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Kanevsky I, Surendran N, McElwee K, Lei L, Watson W, Pride M, Scully I, Karauzum H, Anderson A, Young M. Comparison of pneumococcal immunogenicity elicited by the PCV13 and PCV15 vaccines in adults 18 through 49 years of age. Vaccine 2023; 41:6625-6629. [PMID: 37793976 DOI: 10.1016/j.vaccine.2023.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Abstract
AIM Pneumococcal conjugate vaccines (PCV13, PCV15, PCV20) effectively target the capsular polysaccharides of the most common disease-causing Streptococcus pneumoniae serotypes. In this short communication, we analyzed healthy participants who received PCV13 and PCV15 vaccines as part of a recently concluded exploratory clinical trial and report antibody responses to the 13 shared serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F) as well as functional OPA responses to serotype 3. METHODS Sera from 87 adult participants (18 through 49 years of age) randomized to receive either PCV13 or PCV15 were collected (n = 46 or n = 41, respectively), from 17 study centers in the US. IgG concentrations of the 13 shared serotypes and serotype 3-specific OPA titers were analyzed before and 1 month after vaccination using internally validated assays. RESULTS At 1 month after vaccination, IgG GMCs of the 13 shared serotypes in PCV13 were similar to those for PCV15. Specifically, serotype 3 OPA GMTs and 95% CIs were similar 1 month after vaccination for PCV13 (62.9 [48.9, 80.9]) and PCV15 (71.1 [50.9, 99.2]). CONCLUSION In healthy participants who received either PCV13 or PCV15, similar serotype-specific responses were observed between all shared serotypes when a uniform validated internal assay was used. Of note, data from this study suggest that both vaccines induce similar functional antibody responses against pneumococcal serotype 3.
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Affiliation(s)
- Isis Kanevsky
- Vaccine Research & Development, Pfizer Inc., Pearl River, NY 10965, USA.
| | - Naveen Surendran
- Vaccine Research & Development, Pfizer Inc., Pearl River, NY 10965, USA
| | - Kathleen McElwee
- Vaccine Research & Development, Pfizer Inc., Collegeville, PA 19426, USA
| | - Lanyu Lei
- Vaccine Research & Development, Pfizer Inc., Collegeville, PA 19426, USA
| | - Wendy Watson
- Vaccine Research & Development, Pfizer Inc., Collegeville, PA 19426, USA
| | - Michael Pride
- Vaccine Research & Development, Pfizer Inc., Pearl River, NY 10965, USA
| | - Ingrid Scully
- Vaccine Research & Development, Pfizer Inc., Pearl River, NY 10965, USA
| | - Hatice Karauzum
- Vaccine Research & Development, Pfizer Inc., Pearl River, NY 10965, USA
| | | | - Mariano Young
- Vaccine Research & Development, Pfizer Inc., Collegeville, PA 19426, USA.
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Ljunghill Hedberg A, Pauksens K, Enblad P, Larsson A, Sjölin J. Relationship between T-cell-dependent and T-cell-independent vaccines after neurotrauma; is the B-cell response preserved? Hum Vaccin Immunother 2022; 18:2088971. [PMID: 35704795 PMCID: PMC9621013 DOI: 10.1080/21645515.2022.2088971] [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] [Indexed: 11/06/2022] Open
Abstract
Background After trauma and central nervous system (CNS) injury, trauma-induced immune deficiency syndrome (TIDS) and CNS injury-induced immune deficiency syndrome (CIDS) may negatively affect responses to T-cell-dependent vaccines, such as pneumococcal conjugate vaccine (PCV) recommended after basilar fracture. This study (NCT02806284) aimed to investigate whether there after neurotrauma is a correlation between T-cell-dependent and independent vaccine responses and, thus, if B-cell activity is similarly depressed and whether the T-cell-dependent response is possible to predict. Methods Adult patients with basilar fracture (n = 33) and those undergoing pituitary gland surgery (n = 23) were within 10 days vaccinated with a T-cell-dependent vaccine against Haemophilus influenzae type b (Hib) and a T-cell-independent pneumococcal polysaccharide vaccine (PPSV). Samples reflecting the systemic inflammatory response and pre- and post-vaccination antibody levels after 3–6 weeks against Hib and PPSV were collected and determined by enzyme immunoassays. Results High and significant correlations were detected in the responses to different pneumococcal serotypes, but none between the Hib and PPSV responses. No differences in trauma scores, C-reactive protein, IL-6, IL-10, pentraxin 3, fractalkine or calprotectin plasma concentrations or in ex vivo TNF-α, IL-6 or IL-10 responses to endotoxin were found between Hib vaccination responders and non-responders. Conclusions There was no correlation between the pneumococcal responses and that to Hib, indicating that B-cell function is not similarly depressed as T-cell function. Grading of the trauma or parameters reflecting the innate immune response could not predict the T-cell-dependent vaccine response. There is a need of further studies evaluating the vaccine response after neurotrauma.
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Affiliation(s)
- Anna Ljunghill Hedberg
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Karlis Pauksens
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Jan Sjölin
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
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Simon JK, Staerke NB, Hemming-Harlo M, Layle S, Dagan R, Shekar T, Pedley A, Jumes P, Tamms G, Sterling T, Musey L, Buchwald UK. Lot-to-lot consistency, safety, tolerability, and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine, in healthy adults aged ≥50 years: A randomized phase 3 trial (PNEU-TRUE). Vaccine 2022; 40:1342-1351. [PMID: 35039194 DOI: 10.1016/j.vaccine.2021.12.067] [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: 07/19/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Older adults are at risk of pneumococcal disease and associated morbidity and mortality. This phase 3 study (V114-020) assessed lot-to-lot consistency across safety and immunogenicity outcomes for V114, a 15-valent pneumococcal conjugate vaccine (PCV), in healthy adults aged ≥ 50 years. METHODS Adults were randomized in a 3:3:3:1 ratio to receive a single dose of one of three lots of V114 or 13-valent PCV (PCV13), stratified by age (50-64 years, 65-74 years, and ≥ 75 years). Serotype-specific opsonophagocytic activity (OPA) and immunoglobulin G (IgG) antibodies were evaluated at baseline (Day 1) and 30 days post-vaccination. Non-serious and serious adverse events (AEs) were evaluated post-vaccination through 14 days and Month 6, respectively. RESULTS Of 2340 participants enrolled, 2282 (97.5%) completed the study. Proportions of participants experiencing ≥ 1 AE were 81.0%, 77.4%, and 78.0% for V114 lots 1, 2, and 3, respectively. Comparison of V114 combined lots with PCV13 showed that proportions of participants experiencing AEs, solicited AEs, and serious AEs were comparable for both vaccines, with the exception of injection-site pain (more frequently reported with V114). OPA geometric mean titers (GMTs) and IgG geometric mean concentrations (GMCs) at 30 days post-vaccination were comparable across V114 lots, and all lots met predefined equivalence criteria for all 15 vaccine serotypes (lower and upper limits of the 95% confidence intervals of serotype-specific OPA GMT ratios for all possible pairwise comparisons across the three lots were within the equivalence margin of 0.5-2.0). Serotype-specific OPA GMTs and IgG GMCs were comparable in the V114 combined lots and PCV13 groups for the 13 shared serotypes and higher in the V114 group for serotypes unique to V114 (22F and 33F). CONCLUSIONS V114 is well tolerated with a consistent safety profile and immune response across manufacturing lots. CLINICAL TRIALS REGISTRATION NCT03950856 (www.clinicaltrials.gov); 2018-004266-33 (EudraCT).
