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Anastassopoulou C, Ferous S, Medić S, Siafakas N, Boufidou F, Gioula G, Tsakris A. Vaccines for the Elderly and Vaccination Programs in Europe and the United States. Vaccines (Basel) 2024; 12:566. [PMID: 38932295 PMCID: PMC11209271 DOI: 10.3390/vaccines12060566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
The share of the elderly population is growing worldwide as life expectancy increases. Immunosenescence and comorbidities increase infectious diseases' morbidity and mortality in older adults. Here, we aimed to summarize the latest findings on vaccines for the elderly against herpes zoster, influenza, respiratory syncytial virus (RSV), COVID-19, and pneumococcal disease and to examine vaccine recommendation differences for this age group in Europe and the United States. PubMed was searched using the keywords "elders" and "vaccine" alongside the disease/pathogen in question and paraphrased or synonymous terms. Vaccine recommendations were also sought in the European and US Centers for Disease Control and Prevention databases. Improved vaccines, tailored for the elderly, mainly by using novel adjuvants or by increasing antigen concentration, are now available. Significant differences exist between immunization policies, especially between European countries, in terms of the recipient's age, number of doses, vaccination schedule, and implementation (mandatory or recommended). Understanding the factors that influence the immune response to vaccination in the elderly may help to design vaccines that offer long-term protection for this vulnerable age group. A consensus-based strategy in Europe could help to fill the gaps in immunization policy in the elderly, particularly regarding vaccination against RSV and pneumococcus.
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Affiliation(s)
- Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.F.); (A.T.)
| | - Stefanos Ferous
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.F.); (A.T.)
| | - Snežana Medić
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
| | - Nikolaos Siafakas
- Clinical Microbiology Laboratory, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Georgia Gioula
- Microbiology Department, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.F.); (A.T.)
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Wassil J, Sisti M, Fairman J, Davis M, Fierro C, Bennett S, Johnson D, Migone TS, Nguyen K, Sauer P, Currie M, Iki S, Simon JK. Evaluating the safety, tolerability, and immunogenicity of a 24-valent pneumococcal conjugate vaccine (VAX-24) in healthy adults aged 18 to 64 years: a phase 1/2, double-masked, dose-finding, active-controlled, randomised clinical trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:308-318. [PMID: 38061367 DOI: 10.1016/s1473-3099(23)00572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Despite substantial reductions in pneumococcal disease with the availability of pneumococcal conjugate vaccines, a significant burden of pneumococcal disease remains due to the diversity of serotypes combined with serotype replacement. We developed a new vaccine candidate, VAX-24 (24-valent pneumococcal conjugate vaccine), using cell-free protein synthesis to produce a variant of cross-reactive material 197 (eCRM) as the carrier protein, increasing serotype coverage while minimising carrier suppression. The aim of this clinical trial was to assess the safety, tolerability, and immunogenicity of three different doses of VAX-24 compared to pneumococcal 20-valent conjugate vaccine (PCV20). METHODS This was a phase 1/2, randomised, double-masked study of VAX-24 versus PCV20 conducted in the USA. Key inclusion criteria included being a male or female aged 18 to 64 years in good health; key exclusion criteria included previous history of pneumococcal disease, receipt of a licensed or investigational pneumococcal vaccine, or immunosuppressive therapy. Participants were randomly allocated in a 1:1:1:1 ratio by permuted block to receive one dose of VAX-24 (1·1 μg of each antigen, 2·2 μg of each antigen, or 2·2 μg of 17 antigens mixed with 4·4 μg of seven antigens), or PCV20. The safety population included all participants with safety data. The immunogenicity population was as per-treatment in phase 2. Primary outcome measures included solicited and unsolicited adverse events. Secondary outcomes included serotype-specific opsonophagocytic activity (OPA) geometric mean titres (GMT), and IgG geometric mean concentrations (GMC) were measured 1 month postvaccination. Traditional non-inferiority criteria included OPA geometric mean ratio (GMR), with a lower bound of the two sided 95% CI of greater than 0·5 for shared serotypes. This completed trial is registered at ClinicalTrials.gov, NCT05266456. FINDINGS Safety profiles were comparable among the treatment groups, with 170 of 209 participants (81%, 95% CI 75·2-86·2) to 178 of 207 participants (86%, 80·5-90·4) reporting at least one solicited adverse event among the three VAX-24 groups. 24 of 207 participants (12%, 7·6-16·8) to 32 of 209 of participants (15%, 10·7-20·9) experiened an unsolicited treatment emergent adverse event within 1 month postvaccination. VAX-24 2·2 μg met traditional OPA GMR non-inferiority criteria for all 20 shared serotypes; 16 serotypes elicited GMR point estimates greater than 1·0, and four reached the lower bound of the two-sided 95% CI greater than 1·0. INTERPRETATION VAX-24 had a safety profile similar to PCV20 at all doses, with the 2·2 μg dose showing increased serotype coverage with decreased carrier suppression. FUNDING Vaxcyte.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Sam Iki
- Vaxcyte, San Carlos, CA, USA
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Paróczai D, Burian K, Bikov A. Bacterial Vaccinations in Patients with Chronic Obstructive Pulmonary Disease. Vaccines (Basel) 2024; 12:213. [PMID: 38400196 PMCID: PMC10893474 DOI: 10.3390/vaccines12020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a frequent, often progressive, chronic disease of the lungs. Patients with COPD often have impaired immunity; therefore, they are prone to chest infections, such as pneumonia or bronchitis. Acute exacerbations of COPD are major events that accelerate disease progression, contributing to its symptoms' burden, morbidity, and mortality. Both pneumonia and acute exacerbations in COPD are caused by bacteria against which there are effective vaccinations. Although the number of randomised controlled studies on bacterial vaccinations in COPD is limited, national and international guidelines endorse specific vaccinations in patients with COPD. This review will summarise the different types of vaccinations that prevent pneumonia and COPD exacerbations. We also discuss the results of early phase studies. We will mainly focus on Streptococcus pneumoniae, as this bacterium was predominantly investigated in COPD. However, we also review studies investigating vaccinations against Haemophilus influenzae, Moraxella catarrhalis, and Bordetella pertussis.
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Affiliation(s)
- Dóra Paróczai
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary; (D.P.); (K.B.)
- Albert Szent-Györgyi Health Center, Department of Pulmonology, University of Szeged, H-6720 Szeged, Hungary
| | - Katalin Burian
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary; (D.P.); (K.B.)
| | - Andras Bikov
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester M13 9PL, UK
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Galili U. Antibody production and tolerance to the α-gal epitope as models for understanding and preventing the immune response to incompatible ABO carbohydrate antigens and for α-gal therapies. Front Mol Biosci 2023; 10:1209974. [PMID: 37449060 PMCID: PMC10338101 DOI: 10.3389/fmolb.2023.1209974] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
This review describes the significance of the α-gal epitope (Galα-3Galβ1-4GlcNAc-R) as the core of human blood-group A and B antigens (A and B antigens), determines in mouse models the principles underlying the immune response to these antigens, and suggests future strategies for the induction of immune tolerance to incompatible A and B antigens in human allografts. Carbohydrate antigens, such as ABO antigens and the α-gal epitope, differ from protein antigens in that they do not interact with T cells, but B cells interacting with them require T-cell help for their activation. The α-gal epitope is the core of both A and B antigens and is the ligand of the natural anti-Gal antibody, which is abundant in all humans. In A and O individuals, anti-Gal clones (called anti-Gal/B) comprise >85% of the so-called anti-B activity and bind to the B antigen in facets that do not include fucose-linked α1-2 to the core α-gal. As many as 1% of B cells are anti-Gal B cells. Activation of quiescent anti-Gal B cells upon exposure to α-gal epitopes on xenografts and some protozoa can increase the titer of anti-Gal by 100-fold. α1,3-Galactosyltransferase knockout (GT-KO) mice lack α-gal epitopes and can produce anti-Gal. These mice simulate human recipients of ABO-incompatible human allografts. Exposure for 2-4 weeks of naïve and memory mouse anti-Gal B cells to α-gal epitopes in the heterotopically grafted wild-type (WT) mouse heart results in the elimination of these cells and immune tolerance to this epitope. Shorter exposures of 7 days of anti-Gal B cells to α-gal epitopes in the WT heart result in the production of accommodating anti-Gal antibodies that bind to α-gal epitopes but do not lyse cells or reject the graft. Tolerance to α-gal epitopes due to the elimination of naïve and memory anti-Gal B cells can be further induced by 2 weeks in vivo exposure to WT lymphocytes or autologous lymphocytes engineered to present α-gal epitopes by transduction of the α1,3-galactosyltransferase gene. These mouse studies suggest that autologous human lymphocytes similarly engineered to present the A or B antigen may induce corresponding tolerance in recipients of ABO-incompatible allografts. The review further summarizes experimental works demonstrating the efficacy of α-gal therapies in amplifying anti-viral and anti-tumor immune-protection and regeneration of injured tissues.
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Affiliation(s)
- Uri Galili
- Department of Medicine, Rush University Medical College, Chicago, IL, United States
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Zhu N, Zhang F, Zhou H, Ma W, Mao H, Wang M, Ke Z, Wang J, Qi L. Mechanisms of Immune-Related Long Non-Coding RNAs in Spleens of Mice Vaccinated with 23-Valent Pneumococcal Polysaccharide Vaccine (PPV23). Vaccines (Basel) 2023; 11:vaccines11030529. [PMID: 36992112 DOI: 10.3390/vaccines11030529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/05/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
The 23-valent pneumococcal vaccine (PPV23) is a classical common vaccine used to prevent pneumococcal disease. In past decades, it was thought that vaccination with this vaccine induces humoral immunity, thereby reducing the disease associated with infection with 23 common serotypes of Streptococcus pneumoniae (Sp). However, for this polysaccharide vaccine, the mechanism of immune response at the transcriptional level has not been fully studied. To identify the lncRNAs (long noncoding RNAs) and mRNAs in spleens related to immunity after PPV23 vaccination in mice, high-throughput RNA sequencing of spleens between a PPV23 treatment group and a control group were performed and evaluated in this study. The RNA-seq results identified a total of 41,321 mRNAs and 34,375 lncRNAs, including 55 significantly differentially expressed (DE) mRNAs and 389 DE lncRNAs (p < 0.05) between the two groups. GO and KEGG annotation analysis indicated that the target genes of DE lncRNAs and DE mRNAs were related to T-cell costimulation, positive regulation of alpha–beta T-cell differentiation, the CD86 biosynthetic process, and the PI3K-Akt signaling pathway, indicating that the polysaccharide component antigens of PPV23 might activate a cellular immune response during the PPV23 immunization process. Moreover, we found that Trim35 (tripartite motif containing 35), a target gene of lncRNA MSTRG.9127, was involved in regulating immunity. Our study provides a catalog of lncRNAs and mRNAs associated with immune cells’ proliferation and differentiation, and they deserve further study to deepen the understanding of the biological processes in the regulation of PPV23 during humoral immunity and cellular immunity.
