Prevention of typhoid fever in Nepal with the Vi capsular polysaccharide of Salmonella typhi. A preliminary report

Epidemiology of typhoid fever in Singapore

A total of 1452 cases of typhoid fever was notified in Singapore from 1980-9. The morbidity rates of indigenous cases showed a steady decline from 5.9 per 100,000 population in 1980 to 1.2 per 100,000 population in 1989. The mean case fatality was 0.8%. Children, adolescents and young adults were most susceptible to typhoid fever. There was no significant difference in morbidity rates between the major ethnic groups. The vast majority of indigenous cases were sporadic while outbreaks accounted for almost one third of them. Food was the main vehicle of transmission. The commonest indigenous phage types were B1, D1 and A. Antimicrobial resistance was infrequently seen. The proportion of imported cases rose from 32% in 1980 to 72% in 1989. Almost half (48.5%) of all imported cases were local residents who contracted typhoid fever while travelling in endemic countries. As imported cases assume greater importance in the epidemiology of typhoid fever in Singapore, further drop in typhoid fever incidence would require reduction of travel-related cases through greater awareness of food hygiene and effective vaccination.

Evaluation in volunteers of a candidate live oral attenuated Salmonella typhi vector vaccine

Candidate vector vaccine strain CVD 906 (aroC- and aroD- derivative of virulent Salmonella typhi strain ISP1820) was evaluated in phase 1 clinical trials. The first nine volunteers ingested a single dose of 5 x 10(7) CVD 906 bacilli. At this dose CVD 906 stimulates remarkable systemic and mucosal immune responses, inasmuch as 89% of volunteers developed marked serum antibody levels to S. typhi antigens and high numbers of antigen-specific gut-derived antibody-secreting cells. Four (44%) volunteers developed asymptomatic vaccinemia 4-10 d after immunization and all volunteers excreted CVD 906 on at least one occasion. However, two volunteers developed febrile adverse reactions, one on the day of vaccination and the other on day 4. Of 11 volunteers who ingested a single dose of 5 x 10(3) CVD 906 bacilli, none displayed side effects but 27% developed significant serum responses to S. typhi LPS. In vitro, CVD 906 replicates for only nine generations in pooled human serum, indicating that CVD 906 growth is limited in this physiologically relevant medium. In phorbol myristate acetate-induced U937 human macrophage-like cells, CVD 906 replicates intracellularly to a lesser extent than parent strain ISP1820. Although, strain CVD 906 is attenuated and highly immunogenic, the occasional febrile reactions at high doses indicate that further attenuation of this strain is necessary.

Construction of a recombinant oral vaccine against Salmonella typhi and Salmonella typhimurium

The viaB gene coding for the Vi antigen of Salmonella typhi Ty2 was subcloned into expression vector pYA248. The recombinant plasmid was termed SMM202 and transformed into Salmonella typhimurium chi 4072, an attenuated delta cya delta crp mutant. Recombinant S. typimurium Vi4072 had the ability to produce Vi capsular polysaccharide and also to invade and colonize the small intestine, mesenteric lymph nodes, and spleen of BALB/c mice. Mice orally immunized with Vi4072 developed serum and secretory antibody responses to the Vi antigen, as measured by a passive hemagglutination assay. Mice developed a delayed-type hypersensitivity following a footpad injection with Vi antigen after being sensitized orally with a suitable dose of Vi4072. Immunization of mice with Vi4072 afforded complete protection against fatal infection with virulent S. typhi Ty2. All data indicate that this route of antigen delivery is effective for stimulating antibody-mediated immunity and for inducing a cell-mediated immune response in BALB/c mice. Thus, S. typhimurium Vi4072 may serve as a vaccine for protection against typhoid fever and salmonellosis caused by S. typhimurium.