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Affiliation(s)
| | | | | | - Stacey Layle
- Artemis Institute for Clinical Research, San Diego, CA, USA
| | - Ron Dagan
- Ben-Gurion University, Beer-Sheva, Israel
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Essink B, Sabharwal C, Cannon K, Frenck R, Lal H, Xu X, Sundaraiyer V, Peng Y, Moyer L, Pride MW, Scully IL, Jansen KU, Gruber WC, Scott DA, Watson W. Pivotal Phase 3 Randomized Clinical Trial of the Safety, Tolerability, and Immunogenicity of 20-Valent Pneumococcal Conjugate Vaccine in Adults 18 Years and Older. Clin Infect Dis 2021; 75:390-398. [PMID: 34940806 PMCID: PMC9427137 DOI: 10.1093/cid/ciab990] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) have significantly reduced pneumococcal disease, but disease from non-PCV serotypes remains. Safety, tolerability, and immunogenicity of a 20-valent PCV (PCV20) were evaluated. METHODS This pivotal phase 3, randomized, double-blind study enrolled adults into 3 age groups (≥60, 50-59, 18-49 years) at US and Swedish sites. Participants were randomized to receive one PCV20 or PCV13 dose. After 1 month, participants ≥60 years also received one dose of saline or 23-valent polysaccharide vaccine (PPSV23). Safety assessments included local reactions, systemic events, adverse events, serious adverse events, and newly diagnosed chronic medical conditions. Opsonophagocytic activity (OPA) geometric mean titers (GMTs) 1 month after PCV20 were compared to 13 matched serotypes after PCV13 and to 7 additional serotypes after PPSV23 in participants ≥60 years; noninferiority was declared if lower bound of the 2-sided 95% CI for OPA GMT ratio (PCV20/saline:PCV13/PPSV23 group) was >0.5. PCV20-elicited immune responses in younger participants were also bridged to those in 60-64-year-olds. RESULTS Severity and frequency of prompted local reactions and systemic events were similar after PCV20 or PCV13; no safety concerns were identified. Primary immunogenicity objectives were met, with immune responses after PCV20 noninferior to 13 matched serotypes after PCV13 and to 6 additional PPSV23 serotypes in participants ≥60 years; serotype 8 missed the statistical noninferiority criterion. PCV20 induced robust responses to all 20 vaccine serotypes across age groups. CONCLUSIONS PCV20 was safe and well tolerated, with comparable immunogenicity to PCV13/PPSV23. PCV20 is anticipated to expand protection against pneumococcal disease in adults.
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Affiliation(s)
| | - Charu Sabharwal
- Vaccine Research and Development, Pfizer, Inc, Pearl River, New York, USA
| | - Kevin Cannon
- PMG Research of Wilmington, Wilmington, North Carolina, USA
| | - Robert Frenck
- Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Himal Lal
- Vaccine Research and Development, Pfizer, Inc, Collegeville, PA, USA
| | - Xia Xu
- Vaccine Research and Development, Pfizer, Inc, Collegeville, PA, USA
| | | | - Yahong Peng
- Vaccine Research and Development, Pfizer, Inc, Collegeville, PA, USA
| | - Lisa Moyer
- Vaccine Research and Development, Pfizer, Inc, Collegeville, PA, USA
| | - Michael W Pride
- Vaccine Research and Development, Pfizer, Inc, Pearl River, New York, USA
| | - Ingrid L Scully
- Vaccine Research and Development, Pfizer, Inc, Pearl River, New York, USA
| | - Kathrin U Jansen
- Vaccine Research and Development, Pfizer, Inc, Pearl River, New York, USA
| | - William C Gruber
- Vaccine Research and Development, Pfizer, Inc, Pearl River, New York, USA
| | - Daniel A Scott
- Vaccine Research and Development, Pfizer, Inc, Collegeville, PA, USA
| | - Wendy Watson
- Vaccine Research and Development, Pfizer, Inc, Collegeville, PA, USA
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Mt-Isa S, Abderhalden LA, Musey L, Weiss T. Matching-adjusted indirect comparison of pneumococcal vaccines V114 and PCV20. Expert Rev Vaccines 2021; 21:115-123. [PMID: 34672224 DOI: 10.1080/14760584.2021.1994858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND V114 (15-valent pneumococcal conjugate vaccine [PCV15]) and a 20-valent PCV (PCV20) are approved for adults (≥18 years) in the United States. We present methodologies to indirectly compare immune responses to V114 versus PCV20. RESEARCH DESIGN AND METHODS Indirect treatment comparison and matching-adjusted indirect comparison (MAIC) were performed to estimate opsonophagocytic activity (OPA) geometric mean titer (GMT) ratios of V114/PCV20 at 30 days post-vaccination with PCV13 as common comparator for 13 serotypes (STs) shared with a 13-valent PCV (PCV13) among pneumococcal vaccine-naïve adults aged ≥60 years. Data from three V114 studies were pooled (V114, N = 2,196; PCV13, N = 843). In the MAIC analysis, data were reweighted, matching participant age and sex in NCT03760146 (PCV20, N = 1,507; PCV13, N = 1,490). RESULTS The lower bound of V114/PCV20 OPA GMT ratio for all PCV13 STs is greater than the prespecified 0.5 non-inferiority margin and those for five PCV13 STs (3, 6A, 6B, 18C, and 23F) are greater than the prespecified 1.2 superiority margin. V114 was associated with 77% greater OPA GMT for ST3 versus PCV20. CONCLUSION V114 was non-inferior to PCV20 for all PCV13 STs and statistically superior for five PCV13 STs.
