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Ahmed AK, Sijercic VC, Akhtar MS, Elbayomy A, Marouf MA, Zeleke MS, Sayad R, Abdelshafi A, Laird NJ, El‐Mokhtar MA, Ruthig GR, Hetta HF. Cholera rages in Africa and the Middle East: A narrative review on challenges and solutions. Health Sci Rep 2024; 7:e2013. [PMID: 38742091 PMCID: PMC11089255 DOI: 10.1002/hsr2.2013] [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: 11/27/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Background and Aim Cholera is a life-threatening infectious disease that is still one of the most common acute watery diarrheal diseases in the world today. Acute diarrhea and severe dehydration brought on by cholera can cause hypovolemic shock, which can be fatal in minutes. Without competent clinical therapy, the rate of case fatality surpasses 50%. The purpose of this review was to highlight cholera challenges in Africa and the Middle East and explain the reasons for why this region is currently a fertile environment for cholera. We investigated cholera serology, epidemiology, and the geographical distribution of cholera in Africa and the Middle East in 2022 and 2023. We reviewed detection methods, such as rapid diagnostic tests (RDTs), and treatments, such as antibiotics and phage therapy. Finally, this review explored oral cholera vaccines (OCVs), and the vaccine shortage crisis. Methods We carried out a systematic search in multiple databases, including PubMed, Web of Science, Google Scholar, Scopus, MEDLINE, and Embase, for studies on cholera using the following keywords: ((Cholera) OR (Vibrio cholera) and (Coronavirus) OR (COVID-19) OR (SARS-CoV2) OR (The Middle East) OR (Africa)). Results and Conclusions Cholera outbreaks have increased dramatically, mainly in Africa and many Middle Eastern countries. The COVID-19 pandemic has reduced the attention devoted to cholera and disrupted diagnosis and treatment services, as well as vaccination initiatives. Most of the cholera cases in Africa and the Middle East were reported in Malawi and Syria, respectively, in 2022. RDTs are effective in the early detection of cholera epidemics, especially with limited advanced resources, which is the case in much of Africa. By offering both direct and indirect protection, expanding the use of OCV will significantly reduce the burden of current cholera outbreaks in Africa and the Middle East.
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Affiliation(s)
| | | | | | - Ahmed Elbayomy
- Faculty of MedicineMansoura UniversityMansouraEgypt
- School of Medicine and Public HealthUniversity of Wisconsin−MadisonMadisonWisconsinUSA
| | - Mohamed A. Marouf
- Faculty of MedicineMansoura UniversityMansouraEgypt
- Department of Internal Medicine, Morsani College of MedicineUniversity of South FloridaTampaFloridaUSA
| | - Mahlet S. Zeleke
- Menelik II Medical and Health Science CollegeKotebe Metropolitan UniversityAddis AbabaEthiopia
| | - Reem Sayad
- Faculty of MedicineAssiut UniversityAssiutEgypt
| | | | | | - Mohamed A. El‐Mokhtar
- Gilbert & Rose‐Marie Chagoury School of MedicineLebanese American UniversityByblosLebanon
| | | | - Helal F. Hetta
- Division of Microbiology and Immunology, Department of Natural Products and Alternative Medicine, Faculty of PharmacyUniversity of TabukTabukSaudi Arabia
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Song Y, Mehl F, Zeichner SL. Vaccine Strategies to Elicit Mucosal Immunity. Vaccines (Basel) 2024; 12:191. [PMID: 38400174 PMCID: PMC10892965 DOI: 10.3390/vaccines12020191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Vaccines are essential tools to prevent infection and control transmission of infectious diseases that threaten public health. Most infectious agents enter their hosts across mucosal surfaces, which make up key first lines of host defense against pathogens. Mucosal immune responses play critical roles in host immune defense to provide durable and better recall responses. Substantial attention has been focused on developing effective mucosal vaccines to elicit robust localized and systemic immune responses by administration via mucosal routes. Mucosal vaccines that elicit effective immune responses yield protection superior to parenterally delivered vaccines. Beyond their valuable immunogenicity, mucosal vaccines can be less expensive and easier to administer without a need for injection materials and more highly trained personnel. However, developing effective mucosal vaccines faces many challenges, and much effort has been directed at their development. In this article, we review the history of mucosal vaccine development and present an overview of mucosal compartment biology and the roles that mucosal immunity plays in defending against infection, knowledge that has helped inform mucosal vaccine development. We explore new progress in mucosal vaccine design and optimization and novel approaches created to improve the efficacy and safety of mucosal vaccines.