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Affiliation(s)
- Nan Zhu
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
- Aimei Vacin BioPharm (Zhejiang) Co., Ltd., Ningbo 315000, China
| | - Fan Zhang
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
- Aimei Vacin BioPharm (Zhejiang) Co., Ltd., Ningbo 315000, China
| | - Huan Zhou
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
- Aimei Vacin BioPharm (Zhejiang) Co., Ltd., Ningbo 315000, China
| | - Wei Ma
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
- Aimei Vacin BioPharm (Zhejiang) Co., Ltd., Ningbo 315000, China
| | - Haiguang Mao
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
| | - Mengting Wang
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
| | - Zhijian Ke
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
| | - Jinbo Wang
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
| | - Lili Qi
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China
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Durability of Antibody Response after Primary Pneumococcal Double-Dose Prime-Boost Vaccination in Adult Kidney Transplant Recipients and Candidates: 18-Month Follow-Up in a Non-Blinded, Randomised Clinical Trial. Vaccines (Basel) 2022; 10:vaccines10071091. [PMID: 35891255 PMCID: PMC9323946 DOI: 10.3390/vaccines10071091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/26/2022] [Accepted: 07/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Pneumococcal prime-boost vaccination is recommended for solid organ transplant recipients and candidates. The long-term durability of the antibody (AB) response is unknown. The same applies to a dose-dependent immune response. Methods: We studied the durability of the vaccine response after 18 months in kidney transplant recipients (KTRs) and patients on the kidney transplant waiting list (WLPs). Both groups received either a normal dose (ND) or a double dose (DD) of the 13-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine. The average pneumococcal AB geometric mean concentration (GMC) was evaluated. A level ≥ 1 mg/L was considered protective against invasive pneumococcal disease (IPD). Results: Sixty WLPs and 70 KTRs were included. The proportion of participants protected declined from 52% to 33% in WLPs and from 29% to 16% in KTRs, with the previously significant dose-effect in WLPs no longer present (40% DD vs. 27% ND; p = 0.273). Average pneumococcal AB GMCs remained significantly above baseline levels (all groups p ≤ 0.001). Drug-induced immunosuppression diminished the vaccine dose-effect. Conclusions: At follow-up, the pneumococcal prime-boost vaccination still provided significantly elevated average pneumococcal AB GMCs in both populations. Though the proportion of participants protected against IPD in WLP-DD and WLP-ND were statistically comparable, a DD may still be recommended for WLPs (EudraCT: 2016-004123-23).
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Immunogenicity and safety of double dosage of pneumococcal vaccines in adult kidney transplant recipients and waiting list patients: A non-blinded, randomized clinical trial. Vaccine 2022; 40:3884-3892. [PMID: 35644672 DOI: 10.1016/j.vaccine.2022.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pneumococcal prime-boost vaccination is recommended for solid organ transplant recipients, but is not thoroughly tested in this population. Furthermore, a pneumococcal vaccine dose effect has never been investigated, though observed in healthy adults. To assess whether a double dose of 13-valent pneumococcal conjugate vaccine (PCV13) and of 23-valent pneumococcal polysaccharide vaccine (PPV23) increases the immunogenicity of prime-boost vaccination in kidney transplant recipients (KTRs) and patients on the kidney transplant waiting list (WLPs), a phase 3, randomized, non-blinded trial was conducted. METHODS KTRs and WLPs were in parallel groups assigned either normal or double dosage of both vaccines 12 weeks apart. A 'protective response' was an average geometric mean concentration ≥ 1 mg/L based on 12 vaccine shared serotype-specific IgG antibodies. Furthermore, number of antibodies with ≥ 2-fold rises and individual serotype-specific antibody concentrations were evaluated. Follow-up was 48 weeks. RESULTS Seventy-four KTRs and 65 WLPs were enrolled. In WLPs, double dosage resulted in a significantly higher proportion of participants with a 'protective response' (66.7%), 5 weeks after PPV23, compared to normal dosage (35.5%), p = 0.015. KTRs exhibited no dose effect. After PPV23, all four groups had increased their number of serotypes with ≥ 2-fold rises (p ≤ 0.05 for both WLPs groups; p ≤ 0.01 for both KTRs groups). Vaccines were safe, well tolerated and still immunogenic at week 48. CONCLUSIONS Data suggests that double dosage of pneumococcal vaccines used according to the prime-boost strategy might be recommendable for WLPs. Furthermore, our data supports PPV23́s additive effect to PCV13 in KTRs and WLPs. (EudraCT: 2016-004123-23).
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Lucinde RK, Ong'ayo G, Houlihan C, Bottomley C, Goldblatt D, Scott JAG, Gallagher KE. Pneumococcal conjugate vaccine dose-ranging studies in humans: A systematic review. Vaccine 2021; 39:5095-5105. [PMID: 34340858 PMCID: PMC7613540 DOI: 10.1016/j.vaccine.2021.07.033] [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: 02/03/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is one of the most common bacterial pathogens of infants and young children. Antibody responses against the pneumococcal polysaccharide capsule are the basis of vaccine-mediated protection. We examined the relationship between the dose of polysaccharide in pneumococcal conjugate vaccines (PCVs) and immunogenicity. METHODS A systematic search of English publications that evaluated the immunogenicity of varying doses of pneumococcal conjugate vaccines was performed in Medline and Embase (Ovid Sp) databases in August 2019. We included only articles that involved administration of pneumococcal conjugate vaccine in humans and assessed the immunogenicity of more than one serotype-specific saccharide dose. Results were synthesised descriptively due to the heterogeneity of product valency, product content and vaccine schedule. RESULTS We identified 1691 articles after de-duplication; 9 studies met our inclusion criteria; 2 in adults, 6 in children and 1 in both. Doses of polysaccharide evaluated ranged from 0.44 mcg to 17.6 mcg. In infants, all doses tested elicited IgG geometric mean concentrations (GMCs) above the established correlate of protection (COP; 0.35 mcg/ml). A month after completion of the administered vaccine schedule, 95% confidence intervals of only three out of all the doses evaluated had GMCs that crossed below the COP. In the adult studies, all adults achieved GMCs that would be considered protective in children who have received 3 standard vaccine doses. CONCLUSION For some products, the mean antibody concentrations induced against some pneumococcal serotypes increased with increasing doses of the polysaccharide conjugate, but for other serotypes, there were no clear dose-response relationships or the dose response curves were negative. Fractional doses of polysaccharide which contain less than is included in currently distributed formulations may be useful in the development of higher valency vaccines, or dose-sparing delivery for paediatric use.
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Affiliation(s)
- R K Lucinde
- KEMRI-Wellcome Trust Research Programme (KWTRP), Centre for Geographic Medical Research - Coast (CGMRC), Kilifi, Kenya.
| | - G Ong'ayo
- KEMRI-Wellcome Trust Research Programme (KWTRP), Centre for Geographic Medical Research - Coast (CGMRC), Kilifi, Kenya
| | - C Houlihan
- Division of Infection and Immunity, University College London, London, UK
| | - C Bottomley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | - D Goldblatt
- Great Ormond Street Institute of Child Health, University College London, UK
| | - J A G Scott
- KEMRI-Wellcome Trust Research Programme (KWTRP), Centre for Geographic Medical Research - Coast (CGMRC), Kilifi, Kenya; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | - K E Gallagher
- KEMRI-Wellcome Trust Research Programme (KWTRP), Centre for Geographic Medical Research - Coast (CGMRC), Kilifi, Kenya; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
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Froneman C, Kelleher P, José RJ. Pneumococcal Vaccination in Immunocompromised Hosts: An Update. Vaccines (Basel) 2021; 9:536. [PMID: 34063785 PMCID: PMC8223771 DOI: 10.3390/vaccines9060536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
Infections with the pathogen, Streptococcus pneumoniae, are a common cause of morbidity and mortality worldwide. It particularly affects those at the extremes of age and immunocompromised individuals. Preventing pneumococcal disease is paramount in at risk individuals, and pneumococcal vaccination should be offered. Here, we discuss the role of pneumococcal vaccination in specific groups of immunocompromised hosts.
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Affiliation(s)
- Claire Froneman
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
| | - Peter Kelleher
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
- Department of Infectious Disease, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Ricardo J. José
- Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP, UK; (C.F.); (P.K.)
- Centre for Inflammation and Tissue Repair, UCL, London WC1E 6BT, UK
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Scelfo C, Menzella F, Fontana M, Ghidoni G, Galeone C, Facciolongo NC. Pneumonia and Invasive Pneumococcal Diseases: The Role of Pneumococcal Conjugate Vaccine in the Era of Multi-Drug Resistance. Vaccines (Basel) 2021; 9:420. [PMID: 33922273 PMCID: PMC8145843 DOI: 10.3390/vaccines9050420] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
Streptococcus pneumoniae related diseases are a leading cause of morbidity and mortality, especially in children and in the elderly population. It is transmitted to other individuals through droplets and it can spread to other parts of the human host, causing a wide spectrum of clinical syndromes, affecting between 10 and 100 cases per 100,000 people in Europe and the USA. In order to reduce morbidity and mortality caused by this agent, pneumococcal vaccines have been developed over the years and have shown incredible effectiveness in reducing the spread of this bacterium and the development of related diseases, obtaining a significant reduction in mortality, especially in developing countries. However, considerable problems are emerging mainly due to the replacement phenomenon, multi-drug resistance, and the high production costs of conjugated vaccines. There is still a debate about the indications given by various countries to different age groups; this is one of the reasons for the diffusion of different serotypes. To cope with these problems, significant efforts have been made in the research field to further improve vaccination serotypes coverage. On the other hand, an equally important commitment by health care systems to all age group populations is needed to improve vaccination coverage.
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Affiliation(s)
- Chiara Scelfo
- Pneumology Unit, Department of Medical Specialties, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (F.M.); (M.F.); (G.G.); (C.G.); (N.C.F.)
