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Shah N, Ghosh A, Kumar K, Dutta T, Mahajan M. A review of safety and immunogenicity of a novel measles, mumps, rubella (MMR) vaccine. Hum Vaccin Immunother 2024; 20:2302685. [PMID: 38236022 PMCID: PMC10798359 DOI: 10.1080/21645515.2024.2302685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
Measles, mumps, and rubella (MMR) are highly infectious viral diseases affecting young children and have high secondary attack rates. Present MMR vaccines show consistent seroconversion rates for anti-measles and anti-rubella antibodies with variable responses for anti-mumps antibodies. Most common strains for MMR vaccines, currently available in India, are the Edmonston-Zagreb measles strain, Leningrad Zagreb (L-Z) mumps strain, and the RA 27/3 rubella strain. L-Z strain of mumps virus has been found to be associated with aseptic meningitis by different studies from different parts of the world including India. Recently, a novel freeze-dried MMR vaccine developed by Zydus Lifesciences (Zyvac MMR) contains Edmonston Zagreb measles strain, Hoshino mumps strain, and RA 27/3 rubella strain. The Hoshino strain is WHO approved and was found to induce interferon gamma production. This review article aims to provide a comprehensive appraisal of the data available on the safety and immunogenicity of the novel MMR vaccine.
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Affiliation(s)
- Nitin Shah
- Department of Peadiatrics, P.D Hinduja Hospital & Medical Research Centre, Mumbai, India
| | - Apurba Ghosh
- Department of Peadiatrics, Institute of Child Health, Kolkata, India
| | - Kishore Kumar
- Department of Peadiatrics, CloudNine Group of Hospitals, Bengaluru, India
| | - Trayambak Dutta
- Medical Affairs, Zydus Lifesciences Ltd., Zydus Corporate Park, Ahmedabad, India
| | - Manish Mahajan
- Medical Affairs, Zydus Lifesciences Ltd., Zydus Corporate Park, Ahmedabad, India
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Grover M, Gupta E, Samal J, Prasad M, Prabhakar T, Chhabra R, Agarwal R, Raghuvanshi BB, Sharma MK, Alam S. Rising trend of symptomatic infections due to Hepatitis A virus infection in adolescent and adult age group: An observational study from a tertiary care liver institute in India. Indian J Med Microbiol 2024; 50:100653. [PMID: 38906330 DOI: 10.1016/j.ijmmb.2024.100653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/27/2024] [Accepted: 06/19/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Hepatitis A Virus (HAV) is the most common cause of Acute Viral Hepatitis (AVH) in children. It causes self-limiting illness and rarely acute liver failure. The shifting pattern in HAV endemicity is rendering adolescents and adults vulnerable to infection. METHODS In this retrospective study, samples received from 14,807 patients with acute onset icteric illness from January 2014-December 2022 were analyzed. HAV infection was detected by anti-HAV IgM positivity. The cases were divided into 3 age groups, pediatric, adolescents and adults, and clinical presentations were compared. RESULTS Overall, 7.72%(1144) were positive for anti-HAV IgM. Of these, 60%(690) were finally included in the study. The positive cases were divided into adults, ≥18 years (44%, 304); pediatric, <12 years (31%, 212) and adolescents (25%,174) age groups. Overall males were predominant [72.4%(500)], with a median age of 16 (IQR:9-21) years. Cases were characterised into AVH (68.1%, 470/690), Acute Liver Failure (ALF) (31.4%, 217/690) and Acute-on-Chronic Liver Failure (0.43%, 3/690). AVH in the pediatric age group was 69%(146/212), adolescents was 67%(117/174), and adults was 68%(207/304). ALF cases among the 3 groups were 30%(65/212), 33%(57/174), and 31%(95/304) respectively. Overall mortality was seen in 6.52%(45/690), maximum in adolescents with ALF presentation [10.3%(18/174)]. On molecular characterization of infection, viremia was seen in 28.9%(200/690) and all the isolates were Genotype IIIA. CONCLUSIONS The number of adults experiencing symptomatic HAV infection was seen to increase over the years in the present study. Infection in adolescents was associated with higher mortality and ALF as the clinical presentation.
