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Ma Y, Ying Z, Li J, Gu Q, Wang X, Cai L, Shi L, Sun M. Immunogenicity of fractional-dose of inactivated poliomyelitis vaccine made from Sabin strains delivered by intradermal vaccination in Wistar rats. Biologicals 2022; 75:3-11. [DOI: 10.1016/j.biologicals.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/06/2021] [Accepted: 01/12/2022] [Indexed: 11/02/2022] Open
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Hettinga J, Carlisle R. Vaccination into the Dermal Compartment: Techniques, Challenges, and Prospects. Vaccines (Basel) 2020; 8:E534. [PMID: 32947966 PMCID: PMC7564253 DOI: 10.3390/vaccines8030534] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/06/2023] Open
Abstract
In 2019, an 'influenza pandemic' and 'vaccine hesitancy' were listed as two of the top 10 challenges to global health by the WHO. The skin is a unique vaccination site, due to its immune-rich milieu, which is evolutionarily primed to respond to challenge, and its ability to induce both humoral and cellular immunity. Vaccination into this dermal compartment offers a way of addressing both of the challenges presented by the WHO, as well as opening up avenues for novel vaccine formulation and dose-sparing strategies to enter the clinic. This review will provide an overview of the diverse range of vaccination techniques available to target the dermal compartment, as well as their current state, challenges, and prospects, and touch upon the formulations that have been developed to maximally benefit from these new techniques. These include needle and syringe techniques, microneedles, DNA tattooing, jet and ballistic delivery, and skin permeabilization techniques, including thermal ablation, chemical enhancers, ablation, electroporation, iontophoresis, and sonophoresis.
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Affiliation(s)
| | - Robert Carlisle
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, UK;
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3
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Schnyder JL, De Pijper CA, Garcia Garrido HM, Daams JG, Goorhuis A, Stijnis C, Schaumburg F, Grobusch MP. Fractional dose of intradermal compared to intramuscular and subcutaneous vaccination - A systematic review and meta-analysis. Travel Med Infect Dis 2020; 37:101868. [PMID: 32898704 PMCID: PMC7474844 DOI: 10.1016/j.tmaid.2020.101868] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vaccine supply shortages are of global concern. We hypothesise that intradermal (ID) immunisation as an alternative to standard routes might augment vaccine supply utilisation without loss of vaccine immunogenicity and efficacy. METHODS We conducted a systematic review and meta-analysis searching Medline, Embase and Web of Science databases. Studies were included if: licensed, currently available vaccines were used; fractional dose of ID was compared to IM or SC immunisation; primary immunisation schedules were evaluated; immunogenicity, safety data and/or cost were reported. We calculated risk differences (RD). Studies were included in meta-analysis if: a pre-defined immune correlate of protection was assessed; WHO-recommend schedules and antigen doses were used in the control group; the same schedule was applied to both ID and control groups (PROSPERO registration no. CRD42020151725). RESULTS The primary search yielded 5,873 articles, of which 156 articles were included; covering 12 vaccines. Non-inferiority of immunogenicity with 20-60% of antigen used with ID vaccines was demonstrated for influenza (H1N1: RD -0·01; 95% CI -0·02, 0·01; I2 = 55%, H2N3: RD 0·00; 95% CI -0·01, 0·01; I2 = 0%, B: RD -0·00; 95% CI -0·02, 0·01; I2 = 72%), rabies (RD 0·00; 95% CI -0·02, 0·02; I2 = 0%), and hepatitis B vaccines (RD -0·01; 95% CI -0·04, 0·02; I2 = 20%). Clinical trials on the remaining vaccines yielded promising results, but are scarce. CONCLUSIONS There is potential for inoculum/antigen dose-reduction by using ID immunisation as compared to standard routes of administration for some vaccines (e.g. influenza, rabies). When suitable, vaccine trials should include an ID arm.
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Affiliation(s)
- Jenny L Schnyder
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
| | - Cornelis A De Pijper
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
| | - Hannah M Garcia Garrido
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Abraham Goorhuis
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
| | - Cornelis Stijnis
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149, Münster, Germany
| | - Martin P Grobusch
- Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, Netherlands.
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Moulenat T, Petit C, Bosch Castells V, Houillon G. Purified Vero Cell Rabies Vaccine (PVRV, Verorab ®): A Systematic Review of Intradermal Use Between 1985 and 2019. Trop Med Infect Dis 2020; 5:E40. [PMID: 32156005 PMCID: PMC7157209 DOI: 10.3390/tropicalmed5010040] [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: 12/18/2019] [Revised: 01/31/2020] [Accepted: 03/02/2020] [Indexed: 12/25/2022] Open
Abstract
The purified Vero cell rabies vaccine (PVRV; Verorab®, Sanofi Pasteur) has been used in rabies prevention since 1985. Evolving rabies vaccination trends, including shorter intradermal (ID) regimens with reduced volume, along with WHO recommendation for ID administration has driven recent ID PVRV regimen assessments. Thus, a consolidated review comparing immunogenicity of PVRV ID regimens during pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) is timely and beneficial in identifying gaps in current research. A search of seven databases for studies published from 1985 to November 2019 identified 35 studies. PrEP was assessed in 10 studies (n = 926) with 1-3-site, 1-3-visit regimens of up to 3-months duration. Seroconversion (rabies virus neutralizing antibodies [RVNA] ≥ 0.5 IU/mL) rates of 90-100% were reported within weeks, irrespective of regimen, with robust booster responses at 1 year (100% seroconversion rates by day 14 post-booster). However, data are lacking for the current WHO-recommended, 2-site, 1-week ID PrEP regimen. PEP was assessed in 25 studies (n = 2136) across regimens of 1-week to 90-day duration. All ID PEP regimens assessed induced ≥ 99% seroconversion rates (except in HIV participants) by day 14-28. This review confirms ID PVRV suitability for rabies prophylaxis and highlights the heterogeneity of use in the field.
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Affiliation(s)
- Thomas Moulenat
- Université Claude Bernard Lyon 1, Institut des Sciences Pharmaceutiques et Biologiques (ISPB)—Faculté de Pharmacie de Lyon, 69008 Lyon, France;
| | - Céline Petit
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France; (C.P.); (V.B.C.)
| | | | - Guy Houillon
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France; (C.P.); (V.B.C.)