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Adler H, German EL, Mitsi E, Nikolaou E, Pojar S, Hales C, Robinson R, Connor V, Hill H, Hyder-Wright AD, Lazarova L, Lowe C, Smith EL, Wheeler I, Zaidi SR, Jochems SP, Loukov D, Reiné J, Solórzano-Gonzalez C, de Gorguette d'Argoeuves P, Jones T, Goldblatt D, Chen T, Aston SJ, French N, Collins AM, Gordon SB, Ferreira DM, Rylance J. Experimental Human Pneumococcal Colonization in Older Adults Is Feasible and Safe, Not Immunogenic. Am J Respir Crit Care Med 2021; 203:604-613. [PMID: 32941735 DOI: 10.1164/rccm.202004-1483oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Pneumococcal colonization is key to the pathogenesis of invasive disease but is also immunogenic in young adults, protecting against recolonization. Colonization is rarely detected in older adults, despite high rates of pneumococcal disease.Objectives: To establish experimental human pneumococcal colonization in healthy adults aged 50-84 years, to measure the immune response to pneumococcal challenge, and to assess the protective effect of prior colonization against autologous strain rechallenge.Methods: Sixty-four participants were inoculated with Streptococcus pneumoniae (serotype 6B; 80,000 cfu in each nostril). Colonization was determined by bacterial culture of nasal wash, and humoral immune responses were assessed by anticapsular and antiprotein IgG concentrations.Measurements and Main Results: Experimental colonization was established in 39% of participants (25/64) with no adverse events. Colonization occurred in 47% (9/19) of participants aged 50-59 compared with 21% (3/14) in those aged ≥70 years. Previous pneumococcal polysaccharide vaccination did not protect against colonization. Colonization did not confer serotype-specific immune boosting, with a geometric mean titer (95% confidence interval) of 2.7 μg/ml (1.9-3.8) before the challenge versus 3.0 (1.9-4.7) 4 weeks after colonization (P = 0.53). Furthermore, pneumococcal challenge without colonization led to a drop in specific antibody concentrations from 2.8 μg/ml (2.0-3.9) to 2.2 μg/ml (1.6-3.0) after the challenge (P = 0.006). Antiprotein antibody concentrations increased after successful colonization. Rechallenge with the same strain after a median of 8.5 months (interquartile range, 6.7-10.1) led to recolonization in 5/16 (31%).Conclusions: In older adults, experimental pneumococcal colonization is feasible and safe but demonstrates different immunological outcomes compared with younger adults in previous studies.
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Affiliation(s)
- Hugh Adler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Esther L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Caz Hales
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Rachel Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Victoria Connor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Angela D Hyder-Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Clinical Research Network, North West Coast, United Kingdom
| | - Lepa Lazarova
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Catherine Lowe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Emma L Smith
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - India Wheeler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Seher R Zaidi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Simon P Jochems
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Dessi Loukov
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano-Gonzalez
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Tessa Jones
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - David Goldblatt
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen J Aston
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Neil French
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Aintree University Hospital, Liverpool, United Kingdom; and
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
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12
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Wagner A, Weinberger B. Vaccines to Prevent Infectious Diseases in the Older Population: Immunological Challenges and Future Perspectives. Front Immunol 2020; 11:717. [PMID: 32391017 PMCID: PMC7190794 DOI: 10.3389/fimmu.2020.00717] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
Infectious diseases are a major cause for morbidity and mortality in the older population. Demographic changes will lead to increasing numbers of older persons over the next decades. Prevention of infections becomes increasingly important to ensure healthy aging for the individual, and to alleviate the socio-economic burden for societies. Undoubtedly, vaccines are the most efficient health care measure to prevent infections. Age-associated changes of the immune system are responsible for decreased immunogenicity and clinical efficacy of most currently used vaccines in older age. Efficacy of standard influenza vaccines is only 30-50% in the older population. Several approaches, such as higher antigen dose, use of MF59 as adjuvant and intradermal administration have been implemented in order to specifically target the aged immune system. The use of a 23-valent polysaccharide vaccine against Streptococcus pneumoniae has been amended by a 13-valent conjugated pneumococcal vaccine originally developed for young children several years ago to overcome at least some of the limitations of the T cell-independent polysaccharide antigens, but still is only approximately 50% protective against pneumonia. A live-attenuated vaccine against herpes zoster, which has been available for several years, demonstrated efficacy of 51% against herpes zoster and 67% against post-herpetic neuralgia. Protection was lower in the very old and decreased several years after vaccination. Recently, a recombinant vaccine containing the viral glycoprotein gE and the novel adjuvant AS01B has been licensed. Phase III studies demonstrated efficacy against herpes zoster of approx. 90% even in the oldest age groups after administration of two doses and many countries now recommend the preferential use of this vaccine. There are still many infectious diseases causing substantial morbidity in the older population, for which no vaccines are available so far. Extensive research is ongoing to develop vaccines against novel targets with several vaccine candidates already being clinically tested, which have the potential to substantially reduce health care costs and to save many lives. In addition to the development of novel and improved vaccines, which specifically target the aged immune system, it is also important to improve uptake of the existing vaccines in order to protect the vulnerable, older population.
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Affiliation(s)
- Angelika Wagner
- Department of Pathophysiology, Infectiology, and Immunology, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
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Rupp R, Hurley D, Grayson S, Li J, Nolan K, McFetridge RD, Hartzel J, Abeygunawardana C, Winters M, Pujar H, Benner P, Musey L. A dose ranging study of 2 different formulations of 15-valent pneumococcal conjugate vaccine (PCV15) in healthy infants. Hum Vaccin Immunother 2019; 15:549-559. [PMID: 30689507 DOI: 10.1080/21645515.2019.1568159] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Two new formulations of an investigational 15-valent pneumococcal conjugate vaccine (PCV15-A and PCV15-B) were developed using 2 different protein-polysaccharide conjugation processes and evaluated in separate phase I/II studies (NCT02037984 [V114-004] and NCT02531373 [V114-005]) to assess optimal concentrations of pneumococcal polysaccharide (PnPs) and Aluminum Phosphate Adjuvant. METHODS Various lots of PCV15-A and PCV15-B containing different concentrations of PnPs and/or adjuvant were compared to PCV13 in young adults and infants. Adults received single dose and infants received 4 doses at 2, 4, 6, and 12-15 months of age. Adverse events (AEs) were collected after each dose. Serotype-specific immunoglobulin G (IgG) concentrations and opsonophagocytic activity (OPA) were measured prior and 30 days postvaccination in adults, at 1 month postdose 3 (PD3), pre-dose4, and postdose 4 (PD4) in infants. RESULTS Safety profiles were comparable across vaccination groups. At PD3, serotype-specific IgG GMCs were generally lower for either PCV15 formulation than PCV13 for most shared serotypes. PCV15 consistently elicited higher antibody responses to the 2 serotypes unique to the vaccine (22F and 33F) and serotype 3 for which PCV13 was shown to be ineffective. Except for serotypes 6A and 6B, no dose-response effect was observed with increasing concentrations of PnPs and/or adjuvant. CONCLUSION PCV15 is safe and induces IgG and OPA responses to all 15 serotypes in the vaccine. No significant differences in antibody responses were observed with increases in PnPs and/or Aluminum Phosphate Adjuvant.
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Affiliation(s)
- R Rupp
- a University of Texas Medical Branch , Galveston , TX , USA
| | - D Hurley
- b Wasatch Pediatrics, Cottonwood Office , Murray , UT , USA
| | - S Grayson
- c Merck & Co., Inc ., Kenilworth , NJ , USA
| | - J Li
- c Merck & Co., Inc ., Kenilworth , NJ , USA
| | - K Nolan
- c Merck & Co., Inc ., Kenilworth , NJ , USA
| | | | - J Hartzel
- c Merck & Co., Inc ., Kenilworth , NJ , USA
| | | | - M Winters
- c Merck & Co., Inc ., Kenilworth , NJ , USA
| | - H Pujar
- c Merck & Co., Inc ., Kenilworth , NJ , USA
| | - P Benner
- c Merck & Co., Inc ., Kenilworth , NJ , USA
| | - L Musey
- c Merck & Co., Inc ., Kenilworth , NJ , USA
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14
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Jackson LA, El Sahly HM, George S, Winokur P, Edwards K, Brady RC, Rouphael N, Keitel WA, Mulligan MJ, Burton RL, Nakamura A, Ferreria J, Nahm MH. Randomized clinical trial of a single versus a double dose of 13-valent pneumococcal conjugate vaccine in adults 55 through 74 years of age previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine 2017; 36:606-614. [PMID: 29279281 DOI: 10.1016/j.vaccine.2017.12.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In older adults, prior administration of 23-valent pneumococcal polysaccharide vaccine (PPSV23) blunts the opsonophagocytic antibody (OPA) response to subsequent administration of 13-valent pneumococcal conjugate vaccine (PCV13). To determine whether a higher dose of PCV13 could mitigate this effect in adults 55 through 74 years of age, we compared OPA responses to a double dose of PCV13 in persons previously vaccinated with PPSV23 with responses to a single dose of PCV13 in previously vaccinated persons, and with a single dose in PPSV23 naïve persons. METHODS Subjects previously vaccinated with PPSV23 were randomly assigned to receive either a single injection or two concurrent injections of 0.5 mL PCV13. Naïve subjects received a single injection of 0.5 mL PCV13. Serotype-specific OPA responses to 12 of the PCV13 serotypes were assessed on samples collected on Day 29 and Day 181. Comparisons of the OPA titers between study groups were based on the lower bound of the 95% confidence interval of the log geometric mean ratio to define superiority (>1) and non-inferiority (>0.5). RESULTS At Day 29, the OPA responses to one dose in previously vaccinated (n = 284) versus one dose in naïve subjects (n = 311) achieved the threshold for non-inferiority for only 3 of the 12 serotypes. In previously vaccinated subjects, responses to a double dose (n = 288) versus a single dose met the threshold for superiority for 7 serotypes. The responses to a double dose in previously vaccinated subjects versus a single dose in naïve subjects met the threshold for non-inferiority for 9 serotypes. CONCLUSIONS There is a dose response to PCV13 in older adults and the higher response to a double dose in previously vaccinated adults is non-inferior to that of a single dose in naïve adults for 9 of the 12 PCV13 serotypes evaluated.