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Affiliation(s)
- Malika Grover
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Jasmine Samal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Manya Prasad
- Department of Epidemiology and Clinical Research, Institute of Liver & Biliary Sciences, New Delhi, India.
| | - Tushar Prabhakar
- Department of Epidemiology and Clinical Research, Institute of Liver & Biliary Sciences, New Delhi, India.
| | - Ruchita Chhabra
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Reshu Agarwal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | | | - Manoj Kumar Sharma
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
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O'Neill S, Grieve R, Singh K, Dutt V, Powell-Jackson T. Persistence and heterogeneity of the effects of educating mothers to improve child immunisation uptake: Experimental evidence from Uttar Pradesh in India. JOURNAL OF HEALTH ECONOMICS 2024; 96:102899. [PMID: 38805881 DOI: 10.1016/j.jhealeco.2024.102899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
Childhood vaccinations are among the most cost-effective health interventions. Yet, in India, where immunisation services are widely available free of charge, a substantial proportion of children remain unvaccinated. We revisit households 30 months after a randomised experiment of a health information intervention designed to educate mothers on the benefits of child vaccination in Uttar Pradesh, India. We find that the large short-term effects on the uptake of diphtheria-pertussis-tetanus and measles vaccination were sustained at 30 months, suggesting the intervention did not simply bring forward vaccinations. We apply causal forests and find that the intervention increased vaccination uptake, but that there was substantial variation in the magnitude of the estimated effects. We conclude that characterising those who benefited most and conversely those who benefited least provides policy-makers with insights on how the intervention worked, and how the targeting of households could be improved.
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Affiliation(s)
- Stephen O'Neill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kultar Singh
- Sambodhi Research and Communications, Noida, Uttar Pradesh, India
| | - Varun Dutt
- ConveGenius Insights Pvt. Ltd, Hyderabad, India
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Chitkara AJ, Balasubramanian S, Choudhury J, Dash N, Forsyth K, Heininger U, Hozbor DF, Muloiwa R, Tan T, von König CHW. Pertussis in India: Past, Present, and Future. Indian J Pediatr 2023; 90:393-399. [PMID: 36522518 DOI: 10.1007/s12098-022-04384-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/04/2022] [Accepted: 08/18/2022] [Indexed: 12/23/2022]
Abstract
While vaccines have markedly reduced the incidence of pertussis, a resurgence has occurred in many countries. Until recently, pertussis has not been recognized as an important public health challenge in India due to its successful infant immunization program. However, India still accounts for a large proportion of the world's cases, and increasing reports of pertussis in other countries and in neonates have regenerated interest in pertussis among Indian authorities. The Global Pertussis Initiative (GPI) Annual Meeting was held virtually in October 2020, in part, to gain a better understanding of the epidemiology and disease burden of pertussis and to explore opportunities to improve its prevention in India. There was a consensus that pertussis cases are being underestimated in India due to multiple factors, such as a reliance on passive surveillance and diagnostic challenges. India offers both whole-cell pertussis and acellular pertussis vaccines, but vaccine coverage is inconsistent across regions due to differences in vaccine availability, access to health care, and regional administrative challenges. This report summarizes the outcomes and considers the key clinical implications of this meeting. The GPI agreed that active surveillance of pertussis in India would be optimal and recommended several studies, including serosurveillance among women of reproductive age to assess the prevalence of recent pertussis infection and to enable policy changes that will enhance the rational use of acellular and whole-cell vaccines. It also recommended engagement with nongovernmental organizations in order to encourage pregnancy immunization in the public sector. To achieve effective control of pertussis in the future, the GPI recognizes there are opportunities to characterize the burden of pertussis in India appropriately and increase vaccination coverage in multiple age groups.