Antibodies to shiga holotoxin and to two synthetic peptides of the B subunit in sera of patients with Shigella dysenteriae 1 dysentery

Acute- and convalescent-phase sera from 18 Thai patients and convalescent-phase sera from two Israeli patients and one Bangladeshi patient with Shigella dysenteriae 1 (Shiga) dysentery were tested by enzyme-linked immunosorbent assay to detect antibodies that bind S. dysenteriae lipopolysaccharide (LPS), Shiga holotoxin, or two synthetic peptides representing epitopes from the B subunit of Shiga toxin. Paired sera from 24 Maryland adults with Shigella flexneri 2a or Shigella sonnei diarrhea served as negative controls. Of the 16 paired Thai serum samples tested for immunoglobulin G LPS antibody, 10 had greater than or equal to 4-fold rises (the two subjects with the highest convalescent-phase titers exhibited toxin-neutralizing activity); acute-phase specimens from four of the remaining six individuals already had elevated Shiga LPS titers in their acute specimens ranging from 1:800 to 1:12,800. Similarly, convalescent-phase sera from the two Israeli patients and the Bangladeshi patient revealed LPS titers of 1:800 to 1:3,200. In contrast, none of the Maryland volunteers with S. flexneri or S. sonnei diarrhea manifested rises in Shiga anti-LPS (P less than 0.00001 versus 10 of 16 Thai patients). Only 4 of the 18 Thai patients had significant rise in antibody to purified Shiga toxin, while one of the two Israeli patients and the one Bangladeshi patient had elevated convalescent-phase titers. None of the sera that reacted with Shiga holotoxin had antibody that bound to the peptides. This report, which describes a search for serum antibodies that bind Shiga toxin in patients with Shiga dysentery, demonstrates such antibodies in only a minority of patients with bacteriologically confirmed disease. During Shiga dysentery, Shiga toxin may be elaborated in such small quantities in vivo that it fails to elicit an immune response in most patients even though it may exert biological effects. In this behavior Shiga toxin resembles tetanus toxin, another potent exotoxin that fails to elicit antitoxic responses in people who recover from clinical tetanus.

Experience with Vi typhoid capsular polysaccharide vaccine in the U.K

Adult volunteers were immunised with a single dose of typhoid Vi capsular polysaccharide vaccine. After immunisation, 96% of the 103 subjects seroconverted and 94% had antibody levels above the protective threshold. Systemic reactions were uncommon, local reactions were mild and transient.

Typhoid Vi: a less reactogenic vaccine

A typhoid vaccine derived from the purified Vi capsular polysaccharide (CPS) antigen of Salmonella typhi was compared with a heat-killed whole-cell typhoid vaccine in 637 healthy male volunteers. The individuals were placed in three groups: group 1 received two doses of heat-killed whole-cell typhoid vaccine, at an interval of 28 days; group 2 received a single dose of typhoid Vi CPS vaccine followed after 28 days by water for injection; and group 3 received water for injection on the first occasion and a single dose of typhoid Vi CPS vaccine 28 days later. Local and systemic adverse reactions were recorded for 5 days following each injection. Subjects receiving the typhoid Vi CPS vaccine complained of fewer local adverse reactions on each of the first 3 days following immunization: on day 1, 18.6% of subjects given typhoid Vi CPS vaccine reported local reactions compared with 59.7% of those receiving heat-killed whole-cell vaccine (P less than 0.001). The percentage of subjects receiving the heat-killed whole-cell vaccine who complained of systemic reactions was more than twice that of subjects receiving the Vi CPS vaccine (7.9% and 3.4%, respectively, on day 1; P less than 0.01).

Epidemiology and control of an outbreak of typhoid in a psychiatric institution

An outbreak of typhoid caused by Salmonella typhi of the same Vi-phage type (D1) and of the same antibiogram was reported in a large psychiatric institution in Singapore. A total of 95 (4.8%) of the 1965 inmates were infected, 47 with symptoms and 48 asymptomatic. Transmission was through close person-to-person contact and not through contaminated food or water. The source of infection could not be established. The outbreak was brought under control by maintaining a high standard of environmental sanitation, active search for fever and diarrhoeal cases, identification of asymptomatic cases by rectal swabbing, and isolation of those found to be infected. Mass immunization with two doses of heat-phenol inactivated typhoid vaccine was also carried out concurrently. The vaccine was found to have an efficacy of 65.8% in preventing clinical illness.