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Affiliation(s)
- Shahrul Mt-Isa
- Biostatistics and Research Decision Sciences, MSD, Zurich, Switzerland
| | | | - Luwy Musey
- Vaccines, Clinical Research For Thomas Weiss the affiliation should read: Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Thomas Weiss
- Vaccines, Clinical Research For Thomas Weiss the affiliation should read: Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
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Absalon J, Segall N, Block SL, Center KJ, Scully IL, Giardina PC, Peterson J, Watson WJ, Gruber WC, Jansen KU, Peng Y, Munson S, Pavliakova D, Scott DA, Anderson AS. Safety and immunogenicity of a novel hexavalent group B streptococcus conjugate vaccine in healthy, non-pregnant adults: a phase 1/2, randomised, placebo-controlled, observer-blinded, dose-escalation trial. THE LANCET. INFECTIOUS DISEASES 2020; 21:263-274. [PMID: 32891191 DOI: 10.1016/s1473-3099(20)30478-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/13/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Group B streptococcus (GBS) is a major cause of invasive disease in young infants. Infants born to women with sufficient pre-existing anti-GBS capsular IgG antibodies are at reduced risk of GBS disease, making maternal immunisation a potential strategy for prevention. We aimed to assess the safety and immunogenicity of a novel hexavalent (serotypes Ia, Ib, II, III, IV, and V) GBS conjugate vaccine (GBS6). METHODS This phase 1/2, placebo-controlled, observer-blinded, dose-escalation trial, was done at four clinical research centres in the USA (Kentucky, Georgia, and two sites in Utah). Healthy, non-pregnant adults aged 18-49 years were randomly assigned using an interactive, web-based response technology system. Within each dose group (low, medium, or high), participants in sentinel cohorts were randomly assigned 2:2:1 and expanded cohort participants were randomly assigned 4:4:1 to receive GBS6 with aluminium phosphate (AlPO4), GBS6 without AlPO4, or placebo (saline control). One 0·5 mL dose of either saline placebo or 5 μg capsular polysaccharide per serotype in the low-dose group, 10 μg capsular polysaccharide per serotype in the medium-dose group, or 20 μg capsular polysaccharide per serotype in the high-dose group was administered by intramuscular injection into the deltoid muscle on day 1. The primary outcome was safety up to 6 months after vaccination, including the proportion of sentinel cohort participants with clinical laboratory abnormalities at 1 week, the proportion of all participants reporting solicited local reactions, systemic events, or use of antipyretic or pain medication within 14 days, adverse events up to 1 month, and medically attended or serious adverse events up to 6 months. The secondary outcome was GBS immunogenicity (serotype-specific IgG geometric mean concentrations at 1 month). This study is registered with ClinicalTrials.gov, NCT03170609. FINDINGS Between June 5, 2017, and June 25, 2018, 365 participants were randomly assigned and 364 (52 in each dose group) were vaccinated and included in the safety analysis. Unsolicited adverse events were reported by 15 (29%) participants in the 5 μg with AlPO4 group, 13 (25%) in the 5 μg without AlPO4 group, 22 (42%) in the 10 μg with AlPO4 group, 12 (23%) in the 10 μg without AlPO4 group, 25 (48%) in the 20 μg with AlPO4 group, 21 (40%) in the 20 μg without AlPO4 group, and 20 (38%) in the placebo group. The most common unsolicited adverse events were in the system organ class of infections and infestations in any dose or formulation of GBS6 (ranging from six [12%] in the 10 μg without AlPO4 group to 15 [29%] in the 20 μg with AlPO4 group and placebo group). Three participants reported at least one serious adverse event during the study, one each in the 5 μg GBS6 with AlPO4 group (diabetic ketoacidosis, two events; resolved), 10 μg GBS6 with AlPO4 group (died by suicide), and 20 μg GBS6 with AlPO4 group (metrorrhagia; resolved). None of these serious adverse events were considered related to the vaccine. 11 of the 365 participants were excluded from the evaluable immunogenicity population, including one participant who did not receive the vaccine, and ten who at 1 month after vaccination were withdrawn for various reasons. GBS serotype-specific IgG geometric mean concentrations increased by 1 week after vaccination for all GBS6 groups, peaked at 2 weeks, stabilised by 1 month, and declined gradually but remained higher than placebo at 6 months. INTERPRETATION GBS6 was well tolerated in healthy adults and elicited robust immune responses for all dose levels and formulations that persisted 6 months after vaccination. This study supports further evaluation of GBS6 in pregnant women. FUNDING Pfizer.
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Affiliation(s)
- Judith Absalon
- Vaccine Research and Development, Pfizer, Pearl River, NY, USA.
| | | | - Stan L Block
- Kentucky Pediatric/Adult Research, Bardstown, KY, USA
| | | | - Ingrid L Scully
- Vaccine Research and Development, Pfizer, Pearl River, NY, USA
| | | | | | - Wendy J Watson
- Vaccine Research and Development, Pfizer, Collegeville, PA, USA
| | | | | | - Yahong Peng
- Vaccine Research and Development, Pfizer, Collegeville, PA, USA
| | - Samantha Munson
- Vaccine Research and Development, Pfizer, Collegeville, PA, USA
| | | | - Daniel A Scott
- Vaccine Research and Development, Pfizer, Collegeville, PA, USA
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7
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Oesterreich S, Lindemann M, Goldblatt D, Horn PA, Wilde B, Witzke O. Humoral response to a 13-valent pneumococcal conjugate vaccine in kidney transplant recipients. Vaccine 2020; 38:3339-3350. [PMID: 32178906 DOI: 10.1016/j.vaccine.2020.02.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/30/2019] [Accepted: 02/29/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Vaccination against S. pneumoniae is recommended by national guidelines. Moderate immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) has been reported in adult kidney transplant recipients (KTR). This study further defines the immunogenicity of PCV13 in this cohort. METHODS 49 KTR were immunized with PCV13. A validated opsonophagocytic killing assay (OPA), a global anti-pneumococcal capsular polysaccharide (anti-PCP) IgG, IgG2, IgM and IgA ELISA, and - for selected patients - a serotype specific anti-PCP WHO reference ELISA were performed pre-vaccination and at month 1 and 12 post-vaccination. RESULTS Geometric mean OPA titers increased significantly for 13/13 serotypes at month 1 and for 10/13 serotypes at month 12 post-vaccination. Vaccine response defined as an OPA titer ≥1:8 was reached in 9/13 serotypes (median). 53% reached the vaccine response criteria at month 1 and 45% at month 12. At month 1 after vaccination, the median OPA titer in an age-group matched healthy reference population was 5- to 10-fold higher than in KTR. OPA titers correlated strongly with results to the global and serotype specific anti-PCP IgG ELISA. Lower OPA titers significantly (p < 0.05) correlated with albuminuria, an interval between vaccination and transplantation <12 months, age and treatment with mycophenolate mofetil. Global IgG, IgG2, IgM and IgA, as well as serotype specific anti-PCP antibody concentrations (12/13 serotypes) increased significantly at month 1 and 12 post-vaccination. CONCLUSIONS Kidney transplant recipients show a significant humoral response after vaccination with PCV13. Functional antibody response exists, but is not as vigorous as in healthy adults.
