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Bornstein K, Hungerford L, Hartley D, Sorkin JD, Tapia MD, Sow SO, Onwuchekwa U, Simon R, Tennant SM, Levine MM. Modeling the Potential for Vaccination to Diminish the Burden of Invasive Non-typhoidal Salmonella Disease in Young Children in Mali, West Africa. PLoS Negl Trop Dis 2017; 11:e0005283. [PMID: 28182657 PMCID: PMC5300129 DOI: 10.1371/journal.pntd.0005283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022] Open
Abstract
Background In sub-Saharan Africa, systematic surveillance of young children with suspected invasive bacterial disease (e.g., septicemia, meningitis) has revealed non-typhoidal Salmonella (NTS) to be a major pathogen exhibiting high case fatality (~20%). Where infant vaccination against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae has been introduced to prevent invasive disease caused by these pathogens, as in Bamako, Mali, their burden has decreased markedly. In parallel, NTS has become the predominant invasive bacterial pathogen in children aged <5 years. While NTS is believed to be acquired orally via contaminated food/water, epidemiologic studies have failed to identify the reservoir of infection or vehicles of transmission. This has precluded targeting food chain interventions to diminish disease transmission but conversely has fostered the development of vaccines to prevent invasive NTS (iNTS) disease. We developed a mathematical model to estimate the potential impact of NTS vaccination programs in Bamako. Methodology/Principal Findings A Markov chain transmission model was developed utilizing age-specific Bamako demographic data and hospital surveillance data for iNTS disease in children aged <5 years and assuming vaccine coverage and efficacy similar to the existing, successfully implemented, Hib vaccine. Annual iNTS hospitalizations and deaths in children <5 years, with and without a Salmonella Enteritidis/Salmonella Typhimurium vaccine, were the model’s outcomes of interest. Per the model, high coverage/high efficacy iNTS vaccination programs would drastically diminish iNTS disease except among infants age <8 weeks. Conclusions/Significance The public health impact of NTS vaccination shifts as disease burden, vaccine coverage, and serovar distribution vary. Our model shows that implementing an iNTS vaccine through an analogous strategy to the Hib vaccination program in Bamako would markedly reduce cases and deaths due to iNTS among the pediatric population. The model can be adjusted for use elsewhere in Africa where NTS epidemiologic patterns, serovar prevalence, and immunization schedules differ from Bamako. A surveillance program at Gabriel Touré Hospital in Mali observed a high burden of invasive disease caused by non-typhoidal Salmonella (iNTS). This surveillance program was originally instituted to measure the amount of invasive disease (e.g., septicemia, meningitis) caused by two bacteria that invade the respiratory tract: Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (pneumococcus). While documenting the burden of these pathogens, the surveillance program also found that serotypes of iNTS, mainly Salmonella Typhimurium and Salmonella Enteritidis, were common causes of severe invasive disease. As the number of cases of Hib and pneumococcus markedly decreased following the introduction of relevant vaccines, the relative threat of iNTS increased. Little is known about the reservoir of iNTS, whether it resides in humans, animals, or the environment, or how it is spread to susceptible children. Without this knowledge, it is not possible to employ certain disease control methods useful in interrupting the transmission of other pathogens. Therefore, vaccination remains the one promising control strategy for this disease. Our research modeled the potential effects of introducing an iNTS vaccine. The findings are of great importance to Mali and other developing countries where young children are at a high risk of developing iNTS disease.
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Affiliation(s)
- Kristin Bornstein
- Center for Vaccine Development and Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Laura Hungerford
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - David Hartley
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - John D. Sorkin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Baltimore VA Medical Center GRECC (Geriatric Research, Education, and Clinical Center), Baltimore Maryland
| | - Milagritos D. Tapia
- Center for Vaccine Development and Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Mali (CVD-Mali), Bamako, Mali, Africa
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins, Mali (CVD-Mali), Bamako, Mali, Africa
| | - Raphael Simon
- Center for Vaccine Development and Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sharon M. Tennant
- Center for Vaccine Development and Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Myron M. Levine
- Center for Vaccine Development and Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States of America
- * E-mail:
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Lee S, Kim HW, Kim K. Functional antibodies toHaemophilus influenzaetype B,Neisseria meningitidis, andStreptococcus pneumoniaecontained in intravenous immunoglobulin products. Transfusion 2016; 57:157-165. [DOI: 10.1111/trf.13869] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 08/15/2016] [Accepted: 08/25/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Soyoung Lee
- Center for Vaccine Evaluation and StudyMedical Research InstituteSeoul Republic of Korea
| | - Han Wool Kim
- Center for Vaccine Evaluation and StudyMedical Research InstituteSeoul Republic of Korea
| | - Kyung‐Hyo Kim
- Center for Vaccine Evaluation and StudyMedical Research InstituteSeoul Republic of Korea
- Department of PediatricsEwha Womans University School of MedicineSeoul Republic of Korea