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5
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Incorporating B cell activating factor (BAFF) into the membrane of rabies virus (RABV) particles improves the speed and magnitude of vaccine-induced antibody responses. PLoS Negl Trop Dis 2019; 13:e0007800. [PMID: 31725816 PMCID: PMC6855436 DOI: 10.1371/journal.pntd.0007800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022] Open
Abstract
B cell activating factor (BAFF) is a member of the tumor necrosis factor (TNF) superfamily of cytokines that links innate with adaptive immunity. BAFF signals through receptors on B cells, making it an attractive molecule to potentiate vaccine-induced B cell responses. We hypothesized that a rabies virus (RABV)-based vaccine displaying both antigen and BAFF on the surface of the same virus particle would target antigen-specific B cells for activation and improve RABV-specific antibody responses. To test this hypothesis, we constructed a recombinant RABV-based vector expressing virus membrane-anchored murine BAFF (RABV-ED51-mBAFF). BAFF was incorporated into the RABV particle and determined to be biologically functional, as demonstrated by increased B cell survival of primary murine B cells treated ex-vivo with RABV-ED51-mBAFF. B cell survival was inhibited by pre-treating RABV-ED51-mBAFF with an antibody that blocks BAFF functions. RABV-ED51-mBAFF also activated primary murine B cells ex-vivo more effectively than RABV as shown by significant upregulation of CD69, CD40, and MHCII on the surface of infected B cells. In-vivo, RABV-ED51-mBAFF induced significantly faster and higher virus neutralizing antibody (VNA) titers than RABV while not adversely affecting the longevity of the vaccine-induced antibody response. Since BAFF was incorporated into the virus particle and genome replication was not required for BAFF expression in-vivo, we hypothesized that RABV-ED51-mBAFF would be effective as an inactivated vaccine. Mice immunized with 250 ng/mouse of β-propriolactone-inactivated RABV-ED51-mBAFF showed faster and higher anti-RABV VNA titers compared to mice immunized with inactivated RABV. Together, this model stands as a potential foundation for exploring other virus membrane-anchored molecular adjuvants to make safer, more effective inactivated RABV-based vaccines.
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Denis M, Knezevic I, Wilde H, Hemachudha T, Briggs D, Knopf L. An overview of the immunogenicity and effectiveness of current human rabies vaccines administered by intradermal route. Vaccine 2018; 37 Suppl 1:A99-A106. [PMID: 30551985 DOI: 10.1016/j.vaccine.2018.11.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/16/2018] [Accepted: 11/26/2018] [Indexed: 12/01/2022]
Abstract
Pre- as well as post-exposure prophylaxis plays an important role in controlling the number of deaths associated with human rabies. Rabies vaccines, classically injected intramuscularly, are now also administered by intradermal (ID) route. Vaccines to be administered by the ID route should meet the same quality, safety and efficacy specifications as vaccines for intramuscular (IM) use. The aim of this paper is to provide information based on publicly available data regarding the ID use of rabies vaccines and to identify potential needs for further analysis of the potency, immunogenicity and effectiveness of rabies vaccines administered by this route. A first literature search, focused on the immunogenicity of rabies vaccines given by ID route, identified 338 publications in the period 1997-2018, 40 of which were included in our analyses. A second search investigating the effectiveness of ID vaccination resulted in 371 hits for the period 2007-2018, of which 13 suitable publications were retained. The immunogenicity of current rabies vaccines was analyzed in 3 ways: proportion of subjects reaching the antibody threshold of 0.5 IU/ml after ID vaccination, relationship between potency and immunogenicity of the vaccine given intradermally, and comparison of antibody responses after IM or ID vaccination. Overall, vaccines administered intradermally were found immunogenic. Post-exposure prophylaxis by ID route appeared at least as immunogenic as by IM regimens. By contrast, ID pre-exposure prophylaxis trended towards lower antibody titers than IM vaccination, but the observation was not associated with any clinical relevance. Vaccine effectiveness was assessed by investigating survival after exposure. Data from more than 30,000 patients who sought rabies post-exposure prophylaxis did not indicate that current vaccines administered by ID route lack efficacy. These results support current recommendations for ID vaccination against rabies. However, published data on ID performance were associated with significant weaknesses that future research should better address.
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Affiliation(s)
| | - Ivana Knezevic
- Department of Essential Medicines and Health Products, Norms and Standards for Biologicals, World Health Organization, Geneva, Switzerland
| | - Henry Wilde
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thiravat Hemachudha
- World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Deborah Briggs
- Kansas State University, College of Veterinary Medicine Manhattan, USA
| | - Lea Knopf
- Neglected Zoonotic Diseases, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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7
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Medeiros R, Jusot V, Houillon G, Rasuli A, Martorelli L, Kataoka AP, Mechlia MB, Le Guern AS, Rodrigues L, Assef R, Maestri A, Lima R, Rotivel Y, Bosch-Castells V, Tordo N. Persistence of Rabies Virus-Neutralizing Antibodies after Vaccination of Rural Population following Vampire Bat Rabies Outbreak in Brazil. PLoS Negl Trop Dis 2016; 10:e0004920. [PMID: 27653947 PMCID: PMC5031405 DOI: 10.1371/journal.pntd.0004920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 07/22/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Animal control measures in Latin America have decreased the incidence of urban human rabies transmitted by dogs and cats; currently most cases of human rabies are transmitted by bats. In 2004-2005, rabies outbreaks in populations living in rural Brazil prompted widespread vaccination of exposed and at-risk populations. More than 3,500 inhabitants of Augusto Correa (Pará State) received either post-exposure (PEP) or pre-exposure (PrEP) prophylaxis. This study evaluated the persistence of rabies virus-neutralizing antibodies (RVNA) annually for 4 years post-vaccination. The aim was to evaluate the impact of rabies PrEP and PEP in a population at risk living in a rural setting to help improve management of vampire bat exposure and provide additional data on the need for booster vaccination against rabies. METHODOLOGY/PRINCIPAL FINDINGS This prospective study was conducted in 2007 through 2009 in a population previously vaccinated in 2005; study participants were followed-up annually. An RVNA titer >0.5 International Units (IU)/mL was chosen as the threshold of seroconversion. Participants with titers ≤0.5 IU/mL or Equivalent Units (EU)/mL at enrollment or at subsequent annual visits received booster doses of purified Vero cell rabies vaccine (PVRV). Adherence of the participants from this Amazonian community to the study protocol was excellent, with 428 of the 509 (84%) who attended the first interview in 2007 returning for the final visit in 2009. The long-term RVNA persistence was good, with 85-88.0% of the non-boosted participants evaluated at each yearly follow-up visit remaining seroconverted. Similar RVNA persistence profiles were observed in participants originally given PEP or PrEP in 2005, and the GMT of the study population remained >1 IU/mL 4 years after vaccination. At the end of the study, 51 subjects (11.9% of the interviewed population) had received at least one dose of booster since their vaccination in 2005. CONCLUSIONS/SIGNIFICANCE This study and the events preceding it underscore the need for the health authorities in rabies enzootic countries to decide on the best strategies and timing for the introduction of routine rabies PrEP vaccination in affected areas.