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Affiliation(s)
- Simon Oesterreich
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - David Goldblatt
- University College London, Institute of Child Health, London, United Kingdom; World Health Organisation, Pneumococcal Serology Reference Laboratory, London, United Kingdom
| | - Peter A Horn
- Institute for Transfusion Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Thompson A, Lamberth E, Severs J, Scully I, Tarabar S, Ginis J, Jansen KU, Gruber WC, Scott DA, Watson W. Phase 1 trial of a 20-valent pneumococcal conjugate vaccine in healthy adults. Vaccine 2019; 37:6201-6207. [DOI: 10.1016/j.vaccine.2019.08.048] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 11/24/2022]
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Marra F, Vadlamudi NK. Efficacy and Safety of the Pneumococcal Conjugate-13 Valent Vaccine in Adults. Aging Dis 2019; 10:404-418. [PMID: 31011485 PMCID: PMC6457056 DOI: 10.14336/ad.2018.0512] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/04/2018] [Indexed: 12/29/2022] Open
Abstract
Invasive pneumococcal disease and pneumococcal pneumonia cause substantial morbidity and mortality in the elderly. This review focuses on the immunogenicity, safety, efficacy and effectiveness data on the use of the 13-valent conjugate pneumococcal vaccine (PCV13) in adults. A MEDLINE literature search was performed from January 1946 to December 2017. Additional references were identified from a review of literature citations. All English-language randomized trials, observational studies and meta-analyses assessing the immunogenicity, efficacy, effectiveness and safety of PCV13 in adults were evaluated. Six randomized controlled studies evaluated immunogenicity and safety of PCV13 in adults and showed that the conjugated vaccine elicited a greater immune response to the majority of the 13 serotypes compared to the 23-valent polysaccharide pneumococcal vaccine (PPV23). Administering PCV13 prior to PPV23 elicits greater immune responses and multiple doses of PCV13 demonstrated modest advantage. PCV13 titers declined after a year but remained above baseline. A randomized clinical trial (CAPiTA) showed that PCV13 was effective in preventing community-acquired pneumonia (CAP) and vaccine-type invasive pneumococcal disease, but not any cause pneumonia. Safety data shows PCV13 elicits minor local reactions, such as pain at the injection site. Major side effects that were commonly reported included muscle fatigue and headache. Both local and systemic adverse events were comparable to PPV23. While PCV13 has a well-established immunogenicity and safety profile in adults, there is sparse data on sequential or multiple dosing, efficacy and effectiveness in adults. As there are few countries who have adopted PCV13 for routine adult immunization, there is a need to evaluate the effectiveness of PCV13 in a real-world setting.
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Affiliation(s)
- Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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Juergens C, Trammel J, Shoji Y, Patterson S, Watson W, Webber C, Gruber WC, Scott DA, Schmoele-Thoma B. Late onset of injection site reactions after vaccination with the 13-valent pneumococcal conjugate vaccine in adult study populations. Hum Vaccin Immunother 2018. [PMID: 29543583 PMCID: PMC6149808 DOI: 10.1080/21645515.2018.1452576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Injection site reactions (ISRs; redness, swelling and pain) commonly occur within 1–2 days after vaccination. After administration of toxoid vaccines including diphtheria toxoid, a later onset of ISRs has also been observed. As the serotype capsular polysaccharides in the 13-valent pneumococcal conjugate vaccine (PCV13) are conjugated to cross-reactive material 197 (CRM197), a nontoxic variant of diphtheria toxin, the onset of ISRs over 14 days was explored in 8 adult studies with 19 cohorts. Subjects received PCV13 with aluminum phosphate (AlPO4, n = 5667) or without AlPO4 (n = 304); 1097 subjects received 23-valent pneumococcal polysaccharide vaccine (PPSV23). Late ISRs with onset between days 6–14 were observed in 8/8 cohorts aged ≥65 years after PCV13 with AlPO4 (incidence across cohorts for redness, 2.3%-19.6%; swelling, 0.9%-10.8%; pain, 1.6%-10.0%) and in 1/1 cohort after PCV13 without AlPO4 (redness 10.5%; swelling 7.5%; pain 12.3%); and in 2/4 cohorts aged 50 to 64 years after PCV13 (redness 3.1%-4.8%; swelling 1.0%-3.2%; pain 3.7%-5%). Late ISRs were not generally observed in 1/1 cohort aged 18 to 49 years after PCV13; in 2/2 cohorts aged ≥53 years after PCV13 revaccination; and in 3/3 cohorts aged ≥60 years who received PPSV23, which does not contain CRM197. Post hoc analysis demonstrated numerically higher pneumococcal immune responses in subgroups with late ISRs versus those without. In conclusion, causality of late ISRs is likely multifactorial, with age and the PCV13 carrier protein CRM197 potentially associated. AlPO4, a vaccine adjuvant, did not appear causally related. Observations do not affect the favorable risk-benefit profile of PCV13.
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Affiliation(s)
- Christine Juergens
- a Pfizer Vaccine Clinical Research and Development , Pfizer Pharma GmbH , Berlin , Germany
| | - James Trammel
- b Biostatistics, Syneos Health , Stonewall , LA , USA
| | - Yasuko Shoji
- c Pfizer Vaccine Clinical Research and Development , Tokyo , Japan
| | - Scott Patterson
- d Pfizer Vaccines Clinical Research & Development , Collegeville , PA , USA
| | - Wendy Watson
- d Pfizer Vaccines Clinical Research & Development , Collegeville , PA , USA
| | - Chris Webber
- e Pfizer Vaccines Clinical Research & Development , Pearl River , NY , USA
| | - William C Gruber
- e Pfizer Vaccines Clinical Research & Development , Pearl River , NY , USA
| | - Daniel A Scott
- d Pfizer Vaccines Clinical Research & Development , Collegeville , PA , USA
| | - Beate Schmoele-Thoma
- a Pfizer Vaccine Clinical Research and Development , Pfizer Pharma GmbH , Berlin , Germany
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Dendle C, Stuart RL, Polkinghorne KR, Balloch A, Kanellis J, Ling J, Kummrow M, Moore C, Thursky K, Buttery J, Mulholland K, Gan PY, Holdsworth S, Mulley WR. Seroresponses and safety of 13-valent pneumococcal conjugate vaccination in kidney transplant recipients. Transpl Infect Dis 2018; 20:e12866. [PMID: 29512234 DOI: 10.1111/tid.12866] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Conjugated pneumococcal vaccine is recommended for kidney transplant recipients, however, their immunogenicity and potential to trigger allograft rejection though generation of de novo anti-human leukocyte antigen antibodies has not been well studied. METHODS Clinically stable kidney transplant recipients participated in a prospective cohort study and received a single dose of 13-valent conjugate pneumococcal vaccine. Anti-pneumococcal IgG was measured for the 13 vaccine serotypes pre and post vaccination and functional anti-pneumococcal IgG for 4 serotypes post vaccination. Anti-human leukocyte antigen antibodies antibodies were measured before and after vaccination. Kidney transplant recipients were followed clinically for 12 months for episodes of allograft rejection or invasive pneumococcal disease. RESULTS Forty-five kidney transplant recipients participated. Median days between pre and post vaccination serology was 27 (range 21-59). Post vaccination, there was a median 1.1 to 1.7-fold increase in anti-pneumococcal IgG antibody concentrations for all 13 serotypes. Kidney transplant recipients displayed a functional antibody titer ≥1:8 for a median of 3 of the 4 serotypes. Post vaccination, there were no de novo anti-human leukocyte antigen antibodies, no episodes of biopsy proven rejection or invasive pneumococcal disease. CONCLUSION A single dose of 13-valent conjugate pneumococcal vaccine elicits increased titers and breadth of functional anti-pneumococcal antibodies in kidney transplant recipients without stimulating rejection or donor-specific antibodies.