Relation between structure and immunologic properties of the Vi capsular polysaccharide

The Vi capsular polysaccharide of Salmonella typhi is a linear homopolymer of poly-alpha(1----4)GalNAcp variably O acetylated at the C-3 position. Serum antibodies elicited by this antigen confer protective immunity against typhoid fever. The relation between the immunologic properties and structure of Vi was investigated by carboxyl reduction, O deacetylation, and acid hydrolysis. The immunogenicity of Vi was closely related to its degree of O acetylation. Partial O deacetylation slightly increased immunogenicity; complete O deacetylation eliminated the immunogenicity of Vi. O-deacetylated Vi, however, still reacted with antisera prepared by injection of whole bacteria. Carboxyl reduction, in contrast, had a comparatively slight effect upon both the immunogenicity and antigenicity of Vi. Retention levels of antigenicity after acid treatment were greater for both the native and carboxyl-reduced Vi than for the O-deacetylated product. The Courtauld-Koltun space-filling model of a pentamer of Vi demonstrated that the bulky nonpolar O-acetyls, which protrude in rows on both sides, make up most of the surface. The carboxyls are less exposed and are partially shielded by the O-acetyls. The molecular model thus provides an explantation for the dominant role of the O-acetyls, as well as the lesser effect of carboxyl reduction, upon the immunologic properties of Vi.

Oral immunisation against typhoid fever in Indonesia with Ty21a vaccine

When tested under conditions of moderate transmission of typhoid fever, a liquid formulation of the oral typhoid fever vaccine Ty21a had a protective efficacy of 96% in Egypt, and an enteric coated capsule formulation had an efficacy of 67% in Chile. We compared the two formulations under conditions of intense transmission of typhoid fever in Indonesia in a randomised, double-blind trial. 20,543 subjects (age range 3-44 years) received either three doses of enteric coated capsules containing placebo or live Ty21a, or three doses of lyophilised placebo or live Ty21a reconstituted with phosphate buffer. During 30 months of follow-up, the rate of blood-culture-positive typhoid fever among controls was 810/100,000 per year. Rates of typhoid fever were 379/100,000 per year for subjects who received the liquid formulation of vaccine and 468/100,000 per year for subjects who received enteric coated capsules. The protective efficacies of the liquid and enteric coated formulations were 53% and 42%, respectively. Neither formulation protected against infection with Salmonella paratyphi A. No major side-effects were noted, but the overall incidence of side-effects was greater in the vaccine groups. Under conditions of intense transmission, Ty21a protected against typhoid fever; however, because Ty21a will not protect all individuals, there is a need for additional approaches to prevent the disease.

Oral enteric vaccines--clinical trials

Oral enteric vaccines are reviewed with particular reference to cholera and typhoid. Enterotoxigenic E. coli, Shigella and Rotavirus vaccines are also considered. Clinical trials of those potentially useful vaccines are surveyed.

Vaccines and milk immunoglobulin concentrates for prevention of infectious diarrhea

Considerable progress has been made in the last decade in developing vaccines against the most important enteric infections. Two new, widely licensed vaccines (oral Ty21a and parenteral Vi) are available against typhoid fever, and new attenuated Salmonella typhi strains are ready for testing. An engineered live orally administered cholera vaccine, CVD 103-HgR, is undergoing clinical trials for safety, immunogenicity, and transmissibility in children in areas where cholera is endemic. Multiple candidate vaccines against rotavirus, Shigella, and enterotoxigenic Escherichia coli are in clinical trials. Newly acquired knowledge about pathogenesis and mucosal and cellular immunology, coupled with application of biotechnology, has already resulted in many candidates for vaccines, and more are expected to appear within the next few years.