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Affiliation(s)
- Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
| | - Hana M El Sahly
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sarah George
- Division of Infectious Diseases, Allergy, & Immunology, Saint Louis University School of Medicine, and St. Louis VA Medical Center, St. Louis, MO, United States
| | - Patricia Winokur
- University of Iowa and Iowa City VA Medical Center, Iowa City, IA, United States
| | - Kathryn Edwards
- Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Rebecca C Brady
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nadine Rouphael
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA, United States
| | - Wendy A Keitel
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Mark J Mulligan
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA, United States
| | - Robert L Burton
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Aya Nakamura
- The Emmes Corporation, Rockville, MD, United States
| | | | - Moon H Nahm
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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15
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Nguyen MTT, Lindegaard H, Hendricks O, Jørgensen CS, Kantsø B, Friis-Møller N. Initial Serological Response after Prime-boost Pneumococcal Vaccination in Rheumatoid Arthritis Patients: Results of a Randomized Controlled Trial. J Rheumatol 2017; 44:1794-1803. [PMID: 28966211 DOI: 10.3899/jrheum.161407] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the initial serological responses to pneumococcal vaccination with the 13-valent protein-conjugated pneumococcal vaccine (PCV13) followed by the 23-valent polysaccharide pneumococcal vaccine (PPV23) among patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARD) according to dosing and intervals between immunizations. METHODS Investigator-initiated clinical trial. Patients with RA receiving bDMARD were randomized (1:1:1) to immunization with single dose PCV13 followed by PPV23 after 16 or 24 weeks, or double dose PCV13 followed by PPV23 after 16 weeks. A comparison group of patients with RA treated with conventional synthetic (cs)DMARD received single dose PCV13 followed by PPV23 16 weeks later. Pneumococcal antibodies were collected before and 4 weeks after each vaccination. The primary endpoint was the proportion of participants responding to ≥ 6/12 pneumococcal serotypes 4 weeks after both vaccinations. RESULTS Sixty-five participants receiving bDMARD and 35 participants receiving csDMARD were included. After PPV23 vaccination, 87% (95% CI 0.76-0.94) and 94% (95% CI 0.77-0.99), respectively, of participants treated with bDMARD and csDMARD had reached the primary endpoint. There was no significant difference in primary endpoint between the 3 randomization arms. The response for rituximab-treated participants was 25% compared to ≥ 89% in participants treated with bDMARD with other mode of action. CONCLUSION The early serological response to prime-boost vaccination with PCV13 followed by PPV23 was very similar among participants receiving bDMARD and csDMARD. However, notable differences in response were observed according to individual bDMARD. It is important to consider the RA treatment when planning pneumococcal vaccination in patients with RA.
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Affiliation(s)
- Mai T T Nguyen
- From the Department of Infectious Diseases, and Department of Rheumatology, and Odense Patient data Explorative Network (OPEN), Odense University Hospital; Institute of Clinical Research, University of Southern Denmark; Institute of Regional Research, University of Southern Denmark, Odense; Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, Graasten; Department of Microbiology and Virology, Statens Serum Institut, Copenhagen; Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark. .,M.T. Nguyen, MD, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and OPEN, Odense University Hospital; H. Lindegaard, MD, PhD, Institute of Clinical Research, University of Southern Denmark, and Department of Rheumatology, Odense University Hospital; O. Hendricks, MD, PhD, Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, and Institute of Regional Research, University of Southern Denmark; C.S. Jørgensen, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; B. Kantsø, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; N. Friis-Møller, MD, DMSc, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital.
| | - Hanne Lindegaard
- From the Department of Infectious Diseases, and Department of Rheumatology, and Odense Patient data Explorative Network (OPEN), Odense University Hospital; Institute of Clinical Research, University of Southern Denmark; Institute of Regional Research, University of Southern Denmark, Odense; Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, Graasten; Department of Microbiology and Virology, Statens Serum Institut, Copenhagen; Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,M.T. Nguyen, MD, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and OPEN, Odense University Hospital; H. Lindegaard, MD, PhD, Institute of Clinical Research, University of Southern Denmark, and Department of Rheumatology, Odense University Hospital; O. Hendricks, MD, PhD, Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, and Institute of Regional Research, University of Southern Denmark; C.S. Jørgensen, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; B. Kantsø, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; N. Friis-Møller, MD, DMSc, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital
| | - Oliver Hendricks
- From the Department of Infectious Diseases, and Department of Rheumatology, and Odense Patient data Explorative Network (OPEN), Odense University Hospital; Institute of Clinical Research, University of Southern Denmark; Institute of Regional Research, University of Southern Denmark, Odense; Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, Graasten; Department of Microbiology and Virology, Statens Serum Institut, Copenhagen; Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,M.T. Nguyen, MD, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and OPEN, Odense University Hospital; H. Lindegaard, MD, PhD, Institute of Clinical Research, University of Southern Denmark, and Department of Rheumatology, Odense University Hospital; O. Hendricks, MD, PhD, Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, and Institute of Regional Research, University of Southern Denmark; C.S. Jørgensen, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; B. Kantsø, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; N. Friis-Møller, MD, DMSc, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital
| | - Charlotte Sværke Jørgensen
- From the Department of Infectious Diseases, and Department of Rheumatology, and Odense Patient data Explorative Network (OPEN), Odense University Hospital; Institute of Clinical Research, University of Southern Denmark; Institute of Regional Research, University of Southern Denmark, Odense; Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, Graasten; Department of Microbiology and Virology, Statens Serum Institut, Copenhagen; Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,M.T. Nguyen, MD, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and OPEN, Odense University Hospital; H. Lindegaard, MD, PhD, Institute of Clinical Research, University of Southern Denmark, and Department of Rheumatology, Odense University Hospital; O. Hendricks, MD, PhD, Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, and Institute of Regional Research, University of Southern Denmark; C.S. Jørgensen, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; B. Kantsø, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; N. Friis-Møller, MD, DMSc, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital
| | - Bjørn Kantsø
- From the Department of Infectious Diseases, and Department of Rheumatology, and Odense Patient data Explorative Network (OPEN), Odense University Hospital; Institute of Clinical Research, University of Southern Denmark; Institute of Regional Research, University of Southern Denmark, Odense; Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, Graasten; Department of Microbiology and Virology, Statens Serum Institut, Copenhagen; Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,M.T. Nguyen, MD, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and OPEN, Odense University Hospital; H. Lindegaard, MD, PhD, Institute of Clinical Research, University of Southern Denmark, and Department of Rheumatology, Odense University Hospital; O. Hendricks, MD, PhD, Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, and Institute of Regional Research, University of Southern Denmark; C.S. Jørgensen, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; B. Kantsø, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; N. Friis-Møller, MD, DMSc, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital
| | - Nina Friis-Møller
- From the Department of Infectious Diseases, and Department of Rheumatology, and Odense Patient data Explorative Network (OPEN), Odense University Hospital; Institute of Clinical Research, University of Southern Denmark; Institute of Regional Research, University of Southern Denmark, Odense; Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, Graasten; Department of Microbiology and Virology, Statens Serum Institut, Copenhagen; Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark.,M.T. Nguyen, MD, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and OPEN, Odense University Hospital; H. Lindegaard, MD, PhD, Institute of Clinical Research, University of Southern Denmark, and Department of Rheumatology, Odense University Hospital; O. Hendricks, MD, PhD, Department of Rheumatology, King Christian Xth Hospital for Rheumatic Disease, and Institute of Regional Research, University of Southern Denmark; C.S. Jørgensen, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; B. Kantsø, MSc, PhD, Department of Microbiology and Virology, Statens Serum Institut; N. Friis-Møller, MD, DMSc, Department of Infectious Diseases, Odense University Hospital, and Institute of Clinical Research, University of Southern Denmark, and Unit of Infectious Diseases, Department of Internal Medicine, Zealand University Hospital
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16
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Laratta CR, Williams K, Vethanayagam D, Ulanova M, Vliagoftis H. A case series evaluating the serological response of adult asthma patients to the 23-valent pneumococcal polysaccharide vaccine. Allergy Asthma Clin Immunol 2017; 13:27. [PMID: 28596792 PMCID: PMC5463404 DOI: 10.1186/s13223-017-0200-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 05/23/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Asthma is an independent risk factor for invasive pneumococcal disease; however, the immune response of adult asthma patients to pneumococcal vaccination is unknown. We explore the serologic response of patients with moderate to severe asthma to the 23-valent pneumococcal polysaccharide vaccine (PPSV23). METHODS Seventeen moderate to severe adult asthma patients that had not been vaccinated against pneumococcus over the 5 previous years were prospectively recruited from a tertiary care asthma clinic. Serum was analyzed for the presence of antibodies to five capsular polysaccharide (CP) antigens (6B, 9V, 19A, 19F, 23F) before and 4 weeks after PPSV23 vaccination. RESULTS There was a wide variability in baseline anti-CP antibody concentrations. Other than for serotype 19A, our patients frequently have baseline anti-CP antibody concentrations below 1 µg/mL (35% for serotype 19F, 41% for serotypes 9V and 23F, and 59% for serotype 6B). All post-vaccination geometric mean antibody concentrations were significantly higher than baseline. In the 31 tests where the baseline antibody concentration was <1 µg/mL, 77.4% had at least a twofold increase post-vaccination. Despite this, a large proportion of post-vaccination anti-CP antibody concentrations remained <1 µg/mL (51.6% of tests). Nine patients had at least one anti-CP antibody concentration <1 µg/mL post-vaccination. There was no difference between these patients and the remaining eight patients in demographic or clinical variables. CONCLUSIONS Patients with moderate to severe asthma have variable baseline and low post-vaccination antibody concentrations to common CP antigens included in the PPSV23 vaccine. The clinical relevance of these observations remains to be determined since the threshold concentration in adults required for clinical protection from invasive pneumococcal disease is uncertain.
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Affiliation(s)
- C R Laratta
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - K Williams
- Medical Sciences Division, Northern Ontario School of Medicine, Lakehead University Campus, Thunder Bay, ON Canada
| | - D Vethanayagam
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - M Ulanova
- Medical Sciences Division, Northern Ontario School of Medicine, Lakehead University Campus, Thunder Bay, ON Canada
| | - H Vliagoftis
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, AB Canada.,Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Room 3-105 Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G 2G3 Canada
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17
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Pneumococcal Capsular Polysaccharide Immunity in the Elderly. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00004-17. [PMID: 28424198 DOI: 10.1128/cvi.00004-17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immunity to pneumococcal infections is impaired in older people, and current vaccines are poorly protective against pneumococcal disease in this population. Naturally acquired immunity to pneumococcal capsular polysaccharides develops during childhood and is robust in young adults but deteriorates with advanced age. In particular, antibody levels and function are reduced in older people. Pneumococcal vaccines are recommended for people >65 years old. However, the benefits of polysaccharide and protein-conjugated vaccines in this population are small, because of both serotype replacement and incomplete protection against vaccine serotype pneumococcal disease. In this review, we overview the immune mechanisms by which naturally acquired and vaccine-induced pneumococcal capsular polysaccharide immunity declines with age, including altered colonization dynamics, reduced opsonic activity of antibodies (particularly IgM), and impaired mucosal immunity.
