrate the importance of assumptions about host mobility in a framework for dynamic modeling of infectious disease spread among districts within a large urban area. Our analysis focused on spatial and temporal variation in the transmission of dengue virus (DENV) during a series of large seasonal epidemics in Lahore, Pakistan during 2011-2014. Similar to many directly transmitted diseases, DENV transmission occurs primarily where people spend time during daytime hours, given that DENV is transmitted by a day-biting mosquito. We inferred spatiotemporal variation in DENV transmission under five different assumptions about mobility patterns among ten districts of Lahore: no movement among districts, movement following patterns of geo-located tweets, movement proportional to district population size, and movement following the commonly used gravity and radiation models. Overall, we found that inferences about spatiotemporal variation in DENV transmission were highly sensitive to this range of assumptions about intra-urban human mobility patterns, although the three assumptions that allowed for a modest degree of intra-urban mobility all performed similarly in key respects. Differing inferences about transmission patterns based on our analysis are significant from an epidemiological perspective, as they have different implications for where control efforts should be targeted and whether conditions for transmission became more or less favorable over time. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (10.1140/epjds/s13688-018-0144-x) contains supplementary material.
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Affiliation(s)
- Moritz U. G. Kraemer
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, USA
- Department of Zoology, University of Oxford, Oxford, UK
| | - D. Bisanzio
- RTI International, Washington, USA
- Center for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - R. C. Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - R. Zakar
- Department of Public Health, University of Punjab, Lahore, Pakistan
| | - J. B. Hawkins
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, USA
| | - C. C. Freifeld
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, USA
- College of Computer and Information Science, Northeastern University, Boston, USA
| | - D. L. Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
- Sanaria Institute for Global Health and Tropical Medicine, Rockville, USA
| | - S. I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - J. S. Brownstein
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, USA
| | - T. Alex Perkins
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, USA
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Dengue vaccine supplies under endemic and epidemic conditions in three dengue-endemic countries: Colombia, Thailand, and Vietnam. Vaccine 2017; 35:6957-6966. [PMID: 29110932 DOI: 10.1016/j.vaccine.2017.10.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Dengue fever has been a major public health concern in Colombia, Thailand, and Vietnam. Unlike other infectious diseases, dengue vaccines had not been available for a long time, causing difficulties to control the disease. However, the first live attenuated, tetravalent dengue vaccine (CYD-TDV) became available in 2016 and has been already licensed in some dengue-endemic countries. Because several second-generation dengue vaccines are also in the pipeline, it is critical to understand the efficient allocation of dengue vaccines considering the geographical variation of the disease. METHODS The Climate Risk Factor (CRF) index was created using the climate and non-climate factors in the three countries. A random-coefficient negative binomial model was chosen to validate the relationship between the CRF index and dengue incidence proxy. Given the statistical significance of the CRF index, high risk areas for dengue fever were identified at the 5 km by 5 km resolution and used to estimate vaccination coverage rates and the number of doses required for various types of vaccination scenarios by country. RESULTS AND CONCLUSIONS Based upon a three-dose scheme, the estimated number of vaccines required for routine vaccination targeting 9 years old ranged from 1 to 2.6 million doses across the countries during the first year of introduction. A one-off catch-up campaign targeting the age group of 10-17 year olds would require 8 to 18 million additional doses. Routine vaccination (with or without a catch-up campaign) covered 63%, 90%, and 91% of the targeted age group populations in Colombia, Thailand, and Vietnam respectively. Given that many dengue-endemic countries face limited resources and that the costs for mass vaccination campaigns may not be trivial, the findings of this study can guide the decision makers in the three countries regarding the efficient distribution of vaccines by identifying populations at high risk at 5 km by 5 km resolution.
