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Chaithongwongwatthana S, Wijagkanalan W, Wanlapakorn N, Fortuna L, Yuwaree V, Kerdsomboon C, Poredi IK, Mansouri S, Pham HT, Poovorawan Y. Transplacental transfer of maternal antibodies following immunization with recombinant pertussis vaccines during pregnancy: Real-world evidence. Int J Infect Dis 2024; 144:107047. [PMID: 38609035 DOI: 10.1016/j.ijid.2024.107047] [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: 02/08/2024] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/14/2024] Open
Abstract
AIM/OBJECTIVE This study investigates placental antibody transfer following recombinant pertussis vaccination in pregnancy in a real-world setting. METHODS This postmarketing observational study recruited pregnant women vaccinated with monovalent recombinant acellular pertussis (aP) vaccine (aPgen; n = 199) or combined to tetanus-diphtheria (TdaPgen; n = 200), or Td-vaccine only (n = 54). Pregnancy, delivery, and neonatal outcomes were assessed. Cord blood was collected postdelivery and pertussis toxin (PT)-IgG, filamentous hemagglutinin (FHA)-IgG, and PT-neutralizing antibodies (PT-Nab) were assessed. RESULTS No adverse pregnancy, delivery, or neonatal outcomes attributed to aPgen, TdaPgen, or Td vaccination were reported. High anti-PT antibody levels were detected in cord samples from women vaccinated with aPgen (geometric mean concentration [GMC] PT-IgG 206.1 IU/ml, 95% confidence intervals [CI]: 164.3-258.6; geometric mean titer [GMT] PT-Nab 105.3 IU/ml, 95% CI: 81.7-135.8) or TdaPgen (GMC PT-IgG 153.1 IU/ml, 95% CI: 129.1-181.5; GMT PT-Nab 81.5 IU/ml, 95% CI: 66.4-100.0). In the Td-only group, anti-PT antibodies were low (GMC PT-IgG 6.5 IU/ml, 95% CI: 4.9-8.8; GMT PT-Nab 3.8 IU/ml, 95% CI: 2.8-5.1). The same was found for FHA-IgG. Recombinant pertussis vaccination at <27 or 27-36 weeks gestation induced similar cord pertussis antibody levels. CONCLUSION This first real-world study confirms that recombinant pertussis vaccination in the second or third trimester of pregnancy results in high levels of passive immunity in infants. Thai Clinical Trial Registry: TCTR20200528006.
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Affiliation(s)
| | | | - Nasamon Wanlapakorn
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | | | | | | | | | | | | | - Yong Poovorawan
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Shafi J, Virk MK, Kalk E, Carlucci JG, Chepkemoi A, Bernard C, McHenry MS, Were E, Humphrey J, Davies MA, Mehta UC, Patel RC. Pharmacovigilance in Pregnancy Studies, Exposures and Outcomes Ascertainment, and Findings from Low- and Middle-Income Countries: A Scoping Review. Drug Saf 2024:10.1007/s40264-024-01445-1. [PMID: 38907172 DOI: 10.1007/s40264-024-01445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Pharmacovigilance (PV), or the ongoing safety monitoring after a medication has been licensed, plays a crucial role in pregnancy, as clinical trials often exclude pregnant people. It is important to understand how pregnancy PV projects operate in low- and middle-income countries (LMICs), where there is a disproportionate lack of PV data yet a high burden of adverse pregnancy outcomes. We conducted a scoping review to assess how exposures and outcomes were measured in recently published pregnancy PV projects in LMICs. METHODS We utilized a search string, secondary review, and team knowledge to review publications focusing on therapeutic or vaccine exposures among pregnant people in LMICs. We screened abstracts for relevance before conducting a full text review, and documented measurements of exposures and outcomes (categorized as maternal, birth, or neonatal/infant) among other factors, including study topic, setting, and design, comparator groups, and funding sources. RESULTS We identified 31 PV publications spanning at least 24 LMICs, all focusing on therapeutics or vaccines for infectious diseases, including HIV (n = 17), tuberculosis (TB; n = 9), malaria (n = 7), pertussis, tetanus, and diphtheria (n = 1), and influenza (n = 3). As for outcomes, n = 15, n = 31, and n = 20 of the publications covered maternal, birth, and neonatal/infant outcomes, respectively. Among HIV-specific publications, the primary exposure-outcome relationship of focus was exposure to maternal antiretroviral therapy and adverse outcomes. For TB-specific publications, the main exposures of interest were second-line drug-resistant TB and isoniazid-based prevention therapeutics for pregnant people living with HIV. For malaria-specific publications, the primary exposure-outcome relationship of interest was antimalarial medication exposure