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Affiliation(s)
- Yufeng Song
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22908, USA; (Y.S.)
| | - Frances Mehl
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22908, USA; (Y.S.)
| | - Steven L. Zeichner
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22908, USA; (Y.S.)
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, Charlottesville, VA 22908, USA
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3
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McCarty JM, Cassie D, Bedell L. Immunogenicity of partial doses of live oral cholera vaccine CVD 103-HgR in children in the United States. Vaccine 2023; 41:2739-2742. [PMID: 36959054 DOI: 10.1016/j.vaccine.2023.03.013] [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: 09/29/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/25/2023]
Abstract
In a phase 4, placebo-controlled, double-blind, multi-center study performed to assess the immunogenicity of a single oral dose of live, attenuated cholera vaccine, volunteers aged 2-17 years were randomized 6:1 to receive 1 × 109 colony forming units of PXVX0200 or placebo. In the subset of subjects who consumed < 80 % of the vaccine dose, seroconversion rates were calculated and stratified by amount consumed. Of 468 subjects dosed, a subset of 33 (7 %) received < 80 % of the vaccine dose. SVA seroconversion occurred in 75.8 % of these subjects, including 100 % (7/7) of those who took 50-80 % and 69.2 % (18/26) of those who took < 50 %, versus 98.5 % of those who consumed 80 % or more. Vaccination with PXVX0200 produced an immune response in most children who received partial dosing. Since SVA seroconversion is a strong correlate of protection, PXVX0200 may protect against cholera infection in children who ingest only part of the vaccine dose.
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Affiliation(s)
| | - David Cassie
- Emergent BioSolutions Inc., Gaithersburg, MD, United States
| | - Lisa Bedell
- Emergent BioSolutions Inc., Gaithersburg, MD, United States
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Kim EJ, Bae J, Ju YJ, Ju DB, Lee D, Son S, Choi H, Ramamurthy T, Yun CH, Kim DW. Inactivated Vibrio cholerae Strains That Express TcpA via the toxT-139F Allele Induce Antibody Responses against TcpA. J Microbiol Biotechnol 2022; 32:1396-1405. [PMID: 36317425 PMCID: PMC9720071 DOI: 10.4014/jmb.2209.09001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
Cholera remains a major global public health problem, for which oral cholera vaccines (OCVs) being a valuable strategy. Patients, who have recovered from cholera, develop antibody responses against LPS, cholera toxin (CT), toxin-coregulated pilus (TCP) major subunit A (TcpA) and other antigens; thus, these responses are potentially important contributors to immunity against Vibrio cholerae infection. However, assessments of the efficacy of current OCVs, especially inactivated OCVs, have focused primarily on O-antigen-specific antibody responses, suggesting that more sophisticated strategies are required for inactivated OCVs to induce immune responses against TCP, CT, and other antigens. Previously, we have shown that the toxT-139F allele enables V. cholerae strains to produce CT and TCP under simple laboratory culture conditions. Thus, we hypothesized that V. cholerae strains that express TCP via the toxT-139F allele induce TCP-specific antibody responses. As anticipated, V. cholerae strains that expressed TCP through the toxT-139F allele elicited antibody responses against TCP when the inactivated bacteria were delivered via a mouse model. We have further developed TCP-expressing V. cholerae strains that have been used in inactivated OCVs and shown that they effect an antibody response against TcpA in vivo, suggesting that V. cholerae strains with the toxT-139F allele are excellent candidates for cholera vaccines.
