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Cunningham AL, Heineman TC, Lal H, Godeaux O, Chlibek R, Hwang SJ, McElhaney JE, Vesikari T, Andrews C, Choi WS, Esen M, Ikematsu H, Choma MK, Pauksens K, Ravault S, Salaun B, Schwarz TF, Smetana J, Abeele CV, Van den Steen P, Vastiau I, Weckx LY, Levin MJ. Immune Responses to a Recombinant Glycoprotein E Herpes Zoster Vaccine in Adults Aged 50 Years or Older. J Infect Dis 2019. [PMID: 29529222 PMCID: PMC5946839 DOI: 10.1093/infdis/jiy095] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The herpes zoster subunit vaccine (HZ/su), consisting of varicella-zoster virus glycoprotein E (gE) and AS01B Adjuvant System, was highly efficacious in preventing herpes zoster in the ZOE-50 and ZOE-70 trials. We present immunogenicity results from those trials. Methods Participants (ZOE-50: ≥50; ZOE-70: ≥70 years of age) received 2 doses of HZ/su or placebo, 2 months apart. Serum anti-gE antibodies and CD4 T cells expressing ≥2 of 4 activation markers assessed (CD42+) after stimulation with gE-peptides were measured in subcohorts for humoral (n = 3293) and cell-mediated (n = 466) immunogenicity. Results After vaccination, 97.8% of HZ/su and 2.0% of placebo recipients showed a humoral response. Geometric mean anti-gE antibody concentrations increased 39.1-fold and 8.3-fold over baseline in HZ/su recipients at 1 and 36 months post-dose 2, respectively. A gE-specific CD42+ T-cell response was shown in 93.3% of HZ/su and 0% of placebo recipients. Median CD42+ T-cell frequencies increased 24.6-fold (1 month) and 7.9-fold (36 months) over baseline in HZ/su recipients and remained ≥5.6-fold above baseline in all age groups at 36 months. The proportion of CD4 T cells expressing all 4 activation markers increased over time in all age groups. Conclusions Most HZ/su recipients developed robust immune responses persisting for 3 years following vaccination. Clinical Trials Registration NCT01165177; NCT01165229.
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Affiliation(s)
| | | | | | | | - Roman Chlibek
- Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, and National Yang Ming University School of Medicine, Taiwan
| | | | - Timo Vesikari
- Vaccine Research Center, University of Tampere, Finland
| | | | - Won Suk Choi
- Division of Infectious Disease, Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Meral Esen
- Institute of Tropical Medicine, University Clinic of Tuebingen, Germany
| | | | | | - Karlis Pauksens
- Department of Infectious Diseases, Uppsala University Hospital, Sweden
| | | | | | - Tino F Schwarz
- Central Laboratory and Vaccination Centre, Klinikum Würzburg Mitte, Standort Juliusspital, Germany
| | - Jan Smetana
- Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic
| | | | | | | | | | - Myron J Levin
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora.,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Levin MJ, Schmader KE, Pang L, Williams-Diaz A, Zerbe G, Canniff J, Johnson MJ, Caldas Y, Cho A, Lang N, Su SC, Parrino J, Popmihajlov Z, Weinberg A. Cellular and Humoral Responses to a Second Dose of Herpes Zoster Vaccine Administered 10 Years After the First Dose Among Older Adults. J Infect Dis 2015; 213:14-22. [PMID: 26452397 DOI: 10.1093/infdis/jiv480] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/01/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Herpes zoster vaccine (ZV) was administered as a second dose to 200 participants ≥ 70 years old who had received a dose of ZV ≥ 10 years previously (NCT01245751). METHODS Varicella zoster virus (VZV) antibody titers (measured by a VZV glycoprotein-based enzyme-linked immunosorbent assay [gpELISA]) and levels of interferon γ (IFN-γ) and interleukin 2 (IL-2; markers of VZV-specific cell-mediated immunity [CMI], measured by means of ELISPOT analysis) in individuals aged ≥ 70 years who received a booster dose of ZV were compared to responses of 100 participants aged 50-59 years, 100 aged 60-69 years, and 200 aged ≥ 70 years who received their first dose of ZV. The study was powered to demonstrate noninferiority of the VZV antibody response at 6 weeks in the booster-dose group, compared with the age-matched first-dose group. RESULTS Antibody responses were similar at baseline and after vaccination across all age and treatment groups. Both baseline and postvaccination VZV-specific CMI were lower in the older age groups. Peak gpELISA titers and their fold rise from baseline generally correlated with higher baseline and postvaccination VZV-specific CMI. IFN-γ and IL-2 results for subjects ≥ 70 years old were significantly higher at baseline and after vaccination in the booster-dose group, compared with the first-dose group, indicating that a residual effect of ZV on VZV-specific CMI persisted for ≥ 10 years and was enhanced by the booster dose. CONCLUSIONS These findings support further investigation of ZV administration in early versus later age and of booster doses for elderly individuals at an appropriate interval after initial immunization against HZ. CLINICAL TRIALS REGISTRATION NCT01245751.