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Affiliation(s)
- Rita Medeiros
- Universidade Federal do Pará e Instituto Evandro Chagas, Belém-Pará, Brasil
| | | | | | | | | | | | | | | | - Liliam Rodrigues
- Universidade Federal do Pará e Instituto Evandro Chagas, Belém-Pará, Brasil
| | - Rhomero Assef
- Universidade Federal do Pará e Instituto Evandro Chagas, Belém-Pará, Brasil
| | - Alvino Maestri
- Universidade Federal do Pará e Instituto Evandro Chagas, Belém-Pará, Brasil
| | | | | | | | - Noël Tordo
- Institut Pasteur, Paris, France
- Secretaria de Saude do Estado do Pará, Brasil
- Institut Pasteur de Guinée, Gamal Abdel Nasser University, Conakry, Guinea
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8
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Jia F, Liu S, Wu MX, Chen X. Micro-fractional Epidermal Powder Delivery for Skin Vaccination. Methods Mol Biol 2016; 1404:715-723. [PMID: 27076332 DOI: 10.1007/978-1-4939-3389-1_46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Skin is a highly immunogenic site for vaccine delivery due to its richness of antigen-presenting cells. Several vaccines have been approved for skin delivery and in particular intradermal delivery in the last two decades. Yet intradermal delivery often causes frequent and severe local reactions, preventing the incorporation of adjuvants to further boost skin vaccination. Here we describe a novel skin delivery technology, called micro-fractional epidermal powder delivery or EPD, with minimized local reactions for improved skin vaccination. EPD is based on laser or microneedle treatment to generate microchannel arrays in the epidermis followed by topical application of powder vaccine-coated array patches to deliver vaccines into the skin via microchannels. Due to the fractional delivery, EPD significantly reduces vaccine/adjuvant-induced local reactions without compromising vaccine immunogenicity and adjuvant potency. EPD also eliminates needle injection-associated pain and is promising to improve vaccine stability due to the direct powder delivery. This chapter describes detailed methods for the advantageous EPD in preclinical animal models.
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Affiliation(s)
- Feng Jia
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, 50 Blossom Street, Edwards 222, Boston, MA, 02114, USA
| | - Shengwu Liu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, 50 Blossom Street, Edwards 222, Boston, MA, 02114, USA
| | - Mei X Wu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, 50 Blossom Street, Edwards 222, Boston, MA, 02114, USA
| | - Xinyuan Chen
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, 50 Blossom Street, Edwards 222, Boston, MA, 02114, USA. .,Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Room 395L, Kingston, RI, 02881, USA.
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9
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Durrheim DN, Rees H, Briggs DJ, Blumberg LH. Mass vaccination of dogs, control of canine populations and post-exposure vaccination - necessary but not sufficient for achieving childhood rabies elimination. Trop Med Int Health 2015; 20:682-4. [DOI: 10.1111/tmi.12474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- D. N. Durrheim
- School of Medicine and Public Health; University of Newcastle; Newcastle NSW Australia
| | - H. Rees
- Wits Reproductive Health and HIV Institute; University of the Witwatersrand; Johannesburg South Africa
| | - D. J. Briggs
- College of Veterinary Medicine; Kansas State University; Manhattan KS USA
| | - L. H. Blumberg
- National Institute for Communicable Diseases; Johannesburg South Africa
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10
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Chen X, Kositratna G, Zhou C, Manstein D, Wu MX. Micro-fractional epidermal powder delivery for improved skin vaccination. J Control Release 2014; 192:310-6. [PMID: 25135790 DOI: 10.1016/j.jconrel.2014.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/27/2014] [Accepted: 08/06/2014] [Indexed: 01/18/2023]
Abstract
Skin vaccination has gained increasing attention in the last two decades due to its improved potency compared to intramuscular vaccination. Yet, the technical difficulty and frequent local reactions hamper its broad application in the clinic. In the current study, micro-fractional epidermal powder delivery (EPD) is developed to facilitate skin vaccination and minimize local adverse effects. EPD is based on ablative fractional laser or microneedle treatment of the skin to generate microchannel (MC) arrays in the epidermis followed by topical application of powder drug/vaccine-coated array patches to deliver drug/vaccine into the skin. The novel EPD delivered more than 80% sulforhodamine b (SRB) and model antigen ovalbumin (OVA) into murine, swine, and human skin within 1h. EPD of OVA induced anti-OVA antibody titer at a level comparable to intradermal (ID) injection and was much more efficient than tape stripping in both delivery efficiency and immune responses. Strikingly, the micro-fractional delivery significantly reduced local side effects of LPS/CpG adjuvant and BCG vaccine, leading to complete skin recovery. In contrast, ID injection induced severe local reactions that persisted for weeks. While reducing local reactogenicity, EPD of OVA/LPS/CpG and BCG vaccine generated a comparable humoral immune response to ID injection. EPD of vaccinia virus encoding OVA induced significantly higher and long-lasting interferon γ-secreting CD8+ T cells than ID injection. In conclusion, EPD represents a promising technology for needle-free, painless skin vaccination with reduced local reactogenicity and at least sustained immunogenicity.
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Affiliation(s)
- Xinyuan Chen
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA, USA.
| | - Garuna Kositratna
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chang Zhou
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Dieter Manstein
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mei X Wu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Department of Dermatology, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, USA.