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Affiliation(s)
- Eun Jin Kim
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea,Institute of Pharmacological Research, Hanyang University, Ansan 15588, Republic of Korea
| | - Jonghyun Bae
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea,Institute of Pharmacological Research, Hanyang University, Ansan 15588, Republic of Korea
| | - Young-Jun Ju
- Department of Agricultural Biotechnology, and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Do-Bin Ju
- Department of Agricultural Biotechnology, and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Donghyun Lee
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea,Institute of Pharmacological Research, Hanyang University, Ansan 15588, Republic of Korea
| | - Seonghyeon Son
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea,Institute of Pharmacological Research, Hanyang University, Ansan 15588, Republic of Korea
| | - Hunseok Choi
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea,Institute of Pharmacological Research, Hanyang University, Ansan 15588, Republic of Korea
| | | | - Cheol-Heui Yun
- Department of Agricultural Biotechnology, and Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Republic of Korea,Corresponding authors C.-H. Yun Phone: + 82-2-880-4802 E-mail:
| | - Dong Wook Kim
- Department of Pharmacy, College of Pharmacy, Hanyang University, Ansan 15588, Republic of Korea,Institute of Pharmacological Research, Hanyang University, Ansan 15588, Republic of Korea,
D.W. Kim Phone: +82-31-400-5806 E-mail:
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Collins JP, Ryan ET, Wong KK, Daley MF, Ratner AJ, Appiah GD, Sanchez PJ, Gutelius BJ. Cholera Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 2022. MMWR Recomm Rep 2022; 71:1-8. [PMID: 36173766 PMCID: PMC9536201 DOI: 10.15585/mmwr.rr7102a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This report summarizes all recommendations from CDC’s Advisory
Committee on Immunization Practices (ACIP) for the use of lyophilized CVD
103-HgR vaccine (CVD 103-HgR) (Vaxchora, Emergent BioSolutions,
Gaithersburg, MD) in the United States. The live attenuated oral cholera
vaccine is derived from Vibrio cholerae O1 and is administered in a single dose. Cholera is a
toxin-mediated bacterial gastrointestinal illness caused by
toxigenic V. cholerae serogroup O1 or, uncommonly,
O139. Up to 10% of infections manifest as severe cholera (i.e., cholera
gravis), profuse watery diarrhea that can cause severe dehydration and
death within hours. Fluid replacement therapy can reduce the fatality
rate to <1%. Risk factors for cholera gravis include high dose
exposure, blood group O, increased gastric pH (e.g., from antacid
therapy), and partial gastrectomy. Cholera is rare in the United States,
but cases occur among travelers to countries where cholera is endemic or
epidemic and associated with unsafe water and inadequate sanitation.
Travelers might be at increased risk for poor outcomes from cholera if
they cannot readily access medical services or if they have a medical
condition that would be worsened by dehydration, such as cardiovascular
or kidney disease. This report describes previously published ACIP
recommendations about use of CVD 103-HgR for adults aged 18–64
years and introduces a new recommendation for use in children and
adolescents aged 2–17 years. ACIP recommends CVD 103-HgR, the
only cholera vaccine licensed for use in the United States, for
prevention of cholera among travelers aged 2–64 years to an area
with active cholera transmission. Health care providers can use these
guidelines to develop the pretravel consultation for persons traveling
to areas with active cholera transmission.
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McCarty J, Bedell L, De Lame PA, Cassie D, Lock M, Bennett S, Haney D. Update on CVD 103-HgR single-dose, live oral cholera vaccine. Expert Rev Vaccines 2021; 21:9-23. [PMID: 34775892 DOI: 10.1080/14760584.2022.2003709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cholera remains endemic in >50 countries, putting millions at risk, especially young children for whom killed vaccines offer limited protection. An oral, live attenuated vaccine - CVD 103-HgR (Vaxchora vaccine) - was licensed by the US FDA in 2016 for adults aged 18-64 years traveling to endemic regions, based on clinical trials in human volunteers showing the vaccine was well tolerated and conferred 90% efficacy within 10 days. The evidence base for Vaxchora vaccine has expanded with additional clinical trial data, in older adults (aged 46-64 years) and children (aged 2-17 years), demonstrating that the vaccine produces a strong vibriocidal antibody response. Over 68,000 doses have been administered in the United States, with no new safety signals. The dose volume has been reduced in children to improve acceptability, and cold chain requirements are less st ringent, at +2°C─+8°C. The vaccine has recently been licensed in the Untied States for children aged 2-17 years, in Europe for individuals aged ≥2 years, and for home administration in Europe. Next steps include a Phase 4 study in infants (6-23 months). Additional information is needed regarding duration of immunity, the need for and timing of revaccination, and efficacy data from lower-middle-income countries.