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Affiliation(s)
- A J Chitkara
- Department of Pediatrics, Max Super Specialty Hospital, Shalimar Bagh, 118, Vaishali, Pitampura, Delhi, 110088, India.
| | - S Balasubramanian
- Department of Pediatrics, Kanchi Kamkoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | | | - Nabaneeta Dash
- Department of Pediatrics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Kevin Forsyth
- Department of Pediatrics, Flinders University, Adelaide, Australia
| | - Ulrich Heininger
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Daniela Flavia Hozbor
- Department of Biological Sciences, Laboratorio VacSal. Instituto de Biotecnología y Biología Molecular, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CONICET, La Plata, Argentina
| | - Rudzani Muloiwa
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Tina Tan
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
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Garland SM, Anagani M, Bhatla N, Chatterjee S, Lalwani S, Ross C, Group T, Lin J, Luxembourg A, Walia A, Tu Y. Immunogenicity and safety of quadrivalent and 9-valent human papillomavirus vaccines in Indian clinical trial participants. Hum Vaccin Immunother 2022; 18:2105067. [PMID: 35997582 DOI: 10.1080/21645515.2022.2105067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The quadrivalent human papillomavirus (qHPV; HPV6/11/16/18) and 9-valent HPV (9vHPV; HPV6/11/16/18/31/33/45/52/58) vaccines have demonstrated efficacy, immunogenicity, and safety in international clinical trials. We report outcomes from three completed clinical trials in India: a single-arm study (V501-029 [NCT00380367]) in Indian girls (aged 9-15 years; N = 110) evaluating qHPV vaccine immunogenicity and safety; a subgroup analysis (n = 225) of Indian girls/boys (9-15 years) and women (16-26 years) from a global study (V503-002 [NCT00943722]) evaluating 9vHPV vaccine immunogenicity and safety; and a qHPV vaccine post-marketing safety surveillance study (V501-125) in Indian females (aged 9-45 years; N = 188) vaccinated during routine care. In V501-029 and V503-002, HPV vaccines were administered as 3 doses (Day 1, Month 2, Month 6). Serum HPV antibodies were evaluated by competitive Luminex immunoassays at Day 1 and Month 7 (both studies) and Months 12, 24, and 36 (V503-002 only). Adverse events (AEs) were collected by Vaccination Report Card. In V501-125, participants were actively surveilled for serious AEs (SAEs) within 30 days post-qHPV vaccination. In per-protocol analyses, qHPV and 9vHPV vaccines induced robust anti-HPV6/11/16/18 (V501-029) and HPV6/11/16/18/31/33/45/52/58 (V503-002) responses, respectively; ≥97% of participants seroconverted at Month 7 for each vaccine HPV type in both studies, and antibody responses persisted through 36 months in V503-002. The most common AEs were injection-site-associated. Most AEs were mild/moderate; no deaths, vaccine-related SAEs, or discontinuations due to AEs were reported. In V501-125, no SAE was reported. Overall, the qHPV and 9vHPV vaccines elicited robust antibody responses and were generally well tolerated in Indian participants.
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Affiliation(s)
- Suzanne M Garland
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Manjula Anagani
- Woman and Child Institute, CARE Super Specialty Hospital & Transplant Centre, Hyderabad, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sukanta Chatterjee
- Department of Pediatrics, KPC Medical College & Hospital, Kolkata, India
| | | | - Cecil Ross
- Department of Chest Medicine & Hematology, St. John's Medical College Hospital, Bangalore, India
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Berlanda Scorza F, Martin LB, Podda A, Rappuoli R. A strategic model for developing vaccines against neglected diseases: An example of industry collaboration for sustainable development. Hum Vaccin Immunother 2022; 18:2136451. [PMID: 36495000 PMCID: PMC9746511 DOI: 10.1080/21645515.2022.2136451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Infectious diseases continue to disproportionately affect low- and middle-income countries (LMICs) and children aged <5 y. Developing vaccines against diseases endemic in LMICs relies mainly on strong public-private collaborations, but several challenges remain. We review the operating model of the GSK Vaccines Institute for Global Health (GVGH), which aims to address these challenges. The model involves i) selection of vaccine targets based on priority ranking for impact on global health; ii) development from design to clinical proof-of-concept; iii) transfer to an industrial partner, for further technical/clinical development, licensing, manufacturing, and distribution. Cost and risks associated with pre-clinical and early clinical development are assumed by GVGH, increasing the probability to make the vaccine more affordable in LMICs. A conjugate vaccine against typhoid fever, Vi-CRM197, has recently obtained WHO prequalification, within a year from licensure in India, demonstrating the success of the GVGH model for development and delivery of global health vaccines.