Immunity conferred by Aro- Salmonella live vaccines

The specificity of protection conferred by Aro- salmonellae was studied in BALB/c mice challenged 3 months after intravenous (i.v.) vaccination, more than 1 month after the vaccine had been cleared. Oral challenge showed better protection than i.v. challenge. Salmonella typhimurium aroA SL3261 conferred very good protection against wild-type S. typhimurium C5 (over 10,000 x LD50). Cross protection experiments were performed using S. typhimurium, S. enteritidis and S. dublin for vaccination and challenge, including variants of S. typhimurium and S. enteritidis of similar virulence differing in the main LPS antigen (O-4 or O-9). Salmonella typhimurium aroA conferred solid protection against S. typhimurium (O-4), but no protection against wild-type S. enteritidis (O-9). However challenge with LPS variant strains showed that although protection was generally better to strains of the homologous LPS type, specificity of protection was determined more by the parent strain background (S. typhimurium or S. enteritidis) of the challenge than by O-factors 4 or 9, suggesting that other antigens are involved. The nature of the protective antigen(s) in this model is unclear, but it does not appear to be the main O-specific antigen. A S. enteritidis Se795 aroA vaccine gave good protection against wild-type S. enteritidis Se795 2 weeks after vaccination, but much less at 3 months (approximately 10-200 x LD50), although the persistence of the S. enteritidis aroA vaccine in the liver and spleen was similar to that of the S. typhimurium vaccine, and the wild-type Se795 challenge strain was of similar virulence to S. typhimurium C5. A S. dublin aroA vaccine conferred similar protection against wild-type S. dublin (approximately 300 x LD50).

Pathogenicity of foodborne Salmonella

Salmonella remains a leading etiological agent in bacterial foodborne diseases. Although human salmonellosis generally presents as a self-limiting episode of enterocolitis, the disease can degenerate into chronic and debilitating conditions. Antibiotic treatment of uncomplicated salmonellosis is contra-indicated because it tends to prolong the carrier state. Clinical management of systemic infections with newer drugs such as third-generation cephalosporins and quinolones is most promising, particularly in light of the increasing resistance of Salmonella to the traditional ampicillin, chloramphenicol and trimethoprim sulfamethoxazole therapeutic agents. Research into the development of effective vaccines from avirulent auxotrophic or from virulence plasmid-cured strains may ultimately facilitate the control of salmonellosis in human populations and in various agricultural sectors. Human salmonellosis reflects the outcome of a confrontation between humoral and cellular immune responses of the host, and virulence determinants of the invasive pathogen. Following an adhesion-dependent attachment of salmonellae to lumenal epithelial cells, the invasive pathogen is internalized within an epithelial cell by a receptor-mediated endocytotic process. Cytotoxin localized in the bacterial cell wall suggestively may facilitate Salmonella entry into the epithelial layer. Cytoplasmic translocation of the infected endosome to the basal epithelial membrane culminates in the release of salmonellae in the lamina propria. During this invasive process, Salmonella secretes a heat-labile enterotoxin that precipitates a net efflux of water and electrolytes into the intestinal lumen. Although non-typhoid salmonellae generally precipitate a localized inflammatory response in deeper tissues via lymphatics and capillaries, and elicit a major immune response. Current research efforts have focused on the molecular characterization and role of virulence plasmids and chromosomal genes in Salmonella pathogenicity.

Outbreak of diarrhoea due to Escherichia coli O111:B4 in schoolchildren and adults: association of Vi antigen-like reactivity

During six days in November, 1987, 611 pupils (age range 7-19 years) and 39 adults (23-57) at a school complex in southern Finland had diarrhoea due to Escherichia coli O111:B4. Diarrhoea developed in 137 other household members during the two weeks after the school outbreak. The source of the organism remains unknown. The outbreak strains, when incubated at 22 degrees C or exposed to ampicillin, lost the lipopolysaccharide O antigen and began to react with antisera against Salmonella typhi Vi antigen. The Vi antigen-like reactivity increased the adherence of the organisms to Hep-2 cells. These results indicate that E coli O111:B4, and possibly other enteropathogenic E coli strains, should be considered in the diagnosis of all diarrhoea cases and not only in infantile diarrhoea. Expression of Vi antigen in E coli may play a part in virulence by enhancing adherence to the intestinal epithelium.