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Affiliation(s)
- James McCarty
- Stanford University School of Medicine, 291 Campus Drive, Stanford, California, USA
| | - Lisa Bedell
- Emergent Travel Health, Redwood City, California, USA
| | | | - David Cassie
- Emergent Travel Health, Redwood City, California, USA
| | - Michael Lock
- Emergent Travel Health, Redwood City, California, USA
| | - Sean Bennett
- Adjuvance Technologies, Inc., Lincoln, Nebraska, USA
| | - Douglas Haney
- Emergent Travel Health, Redwood City, California, USA
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McCarty JM, Cassie D, Bedell L, Lock MD, Bennett S. Long-Term Immunogenicity of Live Oral Cholera Vaccine CVD 103-HgR in Adolescents Aged 12-17 Years in the United States. Am J Trop Med Hyg 2021; 104:1758-1760. [PMID: 33819178 PMCID: PMC8103473 DOI: 10.4269/ajtmh.20-1576] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/28/2021] [Indexed: 12/11/2022] Open
Abstract
As part of a phase 4, randomized, double-blind, placebo-controlled trial to assess the immunogenicity and safety of PXVX0200 in children and adolescents aged 2-17 years, a subset of 73 adolescent subjects aged 12-17 years was followed for 2 years after vaccination and had blood collected for antibody assays on days 1, 11, 29, 91, 181, 365, 547, and 730. Endpoints included serum vibriocidal antibody (SVA) seroconversion, defined as a 4-fold or greater rise in antibody titer over baseline; geometric mean titers (GMTs); and geometric mean fold increase (GMFI) over baseline. Serum vibriocidal antibody seroconversion persisted in most subjects, with a rate of 64.5% noted at day 730. Geometric mean titers and GMFI both peaked at day 11 and remained greater than baseline at all time points, including day 730. Vaccination with PXVX0200 produces an immune response which persists for at least 2 years in adolescents aged 12-17 years.
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Affiliation(s)
- James M. McCarty
- Stanford University School of Medicine, Stanford, California;,Address correspondence to James M. McCarty, Stanford University School of Medicine, 291 Campus Dr., Stanford, CA 94305. E-mail:
| | - David Cassie
- Emergent BioSolutions Canada, Inc., Winnipeg, Canada
| | - Lisa Bedell
- Emergent Travel Health, Inc., Redwood City, California
| | | | - Sean Bennett
- Emergent Travel Health, Inc., Redwood City, California
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McCarty JM, Cassie D, Bedell L, Lock MD, Bennett S. Safety and Immunogenicity of Live Oral Cholera Vaccine CVD 103-HgR in Children Aged 2-5 Years in the United States. Am J Trop Med Hyg 2020; 104:861-865. [PMID: 33319739 PMCID: PMC7941807 DOI: 10.4269/ajtmh.20-0917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/07/2020] [Indexed: 12/28/2022] Open
Abstract
In a phase 4, randomized, placebo-controlled, double-blind, multicenter study, to assess the safety and immunogenicity of live, attenuated cholera vaccine PXVX0200 in children aged 2-5 years in the United States, 172 volunteers were randomized 6:1 to receive a single dose of 1 × 109 CFU of PXVX0200 or placebo. Immunogenicity endpoints included serum vibriocidal antibody (SVA) levels on days 1, 11, and 29. Safety was assessed by comparing solicited signs and symptoms on days 1-8, unsolicited adverse events through day 29, and serious adverse events (SAEs) through day 181. The SVA seroconversion rates 10 days after immunization were 98.1% and 0% in vaccine and placebo recipients, respectively, and the vaccine seroconversion rate was non-inferior to the 93.5% rate seen in the bridging population of adults aged 18-45 years from a lot consistency study. Most reactogenicity was mild to moderate, and there were no study-related SAEs. PXVX0200 appears safe and immunogenic in children aged 2-5 years.