during pregnancy and adverse outcomes. Among vaccine-focused publications, the exposure was assessed during a specific time during pregnancy, with an overall interest in vaccine safety and/or efficacy. The study settings were frequently from Africa, designs varied from cohort or cross-sectional studies to clinical trials, and funding sources were largely from high-income countries. CONCLUSION The published pregnancy PV projects were largely centered in Africa and concerned with infectious diseases. This may reflect the disease burden in LMICs but also funding priorities from high-income countries. As the prevalence of non-communicable diseases increases in LMICs, PV projects will have to broaden their scope. Birth and neonatal/infant outcomes were most reported, with fewer reporting on maternal outcomes and none on longer-term child outcomes; additionally, heterogeneity existed in definitions and ascertainment of specific measures. Notably, almost all projects covered a single therapeutic exposure, missing an opportunity to leverage their projects to cover additional exposures, add scientific rigor, create uniformity across health services, and bolster existing health systems. For many publications, the timing of exposure, specifically by trimester, was crucial to maternal and neonatal safety. While currently published pregnancy PV literature offer insights into the PV landscape in LMICs, further work is needed to standardize definitions and measurements, integrate PV projects across health services, and establish longer-term monitoring.
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Affiliation(s)
| | | | - Emma Kalk
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | | | | | | | | | | | | | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Ushma C Mehta
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Rena C Patel
- University of Washington, Seattle, WA, USA.
- University of Alabama at Birmingham, Birmingham, AL, USA.
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Puthanakit T, Chokephaibulkit K, Chaithongwongwatthana S, Bhat N, Tang Y, Anugulruengkitt S, Chayachinda C, Anuwutnavin S, Lapphra K, Rungmaitree S, Tawan M, Andi-Lolo I, Holt R, Fortuna L, Kerdsomboon C, Yuwaree V, Mansouri S, Thai PH, Innis BL. A phase 2 randomized controlled dose-ranging trial of recombinant pertussis booster vaccines containing genetically inactivated pertussis toxin in pregnant women. Vaccine 2023:S0264-410X(23)00657-6. [PMID: 37330371 PMCID: PMC10267846 DOI: 10.1016/j.vaccine.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/29/2022] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Despite a decrease in infections caused by Bordetella pertussis due to COVID-19 pandemic, booster vaccination of pregnant women is still recommended to protect newborns. Highly immunogenic vaccines containing genetically inactivated pertussis toxin (PTgen) and filamentous hemagglutinin (FHA) may generate comparable anti-PT antibody concentrations, even at lower doses, to chemically inactivated acellular pertussis vaccines (Tdapchem) shown effective for maternal immunization. METHODS This phase 2 randomized, observer-blind, active-controlled non-inferiority trial was conducted in healthy Thai pregnant women randomly assigned to receive one dose of low-dose recombinant pertussis-only vaccine containing 1 µg PTgen and 1 µg FHA (ap1gen), or tetanus, reduced-dose diphtheria combined with ap1gen (Tdap1gen), or combined with 2 µg PTgen and 5 µg FHA (Tdap2gen), or with 5 µg PTgen and 5 µg FHA (TdaP5gen, Boostagen®) or comparator containing 8 µg of chemically inactivated pertussis toxoid, 8 µg FHA, and 2.5 µg pertactin (Boostrix™, Tdap8chem). Blood was collected at Day 0 and Day 28 post-vaccination. The non-inferiority of the study vaccines was assessed based on anti-PT IgG antibody levels on Day 28 pooled with results from a similarly structured previous trial in non-pregnant women. RESULTS 400 healthy pregnant women received one dose of vaccine. Combined with data from 250 non-pregnant women, all study vaccines containing PTgen were non-inferior to comparator vaccine (Tdap8chem). Both ap1gen and TdaP5gen vaccines could be considered to have superior immunogenicity to Tdap8chem. Local and systemic solicited reactions were similar among all vaccine groups. CONCLUSIONS Vaccine formulations containing PTgen were safe and immunogenic in pregnant women. The ap1gen vaccine, with the lowest cost and reactogenicity, may be suitable for use in pregnant women when diphtheria and tetanus toxoids are not needed. This study is registered in the Thai Clinical Trial Registry (www. CLINICALTRIALS in.th), number TCTR20180725004.