Immunity induced by live attenuated Salmonella vaccines

Studies on the degree and specificity of protection conferred by immunization with aroA salmonella live vaccines in BALB/c mice are described. Animals were immunized i.v. and challenged orally 3 months later to ensure that the vaccine had been cleared from the tissues. Vaccination with Salmonella typhimurium aroA SL3261 conferred very good protection against virulent S. typhimurium C5 (over 10,000 x LD50). The specificity of cross protection was studied using S. typhimurium, Salmonella enteritidis and Salmonella dublin for vaccination and challenge, including challenge with variants of S. typhimurium and S. enteritidis of similar virulence which differed in the main LPS (lipopolysaccharide) antigen (0-4 or 0-9). S. typhimurium SL3261 gave very good protection against S. typhimurium C5 (0-4), but no protection against S. enteritidis Se795 (0-9). However, challenge with strains differing in the main 0 antigens showed that, although protection was generally better to strains expressing the same LPS type as the vaccine, specificity of protection was determined more by the background (S. typhimurium or S. enteritidis) of the parent strain used for the challenge than by 0 factors 4 or 9, suggesting that other factors could be involved. The nature of the antigen(s) responsible for protection in this model is unclear, but it would not appear to be the main 0-specific antigen. An S. enteritidis Se795 aroA vaccine was far less effective than S. typhimurium SL3261; it conferred good protection against the homologous wild type at 2 weeks post-vaccination, but far less at three months (approx 10-200 x LD50). This was unexpected, as the persistence of the S. enteritidis vaccine in the liver and spleen was similar to that of S. typhimurium SL3261, and the S. enteritidis and S. typhimurium challenge strains were of similar virulence. An S. dublin aroA vaccine conferred similar protection against wild type S. dublin (approx 300 x LD50).

Monoclonal antibodies against two discrete determinants on Vi capsular polysaccharide

Vi is a linear homopolymer of 1,4 N-acetyl galactosaminuronic acid. It is present in S. typhi and some other members of Enterobacteriaceae. Vi antigen of S. typhi has been associated with the virulence of the organism and a vaccine based upon this antigen has been found to confer immunity against typhoid. In this paper, we report production and characterization of four hybrid cell clones secreting monoclonal antibodies against Vi capsular polysaccharide. Binding analysis using different derivatives of Vi showed that three monoclonal antibodies reacted with the antigenic determinant constituted by O-acetyl group and one recognised the epitope constituted by N-acetyl and carboxyl groups together. All the antibodies bound to Vi positive strains of S. typhi and did not show any significant reactivity with Vi negative strains of S. typhi, S. paratyphi A, S. paratyphi B and E. coli. Besides their utility in studying the sub-specificity of antibodies produced after vaccination with Vi, these antibodies would be helpful in the diagnosis of typhoid fever.

Comparative immunogenicities of Vi polysaccharide-protein conjugates composed of cholera toxin or its B subunit as a carrier bound to high- or lower-molecular-weight Vi

The effect of molecular weight or size of the components on the immunogenicity of polysaccharide-protein conjugates prepared with the native Vi capsular polysaccharide (Vi) (approximately 3 x 10(3) kilodaltons) or lower-molecular-weight Vi (Vis; approximately 46 kilodaltons) abound to cholera toxin (CT) or to its B subunit (CTB) was studied. In mice, Vi-CT, Vi-CTB, and Vis-CTB elicited higher Vi antibody levels than the Vi alone (P less than 0.0001). Vi-CT and Vi-CTB were more immunogenic than Vis-CTB (P less than 0.01). CT or Vi-CT elicited higher levels of CT antibodies, as measured by enzyme-linked immunosorbent assay, than did CTB or Vi-CTB. In rhesus monkeys, the Vi conjugates elicited higher Vi antibody levels than the Vi alone (P less than 0.01). Vi-CTB elicited higher levels of Vi antibody after each injection than did Vis-CTB. Similar levels of CT antibodies, as measured by enzyme-linked immunosorbent assay, were elicited by all three conjugates. In contrast, Vi-CT elicited higher levels of neutralizing antibodies than Vi-CTB or Vis-CTB when either CT or the related heat-labile toxin of Escherichia coli was used as the antigen. These results indicate that the holotoxin and the native Vi provide the most immunogenic components for conjugates designed to induce both Vi and CT antibodies.