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Viboud C, Simonsen L, Chowell G, Vespignani A. The RAPIDD Ebola forecasting challenge special issue: Preface. Epidemics 2017; 22:1-2. [PMID: 29126933 DOI: 10.1016/j.epidem.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
| | - Lone Simonsen
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; Department of Global Health, George Washington University, Washington, DC, USA
| | - Gerardo Chowell
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA; School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Alessandro Vespignani
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA, USA; Institute for Quantitative Social Sciences at Harvard University, Cambridge, MA, USA; Institute for Scientific Interchange Foundation, Turin, Italy
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El Fezzazi H, Branchu M, Carrasquilla G, Pitisuttithum P, Perroud AP, Frago C, Coudeville L. Resource Use and Costs of Dengue: Analysis of Data from Phase III Efficacy Studies of a Tetravalent Dengue Vaccine. Am J Trop Med Hyg 2017; 97:1898-1903. [PMID: 29141713 PMCID: PMC5805027 DOI: 10.4269/ajtmh.16-0952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A tetravalent dengue vaccine (CYD-TDV) has recently been approved in 12 countries in southeast Asia and Latin America for individuals aged 9–45 years or 9–60 years (age indication approvals vary by country) living in endemic areas. Data on utilization of medical and nonmedical resources as well as time lost from school and work were collected during the active phase of two phase III efficacy studies performed in 10 countries in the Asia-Pacific region and Latin America (NCT01373281; NCT01374516). We compared dengue-related resource utilization and costs among vaccinated and nonvaccinated participants. Country-specific unit costs were derived from available literature. There were 901 virologically confirmed dengue episodes among participants aged ≥ 9 years (N = 25,826): corresponding to 373 episodes in the CYD-TDV group (N = 17,230) and 528 episodes in the control group (N = 8,596). Fewer episodes in the CYD-TDV group resulted in hospitalization than in the control group (7.0% versus 13.3%; P = 0.002), but both had a similar average length of stay of 4 days. Overall, a two-thirds reduction in resource consumption and missed school/work days was observed in the CYD-TDV group relative to the control group. The estimated direct and indirect cost (2014 I$) associated with dengue episodes per participant in the CYD-TDV group was 73% lower than in the control group (I$6.72 versus I$25.08); representing a saving of I$I8.36 (95% confidence interval [CI]:17.05–19.78) per participant with vaccination. This is the first study providing information on dengue costs among vaccinated individuals and direct confirmation that vaccination has the potential to reduce dengue illness costs.
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Affiliation(s)
- Hanna El Fezzazi
- Dengue Vaccination Impact and Economics, Sanofi Pasteur, Lyon, France
| | - Marie Branchu
- Ecole des Hautes Etudes en Santé Publique (EHESP)-ESSEC Business School, Cergy, France
| | | | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ana Paula Perroud
- Clinical Research and Development, Sanofi Pasteur, Sâo Paulo, Brazil
| | - Carina Frago
- Clinical Sciences, Sanofi Pasteur, Singapore, Singapore
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127
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Vigne C, Dupuy M, Richetin A, Guy B, Jackson N, Bonaparte M, Hu B, Saville M, Chansinghakul D, Noriega F, Plennevaux E. Integrated immunogenicity analysis of a tetravalent dengue vaccine up to 4 y after vaccination. Hum Vaccin Immunother 2017; 13:2004-2016. [PMID: 28598256 PMCID: PMC5612045 DOI: 10.1080/21645515.2017.1333211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/28/2017] [Accepted: 05/17/2017] [Indexed: 11/09/2022] Open
Abstract
Two large pivotal phase III studies demonstrated the efficacy of the tetravalent dengue vaccine (CYD-TDV; Dengvaxia®, Sanofi Pasteur) against all dengue serotypes. Here we present an unprecedented integrated summary of the immunogenicity of CYD-TDV to identify the parameters driving the neutralizing humoral immune response and evolution over time. We summarized the immunogenicity profiles of a 3-dose schedule of CYD-TDV administered 6 months apart across 10 phase II and 6 phase III trials undertaken in dengue endemic and non-endemic countries. Dengue neutralizing antibody titers in sera were determined at centralized laboratories using the 50% plaque reduction neutralization test (PRNT50) at baseline, 28 d after the third dose, and annually thereafter for up to 4 y after the third dose in some studies. CYD-TDV elicits neutralizing antibody responses against all 4 dengue serotypes; geometric mean titers (GMTs) increased from baseline to post-dose 3. GMTs were influenced by several parameters including age, baseline dengue seropositivity and region. In the 2 pivotal studies, GMTs decreased initially during the first 2 y post-dose 3 but appear to stabilize or slightly increase again in the third year. GMTs persisted 1.2-3.2-fold higher than baseline levels for up to 4 y post-dose 3 in other studies undertaken in dengue endemic countries. Our integrated analysis captures the fullness of the CYD-TDV immunogenicity profile across studies, age groups and regions; by presenting the available data in this way general trends and substantial outliers within each grouping can be easily identified. CYD-TDV elicits neutralizing antibody responses against all dengue serotypes, with differences by age and endemicity, which persist above baseline levels in endemic countries.