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Affiliation(s)
- Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine and Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research (SICRES) Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok 10700, Thailand; Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok 10700, Thailand
| | - Surasith Chaithongwongwatthana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand
| | - Niranjan Bhat
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Yuxiao Tang
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Suvaporn Anugulruengkitt
- Department of Pediatrics, Faculty of Medicine and Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand
| | - Chenchit Chayachinda
- Department of Obstetrics & Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok 10700, Thailand
| | - Sanitra Anuwutnavin
- Department of Obstetrics & Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok 10700, Thailand
| | - Keswadee Lapphra
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok 10700, Thailand
| | - Supattra Rungmaitree
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok 10700, Thailand
| | - Monta Tawan
- Department of Pediatrics, Faculty of Medicine and Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand
| | - Indah Andi-Lolo
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Renee Holt
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Librada Fortuna
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand.
| | - Chawanee Kerdsomboon
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Vilasinee Yuwaree
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Souad Mansouri
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Pham Hong Thai
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Bruce L Innis
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
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Nian X, Liu H, Cai M, Duan K, Yang X. Coping Strategies for Pertussis Resurgence. Vaccines (Basel) 2023; 11:889. [PMID: 37242993 PMCID: PMC10220650 DOI: 10.3390/vaccines11050889] [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: 03/15/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Pertussis (whooping cough) is a respiratory disease caused primarily by Bordetella pertussis, a Gram-negative bacteria. Pertussis is a relatively contagious infectious disease in people of all ages, mainly affecting newborns and infants under 2 months of age. Pertussis is undergoing a resurgence despite decades of high rates of vaccination. To better cope with the challenge of pertussis resurgence, we evaluated its possible causes and potential countermeasures in the narrative review. Expanded vaccination coverage, optimized vaccination strategies, and the development of a new pertussis vaccine may contribute to the control of pertussis.