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Affiliation(s)
| | | | - Audino Podda
- GSK Vaccines Institute for Global Health, Siena, Italy
| | - Rino Rappuoli
- GSK Vaccines Institute for Global Health, Siena, Italy
- GSK, Siena, Italy
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Thuluva S, Paradkar V, Matur R, Turaga K, Gv SR. A multicenter, single-blind, randomized, phase-2/3 study to evaluate immunogenicity and safety of a single intramuscular dose of biological E's Vi-capsular polysaccharide-CRM 197 conjugate typhoid vaccine (TyphiBEV TM) in healthy infants, children, and adults in comparison with a licensed comparator. Hum Vaccin Immunother 2022; 18:2043103. [PMID: 35333702 PMCID: PMC9196756 DOI: 10.1080/21645515.2022.2043103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The current scenario of typhoid fever warrants early prevention with typhoid conjugate vaccines in susceptible populations to provide lifelong protection. We conducted a multicenter, single-blind, randomized, Phase 2/3 study to assess the immunogenicity and safety of Biological E’s Typhoid Vi-CRM197 conjugate vaccine (TyphiBEVTM) compared to Vi-TT conjugate vaccine manufactured by Bharat Biotech International Limited (Typbar-TCV; licensed comparator) in healthy infants, children, and adults from India. The study’s primary objective was to assess the non-inferiority of TyphiBEVTM in terms of the difference in the proportion of subjects seroconverted with a seroconversion threshold value of ≥2.0 µg/mL against Typbar-TCV. A total of 622 healthy subjects (311 each in both vaccine groups) were randomized and received the single dose of the study vaccine. The TyphiBEVTM group demonstrated noninferiority compared to the Typbar-TCV group at Day 42. The lower 2-sided 95% confidence interval limit of the group difference was −.34%, which met the non-inferiority criteria of ≥10.0%. The geometric mean concentration (24.79 µg/mL vs. 26.58 µg/mL) and proportion of subjects who achieved ≥4-fold increase in antiVi IgG antibody concentrations (96.95% vs. 97.64%) at Day 42 were comparable between the TyphiBEVTM and Typbar-TCV vaccine groups. No apparent difference was observed in the safety profile between both vaccine groups. All adverse events reported were mild or moderate in intensity in all age subsets. This data demonstrates that TyphiBEVTM is non-inferior to TypbarTCV in terms of immunogenicity, and the overall safety and reactogenicity in healthy infants, children, and adults studied from India was comparable.
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Affiliation(s)
- Subhash Thuluva
- Clinical Development Department, Biological E Limited, Hyderabad, India
| | - Vikram Paradkar
- Clinical Development Department, Biological E Limited, Hyderabad, India
| | - Ramesh Matur
- Clinical Development Department, Biological E Limited, Hyderabad, India
| | - Kishore Turaga
- Clinical Development Department, Biological E Limited, Hyderabad, India
| | - Subba Reddy Gv
- Clinical Development Department, Biological E Limited, Hyderabad, India
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Indian Academy of Pediatrics Consensus Guidelines for Adolescent Friendly Health Services. Indian Pediatr 2022. [PMID: 35481487 PMCID: PMC9253249 DOI: 10.1007/s13312-022-2539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Justification Adolescent health is critical to the current and future well- being of the world. Pediatricians need country specific guidelines in accordance with international and national standards to establish comprehensive adolescent friendly health services in clinical practice. Process Indian Academy of Pediatrics (IAP) in association with Adolescent Health Academy formed a committee of subject experts in June, 2019 to formulate guidelines for adolescent friendly health services. After a review of current scientific literature and drafting guidelines on each topic, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by discussions over e-mail and refining of draft recommendations. The final guidelines were approved by the IAP Executive Board in December, 2021. Objective To formulate guidelines to enable pediatricians to establish adolescent friendly health services. Recommendations Pediatricians should coordinate healthcare for adolescents and plan for transition of care to an adult physician by 18 years of age. Pediatricians should establish respectful, confidential and quality adolescent friendly health services for both out-patient and in-patient care. The healthcare facility should provide preventive, therapeutic, and health promoting services. Pediatricians should partner with the multidisciplinary speciality services, community, and adolescents to expand the scope and reach of adolescent friendly health services. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s13312-022-2539-9 and is accessible for authorized users.