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18
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Kong Y, Zhang W, Jiang Z, Wang L, Li C, Li Y, Xia J. Immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in Chinese healthy population aged >2 years: A randomized, double-blinded, active control, phase III trial. Hum Vaccin Immunother 2016; 11:2425-33. [PMID: 26083953 DOI: 10.1080/21645515.2015.1055429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Streptococcus pneumoniae is an important pathogen causing invasive diseases such as sepsis, meningitis, and pneumonia. Vaccines have become the most effective way to prevent pneumococcal infections. This phase III trial was designed to evaluate the immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in Chinese healthy population aged >2 years. We conducted a randomized, double-blinded, active-controlled, multicenter trial in which 1660 healthy population (>2 years of age) were randomly assigned in a 1 : 1 ratio to receive 2 intramuscular doses of either the treatment vaccine or the active control vaccine, PNEUMOVAX 23. The surveillance period was 30 days. The primary end point was the 2-fold increase rate of anti-pneumococcal antibody for all 23 included serotypes in each group. In the intention-to-treat cohort, the 2-fold increase rate of anti-pneumococcal antibody for 23 included serotypes varied from 62.47% to 97.01% in the treatment group, and from 51.49% to 95.77% in the control group. According to -10% non-inferiority margin and 95% confidence intervals of rate difference, almost all included serotypes of the treatment group reached non-inferiority to control group except for serotype 6B, the lower limit of rate difference of which was -10.00%, equal to the non-inferiority margin. The 2-fold increase rates of anti-pneumococcal antibody were significantly higher in the treatment group for serotype 2, 3, 4, 10A, 11A and 20. Furthermore, for all 23 serotypes, IgG geometric mean concentrations (GMCs) at day 30 were significantly higher in treatment group for serotype 2, 3, 4, 9 V, 10A, 11A, 15 B, 18C, 19 A, 22 F and 33 F. Higher geometric mean fold increase (GMFI) were also observed in the treatment group correspondingly. Serious adverse events occurred in 3 of 830 participants in the treatment group (0.36%) and 2 of 830 participants in the control group (0.24%). No death occurred during the trial. The frequencies of both solicited and unsolicited adverse events (AEs) were small lower in the treatment group (34.34% vs 35.66% for solicited AEs, 4.34% vs 5.42% for unsolicited AEs). Both vaccines were well tolerated and most AEs were mild or moderate in intensity. The newly vaccine was well tolerated and immunologically non-inferior to the active control vaccine PNEUMOVAX 23 for all 23 vaccine serotypes in the Chinese population (>2 years of age).
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Affiliation(s)
- Yujia Kong
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Wei Zhang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Zhiwei Jiang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Ling Wang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Chanjuan Li
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Yanping Li
- b Center for Disease Control and Prevention of the Guangxi Zhuang Autonomous Region ; Nanning , China
| | - Jielai Xia
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
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Protease Inhibitors Do Not Affect Antibody Responses to Pneumococcal Vaccination. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:524-529. [PMID: 27074938 DOI: 10.1128/cvi.00026-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/10/2016] [Indexed: 11/20/2022]
Abstract
HIV(+) subjects on optimal antiretroviral therapy have persistently impaired antibody responses to pneumococcal vaccination. We explored the possibility that this effect may be due to HIV protease inhibitors (PIs). We found that in humans and mice, PIs do not affect antibody production in response to pneumococcal vaccination.
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Dirmesropian S, Wood JG, MacIntyre CR, Newall AT. A review of economic evaluations of 13-valent pneumococcal conjugate vaccine (PCV13) in adults and the elderly. Hum Vaccin Immunother 2016; 11:818-25. [PMID: 25933180 PMCID: PMC4514194 DOI: 10.1080/21645515.2015.1011954] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The 13-valent pneumococcal conjugated vaccine (PCV13) is already recommended for some adult groups and is being considered for wider use in many countries. In order to identify the strengths and limitations of the existing economic evaluation studies of PCV13 in adults and the elderly a literature review was conducted. The majority of the studies identified (9 out of 10) found that PCV13 was cost-effective in adults and/or the elderly. However, these results were based on assumptions that could not always be informed by robust evidence. Key uncertainties included the efficacy of PCV13 against non-invasive pneumonia and the herd immunity effect of childhood vaccination programs. Emerging trial evidence on PCV13 in adults from the Netherlands offers the ability to parameterize future economic evaluations with empirical efficacy data. However, it is important that these estimates are used thoughtfully when they are transferred to other settings.
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Affiliation(s)
- S Dirmesropian
- a School of Public Health and Community Medicine; UNSW Australia ; Sydney , NSW Australia
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21
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Long-term immune responses and comparative effectiveness of one or two doses of 7-valent pneumococcal conjugate vaccine (PCV7) in HIV-positive adults in the era of combination antiretroviral therapy. J Int AIDS Soc 2016; 19:20631. [PMID: 26829360 PMCID: PMC4733944 DOI: 10.7448/ias.19.1.20631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/04/2015] [Accepted: 12/21/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction HIV infection impairs maintenance of immunological memory, yet few studies of HIV-positive adults receiving 7-valent pneumococcal conjugate vaccine (PCV7) have followed them beyond the first year. We determined and compared the durability of serological responses and the clinical outcomes of HIV-positive adults annually for five years following vaccination with one or two doses of PCV7. Methods In this non-randomized clinical trial, 221 pneumococcal vaccine-naïve HIV-positive adults receiving one (n=109) or two doses four weeks apart (n=112) of PCV7 between 2008 and 2010 were longitudinally followed for evaluation of significant serological response and for episodes of pneumonia and invasive pneumococcal disease. Results At the time of vaccination, the two groups were well matched for age, risk factors, combination antiretroviral therapy (cART) coverage, CD4 count and plasma HIV RNA load (PVL). At the end of five years, the CD4 counts for the one- and two-dose groups had increased from 407 and 406 to 550 and 592 cells/µL, respectively, and 82.4 and 81.6% of the participants had fully suppressed PVL. Significant immune responses to ≥2 serotypes persisted for 67.9 vs 78.6%, 64.2 vs 71.4%, 66.1 vs 71.4%, 57.8 vs 69.6% in the second, third, fourth and fifth years after one and two doses of PCV7 in the intention-to-treat analysis, respectively. In multivariate analysis, immunization with two doses of PCV7 (odds ratio (OR) 1.71, 95% confidence interval (CI) 1.10 to 2.65, p=0.016), concurrent cART (OR 2.16, 95% CI 1.16 to 4.00, p=0.015) and CD4 proliferation (OR 1.12, 95% CI 1.01 to 1.27, p=0.031) were predictive of persistent serological responses in the fifth year. Only one patient in the one-dose group had documented pneumococcal pneumonia (non-bacteraemic) and none had invasive pneumococcal disease in the 6.5 years of follow-up. Conclusions One or two doses of PCV7 achieve durable seroprotective responses in HIV-treated participants; however, two doses may be more robust than one dose in a larger study population or in real-world populations with less cART coverage.
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Pneumococcus with the "6E" cps Locus Produces Serotype 6B Capsular Polysaccharide. J Clin Microbiol 2016; 54:967-71. [PMID: 26818670 DOI: 10.1128/jcm.03194-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/15/2016] [Indexed: 11/20/2022] Open
Abstract
Genetic studies of serogroup 6 isolates ofStreptococcus pneumoniaeidentified putative serotype 6E. Although its capsular polysaccharide structure has not been elucidated, putative serotype 6E is described in an increasing number of studies as a potentially new serotype. We show here that SPEC6B, which is widely used as a target strain for serotype 6B opsonophagocytosis assays, has the genetic features of the putative serotype 6E but produces capsular polysaccharide identical to 6B capsular polysaccharide as determined by one-dimensional (1D) and 2D nuclear magnetic resonance (NMR). Thus, putative serotype 6E is a mere genetic variant of serotype 6B. Also, SPEC6B is appropriate as a target strain for serotype 6B opsonophagocytosis assays. This example illustrates the difficulties of assigning new bacterial serotypes based on genetic findings alone.
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Lin H, Peng Y, Lin Z, Zhang S, Guo Y. Development of a conjugate vaccine against invasive pneumococcal disease based on capsular polysaccharides coupled with PspA/family 1 protein of Streptococcus pneumoniae. Microb Pathog 2015; 83-84:35-40. [DOI: 10.1016/j.micpath.2015.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 11/30/2022]
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24
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Parry HM, Birtwistle J, Whitelegg A, Hudson C, McSkeane T, Hazlewood P, Mudongo N, Pratt G, Moss P, Drayson MT, Murray J, Richter AG. Poor functional antibody responses are present in nearly all patients with chronic lymphocytic leukaemia, irrespective of total IgG concentration, and are associated with increased risk of infection. Br J Haematol 2015; 171:887-90. [DOI: 10.1111/bjh.13455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Helen M. Parry
- Cancer Sciences; University of Birmingham; Birmingham UK
| | - Jane Birtwistle
- Department of Immunology; University of Birmingham; Birmingham UK
| | - Alison Whitelegg
- Department of Immunology; University of Birmingham; Birmingham UK
| | - Chris Hudson
- School of Medicine and Veterinary Science; University of Nottingham; Nottingham UK
| | - Tina McSkeane
- Cancer Research UK Clinical Trials Unit; University of Birmingham; Birmingham UK
| | - Peter Hazlewood
- Cancer Research UK Clinical Trials Unit; University of Birmingham; Birmingham UK
| | | | - Guy Pratt
- Cancer Sciences; University of Birmingham; Birmingham UK
| | - Paul Moss
- Cancer Sciences; University of Birmingham; Birmingham UK
| | - Mark T. Drayson
- Department of Immunology; University of Birmingham; Birmingham UK
| | - Jim Murray
- Department of Haematology; University Hospital Birmingham; Birmingham UK
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Namkoong H, Funatsu Y, Oishi K, Akeda Y, Hiraoka R, Takeshita K, Asami T, Yagi K, Kimizuka Y, Ishii M, Tasaka S, Suzuki Y, Iwata S, Betsuyaku T, Hasegawa N. Comparison of the immunogenicity and safety of polysaccharide and protein-conjugated pneumococcal vaccines among the elderly aged 80 years or older in Japan: an open-labeled randomized study. Vaccine 2014; 33:327-32. [PMID: 25448102 DOI: 10.1016/j.vaccine.2014.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/10/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
An open-labeled randomized study was conducted to compare the immunogenicity and safety of polysaccharide (PPV23) or protein-conjugated pneumococcal vaccine (PCV7) among the elderly aged 80 years or older. A total of 105 nursing home residents were enrolled in this study. We analyzed the geometric mean concentration (GMC) of serotype-specific immunoglobulin G (IgG) and the geometric mean titer (GMT) of the opsonization index (OI) for serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F. The GMCs of serotype-specific IgG and the GMTs of the OI significantly increased one month after vaccination in both groups for all seven serotypes evaluated. In the PCV7 group, study subjects with serotypes 4, 9V, 18C, and 23F exhibited statistically significant elevations in both serotype-specific IgGs and OIs compared to those of the PPV23 group. Both vaccines were tolerated without any severe adverse events, and no differences in systemic adverse events were observed between the two groups, although adverse reactions such as redness and localized swelling were more common in the PCV7 group. Our data demonstrated that the GMCs of serotype-specific IgG and the GMTs of the OI were higher in the PCV7 group compared to those in the PPV23 group. Our study also confirmed the safety of both the PCV7 and PPV23 vaccines in elderly people aged 80 years or older.