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Affiliation(s)
- Xuanxuan Nian
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Hongbo Liu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Mengyao Cai
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Kai Duan
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
| | - Xiaoming Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan 430207, China
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China
- China National Biotech Group Company Limited, Bejing 100029, China
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Botwright S, Win EM, Kapol N, Benjawan S, Teerawattananon Y. Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures. PHARMACOECONOMICS 2023; 41:77-91. [PMID: 36348154 PMCID: PMC9644008 DOI: 10.1007/s40273-022-01207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness of introducing universal maternal pertussis immunisation under the national vaccine programme in Thailand. METHODS We conducted a cost-utility analysis from a societal perspective to compare maternal vaccination with (1) TdaP vaccine, (2) Td vaccine and aP vaccine, and (3) Td vaccine only. We constructed two decision-tree models with Markov elements, each following a different clinical pathway, to allow us to examine structural uncertainty. Costs were converted to 2021 Thai Baht (THB) and a discount rate of 3% was applied to health and cost outcomes, with sensitivity analysis at 0% and 6%. Parameter uncertainty was investigated through deterministic and probabilistic sensitivity analysis, with expected value of perfect information analysis. RESULTS Maternal pertussis vaccination would avert 27 cases and up to one death per year. The incremental cost-effectiveness ratio (ICER) for adding aP to the maternal immunisation schedule is 2,184,025 THB/QALY and the ICER for replacing maternal Td vaccination with TdaP is 3,198,101 THB/QALY. Maternal pertussis vaccination only becomes favourable in the probabilistic sensitivity analysis at cost-effectiveness thresholds above 6,000,000 THB/QALY, far above the Thai threshold of 160,000 THB/QALY. If incidence is less than 397 cases per 100,000, maternal pertussis vaccination will not be cost-effective in Thailand, within the plausible range for vaccine effectiveness and probability of hospitalisation. Budget impact is dominated by vaccination costs, which represent 12% and 18% of the 2021 national vaccine programme budget for introducing aP vaccine or for switching Td with TdaP vaccine, respectively. CONCLUSIONS We have found that maternal pertussis immunisation is not cost-effective in Thailand. Although there may be substantial under-reporting of pertussis cases, comparison with hospital data suggests that most under-reported cases are not hospitalised and therefore have negligible impact on our results. However, considerations such as affordability and local manufacturing may also be important for national immunisation programme decision-making.
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Affiliation(s)
- Siobhan Botwright
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Ei Mon Win
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Nattiya Kapol
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
- National University of Singapore, Singapore, Singapore
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Blanchard-Rohner G. Novel approaches to reactivate pertussis immunity. Expert Rev Vaccines 2022; 21:1787-1797. [PMID: 36400443 DOI: 10.1080/14760584.2022.2149499] [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: 11/21/2022]
Abstract
INTRODUCTION Whole cell and acellular pertussis vaccines have been very effective in decreasing the deaths of neonates and infants from Bordetella pertussis. Despite high vaccine coverage worldwide, pertussis remains one of the most common vaccine-preventable diseases, thus suggesting that new pertussis vaccination strategies are needed. Several candidates are currently under development, such as acellular pertussis vaccines that use genetically detoxified pertussis toxin, acellular pertussis vaccines delivered with new adjuvants or new delivery systems, or an intranasally delivered, live attenuated vaccine. AREAS COVERED This review discusses the different possibilities for improving current pertussis vaccines and the present state of knowledge on the pertussis vaccine candidates under development. EXPERT OPINION Until there is a safe, effective, and affordable alternative to the two types of existing vaccines, we should maintain sufficient childhood coverage and increase the vaccination of pregnant women, adolescents, and young adults.
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Affiliation(s)
- Geraldine Blanchard-Rohner
- Center of Vaccinology, Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Unit of Immunology and Vaccinology, Division of General Pediatrics, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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A phase 2 randomized controlled dose-ranging trial of recombinant pertussis booster vaccines containing genetically inactivated pertussis toxin in women of childbearing age. Vaccine 2021; 40:2352-2361. [PMID: 34789403 PMCID: PMC9005647 DOI: 10.1016/j.vaccine.2021.10.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022]
Abstract
Recombinant inactivated pertussis vaccines are safe in non-pregnant women. Lower-dose genetically-inactivated pertussis toxin has comparable immunogenicity. Monovalent recombinant pertussis vaccine shows favorable immunogenicity and safety.