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Affiliation(s)
- Claire Dendle
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University and Monash Infectious Diseases, Monash Health, Clayton, Vic., Australia
| | - Rhonda L Stuart
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University and Monash Infectious Diseases, Monash Health, Clayton, Vic., Australia
| | - Kevan R Polkinghorne
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.,Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Vic., Australia
| | - Anne Balloch
- Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - John Kanellis
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.,Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
| | - Johnathan Ling
- Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
| | - Megan Kummrow
- Victorian Transplantation and Immunogenetics Service, West Melbourne, Vic., Australia
| | - Chelsea Moore
- Victorian Transplantation and Immunogenetics Service, West Melbourne, Vic., Australia
| | - Karin Thursky
- University of Melbourne, Parkville, Vic., Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia
| | - Jim Buttery
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Vic., Australia.,Department of Infection and Immunity, Monash Children's Hospital, Monash Health, Melbourne, Vic., Australia
| | - Kim Mulholland
- Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Poh-Yi Gan
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia
| | - Stephen Holdsworth
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.,Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
| | - William R Mulley
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Vic., Australia.,Department of Nephrology, Monash Medical Centre, Clayton, Vic., Australia
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12
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Suaya JA, Jiang Q, Scott DA, Gruber WC, Webber C, Schmoele-Thoma B, Hall-Murray CK, Jodar L, Isturiz RE. Post hoc analysis of the efficacy of the 13-valent pneumococcal conjugate vaccine against vaccine-type community-acquired pneumonia in at-risk older adults. Vaccine 2018; 36:1477-1483. [PMID: 29429807 DOI: 10.1016/j.vaccine.2018.01.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Individuals with certain chronic medical conditions are at higher risk of developing pneumonia and pneumococcal disease than those without. Using data from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), this post hoc analysis assessed the efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13) in adults aged ≥65 years with at-risk conditions. METHODS The Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) was a double-blind, parallel-group, randomized, placebo-controlled study in the Netherlands in which adults aged ≥65 years received either PCV13 or placebo. Outcomes of interest were identified using prespecified clinical criteria, radiographic confirmation, routine microbiologic testing, and a serotype-specific urinary antigen detection assay. In this post hoc analysis, participants were classified by at-risk status based on self-reporting of any of the following chronic medical conditions: heart disease, lung disease, asthma, diabetes, liver disease, and smoking. The objective of this analysis was to assess PCV13 vaccine efficacy (VE) against a first episode of vaccine-serotype community-acquired pneumonia (VT-CAP) in at-risk participants. RESULTS Of the 84,496 adults enrolled in the study, 41,385 (49.2%) were considered at risk owing to chronic medical conditions. Of the 139 VT-CAP cases, 115 (82.7%) occurred in these participants. VE of PCV13 against a first episode of VT-CAP among participants with at-risk conditions was 40.3% (95.2% CI: 11.4%, 60.2%). Average duration of follow-up since vaccination was 3.95 years for at-risk participants; protection did not wane over the study period. CONCLUSIONS This post hoc analysis of the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA) showed significant and persistent efficacy of PCV13 against VT-CAP in at-risk older adults. ClinicalTrials.gov identifier: NCT00744263.
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Affiliation(s)
- José A Suaya
- Pfizer Vaccines Medicines Development & Scientific and Clinical Affairs, New York, NY, USA.
| | - Qin Jiang
- Pfizer Vaccines Medicines Development & Scientific and Clinical Affairs, Collegeville, PA, USA.
| | - Daniel A Scott
- Pfizer Vaccines Clinical Research and Development, Pearl River, NY, USA.
| | - William C Gruber
- Pfizer Vaccines Clinical Research and Development, Pearl River, NY, USA.
| | - Chris Webber
- Pfizer Vaccines Clinical Research and Development, Pearl River, NY, USA.
| | | | - Cassandra K Hall-Murray
- Pfizer Vaccines Medicines Development & Scientific and Clinical Affairs, Collegeville, PA, USA.
| | - Luis Jodar
- Pfizer Vaccines Medicines Development & Scientific and Clinical Affairs, Collegeville, PA, USA.
| | - Raul E Isturiz
- Pfizer Vaccines Medicines Development & Scientific and Clinical Affairs, Collegeville, PA, USA.
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13
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Isturiz RE, Hall-Murray C, McLaughlin JM, Snow V, Schmoele-Thoma B, Webber C, Thompson A, Scott DA. Pneumococcal conjugate vaccine use for the prevention of pneumococcal disease in adults <50 years of age. Expert Rev Vaccines 2017; 17:45-55. [PMID: 29183235 DOI: 10.1080/14760584.2018.1411196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Adults, particularly those with underlying chronic conditions, eg, cardiovascular, liver, and pulmonary diseases and diabetes mellitus, have a persistent pneumococcal disease burden. Thirteen-valent pneumococcal conjugate vaccine (PCV13) is recommended in the United States for all adults aged ≥65 years and immunocompromised adults aged <65 years to protect against vaccine-serotype (VT) invasive pneumococcal disease (IPD) and pneumonia. PCV13 is not recommended for immunocompetent adults aged ≥18 years with comorbidities associated with increased pneumococcal disease risk. AREAS COVERED This US-focused review summarizes PCV13-type IPD and community-acquired pneumonia burden in adults aged <50 years, PCV13 immunogenicity and safety in this population, and adult pneumococcal vaccination recommendations. EXPERT COMMENTARY Considering (i) PCV13 has demonstrated efficacy against VT-IPD and pneumonia in adults aged ≥65 years (with or without underlying chronic conditions), and (ii) immune responses to PCV13 in younger adults are comparable or better than in older adults, PCV13 would likely have similar efficacy in adults aged <50 years. Recommending PCV13 for at-risk adults aged <50 years would provide direct immunologic benefit of a conjugate vaccine and could address an important unmet medical need for pneumococcal pneumonia prevention. Although not directly addressed here, this benefit would likely extend to at-risk adults aged 50-64 years.