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Madhusudana SN, Mani RS. Intradermal vaccination for rabies prophylaxis: conceptualization, evolution, present status and future. Expert Rev Vaccines 2014; 13:641-55. [DOI: 10.1586/14760584.2014.901893] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Shampur Narayan Madhusudana
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS),
Bangalore, Karnataka 560029, India
| | - Reeta Subramaniam Mani
- Department of Neurovirology, WHO Collaborating Centre for Reference and Research on Rabies, National Institute of Mental Health and Neurosciences (NIMHANS),
Bangalore, Karnataka 560029, India
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12
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Trend of human rabies prophylaxis in developing countries: Toward optimal rabies immunization. Vaccine 2013; 31:4079-83. [DOI: 10.1016/j.vaccine.2013.06.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/14/2013] [Accepted: 06/26/2013] [Indexed: 11/18/2022]
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13
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Hoon Han S, Hee Woo J, Weber F, Joo Kim W, Ran Peck K, Il Kim S, Hwa Choi Y, Myung Kim J. Immunogenicity and safety of Intanza(®)/IDflu(®) intradermal influenza vaccine in South Korean adults: a multicenter, randomized trial. Hum Vaccin Immunother 2013; 9:1971-7. [PMID: 23778938 DOI: 10.4161/hv.25295] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Intanza(®)/IDflu(®) (Sanofi Pasteur, Lyon, France) is an intradermal inactivated trivalent influenza vaccine developed as an alternative to intramuscular influenza vaccine. The objective of this study was to confirm the immunogenicity and safety of Intanza/IDflu in South Korean adults. In a phase IV multicenter trial, South Korean adults 18-59 y old (n = 120) and ≥ 60 y old (n = 120) were randomized 1:1 to receive a single dose of Intanza/IDflu (9 µg for 18-59 y, 15 µg for ≥ 60 y) or trivalent intramuscular vaccine (Vaxigrip(®) 15 µg, Sanofi Pasteur, Lyon, France). Blood was collected on pre-vaccination (day 0) and on day 21. Hemagglutination inhibition titers, seroprotection rates and seroconversion rates were determined on day 21. Geometric mean titers, seroprotection and seroconversion rates were similar between the intradermal and intramuscular vaccines in both age groups for all three vaccine strains (A/H1N1, A/H3N2 and B). Both vaccines met Committee for Medicinal Products for Human Use criteria for all three strains. Solicited systemic reactions of the intradermal groups were generally mild, transient, and similar to those of the intramuscular groups. Solicited injection site reactions were more frequent in the intradermal groups but were mostly mild, transient, and consisted mainly of pain, erythema, and pruritus. No treatment-related serious adverse events or other safety concerns were reported. These results confirm that Intanza/IDflu is an effective and well-tolerated alternative to IM influenza vaccination. (Clinicaltrials.gov NCT ID: NCT01215669).
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Affiliation(s)
- Sang Hoon Han
- Department of Internal Medicine; Yonsei University College of Medicine; Seoul, Korea
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Malerczyk C, Vakil HB, Bender W. Rabies pre-exposure vaccination of children with purified chick embryo cell vaccine (PCECV). Hum Vaccin Immunother 2013; 9:1454-9. [PMID: 23571224 DOI: 10.4161/hv.24502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Human rabies, mainly transmitted by dog bites, remains a major public health problem in developing countries. In Asian countries, such as India or the Philippines, where large free-ranging dog populations exist, the human death toll stays high. Children under the age of 15 y are at particular risk, representing up to half of the dog bite victims. While pre-exposure prophylaxis (PrEP) is commonly used in travelers from developed countries visiting areas of high endemicity, rabies vaccination is rarely used in highly endemic countries in contrast to post-exposure prophylaxis (PEP). Purified Chick Embryo Cell Vaccine (PCECV, Rabipur®/RabAvert®, Novartis Vaccines and Diagnostics) is approved for pre- and post-exposure prophylaxis, either by the intramuscular route, or--where registered--by the intradermal route of administration. In more than 25 y of use, PCECV has been widely used for PrEP in children. This review summarizes the pediatric pre-exposure clinical trials using PCECV. In total, PCECV has been administered to more than 1,200 children in clinical trials, from toddlers to those in elementary school, using intramuscular and intradermal schedules, demonstrating safety and immunogenicity. PrEP as part of routine pediatric vaccination programs may have a major role to play in human rabies prevention. Extensive clinical experience with PCECV supports intramuscular and intradermal PrEP in children as one pillar of human rabies prevention in developing countries.
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Affiliation(s)
- Claudius Malerczyk
- Novartis Vaccines and Diagnostics, Medical Affairs Vaccines International Region; Marburg, Germany
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Gorse GJ, Falsey AR, Fling JA, Poling TL, Strout CB, Tsang PH. Intradermally-administered influenza virus vaccine is safe and immunogenic in healthy adults 18-64 years of age. Vaccine 2013; 31:2358-65. [PMID: 23499604 DOI: 10.1016/j.vaccine.2013.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/12/2013] [Accepted: 03/04/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND To increase vaccine acceptance, intradermal (ID) influenza vaccine (Fluzone(®) Intradermal, Sanofi Pasteur Inc.) may be an attractive alternative to intramuscular (IM) vaccination due to smaller needle and volume injected. METHODS A multicenter, randomized (2:1 ID vs IM vaccines) study, blinded for ID vaccine lots, was conducted among 4292 adults 18-64 years of age enrolled in October 2008. Three lots of investigational trivalent influenza vaccine containing 9μg hemagglutinin (HA) per strain in 0.1mL administered ID with a 30 gauge, 1.5mm long needle were compared to standard dose vaccine (0.5mL containing 15μg HA/strain) given IM. RESULTS The post-vaccination antibody geometric mean titers (GMT) for the ID vaccine were similar to the IM vaccine (H1N1: 193.2 vs. 178.3, H3N2: 246.7 vs. 230.7, and B: 102.5 vs. 126.9). Non-inferiority was met for the ID vaccine compared to IM vaccine as assessed by antibody GMT ratios (IM/ID) for all three virus strains (H1N1: 0.92, H3N2: 0.94, and B: 1.24). Seroconversion rates were non-inferior for H1N1 and H3N2, but not for B (ID vs. IM: H1N1: 61.2% vs. 60.5%, H3N2: 75.3% vs. 74.8%, and B: 46.2% vs. 54.2%). Seroprotection (HAI titer ≥1:40) rates were similar between groups (ID vs. IM, H1N1: 91.1% vs. 91.7%, H3N2: 90.7% vs. 91.4%, and B: 87.4% vs. 89.3%). Local injection site reactions overall were more common with ID than IM vaccine (ID vs. IM: 89.2% vs. 60.2%), but were usually grade 1 or 2 and transient. The frequencies of local injection site pain and systemic reactions were similar between vaccine groups, except more myalgia with IM vaccine. CONCLUSIONS The ID vaccine elicited immune responses comparable to IM vaccine except for the seroconversion rate to B virus. With the exception of pain, local injection site reactions were more common with the ID vaccine, but well-tolerated and of short duration. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00772109.
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Affiliation(s)
- Geoffrey J Gorse
- Saint Louis University School of Medicine, 1100 South Grand Blvd. (DRC-8th floor), St. Louis, MO 63104, USA.