Background A phase 2 randomized-controlled safety and immunogenicity trial evaluating different doses of recombinant acellular pertussis vaccine containing genetically-inactivated pertussis toxin (PTgen) was conducted in women of childbearing age in Thailand to identify formulations to advance to a trial in pregnant women. Methods A total of 250 women were randomized 1:1:1:1:1 to receive one dose of one of three investigational vaccines including low-dose recombinant pertussis-only vaccine containing 1 μg PTgen and 1 μg FHA (ap1gen), tetanus, reduced-dose diphtheria (Td) combined to ap1gen (Tdap1gen) or combined to recombinant pertussis containing 2 μg PTgen and 5 μg FHA (Tdap2gen), or one dose of licensed recombinant TdaP vaccine containing 5 μg PTgen and 5 μg FHA (Boostagen®, TdaP5gen) or licensed Tdap vaccine containing 8 μg of chemically inactivated pertussis toxoid (PTchem), 8 μg FHA, and 2.5 μg pertactin (PRN) (BoostrixTM, Tdap8chem). Serum Immunoglobulin G (IgG) antibodies against vaccine antigens were measured before and 28 days after vaccination by ELISA. To advance to a trial in pregnant women, formulations had to induce a PT-IgG seroresponse rate with a 95% confidence interval (95% CI) lower limit of ≥ 50%. Results Between 5 and 22 July 2018, a total of 250 women with median age of 31 years were enrolled. Post-vaccination PT-IgG seroresponse rates were 92% (95% CI 81–98) for ap1gen, 88% (95% CI 76–95) for Tdap1gen, 80% (95% CI 66–90) for Tdap2gen, 94% (95% CI 83–99) for TdaP5gen, and 78% (95% CI 64–88) for Tdap8chem. Frequencies of injection site and systemic reactions were comparable between the groups. No serious adverse events were reported during the 28-day post-vaccination period. Conclusions All recombinant acellular pertussis vaccines were safe and immunogenic in women of childbearing age, and all met pre-defined immunogenicity criteria to advance to a trial in pregnant women. Clinical Trial Registration: Thai Clinical Trial Registry, TCTR20180321004.
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Klemeš JJ, Jiang P, Fan YV, Bokhari A, Wang XC. COVID-19 pandemics Stage II - Energy and environmental impacts of vaccination. RENEWABLE & SUSTAINABLE ENERGY REVIEWS 2021; 150:111400. [PMID: 34248390 PMCID: PMC8259105 DOI: 10.1016/j.rser.2021.111400] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/18/2021] [Accepted: 06/19/2021] [Indexed: 05/02/2023]
Abstract
The COVID-19 pandemic developed the severest public health event in recent history. The first stage for defence has already been documented. This paper moves forward to contribute to the second stage for offensive by assessing the energy and environmental impacts related to vaccination. The vaccination campaign is a multidisciplinary topic incorporating policies, population behaviour, planning, manufacturing, materials supporting, cold-chain logistics and waste treatment. The vaccination for pandemic control in the current phase is prioritised over other decisions, including energy and environmental issues. This study documents that vaccination should be implemented in maximum sustainable ways. The energy and related emissions of a single vaccination are not massive; however, the vast numbers related to the worldwide production, logistics, disinfection, implementation and waste treatment are reaching significant figures. The preliminary assessment indicates that the energy is at the scale of ~1.08 × 1010 kWh and related emissions of ~5.13 × 1012 gCO2eq when embedding for the envisaged 1.56 × 1010 vaccine doses. The cold supply chain is estimated to constitute 69.8% of energy consumption of the vaccination life cycle, with an interval of 26-99% depending on haul distance. A sustainable supply chain model that responds to an emergency arrangement, considering equality as well, should be emphasised to mitigate vaccination's environmental footprint. This effort plays a critical role in preparing for future pandemics, both environmentally and socially. Research in exploring sustainable single-use or reusable materials is also suggested to be a part of the plans. Diversified options could offer higher flexibility in mitigating environmental footprint even during the emergency and minimise the potential impact of material disruption or dependency.