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Affiliation(s)
- James M McCarty
- Stanford University School of Medicine, Stanford, California
| | - David Cassie
- Emergent Travel Health, Inc., Redwood City, California
| | - Lisa Bedell
- Emergent Travel Health, Inc., Redwood City, California
| | | | - Sean Bennett
- Emergent Travel Health, Inc., Redwood City, California
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Gabutti G, Rossanese A, Tomasi A, Giuffrida S, Nicosia V, Barriga J, Florescu C, Sandri F, Stefanati A. Cholera, the Current Status of Cholera Vaccines and Recommendations for Travellers. Vaccines (Basel) 2020; 8:E606. [PMID: 33066373 PMCID: PMC7711912 DOI: 10.3390/vaccines8040606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022] Open
Abstract
Cholera is endemic in approximately 50 countries, primarily in Africa and South and Southeast Asia, and in these areas, it remains a disease associated with poverty. In developed nations, cholera is rare, and cases are typically imported from endemic areas by returning travellers. Cholera is readily preventable with the tools available to modern medicine. In developing nations, cholera transmission can be prevented through improved water, sanitation, and hygiene services and the use of oral cholera vaccines (OCVs). For travellers, risk can be mitigated by practicing regular hand hygiene and consuming food and water from safe sources. OCVs should be considered for high-risk travellers likely to be exposed to cholera patients or contaminated water and food. There are currently three World Health Organization pre-qualified OCVs, which are based on killed whole-cell strains of Vibrio cholerae. These established vaccines offer significant protection in adults and children for up to 2 years. A novel live attenuated vaccine that provides rapid-onset protection in adults and children is licensed in the USA and Europe only. Live attenuated OCVs may mimic the natural infection of V. cholerae more closely, generating rapid immune responses without the need for repeat dosing. These potential benefits have prompted the ongoing development of several additional live attenuated vaccines. The objective of this article is to provide a general review of the current landscape of OCVs, including a discussion of their appropriate use in international travellers.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Andrea Rossanese
- Department of Infectious Tropical Diseases and Microbiology, IRCCS “Sacro Cuore-Don Calabria”, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Alberto Tomasi
- Italian Society of Travel and Migration Medicine (SIMVIM), 00185 Rome, Italy;
| | - Sandro Giuffrida
- Local Health Unit, Department of Prevention, 89121 Reggio Calabria, Italy;
| | - Vincenzo Nicosia
- Head of Health and Occupational Medicine Saipem SpA, 20097 Milan, Italy;
| | - Juan Barriga
- Department of Medical Affairs Europe, Emergent BioSolutions, 1455 Madrid, Spain;
| | - Caterina Florescu
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (F.S.)
| | - Federica Sandri
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy; (C.F.); (F.S.)
| | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
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Xian TH, Sinniah K, Yean CY, Krishnamoorthy V, Bahari MB, Ravichandran M, Prabhakaran G. Immunogenicity and protective efficacy of a live, oral cholera vaccine formulation stored outside-the-cold-chain for 140 days. BMC Immunol 2020; 21:29. [PMID: 32450807 PMCID: PMC7249306 DOI: 10.1186/s12865-020-00360-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/20/2020] [Indexed: 01/29/2023] Open
Abstract
Background Cholera, an acute watery diarrhoeal disease caused by Vibrio cholerae serogroup O1 and O139 across the continents. Replacing the existing WHO licensed killed multiple-dose oral cholera vaccines that demand ‘cold chain supply’ at 2–8 °C with a live, single-dose and cold chain-free vaccine would relieve the significant bottlenecks and cost determinants in cholera vaccination campaigns. In this direction, a prototype cold chain-free live attenuated cholera vaccine formulation (LACV) was developed against the toxigenic wild-type (WT) V. cholerae O139 serogroup. LACV was found stable and retained its viability (5 × 106 CFU/mL), purity and potency at room temperature (25 °C ± 2 °C, and 60% ± 5% relative humidity) for 140 days in contrast to all the existing WHO licensed cold-chain supply (2–8 °C) dependent killed oral cholera vaccines. Results The LACV was evaluated for its colonization potential, reactogenicity, immunogenicity and protective efficacy in animal models after its storage at room temperature for 140 days. In suckling mice colonization assay, the LACV recorded the highest recovery of (7.2 × 107 CFU/mL) compared to those of unformulated VCUSM14P (5.6 × 107 CFU/mL) and the WT O139 strain (3.5 × 107 CFU/mL). The LACV showed no reactogenicity even at an inoculation dose of 104–106 CFU/mL in a rabbit ileal loop model. The rabbits vaccinated with the LACV or unformulated VCUSM14P survived a challenge with WT O139 and showed no signs of diarrhoea or death in the reversible intestinal tie adult rabbit diarrhoea (RITARD) model. Vaccinated rabbits recorded a 275-fold increase in anti-CT IgG and a 15-fold increase in anti-CT IgA antibodies compared to those of rabbits vaccinated with unformulated VCUSM14P. Vibriocidal antibodies were increased by 31-fold with the LACV and 14-fold with unformulated VCUSM14P. Conclusion The vaccine formulation mimics a natural infection, is non-reactogenic and highly immunogenic in vivo and protects animals from lethal wild-type V. cholerae O139 challenge. The single dose LACV formulation was found to be stable at room temperature (25 ± 2 °C) for 140 days and it would result in significant cost savings during mass cholera vaccination campaigns.