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Affiliation(s)
- Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yohei Funatsu
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
| | - Yukihiro Akeda
- International Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Rika Hiraoka
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Kei Takeshita
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Takahiro Asami
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuma Yagi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Kimizuka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Sadatomo Tasaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukio Suzuki
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Satoshi Iwata
- Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan.
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26
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Iyer AS, Ohtola JA, Westerink MAJ. Age-related immune response to pneumococcal polysaccharide vaccination: lessons for the clinic. Expert Rev Vaccines 2014; 14:85-97. [DOI: 10.1586/14760584.2015.963058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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A review of the evidence to inform pneumococcal vaccine recommendations for risk groups aged 2 years and older. Epidemiol Infect 2014; 142:2471-82. [PMID: 24932959 DOI: 10.1017/s0950268814001514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
For decades, vaccination with the 23-valent polysaccharide pneumococcal vaccine (PPV23) has been available for risk groups aged ⩾2 years to prevent invasive pneumococcal disease (IPD). Recently, a 13-valent pneumococcal conjugated vaccine (PCV13) has been licensed for use in all age groups. PCV13 may induce better protection than PPV23 because of different immunogenic properties. This called for a revision of vaccine recommendations for risk groups. We therefore reviewed literature on risk groups for IPD, and effectiveness and safety of pneumococcal vaccines and supplemented that with information from public health institutes, expert consultations and data on IPD epidemiology. We included 187 articles. We discuss the implications of the heterogenic vulnerability for IPD within and between risk groups, large indirect effects of childhood immunization, and limited knowledge on additional clinical benefits of PCV13 in combination with PPV23 for the Norwegian recommendations. These are now step-wise and consider the need for vaccination, choice of pneumococcal vaccines, and re-vaccination interval by risk group.
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MacIntyre CR, Ridda I, Gao Z, Moa AM, McIntyre PB, Sullivan JS, Jones TR, Hayen A, Lindley RI. A randomized clinical trial of the immunogenicity of 7-valent pneumococcal conjugate vaccine compared to 23-valent polysaccharide vaccine in frail, hospitalized elderly. PLoS One 2014; 9:e94578. [PMID: 24760002 PMCID: PMC3997415 DOI: 10.1371/journal.pone.0094578] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/17/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Elderly people do not mount strong immune responses to vaccines. We compared 23-valent capsular polysaccharide (23vPPV) alone versus 7-valent conjugate (PCV7) vaccine followed by 23vPPV 6 months later in hospitalized elderly. METHODS Participants were randomized to receive 23vPPV or PCV7-23vPPV. Antibodies against serotypes 3, 4, 6A, 6B, 9V, 14, 18C, 19A, 19F, 23F were measured by enzyme-linked immunosorbent (ELISA) and opsonophagocytic (OPA) assays at baseline, 6 months and 12 months. RESULTS Of 312 recruited, between 40% and 72% of subjects had undetectable OPA titres at baseline. After one dose, PCV7 recipients had significantly higher responses to serotypes 9V (both assays) and 23F (OPA only), and 23vPPV recipients had significantly higher responses to serotype 3 (ELISA), 19F and 19A (OPA only). In subjects with undetectable OPA titres at baseline, a proportionately greater rise in OPA titre (P<0.01) was seen for all serotypes after both vaccines. The GMT ratio of OPA was significantly higher at 12 months in the PCV7-23vPPV group for serotypes 6A, 9V, 18C and 23F. OPA titre levels for these serotypes increased moderately after 6 months, whereas immunity waned in the 23vPPV only arm. CONCLUSION We did not show overwhelming benefit of one vaccine over the other. Low baseline immunity does not preclude a robust immune response, reiterating the importance of vaccinating the frail elderly. A schedule of PCV7-23vPPV prevents waning of antibody, suggesting that both vaccines could be useful in the elderly. Follow up studies are needed to determine persistence of immunity. TRIAL REGISTRATION The Australian Clinical Trials Registry ACTRN12607000387426.
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Affiliation(s)
- C. Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Australia, The University of New South Wales, Sydney, Australia
- National Centre for Immunization Research and Surveillance (NCIRS), Westmead, Australia
| | - Iman Ridda
- School of Public Health and Community Medicine, UNSW Australia, The University of New South Wales, Sydney, Australia
| | - Zhanhai Gao
- School of Public Health and Community Medicine, UNSW Australia, The University of New South Wales, Sydney, Australia
| | - Aye M. Moa
- School of Public Health and Community Medicine, UNSW Australia, The University of New South Wales, Sydney, Australia
| | - Peter B. McIntyre
- National Centre for Immunization Research and Surveillance (NCIRS), Westmead, Australia
| | - John S. Sullivan
- Central Clinical School, The University of Sydney, Sydney, Australia
| | - Thomas R. Jones
- Pfizer Vaccine Research, Pfizer, Pearl River, New York, United States of America
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, The University of New South Wales, Sydney, Australia
| | - Richard I. Lindley
- Westmead Clinical School, Westmead Hospital, and the George Institute for Global Health, The University of Sydney, Sydney, Australia
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McElhaney JE. Prevention of infectious diseases in older adults through immunization: the challenge of the senescent immune response. Expert Rev Vaccines 2014; 8:593-606. [DOI: 10.1586/erv.09.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Poolman JT, Peeters CCAM, van den Dobbelsteen GPJM. The history of pneumococcal conjugate vaccine development: dose selection. Expert Rev Vaccines 2014; 12:1379-94. [DOI: 10.1586/14760584.2013.852475] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Decreased immune response to pneumococcal conjugate vaccine after 23-valent pneumococcal polysaccharide vaccine in children. Vaccine 2014; 32:417-24. [DOI: 10.1016/j.vaccine.2013.11.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 09/17/2013] [Accepted: 11/06/2013] [Indexed: 11/20/2022]
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32
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Park S, Nahm MH. L-rhamnose is often an important part of immunodominant epitope for pneumococcal serotype 23F polysaccharide antibodies in human sera immunized with PPV23. PLoS One 2013; 8:e83810. [PMID: 24391831 PMCID: PMC3877113 DOI: 10.1371/journal.pone.0083810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/08/2013] [Indexed: 11/18/2022] Open
Abstract
Streptococcus pneumoniae is a major human pathogen which expresses more than 90 serologically distinct capsular polysaccharides (PS) on the surface. Since pneumococcal PSs elicit protective antibodies against pneumococcal diseases, it is important to identify the immunological epitope eliciting anti-pneumococcal PS antibodies. L-rhamnose is a part of the 23F PS repeating unit and is known to be a critical part of immunodominant epitope which elicits antibodies against pneumococcal serotype 23F PS. In order to determine if L-rhamnose is a part of epitope recognized by functional antibodies specific for serotype 23F PS in human serum samples, we evaluated the opsonophagocytic killing of serotype 23F pneumococci by serum antibodies specific for L-rhamnose. Using 10 mM L-rhamnose, opsonic capacities (opsonic indices) of serum antibodies were inhibited by 60% in 19 sera (36%) and 30–60% in 16 sera (30%) out of 53 sera from young and old adults immunized with 23-valent pneumococcal polysaccharide vaccine (PPV23). Interestingly, when IgM antibodies were depleted from immune sera in order to preferentially study IgG antibodies, the proportion of young adult sera showing more than 60% inhibition in opsonic capacity by 10 mM of L-rhamnose increased from 33% (11/31) to 68% (21/31). On the other hand, IgM depletion did not alter the proportion for old adult sera. Therefore, young and old adults may produce different antigen binding profiles of IgG antibodies against serotype 23F PS.
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Affiliation(s)
- Saeyoung Park
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Moon H. Nahm
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Liguori G, Parlato A, Zamparelli AS, Belfiore P, Gallé F, Di Onofrio V, Riganti C, Zamparelli B. Adult immunization with 13-valent pneumococcal vaccine in Campania region, South Italy: an economic evaluation. Hum Vaccin Immunother 2013; 10:492-7. [PMID: 24185467 PMCID: PMC4185884 DOI: 10.4161/hv.26888] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pneumococcal pneumonia has a high clinical burden in terms of morbidity, mortality and hospitalization rate, with heavy implications for worldwide health systems. In particular, higher incidence and mortality rates of community-acquired pneumonia (CAP) cases, with related costs, are registered among elderly. This study aimed to an economic evaluation about the immunization with PCV13 in the adult population in Campania region, South Italy. For this purpose we performed, considering a period of 5 y, a budget impact analysis (BIA) and a cost-effectiveness analysis which considered 2 scenarios of immunization compared with lack of immunization for 2 targeted cohorts: first, the high risk subjects aged 50-79 y, and second the high risk individuals aged 50-64 y, together with all those aged 65 y. Regarding the first group, the decrease of pneumonia could give savings equal to €29,005,660, while the immunization of the second cohort could allow savings equal to €10,006,017. The economic evaluation of pneumococcal vaccine for adult groups represents an essential instrument to support health policies. This study showed that both hypothesized immunization strategies could produce savings. Obtained results support the use of pneumococcal conjugate vaccine for adults. This strategy could represent a sustainable and savings-producer health policy.