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Affiliation(s)
- Jiří Jaromír Klemeš
- Sustainable Process Integration Laboratory - SPIL, NETME Centre, Faculty of Mechanical Engineering, Brno University of Technology- VUT Brno, Technická 2896/2, 616 69, Brno, Czech Republic
| | - Peng Jiang
- Department of Industrial Engineering and Engineering Management, Business School, Sichuan University, Chengdu, 610064, PR China
| | - Yee Van Fan
- Sustainable Process Integration Laboratory - SPIL, NETME Centre, Faculty of Mechanical Engineering, Brno University of Technology- VUT Brno, Technická 2896/2, 616 69, Brno, Czech Republic
| | - Awais Bokhari
- Sustainable Process Integration Laboratory - SPIL, NETME Centre, Faculty of Mechanical Engineering, Brno University of Technology- VUT Brno, Technická 2896/2, 616 69, Brno, Czech Republic
| | - Xue-Chao Wang
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Faculty of Geographical Science, Beijing Normal University, Beijing, 100875, PR China
- School of Natural Resources Science and Technology, Faculty of Geographical Science, Beijing Normal University, Beijing, 100875, PR China
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Pitisuttithum P, Dhitavat J, Sirivichayakul C, Pitisuthitham A, Sabmee Y, Chinwangso P, Kerdsomboon C, Fortuna L, Spiegel J, Chauhan M, Poredi IK, van den Biggelaar AH, Wijagkanalan W, Viviani S, Mansouri S, Pham HT. Antibody persistence 2 and 3 years after booster vaccination of adolescents with recombinant acellular pertussis monovalent aP gen or combined TdaP gen vaccines. EClinicalMedicine 2021; 37:100976. [PMID: 34386749 PMCID: PMC8343263 DOI: 10.1016/j.eclinm.2021.100976] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Recombinant pertussis vaccines inducing long-lasting immune responses could help to control the rise in pertussis. We here report on persisting antibody responses 2 and 3 years after booster vaccination with a new generation recombinant acellular pertussis vaccine. METHODS Participants of a phase 2/3 randomised-controlled clinical trial with a monovalent pertussis vaccine containing genetically inactivated pertussis toxin (aPgen) or its tetanus and diphtheria toxoids combination (TdaPgen), or a chemically detoxified comparator vaccine (Tdapchem), (originally conducted between July and August 2015) were invited to participate in observational studies of persisting antibody responses 2 and 3 years after vaccination. Serum IgG against pertussis toxin (PT-IgG) and filamentous hemagglutinin (FHA-IgG) were assessed by ELISA, and PT-neutralising antibodies (PT-Nab) by Chinese Hamster Ovary cell assay. FINDINGS Waning of antibodies stabilised in aPgen and TdaPgen vaccinees 2 and 3 years after vaccination. Three years post-vaccination PT-neutralising antibodies remained 4·6-fold (95% Confidence Interval (CI) 2·6-8·1) and 3·7-fold (95% CI 2·2-6·1) higher, PT-IgG antibodies 3·0-fold (95% CI 2·2-4·1) and 2·5-fold (95% CI 1·9-3·3) higher, and FHA-IgG antibodies 1·8-fold (95% CI 1·3-2·5) and 1·6-fold (95% CI 1·2-2·1) higher than baseline in aPgen and TdaPgen recipients, respectively. In the Tdapchem group, PT-neutralising and PT-IgG and FHA-IgG antibodies were back at baseline levels 2 years post-vaccination. Three years post-vaccination seroconversion rates for PT-neutralising antibodies were 65·0% (95% CI 44·1-85·9) and 55·0% (95% CI 33·2-76·8) in aPgen and TdaPgen recipients, respectively. INTERPRETATION Considering the persistence of elevated antibody responses 3 years post-booster vaccination, genetically detoxified monovalent aPgen and TdaPgen vaccines can be expected to induce longer-lasting protection than chemically inactivated Tdap vaccines. FUNDING BioNet-Asia.
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Affiliation(s)
- Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Jittima Dhitavat
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Chukiat Sirivichayakul
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Arom Pitisuthitham
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Yupa Sabmee
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Pailinrut Chinwangso
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Chawanee Kerdsomboon
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Librada Fortuna
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Jane Spiegel
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Mukesh Chauhan
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Indrajeet Kumar Poredi
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | | | - Wassana Wijagkanalan
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Simonetta Viviani
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
| | - Souad Mansouri
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
- Corresponding author.
| | - Hong Thai Pham
- BioNet-Asia Co., Ltd., 19 Soi Udomsuk 37, Sukhumvit 103 Road, Bangjak, Prakanong, Bangkok 10260, Thailand
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