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17
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Abstract
INTRODUCTION Rabies is prevented by post-exposure vaccination with several doses of vaccine given over 4 - 14 weeks. In case of severe exposure, the first dose of vaccine is combined with passive transfer of a rabies virus-specific immunoglobulin preparation. Preventative vaccination for rabies, also referred as pre-exposure vaccination, is reserved for humans at high risk. Although available vaccines are efficacious in preventing disease, rabies still claims the lives of an estimated 55,000 humans residing in Africa and Asia each year. Half of the death occurs in children under the age of 15. AREAS COVERED This paper discusses whether preventative vaccination of all children in Africa and Asia, which was deemed non-cost-effective compared to post-exposure vaccination using currently licensed vaccines in Thailand, could be cost-effective using more immunogenic novel vaccines. EXPERT OPINION At least in theory, novel one-dose rabies vaccines may be cost-effective for preventative childhood immunization, which in turn should reduce the incidence of this disease. Further clinical testing of such vaccines with the goal to develop a low-cost vaccine that can be incorporated into childhood immunization programs for areas with a high incidence of rabies-related death should be strongly encouraged.
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Affiliation(s)
- Qin Liu
- The Wistar Institute, 3601 Spruce Street, Philadelphia, PA 19104, USA
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18
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Safety reporting in developing country vaccine clinical trials-a systematic review. Vaccine 2012; 30:3255-65. [PMID: 22406279 DOI: 10.1016/j.vaccine.2012.02.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/17/2012] [Accepted: 02/23/2012] [Indexed: 12/30/2022]
Abstract
With more vaccines becoming available worldwide, vaccine research is on the rise in developing countries. To gain a better understanding of safety reporting from vaccine clinical research in developing countries, we conducted a systematic review in Medline and Embase (1989-2011) of published randomized clinical trials (RCTs) reporting safety outcomes with ≥50% developing country participation (PROSPERO systematic review registration number: CRD42012002025). Developing country vaccine RCTs were analyzed with respect to the number of participants, age groups studied, inclusion of safety information, number of reported adverse events following immunization (AEFI), type and duration of safety follow-up, use of standardized AEFI case definitions, grading of AEFI severity, and the reporting of levels of diagnostic certainty for AEFI. The systematic search yielded a total number of 50 randomized vaccine clinical trials investigating 12 different vaccines, most commonly rotavirus and malaria vaccines. In these trials, 94,459 AEFI were reported from 446,908 participants receiving 735,920 vaccine doses. All 50 RCTs mentioned safety outcomes with 70% using definitions for at least one AEFI. The most commonly defined AEFI was fever (27), followed by local (16) and systemic reactions (14). Logistic regression analysis revealed a positive correlation between the implementation of a fever case definition and the reporting rate for fever as an AEFI (p=0.027). Overall, 16 different definitions for fever and 7 different definitions for erythema were applied. Predefined AEFI case definitions by the Brighton Collaboration were used in only two out of 50 RCTs. The search was limited to RCTs published in English or German and may be missing studies published locally. The reported systematic review suggests room for improvement with respect to the harmonization of safety reporting from developing country vaccine clinical trials and the implementation of standardized case definitions.
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Montaner AD, Nichilo AD, Rodriguez JM, Hernando-Insua A, Fló J, Lopez RA, Sierra V, Paolazzi C, Larghi O, Horn DL, Zorzopulos J, Elias F. IMT504: A New and Potent Adjuvant for Rabies Vaccines Permitting Significant Dose Sparing. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/wjv.2012.24025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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20
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Warrell M. Current rabies vaccines and prophylaxis schedules: Preventing rabies before and after exposure. Travel Med Infect Dis 2012; 10:1-15. [DOI: 10.1016/j.tmaid.2011.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/21/2011] [Indexed: 02/07/2023]
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Kamoltham T, Thinyounyong W, Khawplod P, Phraisuwan P, Phongchamnaphai P, Anders G, Malerczyk C. Immunogenicity of Simulated PCECV Postexposure Booster Doses 1, 3, and 5 Years after 2-Dose and 3-Dose Primary Rabies Vaccination in Schoolchildren. Adv Prev Med 2011; 2011:403201. [PMID: 21991438 PMCID: PMC3170734 DOI: 10.4061/2011/403201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 05/13/2011] [Indexed: 11/28/2022] Open
Abstract
Objectives. To assess the immunogenicity of intradermal (ID) booster doses of Purified Chick Embryo Cell rabies vaccine (PCECV, Rabipur) administered to Thai schoolchildren one, three and five years after a primary ID pre-exposure (PrEP) vaccination series. Methods. In this follow-up study of a randomized, open-label, phase II clinical trial, two simulated post-exposure booster doses of PCECV were administered on days 0 and 3 intradermally to 703 healthy schoolchildren, one, three or five years after primary vaccination with either two or three ID doses of 0.1 mL PCECV. Blood was drawn immediately before and 7, 14 and 365 days after the first booster dose to determine rabies virus neutralizing antibody (RVNA) concentrations. Results. An anamnestic response of approximately 30-fold increase in RVNA concentrations was demonstrated within 14 days after booster. All children (100%) developed adequate RVNA concentrations above 0.5 IU/mL. No vaccine related serious adverse events were seen in any of the vaccinees. Conclusion. ID rabies PrEP with PCECV is safe and immunogenic in schoolchildren and the anamnestic response to a two booster dose vaccination series was found to be adequate one, three, and five years after a two- or three-dose primary PrEP vaccination series.
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Affiliation(s)
| | - Wiravan Thinyounyong
- Provincial Health Office of Phetchabun, Ministry of Health, Phetchabun 67160, Thailand
| | - Pakamatz Khawplod
- Queen Saovabha Memorial Institute, Thai Red Cross Society and Department of Medicine, Chulalongkorn Hospital, 1871 Rama 4 Road, Bangkok 10330, Thailand
| | - Phran Phraisuwan
- Provincial Health Office of Phetchabun, Ministry of Health, Phetchabun 67160, Thailand
| | - Phana Phongchamnaphai
- Provincial Health Office of Phetchabun, Ministry of Health, Phetchabun 67160, Thailand
| | - Gerlind Anders
- Novartis Vaccines and Diagnostics GmbH, Medical Affairs, Emil-von-Behring-Str. 76, Marburg 35041, Germany
| | - Claudius Malerczyk
- Novartis Vaccines and Diagnostics GmbH, Medical Affairs, Emil-von-Behring-Str. 76, Marburg 35041, Germany
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Abstract
Rabies remains a global public health threat that kills more than 55,000 people per year. Rabies disproportionately affects children and, therefore, is ranked the seventh most important infectious disease due to years lost. Prevention of human rabies is accomplished by controlling rabies in domestic and wild animals, including the use of vaccination programs. The usefulness of human rabies vaccines is hampered by high cost, complicated vaccination regimens and lack of compliance, especially in areas of Africa and Asia where human rabies infections are endemic. A single-dose vaccine would greatly benefit efforts to combat this global health threat. However, a single-dose vaccine based on current inactivated vaccines does not appear feasible and other approaches are needed. Technology has advanced since modern human rabies vaccines were developed over 40 years ago. In addition, our understanding of immunological principles that influence the outcome of vaccination has increased. This article describes the current status of inactivated rabies virus vaccines and recent developments arising from the use of reverse genetics technologies designed to develop replication-deficient or single-cycle live rabies virus-based vectors for use as a single-dose rabies vaccine for humans.