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Affiliation(s)
- Giorgio Liguori
- Chair of Hygiene and Epidemiology; Department of Studies of Institutions and Territorial Systems; University of Naples "Parthenope"; Naples, Italy
| | - Antonino Parlato
- Complex Operative Unit "Epidemiology and Prevention"; Local Health Authority NA2 Nord; Naples, Italy
| | - Alessandro Sanduzzi Zamparelli
- Complex Operative Unit of the hospital Monaldi "Second Division of Respiratory Diseases"; University of Naples Federico II; Naples, Italy
| | - Patrizia Belfiore
- Chair of Hygiene and Epidemiology; Department of Studies of Institutions and Territorial Systems; University of Naples "Parthenope"; Naples, Italy
| | - Francesca Gallé
- Chair of Hygiene and Epidemiology; Department of Studies of Institutions and Territorial Systems; University of Naples "Parthenope"; Naples, Italy
| | - Valeria Di Onofrio
- Chair of Hygiene and Epidemiology; Department of Studies of Institutions and Territorial Systems; University of Naples "Parthenope"; Naples, Italy
| | - Carla Riganti
- General Hospital "Federico II"-Institutional Relationships Hospitals and Local Health Authorities of Campania Region; Naples, Italy
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Quach-Thanh C, Thomas MH. Statement on the Use of Conjugate Pneumococcal Vaccine - 13 Valent in Adults (Pneu-C-13): An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) . CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2013; 39:1-52. [PMID: 31682649 PMCID: PMC6802426 DOI: 10.14745/ccdr.v39i00a05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Esposito S, Musio A, Principi N. Paediatric asthma and pneumococcal vaccination. Vaccine 2013; 31:5015-9. [PMID: 24021307 DOI: 10.1016/j.vaccine.2013.08.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/24/2013] [Accepted: 08/28/2013] [Indexed: 11/26/2022]
Abstract
Asthma is a clinical condition that has only recently been considered a risk factor for the development of pneumococcal infections. In the most recent guidelines concerning the use of pneumococcal vaccines, the Advisory Committee on Immunisation Practices recommends pneumococcal vaccination only when children with asthma aged <71 months are treated with high-dose corticosteroids, whereas the same Committee clearly indicates that asthma (without any definition of severity or treatment) is a reason for systematic pneumococcal vaccination in adults. It is also unclear which pneumococcal vaccine should be used and how to face the problem of booster doses. The main aim of this paper is to describe what is known about the real risk of pneumococcal infections in children with asthma, and discuss the unsolved problems regarding the paediatric use of pneumococcal vaccines. There are few published data regarding pneumococcal colonisation and the burden of pneumococcal disease in asthmatic children and adolescents, and none at all concerning the relationship between paediatric asthma and immune responses to pneumococcal vaccines. Further studies are therefore essential to assure that children and adolescents with asthma receive the best protection against pneumococcal diseases.
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Affiliation(s)
- Susanna Esposito
- Pediatric High Intensity Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Immunogenicity and safety of pneumococcal conjugate polysaccharide and free polysaccharide vaccines alone or combined in HIV-infected adults in Brazil. Vaccine 2013; 31:4047-53. [DOI: 10.1016/j.vaccine.2013.04.065] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/05/2013] [Accepted: 04/24/2013] [Indexed: 11/21/2022]
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Abstract
Vaccination with a preparation that currently contains 23 pneumococcal capsular polysaccharides (PPV23) successfully reduces the risk of serious pneumococcal infection by an estimated 50% to 80%. Because infants and young children do not respond to polysaccharide antigens, a conjugated polysaccharide vaccine that first contained 7 capsule types (PCV7) and now contains 13 capsule types (PCV13) was developed for use in them. A single study in patients with AIDS showed protection against pneumococcal disease by PCV13, but not after PPV23. Based on these observations, the CDC has now recommended that immunocompromized adults receive PCV13 followed 8 weeks later by PPV23.
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38
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Jackson LA, Gurtman A, Rice K, Pauksens K, Greenberg RN, Jones TR, Scott DA, Emini EA, Gruber WC, Schmoele-Thoma B. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 70 years of age and older previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine 2013; 31:3585-93. [PMID: 23688527 DOI: 10.1016/j.vaccine.2013.05.010] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/11/2013] [Accepted: 05/01/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The currently recommended single dose of the 23-valent pneumococcal free polysaccharide vaccine (PPSV23) for adults 65 years of age and older does not provide extended protection into older age. This reflects a significant unmet medical need for alternative strategies to protect older adults against pneumococcal infection, which may be met by the 13-valent polysaccharide conjugate vaccine (PCV13). METHODS We performed a randomized, modified double-blind trial in 936 adults aged 70 years and older who had previously received PPSV23 at least 5 years before study entry and were now vaccinated with PCV13 or PPSV23. At 1 year after enrollment, all subjects received a follow-on dose of PCV13. Anti-pneumococcal opsonophagocytic activity (OPA) titers were measured before and at 1 month after each vaccination. RESULTS Following the enrollment vaccination, OPA titers were significantly greater in the PCV13 group compared to the PPSV23 group for 10 of the 12 serotypes common to both vaccines and to serotype 6A which is unique to PCV13. Responses were noninferior for the other 2 common serotypes. Responses to PCV13 given at 1 year were generally lower in the group that received PPSV23 at enrollment. CONCLUSION In adults aged 70 years and older previously vaccinated with PPSV23, PCV13 was significantly more immunogenic than PPSV23 for most of the common serotypes and for serotype 6A. The OPA responses after a follow-on dose of PCV13 one year later indicate that a prior dose of PPSV23, but not PCV13, diminishes the response to the subsequent administration of PCV13.
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Affiliation(s)
- Lisa A Jackson
- The Group Health Research Institute, Group Health, Seattle, WA, USA.
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Abstract
Streptococcus pneumoniae is a major human pathogen responsible for the majority of bacterial pneumonia cases as well as invasive pneumococcal diseases with high mortality and morbidity. Use of conjugate vaccines targeting the pneumococcal capsule has dramatically reduced the incidence of invasive diseases, and there are active efforts to further improve the conjugate vaccines. However, in children new pneumococcal vaccines can no longer be tested with placebo-based clinical trials because effective vaccines are currently available. Thus, vaccine studies must depend on surrogate markers of vaccine efficacy. Although traditional antibody levels (e.g., ELISA) are useful as a surrogate marker of protection, they have limitations, and a bioassay measuring the capacity of antibodies to opsonize pneumococci has been developed. This opsonophagocytosis assay (OPA) replicates the in vivo mechanism of antibody protection and should therefore better reflect protection by vaccine-induced antibodies. Technical improvements of OPA have made this bioassay rapid, multiplexed, and practical for analyzing small samples including those from children. Strong correlations between ELISA and OPA have been observed in many studies of young children. However, poor correlations have been found in some important clinical situations (such as determination of protection by cross-reactive antibodies) and populations (such as elderly adults and immunodeficient patients). In these settings, OPA has become a useful supplementary measure of pneumococcal vaccine immunogenicity. Current efforts to standardize OPA will further expand its uses.
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Duraisingham SS, Rouphael N, Cavanagh MM, Nakaya HI, Goronzy JJ, Pulendran B. Systems biology of vaccination in the elderly. Curr Top Microbiol Immunol 2013; 363:117-42. [PMID: 22903566 DOI: 10.1007/82_2012_250] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aging population demographics, combined with suboptimal vaccine responses in the elderly, make the improvement of vaccination strategies in the elderly a developing public health issue. The immune system changes with age, with innate and adaptive cell components becoming increasingly dysfunctional. As such, vaccine responses in the elderly are impaired in ways that differ depending on the type of vaccine (e.g., live attenuated, polysaccharide, conjugate, or subunit) and the mediators of protection (e.g., antibody and/or T cell). The rapidly progressing field of systems biology has been shown to be useful in predicting immunogenicity and offering insights into potential mechanisms of protection in young adults. Future application of systems biology to vaccination in the elderly may help to identify gene signatures that predict suboptimal responses and help to identify more accurate correlates of protection. Moreover, the identification of specific defects may be used to target novel vaccination strategies that improve efficacy in elderly populations.
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Affiliation(s)
- Sai S Duraisingham
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, GA, 30329, USA
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Smith KJ, Wateska AR, Nowalk MP, Raymund M, Lee BY, Zimmerman RK. Modeling of cost effectiveness of pneumococcal conjugate vaccination strategies in U.S. older adults. Am J Prev Med 2013; 44:373-381. [PMID: 23498103 PMCID: PMC3601581 DOI: 10.1016/j.amepre.2012.11.035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/04/2012] [Accepted: 11/21/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The 13-valent pneumococcal conjugate vaccine (PCV13) is approved by the U.S. Food and Drug Administration for adults, but its role in older adults is unclear. PURPOSE To compare PCV13 strategies to currently recommended vaccination strategies in adults aged ≥65 years. METHODS Using a Markov model, the cost effectiveness of PCV13 and the 23-valent pneumococcal polysaccharide vaccine (PPSV23), alone or in combination, was estimated, in adults aged either 65 years or 75 years. No prior vaccination, prior vaccination, and vaccine hyporesponsiveness scenarios were examined. Pneumococcal disease rates, indirect childhood PCV13 effects, and costs were estimated using CDC Active Bacterial Core surveillance data and U.S. national databases. An expert panel estimated vaccine-related protection. A societal perspective was taken and outcomes were discounted 3% per year. RESULTS In those aged 65 years, single-dose PCV13 cost $11,300 per quality-adjusted life-year (QALY) gained compared to no vaccination; at ages 65 and 80 years, PCV13 cost $83,000/QALY. In those aged 75 years, single-dose PCV13 cost $62,800/QALY gained. PPSV23 cost more and was less effective than PCV13. Results were sensitive to varying vaccine effectiveness and indirect effect estimates. In hyporesponsiveness scenarios, cost-effectiveness ratios increased by 37%-78% for single-dose strategies and 29%-35% for multiple-dose strategies. CONCLUSIONS Single-dose PCV13 strategies are likely to be economically reasonable in older adults.
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Affiliation(s)
- Kenneth J Smith
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Angela R Wateska
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mary Patricia Nowalk
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mahlon Raymund
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bruce Y Lee
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richard K Zimmerman
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Gladstone RA, Jefferies JM, Faust SN, Clarke SC. Pneumococcal 13-valent conjugate vaccine for the prevention of invasive pneumococcal disease in children and adults. Expert Rev Vaccines 2013; 11:889-902. [PMID: 23002969 DOI: 10.1586/erv.12.68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pneumococcal disease remains a global problem despite the availability of effective conjugate vaccines. The 13-valent pneumococcal conjugate vaccine (PCV13) extends the valency of PCV7 by including six additional serotypes highly associated with invasive pneumococcal disease (IPD). Comparisons between PCV13 and PCV7 or the pneumococcal polysaccharide vaccine have established noninferiority of PCV13 for both safety and immunogenicity profiles for use in children and adults, respectively. At the end of 2011, PCV13 had been approved and launched in 104 countries worldwide, with 54 including the vaccine in their pediatric national immunization program. Surveillance data from early adopters of PCV13 has indicated reductions are occurring in both overall IPD and IPD caused by the six non-PCV7 serotypes; early reports of serotype replacement in carriage are also emerging. While serotype replacement for PCV7 was observed to varying degrees for both carriage and disease, the extent to which this will occur for PCV13 is yet to be determined.