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Affiliation(s)
- Tew Hui Xian
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Kurunathan Sinniah
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Chan Yean Yean
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | | | - Mohd Baidi Bahari
- Faculty of Pharmacy, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Manickam Ravichandran
- Centre of Excellence for Omics-Driven Computational Biodiscovery, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Guruswamy Prabhakaran
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia.
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McCarty JM, Gierman EC, Bedell L, Lock MD, Bennett S. Safety and Immunogenicity of Live Oral Cholera Vaccine CVD 103-HgR in Children and Adolescents Aged 6-17 Years. Am J Trop Med Hyg 2020; 102:48-57. [PMID: 31769402 PMCID: PMC6947768 DOI: 10.4269/ajtmh.19-0241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/10/2019] [Indexed: 11/13/2022] Open
Abstract
The attenuated recombinant Vibrio cholerae O1 vaccine strain CVD 103-HgR, redeveloped as PXVX0200, elicits a rapid serum vibriocidal antibody (SVA) response and protects against cholera-induced diarrhea in adult volunteer challenge trials but has not been studied in children in developed countries. We performed a phase 4, placebo-controlled, double-blind, multicenter study to assess the safety, immunogenicity, and tolerability of a single, oral dose of PXVX0200 in children and adolescents aged 6-17 years in the United States and bridged immunogenicity to adults aged 18-45 years from a separate lot consistency study. Volunteers were randomized to receive a single dose of 1 × 109 colony forming units (CFU) of PXVX0200 or placebo. Immunogenicity endpoints included SVA levels on days 1, 11, and 29 in volunteers aged 6-17 years and also on days 91 and 181 in volunteers aged 12-17 years. Safety was assessed by comparing solicited signs and symptoms on days 1-8, unsolicited adverse events (AEs) through day 29, and serious AEs through day 181. A total of 374 participants were enrolled, comprising 321 vaccine and 53 placebo recipients. The SVA seroconversion rates 10 days after immunization were 98.6% and 2.1% in vaccine and placebo recipients, respectively, and the vaccine seroconversion rate was non-inferior to the 93.5% rate seen in adults aged 18-45 years. Most reactogenicity was mild to moderate, and there were no vaccine-related serious AEs. The complete dose was consumed in 95.3% and 98.1% of vaccine and placebo recipients, respectively. PXVX0200 appears safe, immunogenic, and well tolerated in children and adolescents aged 6-17 years.
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12
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Saluja T, Mogasale VV, Excler JL, Kim JH, Mogasale V. An overview of Vaxchora TM, a live attenuated oral cholera vaccine. Hum Vaccin Immunother 2019; 16:42-50. [PMID: 31339792 PMCID: PMC7012186 DOI: 10.1080/21645515.2019.1644882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/22/2019] [Accepted: 07/08/2019] [Indexed: 01/22/2023] Open
Abstract
Cholera remains a public health threat among the least privileged populations and regions affected by conflicts and natural disasters. Together with Water, Sanitation and Hygiene practices, use of oral cholera vaccines (OCVs) is a key tool to prevent cholera. Bivalent whole-cell killed OCVs have been extensively used worldwide and found effective in protecting populations against cholera in endemic and outbreak settings. No cholera vaccine had been available for United States (US) travelers at risk for decades until 2016 when CVD 103-HgR (Vaxchora™), an oral live attenuated vaccine, was licensed by the US FDA. A single dose of Vaxchora™ protected US volunteers against experimental challenge 10 days and 3 months after vaccination. However, use of Vaxchora™ poses several challenges in resource poor settings as it requires reconstitution, is age-restricted to 18 to 64 years, has no data in populations endemic for cholera, and faces challenges related to cold chain and cost.