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Affiliation(s)
- James P McGettigan
- Department of Microbiology and Immunology, Jefferson Vaccine Center, Jefferson Medical College of Thomas Jefferson University, 1020 Locust Street, JAH 466, Philadelphia, PA 19107, USA.
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23
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Falsey AR. New emerging technologies and the intradermal route: the novel way to immunize against influenza. Vaccine 2010; 28 Suppl 4:D24-32. [DOI: 10.1016/j.vaccine.2010.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Sudarshan MK, Gangaboraiah B, Ravish HS, Narayana DHA. Assessing the relationship between antigenicity and immunogenicity of human rabies vaccines when administered by intradermal route: results of a metaanalysis. HUMAN VACCINES 2010; 6:562-5. [PMID: 20523131 PMCID: PMC3322518 DOI: 10.4161/hv.6.7.11934] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 03/10/2010] [Accepted: 03/28/2010] [Indexed: 11/19/2022]
Abstract
The metadata of 10 published studies and 3 vaccine trial reports comprising of 19 vaccine cohorts from four countries conducted over a period of 23 years (1986 - 2009) was used for metaanalysis. The vaccines studied were purified chick embryo cell vaccine (Rabipur, India & Germany), purified vero cell rabies vaccine (Verorab, France; Indirab, India) & human diploid cell vaccine (MIRV, France).The potency of these vaccines varied from 0.55 IU to 2.32 IU per intradermal dose of 0.1 ml per site. The vaccines were administered to 1,011 subjects comprising of 19 cohorts and using five different ID regimens. The immunogenicity was measured by assays of rabies virus neutralizing antibody (RVNA) titres using rapid fluorescent focus inhibition test (RFFIT) [15 cohorts] and mouse neutralization test (MNT) [4 cohorts]. The statistical analysis of the data was done by Karl Pearson's correlation coefficient to measure the relationship between antigenicity and immunogenicity. It was revealed that, there was no significant linear relationship between antigenicity and immunogenicity of rabies vaccines when administered by intradermal route. (p> 0.230 and p>0.568).
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Affiliation(s)
- Mysore K Sudarshan
- Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore, India.
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25
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Intradermal influenza vaccine for older adults: a randomized controlled multicenter phase III study. Vaccine 2009; 27:7304-12. [PMID: 19849996 DOI: 10.1016/j.vaccine.2009.10.033] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 10/01/2009] [Accepted: 10/08/2009] [Indexed: 01/03/2023]
Abstract
In a 3-year, randomized, controlled, open-label phase III trial enrolling 3707 adults aged > or = 60 years we evaluated whether the immunogenicity of an intradermal trivalent inactivated seasonal influenza vaccine, containing 15 microg of haemagglutinin per strain per 0.1 ml dose, is superior to that of a conventional intramuscular vaccine. Intradermal vaccine was given using an intradermal microinjection system. After the first vaccination, both vaccines satisfied the immunogenicity criteria for influenza vaccines for older adults set out in European regulatory guidelines, and geometric mean haemagglutination inhibition antibody titers and seroprotection rates were higher (statistically superior) with intradermal vaccination. Higher immune responses with intradermal vaccine were also observed after the 2nd and 3rd annual vaccinations. Both vaccines were well tolerated with similar systemic reactogenicity profiles. This intradermal influenza vaccine for older adults is a beneficial option for influenza protection, consistently enhancing antibody responses without compromising safety.
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26
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Leroux-Roels I, Vets E, Freese R, Seiberling M, Weber F, Salamand C, Leroux-Roels G. Seasonal influenza vaccine delivered by intradermal microinjection: A randomised controlled safety and immunogenicity trial in adults. Vaccine 2009; 26:6614-9. [PMID: 18930093 DOI: 10.1016/j.vaccine.2008.09.078] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 09/08/2008] [Accepted: 09/15/2008] [Indexed: 11/30/2022]
Abstract
Influenza vaccines remain largely underused. A promising alternative to current intramuscular vaccines is a trivalent inactivated influenza vaccine (TIV) delivered using a microinjection system to offer a less invasive and possibly more acceptable vaccination. A phase II, multicentre, randomised open-label study in 978 healthy adults (18-57 years) evaluated the immunogenicity and safety of intradermal TIV. Subjects received a 0.1 ml injection of intradermal TIV, containing 9 microg of haemagglutinin (HA) per strain (n = 588) or a conventional 0.5 ml intramuscular vaccine (15 microg of HA/strain; n = 390). Intradermal TIV induced non-inferior humoral immune responses against all three strains and superior responses against both A strains (H1N1, H3N2) compared with the control. Both vaccines were well tolerated.
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Affiliation(s)
- Isabel Leroux-Roels
- Center for Vaccinology, Ghent University and Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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27
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Beran J, Ambrozaitis A, Laiskonis A, Mickuviene N, Bacart P, Calozet Y, Demanet E, Heijmans S, Van Belle P, Weber F, Salamand C. Intradermal influenza vaccination of healthy adults using a new microinjection system: a 3-year randomised controlled safety and immunogenicity trial. BMC Med 2009; 7:13. [PMID: 19341446 PMCID: PMC2676311 DOI: 10.1186/1741-7015-7-13] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 04/02/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intradermal vaccination provides direct and potentially more efficient access to the immune system via specialised dendritic cells and draining lymphatic vessels. We investigated the immunogenicity and safety during 3 successive years of different dosages of a trivalent, inactivated, split-virion vaccine against seasonal influenza given intradermally using a microinjection system compared with an intramuscular control vaccine. METHODS In a randomised, partially blinded, controlled study, healthy volunteers (1150 aged 18 to 57 years at enrollment) received three annual vaccinations of intradermal or intramuscular vaccine. In Year 1, subjects were randomised to one of three groups: 3 microg or 6 microg haemagglutinin/strain/dose of inactivated influenza vaccine intradermally, or a licensed inactivated influenza vaccine intramuscularly containing 15 microg/strain/dose. In Year 2 subjects were randomised again to one of two groups: 9 microg/strain/dose intradermally or 15 microg intramuscularly. In Year 3 subjects were randomised a third time to one of two groups: 9 microg intradermally or 15 microg intramuscularly. Randomisation lists in Year 1 were stratified for site. Randomisation lists in Years 2 and 3 were stratified for site and by vaccine received in previous years to ensure the inclusion of a comparable number of subjects in a vaccine group at each centre each year. Immunogenicity was assessed 21 days after each vaccination. Safety was assessed throughout the study. RESULTS In Years 2 and 3, 9 microg intradermal was comparably immunogenic to 15 microg intramuscular for all strains, and both vaccines met European requirements for annual licensing of influenza vaccines. The 3 microg and 6 microg intradermal formulations were less immunogenic than intramuscular 15 microg. Safety of the intradermal and intramuscular vaccinations was comparable in each year of the study. Injection site erythema and swelling was more common with the intradermal route. CONCLUSION An influenza vaccine with 9 microg of haemagglutinin/strain given using an intradermal microinjection system showed comparable immunogenic and safety profiles to a licensed intramuscular vaccine, and presents a promising alternative to intramuscular vaccination for influenza for adults younger than 60 years. TRIAL REGISTRATION (Clinicaltrials.gov) NCT00703651.