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Affiliation(s)
- Claire Vigne
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
| | - Martin Dupuy
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
| | - Aline Richetin
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
| | - Bruno Guy
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
| | | | - Matthew Bonaparte
- Global Clinical Immunology Department, Sanofi Pasteur, Swiftwater, PA, USA
| | - Branda Hu
- Global Clinical Immunology Department, Sanofi Pasteur, Swiftwater, PA, USA
| | | | | | | | - Eric Plennevaux
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
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128
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Fernandez EA. Moving to a Dengue Preventive Treatment Through New Vaccines. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017. [DOI: 10.1007/s40506-017-0132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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129
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Katzelnick LC, Harris E. Immune correlates of protection for dengue: State of the art and research agenda. Vaccine 2017; 35:4659-4669. [PMID: 28757058 PMCID: PMC5924688 DOI: 10.1016/j.vaccine.2017.07.045] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/04/2017] [Accepted: 07/13/2017] [Indexed: 01/15/2023]
Abstract
Dengue viruses (DENV1-4) are mosquito-borne flaviviruses estimated to cause up to ∼400 million infections and ∼100 million dengue cases each year. Factors that contribute to protection from and risk of dengue and severe dengue disease have been studied extensively but are still not fully understood. Results from Phase 3 vaccine efficacy trials have recently become available for one vaccine candidate, now licensed for use in several countries, and more Phase 2 and 3 studies of additional vaccine candidates are ongoing, making these issues all the more urgent and timely. At the "Summit on Dengue Immune Correlates of Protection", held in Annecy, France, on March 8-9, 2016, dengue experts from diverse fields came together to discuss the current understanding of the immune response to and protection from DENV infection and disease, identify key unanswered questions, discuss data on immune correlates and plans for comparison of results across assays/consortia, and propose a research agenda for investigation of dengue immune correlates, all in the context of both natural infection studies and vaccine trials.
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Affiliation(s)
- Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720-3370, USA; Department of Biology, University of Florida, Gainesville, FL 32611, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720-3370, USA.
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130
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Fitzpatrick C, Haines A, Bangert M, Farlow A, Hemingway J, Velayudhan R. An economic evaluation of vector control in the age of a dengue vaccine. PLoS Negl Trop Dis 2017; 11:e0005785. [PMID: 28806786 PMCID: PMC5573582 DOI: 10.1371/journal.pntd.0005785] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/28/2017] [Accepted: 07/06/2017] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Dengue is a rapidly emerging vector-borne Neglected Tropical Disease, with a 30-fold increase in the number of cases reported since 1960. The economic cost of the illness is measured in the billions of dollars annually. Environmental change and unplanned urbanization are conspiring to raise the health and economic cost even further beyond the reach of health systems and households. The health-sector response has depended in large part on control of the Aedes aegypti and Ae. albopictus (mosquito) vectors. The cost-effectiveness of the first-ever dengue vaccine remains to be evaluated in the field. In this paper, we examine how it might affect the cost-effectiveness of sustained vector control. METHODS We employ a dynamic Markov model of the effects of vector control on dengue in both vectors and humans over a 15-year period, in six countries: Brazil, Columbia, Malaysia, Mexico, the Philippines, and Thailand. We evaluate the cost (direct medical costs and control programme costs) and cost-effectiveness of sustained vector control, outbreak response and/or medical case management, in the presence of a (hypothetical) highly targeted and low cost immunization strategy using a (non-hypothetical) medium-efficacy vaccine. RESULTS Sustained vector control using existing technologies would cost little more than outbreak response, given the associated costs of medical case management. If sustained use of existing or upcoming technologies (of similar price) reduce vector populations by 70-90%, the cost per disability-adjusted life year averted is 2013 US$ 679-1331 (best estimates) relative to no intervention. Sustained vector control could be highly cost-effective even with less effective technologies (50-70% reduction in vector populations) and in the presence of a highly targeted and low cost immunization strategy using a medium-efficacy vaccine. DISCUSSION Economic evaluation of the first-ever dengue vaccine is ongoing. However, even under very optimistic assumptions about a highly targeted and low cost immunization strategy, our results suggest that sustained vector control will continue to play an important role in mitigating the impact of environmental change and urbanization on human health. If additional benefits for the control of other Aedes borne diseases, such as Chikungunya, yellow fever and Zika fever are taken into account, the investment case is even stronger. High-burden endemic countries should proceed to map populations to be covered by sustained vector control.