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Affiliation(s)
- Rebecca A Gladstone
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Blasi F, Mantero M, Santus P, Tarsia P. Understanding the burden of pneumococcal disease in adults. Clin Microbiol Infect 2012; 18 Suppl 5:7-14. [DOI: 10.1111/j.1469-0691.2012.03937.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Randomized, single blind, controlled trial to evaluate the prime-boost strategy for pneumococcal vaccination in renal transplant recipients. PLoS One 2012; 7:e46133. [PMID: 23029408 PMCID: PMC3460962 DOI: 10.1371/journal.pone.0046133] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/28/2012] [Indexed: 12/17/2022] Open
Abstract
Renal transplant recipients are at increased risk of developing invasive pneumococcal diseases but may have poor response to the 23-valent pneumococcal polysaccharide vaccine (PPV). It may be possible to enhance immunogenicity by priming with 7-valent pneumococcal conjugate vaccine (7vPnC) and boosting with PPV 1 year later. In a randomized single-blind, controlled study, adult recipients of renal transplants received either 7nPVC or PPV followed by PPV 1 year later. The vaccine response was defined as 2-fold increase in antibody concentration from baseline and an absolute post-vaccination values ≥1 µg/ml. The primary endpoint was vaccine response of the primed group (7vPnC/PPV) compared with single PPV vaccination. Antibody concentrations for 10 serotypes were measured at baseline, 8 weeks after first vaccination, before second vaccination, and 8 weeks after second vaccination. Of 320 screened patients, 80 patients were randomized and 62 completed the study. Revaccination with PPV achieved no significant increase of immune response in the 7vPnC/PPV group compared with the single PPV recipients A response to at least 1 serotype was seen in 77.1% of patients who received 7vPnC and 93.1% of patients who received PPV (P = 0.046). After second vaccination response to at least 1 serotype was seen in 87.5% patients of 7vPnC/PPV group and 87.1% patients of PPV group (non significant p). The median number of serotypes eliciting a response was 3.5 (95% CI 2.5–4.5) in the 7vPnC/PPV group versus 5 (95% CI 3.9–6.1) in the PPV group (non-significant p). Immunogenicity of pneumococcal vaccination was not enhanced by the prime–boost strategy compared with vaccination with PPV alone. Administration of a single dose of PPV should continue to be the standard of care for adult recipients of renal transplants. Trial Registration EudraCT 2007-004590-25.
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Dransfield MT, Harnden S, Burton RL, Albert RK, Bailey WC, Casaburi R, Connett J, Cooper JAD, Criner GJ, Curtis JL, Han MK, Make B, Marchetti N, Martinez FJ, McEvoy C, Nahm MH, Niewoehner DE, Porszasz J, Reilly J, Scanlon PD, Scharf SM, Sciurba FC, Washko GR, Woodruff PG, Lazarus SC. Long-term comparative immunogenicity of protein conjugate and free polysaccharide pneumococcal vaccines in chronic obstructive pulmonary disease. Clin Infect Dis 2012; 55:e35-44. [PMID: 22652582 PMCID: PMC3491850 DOI: 10.1093/cid/cis513] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 05/15/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the 23-valent pneumococcal polysaccharide vaccine (PPSV23) protects against invasive disease in young healthy persons, randomized controlled trials in chronic obstructive pulmonary disease (COPD) have demonstrated no benefit in the intention-to-treat population. We previously reported that the 7-valent diphtheria-conjugated pneumococcal polysaccharide vaccine (PCV7) is safe and induced greater serotype-specific immunoglobulin G (IgG) and functional antibody than did PPSV23 1 month after vaccination. We hypothesized that these advantages would persist at 1 and 2 years. METHODS One hundred eighty-one patients with moderate to severe COPD were randomized to receive PPSV23 (n = 90) or PCV7 (1.0 mL; n = 91). We measured IgG by enzyme-linked immunosorbent assay and assessed functional antibody activity by a standardized opsonophagocytosis assay, reported as a killing index (OPK). We determined differences in IgG and OPK between vaccine groups at 1 and 2 years. RESULTS Relative to PPSV23, PCV7 induced greater OPK at both 1 and 2 years for 6 of 7 serotypes (not 19F). This response was statistically greater for 5 of 7 serotypes at 1 year and 4 of 7 at 2 years. Comparable differences in IgG were observed but were less often statistically significant. Despite meeting Centers for Disease Control and Prevention criteria for PPSV23 administration, almost 50% of individuals had never been vaccinated. No differences in the frequency of acute exacerbations, pneumonia, or hospitalization were observed. CONCLUSIONS PCV7 induces a greater functional antibody response than PPSV23 in patients with COPD that persists for 2 years after vaccination. This superior functional response supports testing of conjugate vaccination in studies examining clinical end points. CLINICAL TRIALS REGISTRATION NCT00457977.
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Affiliation(s)
- Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Vila-Corcoles A, Ochoa-Gondar O. Pneumococcal vaccination among adults with chronic respiratory diseases: a historical overview. Expert Rev Vaccines 2012; 11:221-36. [PMID: 22309670 DOI: 10.1586/erv.11.176] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae, the most common cause of community-acquired pneumonia, remains a major cause of morbidity and mortality worldwide. The presence of chronic respiratory illness is a major risk factor for pneumonia, and smoking (the most common cause of chronic obstructive pulmonary disease) is also an important risk factor for pneumonia and invasive pneumococcal disease. There are currently three established approaches to antipneumococcal vaccination: capsular polysaccharide pneumococcal vaccines (recommended for adults and some children at risk), protein-polysaccharide conjugate pneumococcal vaccines (classically recommended for infants and young children and currently under evaluation for adults aged 50 years or older for the prevention of invasive disease) and experimental protein-based pneumococcal vaccines (under investigation in animal models). Although patients with chronic respiratory diseases are commonly described as an at-risk population for pneumococcal infections, studies on pneumococcal vaccination efficacy in such patients are very limited and vaccination effectiveness remains controversial. This paper reviews available data on the efficacy and effectiveness of polysaccharide pneumococcal vaccination among adults with chronic respiratory diseases.
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Affiliation(s)
- Angel Vila-Corcoles
- Primary Care Service of Tarragona, EPIVAC Study Group, Institut Catala de la Salut, Prat de la Riba 39, 43001, Tarragona, Spain.
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Abstract
With advances in global health care, ageing populations are expected to grow worldwide throughout the 21st century. Increased lifespan is a testament to modern medical and social practices, but also presents a growing challenge to a system with limited resources. Elderly populations present specific concerns related to preventative health practices, especially vaccination. Although the power of vaccination is unquestionable in controlling infectious disease, immunosenescence can lead to reduced immune responses following immunization in the elderly, and increased morbidity and mortality. Further complicating this issue, some vaccines themselves may pose a substantial safety risk in the elderly when compared to younger counterparts. Though any health care intervention must balance risk and reward, safety and immunogenicity are often poorly characterized in older populations. This review explores several domestic and travel vaccines, examining what is known concerning efficacy and safety in the elderly, and considers future alternatives.
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Affiliation(s)
- Ian J Amanna
- Najít Technologies, Inc. 505 NW 185 th Avenue Beaverton, OR 97006, USA
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Ridda I, Musher DM. Is there a potential role for protein-conjugate pneumococcal vaccine in older adults? Australas Med J 2012; 5:231-5. [PMID: 22848316 DOI: 10.4066/amj.2012.1160] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Longstanding controversy over the efficacy of 23-valent pneumococcal polysaccharide vaccine (PPV23) led to a recommendation by the Joint Committee on Vaccination and Immunisation (JCVI) of the United Kingdom in March 2011, to discontinue routine use of PPV23 in older adults.(1) Following careful review of the evidence and feedback from stakeholders, the JCVI decided to retain the original policy of uniform vaccination of adults >65 years of age, while keeping the subject under continued review. In the United States, the Advisory Committee on Immunization Practices (ACIP) which is also concerned about the efficacy of PPV23 is currently considering a different strategy, i.e. adding 13-valent pneumococcal protein-conjugate vaccine (PCV13) for recommended use in adults, following recent Food and Drug Administration (FDA) approval for this purpose in adults over 50 years of age. It is therefore timely to review the options for prevention of pneumococcal disease in adults.
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Affiliation(s)
- Iman Ridda
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales
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Brynjolfsson SF, Henneken M, Bjarnarson SP, Mori E, Del Giudice G, Jonsdottir I. Hyporesponsiveness following booster immunization with bacterial polysaccharides is caused by apoptosis of memory B cells. J Infect Dis 2011; 205:422-30. [PMID: 22158565 DOI: 10.1093/infdis/jir750] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Repeated immunizations with polysaccharide (PS) vaccines cause hyporesponsiveness through undefined mechanisms. We assessed the effects of a PS booster on immune responses, frequency, and survival of PS-specific B-cell subpopulations in spleen and bone marrow. METHODS Neonatal mice were primed with meningococcus serotype C (MenC) conjugate MenC-CRM(197)+CpG1826, boosted with MenC-CRM(197), MenC-PS, or saline; subsequently, bromodeoxyuridine (BrdU) was injected daily intraperitoneally. MenC-PS-specific cells were labeled with fluorescent MenC-PS and phenotyped by flow cytometry. RESULTS After MenC-PS booster, proliferating (BrdU(+)) MenC-PS-specific naive B cells (CD138(-)/B220(+); P = .0003) and plasma cells (CD138(+)/B220(-); P = .0002) in spleen were fewer than after saline booster. BrdU(+) MenC-PS-specific plasma cells were also reduced in bone marrow (P = .0308). Compared to saline, MenC-PS booster reduced BrdU(+) IgG(+) MenC-PS-specific B cells in spleen (P = .0002). Twelve hours after the MenC-PS booster, an increased frequency of apoptotic (AnnexinV(+)) MenC-PS-specific B cells in spleen was observed compared with MenC-CRM(197) (P = .0286) or saline (P = .001) boosters. CONCLUSIONS We demonstrated that the MenC-PS booster significantly reduced the frequency of newly activated MenC-PS-specific B cells-mostly switched IgG(+) memory cells-by driving them into apoptosis. It shows directly that apoptosis of PS-specific memory cells is the cause of PS-induced hyporesponsiveness. These results should be taken into account prior to consideration of the use of PS vaccines.
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Affiliation(s)
- Siggeir F Brynjolfsson
- Department of Immunology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
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