Construction and characterization of a Vi-positive variant of the Salmonella typhi live oral vaccine strain Ty21a

The viaB locus coding for the Vi antigen of Salmonella typhi Ty2 was cloned on a 40.6-kilobase fragment into the cosmid vector pHC79. The live, oral, attenuated Vi-negative S. typhi Ty21a vaccine strain was transformed with the recombinant cosmid encoding the viaB locus. Homologous recombination of the viaB locus into the chromosome of S. typhi Ty21a was induced by UV irradiation, and Vi-positive recombinants were selected in the presence of D-cycloserine. One such isolate, termed WR4103, contained no plasmids or the attendant antibiotic resistance markers and expressed the Vi antigen stably. Vi antigen extracted from WR4103 was immunologically indistinguishable from Vi antigen purified from S. typhi Ty2. The only detectable difference between Ty21a and WR4103 was in the production of Vi antigen. The mean lethal doses of Ty21a and WR4103 for mice were nearly identical. Immunization of mice with WR4103 engendered a Vi antibody response and afforded complete protection against fatal infection with virulent S. typhi Ty2. Thus, S. typhi WR4103 may serve as an improved oral vaccine for protection against typhoid fever.

Characterization of the Salmonella paratyphi C Vi polysaccharide

The Vi capsular polysaccharide (Vi) is both a virulence factor and a protective antigen of Salmonella typhi; its pathogenic role for Salmonella paratyphi C is less well understood. We found no differences between the antigenic and immunogenic properties and the structure of the Vi from representative strains of S. paratyphi C, S. typhi, and Citrobacter freundii. There were, however, differences in both the amount produced per cell and the degree of association with the cell among the Vi from the three species of Enterobacteriaceae. S. paratyphi C produced less Vi than both the wild-type S. typhi and C. freundii did, and it showed the fastest release of Vi into the media. These findings may provide an explanation for the inability of the Vi to inhibit completely the agglutination of S. paratyphi C by anti-O sera. In an outbreak of enteric fever caused by S. paratyphi C, 66 of 78 isolates (85%) were Vi positive.

Immunoblot detection of class-specific humoral immune response to outer membrane proteins isolated from Salmonella typhi in humans with typhoid fever

The studies reported here were undertaken to assess the ability of the outer membrane proteins (OMPs) of Salmonella typhi to induce a humoral immune response in humans with typhoid fever. OMPs were isolated with the nonionic detergent Triton X-100 and were found to be contaminated with approximately 4% lipopolysaccharide. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis patterns showed protein bands with molecular size ranges from 17 to 70 kilodaltons; the major groups of proteins were those that correspond to the porins and OmpA of gram-negative bacteria. Rabbit antiserum to OMPs or to S. typhi recognized OMPs after absorption with lipopolysaccharide. Sera from patients with typhoid fever contained immunoglobulin M antibodies which reacted with a protein of 28 kilodaltons and immunoglobulin G antibodies which reacted mainly with the porins, as determined by immunoblotting. These results indicate that the porins are the major immunogenic OMPs from S. typhi and that the immune response induced in the infection could be related to the protective status.

Vaccines produced by conventional means to control major infectious diseases of man and animals

This chapter reviews the development of some of vaccines and their use in controlling such major diseases as diphtheria, rinderpest, Newcastle disease, smallpox, pertussis, yellow fever, rabies, etc. Park–Williams Number 8 (PW8) strain is used to make diphtherial toxoid for vaccines. As a source of toxin, it is rendered nontoxic by incubation with formalin under alkaline conditions. The product's retention of antigenicity, enabling it to induce antitoxin antibodies, makes it an excellent pediatric vaccine. Vaccine against Rinderpest Virus was developed by Koch in 1897 by administering bile from infected cattle. Animals that survived were permanently immune. Formalin- and chloroform-inactivated vaccines were developed using tissues from the infected animals. For the control of Newcastle disease, a number of attenuated live-virus vaccines have been developed which are widely used to control the disease. The Bl strain, the LaSota strain, and the F strain are used to immunize birds of all ages by different routes, including by addition to drinking water and by spraying. Protection against rabies correlates with SN antibody, which can be assessed by a number of tests. Pasteur's classical vaccine, developed from infected spinal cord tissue dried at room temperature for 3–14 days, was given in a series of 21–28 inoculations beginning with material dried the longest and progressing through material dried for only 3 days.