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Affiliation(s)
- Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Alexander Haines
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- National Guideline Centre, Royal College of Physicians, London, United Kingdom
| | - Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Andrew Farlow
- Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Janet Hemingway
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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131
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Abstract
The first approved dengue vaccine, CYD-TDV, a chimeric, live-attenuated, tetravalent dengue virus vaccine, was recently licensed in 13 countries, including Brazil. In light of recent vaccine approval, we modeled the cost-effectiveness of potential vaccination policies mathematically based on data from recent vaccine efficacy trials that indicated that vaccine efficacy was lower in seronegative individuals than in seropositive individuals. In our analysis, we investigated several vaccination programs, including routine vaccination, with various vaccine coverage levels and those with and without large catch-up campaigns. As it is unclear whether the vaccine protects against infection or just against disease, our model incorporated both direct and indirect effects of vaccination. We found that in the presence of vaccine-induced indirect protection, the cost-effectiveness of dengue vaccination decreased with increasing vaccine coverage levels because the marginal returns of herd immunity decreases with vaccine coverage. All routine dengue vaccination programs that we considered were cost-effective, reducing dengue incidence significantly. Specifically, a routine dengue vaccination of 9-year-olds would be cost-effective when the cost of vaccination per individual is less than $262. Furthermore, the combination of routine vaccination and large catch-up campaigns resulted in a greater reduction of dengue burden (by up to 93%) than routine vaccination alone, making it a cost-effective intervention as long as the cost per course of vaccination is $255 or less. Our results show that dengue vaccination would be cost-effective in Brazil even with a relatively low vaccine efficacy in seronegative individuals.
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Affiliation(s)
- Eunha Shim
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
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132
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Tsai WY, Lin HE, Wang WK. Complexity of Human Antibody Response to Dengue Virus: Implication for Vaccine Development. Front Microbiol 2017; 8:1372. [PMID: 28775720 PMCID: PMC5517401 DOI: 10.3389/fmicb.2017.01372] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/06/2017] [Indexed: 01/21/2023] Open
Abstract
The four serotypes of dengue virus (DENV) are the leading cause of arboviral diseases in humans. Decades of efforts have made remarkable progress in dengue vaccine development. Despite the first dengue vaccine (dengvaxia from Sanofi Pasteur), a live-attenuated tetravalent chimeric yellow fever-dengue vaccine, has been licensed by several countries since 2016, its overall moderate efficacy (56.5–60.8%) in the presence of neutralizing antibodies during the Phase 2b and 3 trials, lower efficacy among dengue naïve compared with dengue experienced individuals, and increased risk of hospitalization among young children during the follow-up highlight the need for a better understanding of humoral responses after natural DENV infection. Recent studies of more than 300 human monoclonal antibodies (mAbs) against DENV have led to the discovery of several novel epitopes on the envelope protein recognized by potent neutralizing mAbs. This information together with in-depth studies on polyclonal sera and B-cells following natural DENV infection has tremendous implications for better immunogen design for a safe and effective dengue vaccine. This review outlines the progress in our understanding of mouse mAbs, human mAbs, and polyclonal sera against DENV envelope and precursor membrane proteins, two surface proteins involved in vaccine development, following natural infection; analyses of these discoveries have provided valuable insight into new strategies involving molecular technology to induce more potent neutralizing antibodies and less enhancing antibodies for next-generation dengue vaccine development.