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Affiliation(s)
- Jiri Beran
- Vaccination and Travel Medicine Centre, Hradec Kralove, Czech Republic.
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28
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A three-year clinical study on immunogenicity, safety, and booster response of purified chick embryo cell rabies vaccine administered intramuscularly or intradermally to 12- to 18-month-old Thai children, concomitantly with Japanese encephalitis vaccine. Pediatr Infect Dis J 2009; 28:335-7. [PMID: 19333080 DOI: 10.1097/inf.0b013e3181906351] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After concomitant administration of purified chick embryo cell rabies vaccine and Japanese encephalitis vaccine to toddlers, adequate rabies and Japanese encephalitis virus neutralizing antibodies concentrations were demonstrated by day 49, 7 days after a booster at 1 year, and in the majorly at 3 years postvaccination. The inclusion of rabies vaccine in the expanded program on immunization should be considered in rabies endemic countries.
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29
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Lang J, Feroldi E, Vien NC. Pre-exposure purified vero cell rabies vaccine and concomitant routine childhood vaccinations: 5-year post-vaccination follow-up study of an infant cohort in Vietnam. J Trop Pediatr 2009; 55:26-31. [PMID: 18048461 DOI: 10.1093/tropej/fmm100] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Children have a high risk of exposure to rabies in countries where the disease is endemic. This prospective, 5-year study followed two groups of children who had received diphtheria, tetanus, whole-cell pertussis and inactivated poliomyelitis vaccine (DTP-IPV) at 2, 3, 4 months and 1 year (Group B) or concomitant with three doses of purified Vero cell rabies vaccine (PVRV), given at 2, 4 months and 1 year (Group A). Antibody determinations were made annually for 5 years. Data were available from a total of 72 subjects; 30 in Group A and 32 in Group B. In Group A, the percentage of patients immunized against rabies (anti-rabies > or = 0.5 IU/ml) decreased from 100% after the third vaccination to 63%, 5 years later. After 5 years, 93.8% in Group A and 96.7% in Group B had seroprotective diphtheria antibody titers > or = 0.01 IU/ml, and all subjects had anti-polio (type 1, 2 and 3) seroprotective titers > or = 5 1:dil. We conclude that co-administration of PVRV with DTP-IPV elicited protective antibody concentrations to all antigens that persist for at least 5 years, with continued protection against rabies in over 60% of subjects. These results are consistent with integration of pre-exposure rabies vaccination into the Expanded Program on Immunization (EPI) in countries where rabies is endemic.
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Affiliation(s)
- Jean Lang
- Sanofi Pasteur, Marcy L'etoile, France.
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Nicolas JF, Guy B. Intradermal, epidermal and transcutaneous vaccination: from immunology to clinical practice. Expert Rev Vaccines 2008; 7:1201-14. [PMID: 18844594 DOI: 10.1586/14760584.7.8.1201] [Citation(s) in RCA: 183] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The dermis and epidermis are alternative sites for prophylactic vaccination that have received renewed interest in recent years, not only because of the ease of access to the skin, but also its unique immunological properties. This review discusses the characteristics of the skin, current knowledge on skin immunity and clinical experience with cutaneous immunization against infectious diseases, with a special focus on intradermal immunization. The most widely accepted paradigm explaining the efficacy of cutaneous immunization is reviewed and recent research suggesting where this paradigm may need some refinement is highlighted. Clinical investigations that have concentrated on the intradermal route to vaccinate against influenza, rabies or hepatitis B support the current knowledge on skin immunity and, when combined with recent progress made in the development of user-friendly injection systems, have stimulated the ongoing clinical development of novel vaccines.
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Affiliation(s)
- Jean-François Nicolas
- University Lyon 1, UFR Lyon-Sud, IFR 128 BioSciences Lyon-Gerland, Institut National de la Santé et de la Recherche Médicale U503, 21 Avenue Tony Garnier, Lyon Cedex 07, Lyon 69365, France.
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31
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Holland D, Booy R, Looze F, Eizenberg P, McDonald J, Karrasch J, McKeirnan M, Salem H, Mills G, Reid J, Weber F, Saville M. Intradermal Influenza Vaccine Administered Using a New Microinjection System Produces Superior Immunogenicity in Elderly Adults: A Randomized Controlled Trial. J Infect Dis 2008; 198:650-8. [DOI: 10.1086/590434] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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32
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McElhaney J, Dutz J. Better Influenza Vaccines for Older People: What Will It Take? J Infect Dis 2008; 198:632-4. [DOI: 10.1086/590435] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vien NC, Feroldi E, Lang J. Long-term anti-rabies antibody persistence following intramuscular or low-dose intradermal vaccination of young Vietnamese children. Trans R Soc Trop Med Hyg 2008; 102:294-6. [PMID: 18191971 DOI: 10.1016/j.trstmh.2007.11.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 11/20/2007] [Accepted: 11/21/2007] [Indexed: 11/19/2022] Open
Abstract
Vietnamese children received purified Vero cell rabies vaccine 1 year after a primary series (Y0) and again 5 years later (Y5), either as intramuscular or 1/5th dose intradermal injections concomitant with diphtheria, tetanus, pertussis and oral poliomyelitis vaccines. Antibody levels were assayed annually for 5 years. All subjects in both groups had anti-rabies antibody titres considered protective after the Y0 booster. Rabies seroprotection rates and geometric mean titres gradually decreased similarly in both groups. Seroprotection after the Y5 booster was 100% in both groups. Satisfactory immunogenicity, long-term antibody persistence and an anamnestic response were conferred by both routes, greatly simplifying any future post-exposure prophylaxis.