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Kang JH, Lee HJ, Kim KH, Oh SH, Cha SH, Lee J, Kim NH, Eun BW, Kim CH, Hong YJ, Kim HH, Lee KY, Kim YJ, Cho EY, Kim HS, Guitton F, Ortiz E. The Immunogenicity and Safety of a Combined DTaP-IPV//Hib Vaccine Compared with Individual DTaP-IPV and Hib (PRP~T) Vaccines: a Randomized Clinical Trial in South Korean Infants. J Korean Med Sci 2016; 31:1383-91. [PMID: 27510380 PMCID: PMC4974178 DOI: 10.3346/jkms.2016.31.9.1383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/18/2016] [Indexed: 11/26/2022] Open
Abstract
Recommended infant vaccination in Korea includes DTaP-IPV and Hib vaccines administered as separate injections. In this randomized, open, controlled study we assessed the non-inferiority of immunogenicity of DTaP-IPV//Hib pentavalent combination vaccine (Pentaxim™) compared with licensed DTaP-IPV and Hib (PRP~T) vaccines. We enrolled 418 healthy Korean infants to receive either separate DTaP-IPV and Hib vaccines (n = 206) or the pentavalent DTaP-IPV//Hib (n = 208) vaccine at 2, 4, 6 months of age. Antibodies to all components were measured before the first vaccination and one month after the third, and safety was assessed after each vaccination including recording of reactions by parents. We confirmed the non-inferiority of DTaP-IPV//Hib compared with DTaP-IPV and Hib vaccines; 100% of both groups achieved seroprotection against D, T, IPV and PRP~T, and 97.5%-99.0% demonstrated seroresponses to pertussis antigens. Antibody levels were similar in both groups, except for those to the Hib component, PRP~T. In separate and combined groups geometric mean concentrations of anti-PRP~T antibodies were 23.9 and 11.0 μg/mL, respectively, but 98.3% and 97.4% had titers ≥ 1 μg/mL, indicative of long-term protection. All vaccines were well tolerated, with no vaccine-related serious adverse event. Both groups had similar safety profiles, but the combined vaccine group had fewer injection site reactions. The immunological non-inferiority and similar safety profile of DTaP-IPV//Hib vaccine to separate DTaP-IPV and Hib vaccines, with the advantage of fewer injections and injection site reactions, supports the licensure and incorporation of DTaP-IPV//Hib into the Korean national vaccination schedule (Clinical trial registry, NCT01214889).
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Affiliation(s)
- Jin Han Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hoan Jong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Kyung Hyo Kim
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Sung Hee Oh
- Department of Pediatrics, Hanyang University Medical Center, Seoul, Korea
| | - Sung Ho Cha
- Department of Pediatrics, Kyung Hee University Hospital, Seoul, Korea
| | - Jin Lee
- Department of Pediatrics, KEPCO Medical Center, Seoul, Korea
| | - Nam Hee Kim
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Byung Wook Eun
- Department of Pediatrics, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea
| | - Chang Hwi Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young Jin Hong
- Department of Pediatrics, Inha University Hospital, Incheon, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Kyung Yil Lee
- Department of Pediatrics, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Yae Jean Kim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Eun Young Cho
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Ravi G, Venkatesh YP. Recognition of flavin mononucleotide, Haemophilus influenzae type b and its capsular polysaccharide vaccines by antibodies specific to D-ribitol-5-phosphate. Glycoconj J 2014; 31:573-85. [PMID: 25108762 DOI: 10.1007/s10719-014-9539-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 11/25/2022]
Abstract
D-Ribitol-5-phosphate (Rbt-5-P) is an important metabolite in the pentose phosphate pathway and an integral part of bacterial cell wall polysaccharides, specifically as polyribosyl ribitol phosphate (PRP) in Haemophilus influenzae type b (Hib). The major objective of this study was to investigate whether an antibody specific to Rbt-5-P can recognize the PRP of Hib. D-Ribose-5-phosphate was reacted with proteins in the presence of sodium cyanoborohydride to obtain Rbt-5-P epitopes; 120 h reaction resulted in conjugation of ~30 and ~17 moles of Rbt-5-P/mole of BSA and OVA, respectively, based on decrease in amino groups, MALDI-TOF analyses, an increase in apparent molecular weight (SDS-PAGE) and glycoprotein staining. Immunization of rabbits with Rbt-5-P-BSA conjugate generated antibodies to Rbt-5-P as demonstrated by dot immunoblot and non-competitive ELISA. Homogeneous Rbt-5-P-specific antibody was purified from Rbt-5-P-BSA antiserum subjected to caprylic acid precipitation followed by hapten-affinity chromatography; its affinity constant is 7.1 × 10(8) M(-1). Rbt-5-P antibody showed 100 % specificity to Rbt-5-P, ~230 %, 10 % and 3.4 % cross-reactivity to FMN, riboflavin and FAD, respectively; the antibody showed ~4 % cross-reactivity to D-ribitol and <3 % to other sugars/sugar alcohols. Rbt-5-P-specific antibody recognized Hib conjugate vaccines containing PRP which was inhibited specifically by Rbt-5-P, and also detected Hib cell-surface capsular polysaccharides by immunofluorescence. In conclusion, Rbt-5-P-protein conjugate used as an immunogen elicited antibodies binding to an epitope also present in PRP and Hib bacteria. Rbt-5-P-specific antibody has potential applications in the detection and quantification of free/bound Rbt-5-P and FMN as well as immunological recognition of Hib bacteria and its capsular polysaccharide.
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Affiliation(s)
- G Ravi
- Department of Biochemistry and Nutrition, CSIR-Central Food Technological Research Institute (CFTRI), 'Chaluvamba Vilas', KRS Road, Mysore, 570020, Karnataka State, India
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