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Affiliation(s)
- Raul E Isturiz
- a Pfizer Vaccine Research and Development, Collegeville , PA , USA.,b Pfizer Pharma GmbH , Berlin , Germany.,c Pfizer Vaccine Research , Pearl River , NY , USA
| | - Cassandra Hall-Murray
- a Pfizer Vaccine Research and Development, Collegeville , PA , USA.,b Pfizer Pharma GmbH , Berlin , Germany.,c Pfizer Vaccine Research , Pearl River , NY , USA
| | - John M McLaughlin
- a Pfizer Vaccine Research and Development, Collegeville , PA , USA.,b Pfizer Pharma GmbH , Berlin , Germany.,c Pfizer Vaccine Research , Pearl River , NY , USA
| | - Vincenza Snow
- a Pfizer Vaccine Research and Development, Collegeville , PA , USA.,b Pfizer Pharma GmbH , Berlin , Germany.,c Pfizer Vaccine Research , Pearl River , NY , USA
| | - Beate Schmoele-Thoma
- a Pfizer Vaccine Research and Development, Collegeville , PA , USA.,b Pfizer Pharma GmbH , Berlin , Germany.,c Pfizer Vaccine Research , Pearl River , NY , USA
| | - Chris Webber
- a Pfizer Vaccine Research and Development, Collegeville , PA , USA.,b Pfizer Pharma GmbH , Berlin , Germany.,c Pfizer Vaccine Research , Pearl River , NY , USA
| | - Allison Thompson
- a Pfizer Vaccine Research and Development, Collegeville , PA , USA.,b Pfizer Pharma GmbH , Berlin , Germany.,c Pfizer Vaccine Research , Pearl River , NY , USA
| | - Daniel A Scott
- a Pfizer Vaccine Research and Development, Collegeville , PA , USA.,b Pfizer Pharma GmbH , Berlin , Germany.,c Pfizer Vaccine Research , Pearl River , NY , USA
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14
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Edouard S, Al-Tawfiq JA, Memish ZA, Yezli S, Gautret P. WITHDRAWN: Impact of the Hajj on pneumococcal carriage and the effect of various pneumococcal vaccines. Vaccine 2017:S0264-410X(17)31028-9. [PMID: 28780980 DOI: 10.1016/j.vaccine.2017.03.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/25/2017] [Accepted: 03/01/2017] [Indexed: 12/27/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Sophie Edouard
- Aix Marseille Univ, CNRS, IRD, INSERM, AP-HM, URMITE, IHU Méditerranée-Infection, Marseille, France
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine Unit, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ziad A Memish
- Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Philippe Gautret
- Aix Marseille Univ, CNRS, IRD, INSERM, AP-HM, URMITE, IHU Méditerranée-Infection, Marseille, France.
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15
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van der Heiden M, Boots AMH, Bonacic Marinovic AA, de Rond LGH, van Maurik M, Tcherniaeva I, Berbers GAM, Buisman AM. Novel Intervention in the Aging Population: A Primary Meningococcal Vaccine Inducing Protective IgM Responses in Middle-Aged Adults. Front Immunol 2017; 8:817. [PMID: 28769927 PMCID: PMC5515833 DOI: 10.3389/fimmu.2017.00817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/27/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Vaccine responses are often reduced in the elderly, leaving part of the elderly population vulnerable to infectious diseases. Timely vaccination may offer a solution for strengthening memory immunity before reaching old age, which classifies middle-aged persons as a target age group for vaccine interventions. However, knowledge regarding the immunogenicity of primary immunizations in middle-aged adults is lacking. We determined the immunogenicity of a primary meningococcal vaccine towards which no or (very) low pre-vaccination immunity exists in middle-aged adults (NTR4636). Methods A vaccine containing multiple meningococcal groups (tetravalent) conjugated to tetanus toxoid (MenACWY-TT) was administered to middle-aged adults (50–65 years of age, N = 204) in a phase IV single-center and open-label study. Blood samples were taken pre-, 7 days, 28 days, and 1 year post-vaccination. Functional antibody titers were measured with the serum bactericidal assay (SBA). Meningococcal- and tetanus-specific antibody responses were determined with a fluorescent bead-based multiplex immunoassay. A bi-exponential decay model was used to estimate long-term protection. Results In the majority of the participants, the meningococcal vaccine clearly induced naïve responses to meningococci W (MenW) and meningococci Y (MenY) as compared to a booster response to meningococci C (MenC). After 28 days, 94, 99, and 97% of the participants possessed a protective SBA titer for MenC, MenW, and MenY, respectively, which was maintained in 76, 94, and 86% 1 year post-vaccination. At this 1-year time point, significantly lower SBA titers were found in participants without a pre-vaccination SBA titer. Overall, protective antibody titers were predicted to persist after 10 years in 40–60% of the participants. The SBA titers correlated well with the meningococcal-specific IgM responses, especially for MenW and MenY. Interestingly, these IgM responses were negatively correlated with age. Conclusion Primary immunization with a tetravalent meningococcal vaccine was highly immunogenic in middle-aged adults, inducing protective antibody titers in the vast majority of the participants lasting for at least 1 year. The age-related decrease in highly functional IgM responses argues in favor of vaccination against de novo antigens before reaching old age and, hence, middle-aged persons are an age group of interest for future vaccine interventions to protect the aging population.