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Affiliation(s)
- Myron J Levin
- University of Colorado-Denver Anschutz Medical Campus, Aurora
| | - Kenneth E Schmader
- Duke University and Geriatric Research Education and Clinical Centers, Durham Veterans Affairs Medical Center, North Carolina
| | - Lei Pang
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - Gary Zerbe
- University of Colorado-Denver Anschutz Medical Campus, Aurora
| | | | | | - Yupanqui Caldas
- University of Colorado-Denver Anschutz Medical Campus, Aurora
| | - Alice Cho
- University of Colorado-Denver Anschutz Medical Campus, Aurora
| | - Nancy Lang
- University of Colorado-Denver Anschutz Medical Campus, Aurora
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Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PGE, Oxman MN, Seward JF, Yamanishi K. Varicella zoster virus infection. Nat Rev Dis Primers 2015; 1:15016. [PMID: 27188665 PMCID: PMC5381807 DOI: 10.1038/nrdp.2015.16] [Citation(s) in RCA: 355] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Infection with varicella zoster virus (VZV) causes varicella (chickenpox), which can be severe in immunocompromised individuals, infants and adults. Primary infection is followed by latency in ganglionic neurons. During this period, no virus particles are produced and no obvious neuronal damage occurs. Reactivation of the virus leads to virus replication, which causes zoster (shingles) in tissues innervated by the involved neurons, inflammation and cell death - a process that can lead to persistent radicular pain (postherpetic neuralgia). The pathogenesis of postherpetic neuralgia is unknown and it is difficult to treat. Furthermore, other zoster complications can develop, including myelitis, cranial nerve palsies, meningitis, stroke (vasculopathy), retinitis, and gastroenterological infections such as ulcers, pancreatitis and hepatitis. VZV is the only human herpesvirus for which highly effective vaccines are available. After varicella or vaccination, both wild-type and vaccine-type VZV establish latency, and long-term immunity to varicella develops. However, immunity does not protect against reactivation. Thus, two vaccines are used: one to prevent varicella and one to prevent zoster. In this Primer we discuss the pathogenesis, diagnosis, treatment, and prevention of VZV infections, with an emphasis on the molecular events that regulate these diseases. For an illustrated summary of this Primer, visit: http://go.nature.com/14xVI1.
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Affiliation(s)
- Anne A Gershon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, New York 10032, USA
| | - Judith Breuer
- Department of Infection and Immunity, University College London, UK
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Massachusetts, USA
| | - Randall J Cohrs
- Departments of Neurology and Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael D Gershon
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Don Gilden
- Departments of Neurology and Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Charles Grose
- Division of Infectious Diseases/Virology, Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Sophie Hambleton
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Peter G E Kennedy
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow University, Glasgow, Scotland, UK
| | - Michael N Oxman
- Infectious Diseases Section, Medicine Service, Veterans Affairs San Diego Healthcare System, Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jane F Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Koichi Yamanishi
- Research Foundation for Microbial Diseases, Osaka University, Suita, Osaka, Japan
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