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Kandulna AK, Uttam KG, Sharma S, Kumar MR, Prasad KS, Goyal VK, Jangid SK, Daultani P, Mittal R, Maithal K. Long-term Persistence of Immunogenicity After Primary Vaccination and Response to Booster Vaccination With Typhoid Conjugate Vaccine: Results of a Phase IV Extension Study. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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What is the true burden of diphtheria, tetanus, pertussis and poliovirus in children aged 3–18 in Asia? A systematic literature review. Int J Infect Dis 2022; 117:116-129. [DOI: 10.1016/j.ijid.2022.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/21/2022] Open
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Kaushik JS, Sondhi V, Yoganathan S, Dubey R, Sharma S, Vinayan KP, Gupta P, Mittal R. Association of Child Neurology (AOCN) Consensus Statement on the Diagnosis and Management of Febrile Seizures. Indian Pediatr 2021. [DOI: 10.1007/s13312-022-2497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Ghia CJ, Rambhad GS. Meningococcal Disease Burden in India: A Systematic Review and Meta-Analysis. Microbiol Insights 2021; 14:11786361211053344. [PMID: 34866912 PMCID: PMC8637695 DOI: 10.1177/11786361211053344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To perform systematic review and meta-analysis of meningococcal disease burden in India. Methods We searched publications on meningococcal disease in India between 1996 and 2020 using PubMed and Google Scholar. Prevalence (proportion) of Meningococcal meningitis and Case-fatality ratio (CFR) were pooled using random effects model. Other outcomes were pooled qualitatively. Results The prevalence of Meningococcal meningitis in epidemic and endemic conditions was 12.1% (95% CI: 5.2-21.4) and 0.76% (95% CI: 0.3-1.4), respectively, with a CFR of 12.8% (95% CI: 6.8-20.4) in epidemic settings; N. meningitis caused 3.2% (95% CI: 1.6-5.3) of Acute Bacterial Meningitis (ABM) cases in endemic settings. The disease appeared in infants, adolescents, and adults with Serogroup A prevalence. Treatment and prophylaxis were limited to antibiotics despite increased resistance. Conclusion The study reveals epidemic and endemic presence of the disease in India with high fatality and serogroup A prevalence. Further monitoring and immunization are required to prevent outbreaks.
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Affiliation(s)
- Canna Jagdish Ghia
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, Maharashtra, India
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Lalwani SK, Ramanan PV, Sapru A, Sundaram B, Shah BH, Kaul D, Karthik Nagesh N, Kalina WV, Chand R, Ding M, Suroju S, Scott DA, Lockhart SP. Safety and immunogenicity of a multidose vial formulation of 13-valent pneumococcal conjugate vaccine administered with routine pediatric vaccines in healthy infants in India: A phase 4, randomized, open-label study. Vaccine 2021; 39:6787-6795. [PMID: 34656378 DOI: 10.1016/j.vaccine.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE This phase 4, randomized, open-label, multicenter study in healthy Indian infants and toddlers evaluated the safety, tolerability, and immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) formulated in a multidose vial (MDV) or single prefilled syringe (PFS). METHODS Healthy Indian infants (6 weeks of age) were randomized 1:1 to receive either PCV13-MDV or PCV13-PFS concomitant with routine pediatric vaccines. Subjects received a single dose of either PCV13-MDV or PCV13-PFS as a 4-dose schedule (infant series: 1 dose at 6, 10, and 14 weeks of age; toddler dose: 12 months of age). Safety was assessed, including local reactions, systemic events, and adverse events (AEs). Immunogenicity 1 month after both the infant series and toddler dose was measured by concentrations of serotype-specific immunoglobulin G (IgG) antibodies and opsonophagocytic activity titers. RESULTS Rates and severities of local reactions and systemic events up to 7 days after each dose of either PCV13-MDV or PCV13-PFS were generally similar, with the majority being of mild or moderate severity. PCV13-MDV had a safety profile comparable with PCV13-PFS; both groups experienced a similar frequency of AEs. PCV13-MDV elicited immune responses comparable with those induced by PCV13-PFS. Clear boosting of immune responses after the PCV13-MDV toddler dose was observed; ≥96% of subjects showed serotype-specific IgG concentrations at or above the defined thresholds 1 month after the PCV13-MDV toddler dose. CONCLUSIONS PCV13-MDV was safe, well tolerated, and immunogenic in healthy Indian infants and toddlers when coadministered with routine pediatric vaccinations. Safety and immunogenicity of PCV13-MDV was comparable with PCV13-PFS. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov: NCT03548337.