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Affiliation(s)
- Wen-Yang Tsai
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at ManoaHonolulu, HI, United States
| | - Hong-En Lin
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at ManoaHonolulu, HI, United States
| | - Wei-Kung Wang
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at ManoaHonolulu, HI, United States
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133
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Vongpunsawad S, Intharasongkroh D, Thongmee T, Poovorawan Y. Seroprevalence of antibodies to dengue and chikungunya viruses in Thailand. PLoS One 2017; 12:e0180560. [PMID: 28662144 PMCID: PMC5491253 DOI: 10.1371/journal.pone.0180560] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/16/2017] [Indexed: 12/31/2022] Open
Abstract
The abundance of Aedes mosquito species enabled widespread transmission of mosquito-borne chikungunya virus (CHIKV) and dengue virus (DENV) in Southeast Asia. Periodic seroprevalence surveys are therefore necessary to assess the viral burden in the population and the effectiveness of public health interventions. Since the current seroprevalence for CHIKV and DENV in Thailand are unknown, we evaluated evidence of past infection among Thais. Eight-hundred and thirty-five serum samples obtained from individuals living in central and southern Thailand were assessed for anti-CHIKV and anti-DENV IgG antibodies using commercial enzyme-linked immunosorbent assays. Overall, 26.8% (224/835) of individuals were seropositive for CHIKV, the majority of whom were also DENV-seropositive (91.1%, 204/224). Approximately half of all adults in their fifth decade of life had attained CHIKV seropositivity. Children under 15 years of age in southern Thailand were significantly more likely to be CHIKV-seropositive compared to those residing in central Thailand. In contrast, 79.2% (661/835) of Thais were DENV-seropositive, 30.9% (204/661) of whom also had antibodies to CHIKV. CHIKV/DENV dual seropositivity among Thais was 24.4% (204/835). The age-standardized seroprevalence for DENV was three times that of CHIKV (80.5% vs. 27.2%). Relatively high CHIKV seroprevalence among adults living in central Thailand revealed an under-recognized CHIKV burden in the region, while the low-to-moderate transmission intensity of DENV (seroprevalence <50% at 9 years) is expected to reduce the impact of DENV vaccination in Thailand. This most recent seroprevalence data provide serological baselines for two of the most common mosquito-borne viruses in this region.
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Affiliation(s)
- Sompong Vongpunsawad
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Duangnapa Intharasongkroh
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanunrat Thongmee
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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134
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Hall A, Troupin A, Londono-Renteria B, Colpitts TM. Garlic Organosulfur Compounds Reduce Inflammation and Oxidative Stress during Dengue Virus Infection. Viruses 2017. [PMID: 28644404 PMCID: PMC5537651 DOI: 10.3390/v9070159] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Dengue virus (DENV) is a mosquito-borne flavivirus that causes significant global human disease and mortality. One approach to develop treatments for DENV infection and the prevention of severe disease is through investigation of natural medicines. Inflammation plays both beneficial and harmful roles during DENV infection. Studies have proposed that the oxidative stress response may be one mechanism responsible for triggering inflammation during DENV infection. Thus, blocking the oxidative stress response could reduce inflammation and the development of severe disease. Garlic has been shown to both reduce inflammation and affect the oxidative stress response. Here, we show that the garlic active compounds diallyl disulfide (DADS), diallyl sulfide (DAS) and alliin reduced inflammation during DENV infection and show that this reduction is due to the effects on the oxidative stress response. These results suggest that garlic could be used as an alternative treatment for DENV infection and for the prevention of severe disease development.
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Affiliation(s)
- Alex Hall
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA.
| | - Andrea Troupin
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA.
| | - Berlin Londono-Renteria
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Tonya M Colpitts
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC 29209, USA.
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135
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Guy B, Noriega F, Ochiai RL, L’azou M, Delore V, Skipetrova A, Verdier F, Coudeville L, Savarino S, Jackson N. A recombinant live attenuated tetravalent vaccine for the prevention of dengue. Expert Rev Vaccines 2017; 16:1-13. [DOI: 10.1080/14760584.2017.1335201] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Bruno Guy
- Research & Development, Sanofi Pasteur, Lyon, France
| | | | | | - Maïna L’azou
- Global Epidemiology, Sanofi Pasteur, Lyon, France
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136
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Abstract
In a Perspective, Jacqueline Deeen discusses challenges in balancing the individual and population risks and benefits for CYD-TDV (Dengvaxia), the first available dengue vaccine.
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