Prevention of invasive bacterial diseases by immunization with polysaccharide-protein conjugates

Covalent binding of CPS to T cell-dependent carrier proteins to form conjugates can be done by clinically acceptable methods. As a component of a conjugate, two immunologic properties of CPS are changed: 1) their immunogenicity is increased and; 2) reinjection induces a booster response in the young (T cell-dependence). Serum antibodies induced by the CPS alone, or as a component of a conjugate, are qualitatively similar: the difference between antibodies elicited by the CPS or the conjugate is quantitative. A clinical trial with a Hib-DT conjugate showed that conjugates could confer immunity in an age group not protected by the CPS alone. (table; see text) Induction of serum CPS antibodies confers protection against capsulated bacteria in the bloodstream: their role in the interaction of these pathogens on the mucous membranes has not been characterized. Preliminary in vitro experiments suggest that secretory antibodies to non-capsular structures may also exert protective immunity.

Protection against Salmonella typhi infection in mice after immunization with outer membrane proteins isolated from Salmonella typhi 9,12,d, Vi

The current studies were undertaken to assess the ability of the outer membrane proteins (OMPs) of Salmonella typhi to induce protection against challenge with the bacteria in mucin. OMPs were isolated as described by Schnaitman (J. Bacteriol. 108:553-556, 1971) and were found to be contaminated with approximately 4% lipopolysaccharide (LPS). Immunization with as little as 30 micrograms of OMPs conferred 100% protection to mice challenged with up to 1,000 50% lethal doses (LD50) of two strains of S. typhi (9,12,d, Vi and Ty2). In addition, 30% protection against challenge with up to 500 LD50 of Salmonella typhimurium was achieved. Immunization with LPS at doses equivalent to those found in the OMPs was considerably inferior to the OMPs in the induction of an immune status. Moreover, LPS was effective only when the challenge was performed with S. typhi 9,12,d, Vi (40% protection to 100 LD50). An antiserum raised in rabbits reacted mainly against the bands of the molecular weights corresponding to the so-called porins contained in the OMP preparation as shown by Western blotting (immunoblotting). This rabbit antiserum protected 100% of mice against challenge with 100 LD50 of either strain of S. typhi and 80% of mice against challenge with the same LD50 of S. typhimurium. These results indicate the usefulness of OMPs in the induction of active immunity against S. typhi in mice.

Persistence of antibody titres three years after vaccination with Vi polysaccharide vaccine against typhoid fever

After a single injection of purified Vi polysaccharide vaccine against typhoid fever, serum titres were followed in student volunteers by passive haemagglutination assay and by radioimmunoassay. Elevated Vi antibody titres were still present after 36 months. This preliminary study should be followed by further investigations on the extent and duration of protection provided by Vi vaccine, and on volunteers in endemic areas.

Restaurant-associated outbreak of typhoid fever in Maryland: identification of carrier facilitated by measurement of serum Vi antibodies

Ten cases of typhoid fever occurred between 24 August and 1 September 1986 in the vicinity of Silver Spring, Md. Shrimp salad served in a fast-food restaurant was implicated as the source of infection. Stool cultures were obtained from 104 employees, and serum Vi antibodies were assayed in 97 of the employees. Salmonella typhi was isolated from stool cultures of an 18-year-old asymptomatic female employee, who was a food handler. A high level of Vi antibodies (79.0 micrograms/ml), measured by radioimmunoassay, was found in her serum. She had emigrated from an endemic area at the age of 14 years and had visited that endemic area 2 years previously. The causal relation between the carrier and the 10 cases of typhoid fever was confirmed by a common bacteriophage type, denoted "degraded Vi resembling O," in the S. typhi isolates. This phage type is rare in the western hemisphere but common in the endemic area from which the carrier had emigrated. The high level of Vi antibody in the asymptomatic carrier, in contrast to the lower levels in the convalescent- and postimmunization-phase sera, facilitated the identification of the source infection in this outbreak. This radioimmunoassay offers a rapid and standardized method for identifying carriers of S. typhi.