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Affiliation(s)
| | | | - Amita Sapru
- Department of Pediatrics, KEM Hospital Research Centre, Pune, Maharashtra, India
| | | | - Bela Hasmukh Shah
- Department of Pediatrics, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Dinesh Kaul
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - N Karthik Nagesh
- Department of Pediatrics, Manipal Hospital, Bengaluru, Karnataka, India
| | - Warren V Kalina
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Rohit Chand
- Global Site and Study Operations, Pfizer Ltd, Mumbai, India
| | - Meichun Ding
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Suresh Suroju
- Vaccine Clinical Research and Development, Pfizer Ltd, Hurley, UK
| | - Daniel A Scott
- Vaccine Clinical Research and Development, Pfizer Inc, Collegeville, PA, USA
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14
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Ghia CJ, Horn EK, Rambhad G, Perdrizet J, Chitale R, Wasserman MD. Estimating the Public Health and Economic Impact of Introducing the 13-Valent Pneumococcal Conjugate Vaccine or 10-Valent Pneumococcal Conjugate Vaccines into State Immunization Programs in India. Infect Dis Ther 2021; 10:2271-2288. [PMID: 34313958 PMCID: PMC8572948 DOI: 10.1007/s40121-021-00498-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/05/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Although the pneumococcal conjugate vaccine (PCV) has been introduced into select state immunization programs (SIPs) in India, many children remain unvaccinated. Recently, India’s Advisory Committee on Vaccines & Immunization Practices recommended PCV on the pediatric immunization schedule nationally. This study estimates the public health and economic impact of introducing either Pfizer’s 13-valent PCV (PCV13-PFE), GlaxoSmithKline’s 10-valent PCV (PCV10-GSK), or Serum Institute of India’s 10-valent PCV (PCV10-SII) into every pediatric SIP. Methods A model was developed to predict the disease cases, deaths, and costs associated with implementing PCV13-PFE, PCV10-GSK, or PCV10-SII in SIPs compared to no vaccination program across a 5-year period (2021–2025). State and national-level uptake rate and clinical and economic input parameters were collected from published literature. Disease outcomes included invasive pneumococcal disease, inpatient and outpatient pneumonia, and otitis media. Costs were estimated as vaccine-related costs and direct medical costs incurred to the healthcare system. Results were reported by individual state and aggregated nationally.
Results Estimated over 5 years, implementing PCV13-PFE in SIPs could avert 12.1 million cases and save 626,512 lives among children under 5 years old compared to no vaccination. This corresponds to net national cost savings of over $1.0 billion. Both lower-valent PCVs are estimated to provide less economic savings than PCV13-PFE inclusive of vaccine-related costs. Compared with PCV13-PFE, implementing PCV10-GSK or PCV10-SII nationally is estimated to have a smaller public health impact, with PCV10-GSK averting 8.4 million cases (436,577 deaths) and PCV10-SII preventing 10.3 million cases (531,545 deaths) in India compared to no vaccination, respectively. Conclusion Implementation of PCV13-PFE throughout India is estimated to provide greater public health and economic benefits than PCV10-GSK or PCV10-SII SIPs. Our analysis highlights the substantial disease cases, deaths, and health system cost savings that may be realized from implementing PCV programs throughout India. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00498-4.
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Affiliation(s)
- Canna J Ghia
- Pfizer Inc., Medical Affairs, Mumbai, India. .,Pfizer Limited, The Capital, 1802, 18th Floor, Plot No. C-70, 'G Block', Bandra Kurla Complex, Bandra East, Mumbai, 400051, India.
| | - Emily K Horn
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | | | - Johnna Perdrizet
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | - Ramaa Chitale
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | - Matt D Wasserman
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
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Indian Academy of Pediatrics Position Paper on Nurturing Care for Early Childhood Development. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2332-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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