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Affiliation(s)
- Tarun Saluja
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Vijayalaxmi V. Mogasale
- Department of Pediatrics, Yenepoya Medical College and Research Center, Yenepoya University, Mangalore, India
| | - Jean-Louis Excler
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Jerome H. Kim
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Vittal Mogasale
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
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Rashid MI, Rehman S, Ali A, Andleeb S. Fishing for vaccines against Vibrio cholerae using in silico pan-proteomic reverse vaccinology approach. PeerJ 2019; 7:e6223. [PMID: 31249730 PMCID: PMC6589079 DOI: 10.7717/peerj.6223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/05/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cholera, an acute enteric infection, is a serious health challenge in both the underdeveloped and the developing world. It is caused by Vibrio cholerae after ingestion of fecal contaminated food or water. Cholera outbreaks have recently been observed in regions facing natural calamities (i.e., earthquake in Haiti 2010) or war (i.e., ongoing civil war in Yemen 2016) where healthcare and sanitary setups have been disrupted as a consequence. Whole-cell oral cholera vaccines (OCVs) have been in market but their regimen efficacy has been questioned. A reverse vaccinology (RV) approach has been applied as a successful anti-microbial measure for many infectious diseases. METHODOLOGY With the aim of finding new protective antigens for vaccine development, the V. cholerae O1 (biovar eltr str. N16961) proteome was computationally screened in a sequential prioritization approach that focused on determining the antigenicity of potential vaccine candidates. Essential, accessible, virulent and immunogenic proteins were selected as potential candidates. The predicted epitopes were filtered for effective binding with MHC alleles and epitopes binding with greater MHC alleles were selected. RESULTS In this study, we report lipoprotein NlpD, outer membrane protein OmpU, accessory colonization factor AcfA, Porin, putative and outer membrane protein OmpW as potential candidates qualifying all the set criteria. These predicted epitopes can offer a potential for development of a reliable peptide or subunit vaccine for V. cholerae.
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Affiliation(s)
- Muhammad I. Rashid
- Department of Industrial Biotechnology, Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
| | - Sammia Rehman
- Department of Industrial Biotechnology, Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
| | - Amjad Ali
- Department of Industrial Biotechnology, Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
| | - Saadia Andleeb
- Department of Industrial Biotechnology, Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
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McCarty JM, Lock MD, Bennett S, Hunt KM, Simon JK, Gurwith M. Age-related immunogenicity and reactogenicity of live oral cholera vaccine CVD 103-HgR in a randomized, controlled clinical trial. Vaccine 2019; 37:1389-1397. [PMID: 30772070 DOI: 10.1016/j.vaccine.2019.01.077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/12/2019] [Accepted: 01/30/2019] [Indexed: 12/20/2022]
Abstract
Aging is accompanied by a decline in immune function which can lead to decreased responses to vaccines. Attenuated recombinant Vibrio cholerae O1 vaccine strain CVD 103-HgR elicits a rapid serum vibriocidal antibody (SVA) response and protects against cholera diarrhea in volunteer challenge studies but has not been studied in older adults. We evaluated CVD 103-HgR (PXVX0200) in adults age 46-64, compared them to previously studied adults age 18-45, and studied age-related immunogenicity across adults 18-64 years of age. Volunteers were randomized to receive a single dose of 1 × 109 CFU of PXVX0200 or placebo. Immunogenicity endpoints included SVA and anti-cholera toxin (CT) antibody levels on days 1, 11, 29, 91 and 181 and lipopolysaccharide (LPS) and CT-specific IgA and IgG memory B cells on days 1, 91 and 181. Safety was assessed by comparing solicited signs and symptoms on days 1-8 and other adverse events through day 181. 2979 volunteers received vaccine, including 291 age 45-64. Day 11 seroconversion occurred in 90.4% of older adults vs 93.5%% of younger adults and met the endpoint of demonstrating non-inferiority between the two groups. Significant increases in LPS-specific IgG and IgA and CT-specific memory IgG memory B cells were seen at days 91 and 181. There appeared to be a continuous age-related decline in SVA seroconversion and geometric mean titers, but not memory B cell responses, across the 18-64 year age range. Most reactogenicity was mild and was more common in the placebo group. PXVX0200 appears safe and immunogenic in older adults. Clinical Trials Registration: clinicaltrials.gov NCT02100631.
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Affiliation(s)
- James M McCarty
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305 USA.
| | - Michael D Lock
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065 USA
| | - Sean Bennett
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065 USA
| | - Kristin M Hunt
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065 USA
| | - Jakub K Simon
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065 USA
| | - Marc Gurwith
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065 USA
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