A group specific anamnestic immune reaction against HIV-1 induced by a candidate vaccine against AIDS

The first experimental immunization of humans against the AIDS retrovirus, HIV-1, was started in a series of HIV seronegative, healthy volunteers in November 1986. For the primary vaccination recombinant vaccinia virus (V25) expressing the complete gp160 env protein of the HTLV-IIIB strain of HIV-1 was introduced by scarification. This elicited a weak primary response which we subsequently attempted to enhance by additional immunizations (boosting), using four different immunization protocols. We report here that intravenous injection of paraformaldehyde-fixed autologous cells infected in vitro with V25 (individual D.Z.) gave the best results. This individual received second and third boosts of intramuscular gp160 derived from an HTLV-IIIB clone using the hybrid vaccinia virus/bacteriophage T7 expression system. An anamnestic humoral and cellular immune reaction was achieved for over one year after the original vaccination, with high levels of antibodies to the viral envelope, and neutralizing antibodies against divergent HIV-1 strains such as HTLV-IIIB and HTLV-IIIRF (also called HTLV-III HAT) after the first boost. In addition, group-specific cell-mediated immunity and cell-mediated cytotoxicity against infected T4 cells were obtained after the primary vaccine and enhanced by the boosts. Finally, skin tests showed both immediate and delayed hypersensitivity to gp160 in vivo. Although this protocol is not practical for a large scale vaccine trial, our results show for the first time that an immune state against HIV can be obtained in man.

Application of optical properties of the Vi capsular polysaccharide for quantitation of the Vi antigen in vaccines for typhoid fever

The capsular polysaccharide of Salmonella typhi and of Citrobacter freundii (Vi) is a linear homopolymer of alpha 1,4-linked N-acetylgalactosaminuronic acid, variably O-acetylated at the C-3 position. Vaccines composed of Vi confer protection against typhoid fever with an efficacy of about 70%; Vi has recently been conjugated to proteins to increase its immunogenicity and effectiveness (I.L. Acharya, R. Tapa, V.L. Gurubacharya, M.B. Shrestha, C.U. Lowe, D.D. Bryla, R. Schneerson, J.B. Robbins, T. Crampton, B. Trollfors, M. Cadoz, D. Schulz, and J. Armand, N. Engl. J. Med. 317:1101-1104, 1987; K.P. Klugman, I. Gilbertson, H.J. Kornhof, J.B. Robbins, R. Schneerson, D. Schulz, M. Cadoz, and J. Armand, Lancet ii:1165-1169, 1987; S.C. Szu, A.L. Stone, J.D. Robbins, R. Schneerson, and J.B. Robbins, J. Exp. Med. 166:1510-1524, 1987). Vi, however, cannot be measured by conventional colorimetric methods. Two optical techniques were adapted to quantitate Vi in vaccines. The first, Fourier-transformed infrared spectroscopy, was performed on salt-free, freeze-dried samples. The intensities of the absorbance peaks of Vi were proportional to the amount of Vi within the range of 0.25 to 2.0 mg. The amount of Vi was determined from integrated absorptions at the 1,235- or 1,417-cm-1 band. The second technique, spectrophotometric titration, was more sensitive than the Fourier-transformed infrared spectroscopy and could be performed on dilute solutions. The metachromatic effect of the reaction between the aromatic cationic dye acridine orange and the carboxyl groups of Vi was quantitative within +/- 2% in the range of 20 to 700 micrograms of Vi per ml. The accuracy of the titration of Vi in the vaccines was within +/- 8%. These two methods may be applicable to measure other capsular polysaccharides in vaccines.