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Affiliation(s)
- Marieke van der Heiden
- Centre for Infectious Disease Control (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.,Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Annemieke M H Boots
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Axel A Bonacic Marinovic
- Centre for Infectious Disease Control (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Lia G H de Rond
- Centre for Infectious Disease Control (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Marjan van Maurik
- Centre for Infectious Disease Control (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Irina Tcherniaeva
- Centre for Infectious Disease Control (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Anne-Marie Buisman
- Centre for Infectious Disease Control (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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16
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van Deursen AMM, van Houten MA, Webber C, Patton M, Scott DA, Patterson S, Sidhu M, Drews W, Gruber WC, Emini EA, Grobbee DE, Bonten MJM, Sanders EAM. Immunogenicity of the 13-Valent Pneumococcal Conjugate Vaccine in Older Adults With and Without Comorbidities in the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Clin Infect Dis 2017; 65:787-795. [DOI: 10.1093/cid/cix419] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/03/2017] [Indexed: 01/10/2023] Open
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17
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Pneumococcal polysaccharide vaccination administered early after neurotrauma or neurosurgery. Vaccine 2017; 35:909-915. [PMID: 28069358 DOI: 10.1016/j.vaccine.2016.12.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/09/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pneumococcal vaccination is recommended to lower the risk of posttraumatic meningitis, and early vaccination may be of importance. After both trauma and central nervous system injury, immune-suppression may occur, which could affect T-cell function and the response to T-cell dependent vaccines. We therefore aimed to investigate the response to early vaccination with a T-cell independent pneumococcal polysaccharide vaccine (PPSV). METHODS Thirty-three patients with basilar skull fracture and 23 patients undergoing transsphenoidal pituitary gland surgery were vaccinated with PPSV within 10days after neurotrauma or neurosurgery. Twenty-nine neurosurgical patients vaccinated ⩾3weeks after neurotrauma or neurosurgery served as controls. Serotype-specific anti-polysaccharide binding IgG antibody levels to serotypes 4, 6B, 9V, 14, 18C, 19F and 23F were determined by enzyme immunoassay. RESULTS The vaccination was safe and a highly significant antibody response was found against all serotypes in all groups (p<0.001 for each of the serotypes). There were no differences between groups or in the group by time interaction in any of the serotypes. After early and late vaccination, protective levels were found in >80% for serotypes 9V, 14, 18C, 19F and 23F and in 70% and 50% for serotypes 6B and 4, respectively. CONCLUSION Patients vaccinated with PPSV within 10days after neurotrauma or neurosurgery respond similarly to those vaccinated after ⩾3weeks, indicating that PPSV can be administered early after neurotrauma or neurosurgery. CLINICAL TRIALS REGISTRATION NCT02806284.
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18
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Effect of Glycyrrhiza uralensis Fisch polysaccharide on growth performance and immunologic function in mice in Ural City, Xinjiang. ASIAN PAC J TROP MED 2016; 9:1078-1083. [DOI: 10.1016/j.apjtm.2016.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/07/2016] [Accepted: 08/10/2016] [Indexed: 11/19/2022] Open
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19
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Tashani M, Alfelali M, Barasheed O, Alqahtani AS, Heron L, Wong M, Rashid H, Booy R. Effect of Tdap when administered before, with or after the 13-valent pneumococcal conjugate vaccine (coadministered with the quadrivalent meningococcal conjugate vaccine) in adults: A randomised controlled trial. Vaccine 2016; 34:5929-5937. [PMID: 27780630 DOI: 10.1016/j.vaccine.2016.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/05/2016] [Accepted: 10/06/2016] [Indexed: 01/07/2023]
Abstract
Sequential or co-administration of vaccines has potential to alter the immune response to any of the antigens. Existing literature suggests that prior immunisation of tetanus/diphtheria-containing vaccines can either enhance or suppress immune response to conjugate pneumococcal or meningococcal vaccines. We examined this interaction among adult Australian travellers before attending the Hajj pilgrimage 2014. We also investigated tolerability of these vaccines separately and concomitantly. We randomly assigned each participant to one of three vaccination schedules. Group A received adult tetanus, diphtheria and acellular pertussis vaccine (Tdap) 3-4weeks before receiving CRM197-conjugated 13-valent pneumococcal vaccine (PCV13) and CRM197-conjugated quadrivalent meningococcal vaccine (MCV4). Group B received all three vaccines on one day. Group C received PCV13 and MCV4 3-4weeks before Tdap. Blood samples collected at baseline, each vaccination visit and 3-4weeks after vaccination were tested using the pneumococcal opsonophagocytic assay (OPA) and by ELISA for diphtheria and tetanus antibodies. Funding for meningococcal serology was not available. Participants completed symptom diaries after each vaccination. A total of 111 participants aged 18-64 (median 40) years were recruited. No statistically significant difference was detected across the three groups in achieving OPA titre ⩾1:8 post vaccination. However, compared to other groups, Group A had a statistically significant lower number of subjects achieving ⩾4-fold rise in serotype 3, and also significantly lower geometric mean titres (GMTs) to six (of 13) pneumococcal serotypes (3, 5, 18C, 4, 19A and 9V). Group C (given prior PCV13 and MVC4) had statistically significant higher pre-Tdap geometric mean concentration (GMC) of anti-diphtheria IgG; however, there was no difference across the three groups following Tdap. Anti-tetanus IgG GMCs were similar across the groups before and after Tdap. No serious adverse events were reported. In conclusion, Tdap vaccination 3-4weeks before concomitant administration of PCV13 and MCV4 significantly reduced the antibody response to six of the 13 pneumococcal serotypes in adults. The trial is registered at the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000536763.
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Affiliation(s)
- M Tashani
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - M Alfelali
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - O Barasheed
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; The Executive Administration of Research, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
| | - A S Alqahtani
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - L Heron
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Kids Research Institute, The Children's Hospital at Westmead, NSW, Australia
| | - M Wong
- Immunology Department, The Children's Hospital at Westmead, Westmead 2145, NSW, Australia
| | - H Rashid
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia
| | - R Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide 5001, Australia
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20
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Chen JJ, Yuan L, Huang Z, Shi NM, Zhao YL, Xia SL, Li GH, Li RC, Li YP, Yang SY, Xia JL. Safety and immunogenicity of a new 13-valent pneumococcal conjugate vaccine versus a licensed 7-valent pneumococcal conjugate vaccine: a study protocol of a randomised non-inferiority trial in China. BMJ Open 2016; 6:e012488. [PMID: 27798013 PMCID: PMC5073664 DOI: 10.1136/bmjopen-2016-012488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The invasive pneumococcal diseases (IPDs) caused by Streptococcus pneumoniae pose an enormous threat to children under 5 years of age. However, routine use of pneumococcal conjugate vaccines could aid in reducing the incidence of IPDs. The purpose of this clinical trial is to assess the non-inferiority of the investigational 13-valent pneumococcal conjugate vaccine (PCV13) to the currently licensed 7-valent pneumococcal conjugate vaccine (PCV7). METHODS AND ANALYSIS 1040 infants will receive a three-dose series of either PCV13 or PCV7 at ages 3, 4 and 5 months, respectively, and a booster dose at 12-15 months. Primary end points are the percentage of participants reaching a serotype-specific IgG concentration of ≥0.35 µg/mL and the IgG antibody geometric mean concentrations (GMCs) measured 30 days after the primary immunisation. Secondary end points include the percentage of vaccine recipients reaching a serotype-specific IgG concentration threshold of 1.0 µg/mL, the percentage of participants reaching the pneumococcal opsonophagocytic assay (OPA) titre threshold of 1:8, and the geometric mean titres (GMTs) of OPA measured 30 days after primary and booster doses. The number of standard IgG responders and IgG GMCs measured 30 days after the booster immunisation will also be determined. To evaluate differences between two groups, the sequential testing of the non-inferiority of PCV13 for the seven common serotypes and its effectiveness in treating the six additional serotypes will be performed. ETHICS AND DISSEMINATION Ethics approvals have been granted by the Ethics Committees at the three provinces involved in this study: Shanxi, Henan and Hebei. The trial will be reported in accordance with the CONSORT guidance. TRIAL REGISTRATION NUMBER NCT02736240.
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Affiliation(s)
- Jing Jing Chen
- Department of Health Statistics of Fourth Military Medical University, Xi'an, China
- Walvax, Walvax Biotechnology Co., Ltd., Kunming, China
| | - Lin Yuan
- Walvax, Walvax Biotechnology Co., Ltd., Kunming, China
| | - Zhen Huang
- Walvax, Walvax Biotechnology Co., Ltd., Kunming, China
| | - Nian Min Shi
- Beijing Chaoyang District Centre for Disease Control and Prevention, Beijing, China
| | - Yu Liang Zhao
- Heibei Province Centre for Disease Control and Prevention, Shijiazhuang, China
| | - Sheng Li Xia
- Henan Province Centre for Disease Control and Prevention, Zhengzhou, China
| | - Guo Hua Li
- Shanxi Province Centre for Disease Control and Prevention, Taiyuan, China
| | - Rong Cheng Li
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Yan Ping Li
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Shu Yuan Yang
- Walvax, Walvax Biotechnology Co., Ltd., Kunming, China
| | - Jie Lai Xia
- Department of Health Statistics of Fourth Military Medical University, Xi'an, China
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21
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Reduction of Streptococcus pneumoniae Colonization and Dissemination by a Nonopsonic Capsular Polysaccharide Antibody. mBio 2016; 7:e02260-15. [PMID: 26838726 PMCID: PMC4742719 DOI: 10.1128/mbio.02260-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Streptococcus pneumoniae colonization of the nasopharynx (NP) is a prerequisite for invasive pneumococcal disease (IPD). The marked reduction in IPD that followed the routine use of pneumococcal polysaccharide conjugate vaccines (PCVs) has been linked to reduced NP colonization with vaccine-included serotypes (STs), with the caveat that PCVs are less effective against pneumonia than against IPD. Although PCV-elicited opsonic antibodies that enhance phagocytic killing of the homologous ST are considered a key correlate of PCV-mediated protection, recent studies question this relationship for some STs, including ST3. Studies with monoclonal antibodies (MAbs) to the pneumococcal capsular polysaccharide (PPS) of ST3 (PPS3) have shown that nonopsonic, as well as opsonic, antibodies can each protect mice against pneumonia and sepsis, but the effect of these types of MAbs on NP colonization is unknown. In this study, we determined the effects of protective opsonic and nonopsonic PPS3 MAbs on ST3 NP colonization in mice. Our results show that a nonopsonic MAb reduced early NP colonization and prevented ST3 dissemination to the lungs and blood, but an opsonic MAb did not. Moreover, the opsonic MAb induced a proinflammatory NP cytokine response, but the nonopsonic MAb had an antiinflammatory effect. The effect of the nonopsonic MAb on colonization did not require its Fc region, but its antiinflammatory effect did. Our findings challenge the paradigm that opsonic MAbs are required to prevent NP colonization and suggest that further studies of the activity of nonopsonic antibodies could advance our understanding of mechanisms of PCV efficacy and provide novel correlates of protection. Pneumococcal conjugate vaccines (PCVs) have markedly reduced the incidence of invasive pneumococcal disease (IPD). Vaccine-elicited pneumococcal polysaccharide (PPS) antibodies that enhance in vitro phagocyte killing of vaccine-included serotypes (STs) (opsonic antibodies) have been considered correlates of vaccine protection and are thought to exert their effect at the initial site of infection, the nasopharynx (NP). However, the data presented here show that this is not the necessarily the case. A nonopsonic PPS monoclonal antibody (MAb) reduced pneumococcal colonization and dissemination of its homologous ST in mice, but surprisingly, an opsonic PPS MAb to the same ST did not. These results reveal that PPS antibodies can work in different ways than previously thought, challenge the paradigm that opsonic antibodies are required to prevent IPD, and provide new insights into PCV efficacy that could lead to novel correlates of vaccine protection.
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Isturiz RE, Schmoele-Thoma B, Scott DA, Jodar L, Webber C, Sings HL, Paradiso P. Pneumococcal conjugate vaccine use in adults. Expert Rev Vaccines 2015; 15:279-93. [PMID: 26651847 DOI: 10.1586/14760584.2016.1132171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Streptococcus pneumoniae is a leading cause of illness and death in adults. A polysaccharide vaccine has been available for over 30 years, but despite significant use, the public health impact of this vaccine has been limited. The 13-valent pneumococcal conjugate vaccine (PCV13) has been licensed by the US Food and Drug Administration and other international regulatory authorities with the assumption that induction of a T cell-dependent immune response and noninferior immunogenicity to vaccine antigens when compared with the polysaccharide vaccine would be important to satisfy a significant unmet medical need. PCV13 efficacy against vaccine-type pneumococcal community-acquired pneumonia was confirmed in a large randomized controlled trial in older adults and its use is now increasingly recommended globally.
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Affiliation(s)
| | | | - Daniel A Scott
- c Pfizer Vaccine Clinical Research , Pearl River , NY , USA
| | | | - Chris Webber
- d Pfizer Vaccine Clinical Research , Maidenhead , UK
| | | | - Peter Paradiso
- e Paradiso Biologics Consulting, LLC , Radnor , PA , USA
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23
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Choi WS, Choi JH, Kwon KT, Seo K, Kim MA, Lee SO, Hong YJ, Lee JS, Song JY, Bang JH, Choi HJ, Choi YH, Lee DG, Cheong HJ. Revised adult immunization guideline recommended by the korean society of infectious diseases, 2014. Infect Chemother 2015; 47:68-79. [PMID: 25844267 PMCID: PMC4384453 DOI: 10.3947/ic.2015.47.1.68] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Won Suk Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jung-Hyun Choi
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Kyung Seo
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Min A Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Internal Medicine, Ulsan University College of Medicine, Ulsan, Korea
| | - Young Jin Hong
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Jung Choi
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Young-Hwa Choi
- Department of Internal Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Dong Gun Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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