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Affiliation(s)
- Nguyen Cong Vien
- Center of Pediatrics, Development and Health, Children's Hospital No. 2, Ho Chi Minh City, Viet Nam
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34
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Rabies vaccines. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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35
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Madhusudana SN, Sukumaran SM. Antemortem diagnosis and prevention of human rabies. Ann Indian Acad Neurol 2008; 11:3-12. [PMID: 19966972 PMCID: PMC2781142 DOI: 10.4103/0972-2327.40219] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 02/17/2008] [Accepted: 02/24/2008] [Indexed: 12/25/2022] Open
Abstract
Human rabies still continues to be a significant health problem in India and other developing countries where dogs are the major vectors of transmission. Rabies in humans can present in two clinical forms, i.e., furious and paralytic. While diagnosis of furious rabies can be made based on the typical symptoms and signs, paralytic rabies poses a diagnostic dilemma to the neurologists who may encounter these cases in their practice. Although there are certain clinical features that distinguish this disease from other forms of Guillain-Barre syndromes, confirmation of diagnosis may require laboratory assistance. Conventional techniques such as antigen detection, antibody assays and virus isolation have limited success. The recently introduced molecular techniques show more promise in confirming the cases of paralytic rabies. There has not been much success in the treatment of confirmed rabies cases and recovery from rabies is extremely rare. Therefore, preventive measures of this dreaded disease after an exposure become extremely important. The present article reviews the current status of human rabies with regard to antemortem diagnosis, disease management and post-exposure prophylaxis.
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Affiliation(s)
- Shampur Narayana Madhusudana
- Department of Neurovirology, Human Brain Tissue Repository, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore - 560 029, India
| | - Suja Moorlyath Sukumaran
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore - 560 029, India
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Dodet B. An important date in rabies history. Vaccine 2007; 25:8647-50. [DOI: 10.1016/j.vaccine.2007.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 10/03/2007] [Indexed: 11/29/2022]
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Wilde H. Failures of post-exposure rabies prophylaxis. Vaccine 2007; 25:7605-9. [PMID: 17905484 DOI: 10.1016/j.vaccine.2007.08.054] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Revised: 08/27/2007] [Accepted: 08/27/2007] [Indexed: 11/27/2022]
Abstract
Rabies remains a public health problem in many emerging countries. Virtually all is known that should enable us to eliminate this scourge by controlling the disease in canine populations and by diligent provision of WHO recommended post-exposure prophylaxis (PEP). Nevertheless, post-exposure prophylaxis failures do occur. Most common failures are due to deviations from WHO management recommendations and lack of essential biologicals. True failures, where all was done according to WHO recommendations, are fortunately extremely rare. Presented are seven such deaths. Other examples of common management deviations that resulted in deaths are also shown.
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Affiliation(s)
- Henry Wilde
- Infectious Disease Unit, Department of Medicine, Division of Research and Development, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand.
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Toovey S. Preventing rabies with the Verorab® vaccine: 1985–2005. Travel Med Infect Dis 2007; 5:327-48. [DOI: 10.1016/j.tmaid.2007.07.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 07/12/2007] [Indexed: 11/16/2022]
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Giovanetti F. Immunisation of the travelling child. Travel Med Infect Dis 2007; 5:349-64. [PMID: 17983974 DOI: 10.1016/j.tmaid.2007.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 09/13/2007] [Indexed: 11/30/2022]
Abstract
As a direct consequence of the current increase in international mobility, a significant increase in family travel is occurring. Protection against vaccine preventable diseases in the travelling child plays a key role both from an individual and a public health perspective: pre-travel immunisation protects travelling children and, at the same time, prevents the importation of pathogens that can spread throughout the community. Children immunisation presents unique challenges in travel medicine practice: some vaccines cannot be given below a definite age for several reasons and altering the standard schedule of routine vaccines is sometimes needed to ensure early protection. Furthermore, the risk for some travel-related diseases is higher among children. The aim of this review is to analyse the main epidemiological and clinical aspects relevant to immunisation of travelling children and to provide travel medicine practitioners with a practical approach to this issue.
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Affiliation(s)
- Franco Giovanetti
- Azienda Sanitaria Locale Alba Bra, Dipartimento di Prevenzione, via Vida 10, 12051 Alba, Italy.
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Shaw MM, Leggat PA, Williams ML. Intradermal pre-exposure rabies immunisation in New Zealand. Travel Med Infect Dis 2006; 4:29-33. [PMID: 16887722 DOI: 10.1016/j.tmaid.2004.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Revised: 11/04/2004] [Accepted: 11/08/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rabies is a fatal infection and immunisation is important to consider in those travellers going to rabies endemic areas. In those at high risk, a course of three immunisations may be given by the intramuscular (IM) or intradermal (ID) route, both of which are approved by the World Health Organization (WHO) and the Centers for Disease Control (CDC). Little is known in the New Zealand context regarding the effectiveness of pre-exposure ID rabies immunisation. METHODS The data was collected prospectively on all travellers requiring the immunisation from July 2001 to September 2003 in Auckland. The standard WHO rabies immunisation protocol was used with three ID injections of 0.1 ml, given on days 0, 7, and 21 or 28 with a booster after 12 months. The vaccine used was the Pasteur Merieux human diploid cell vaccine (HDCV) or the Rabipur Purified chick embryo cell (PCEC) vaccine. Both vaccines are approved by the WHO and the CDC, and are interchangeable. Serology was performed approximately 2 weeks after completion of the primary immunisation course or after a booster, wherever possible. Antibody levels were measured using EIA, and levels of >0.5 IU/ml were considered protective. RESULTS Of the 263 travellers assessed in this study, 125 were males and 138 were females. The mean age of the cohort was 34.8 years (SD=11.7). There were not found to be any statistically significant correlations between age and antibody levels neither was there any significant association between gender and antibody levels. In addition to the sample group, a further 12 travellers had rabies serology performed but were excluded from the study because they had IM vaccines as part of their primary course. Whilst rabies serology ranged from 0.2 to 27.9 IU/ml in the study cohort, the mean antibody level for the group was 4.7 IU/ml (SD=4.1 IU/ml). The mean antibody level for males was 4.3 IU/ml (SD=3.3), and for females, 5.2 IU/ml (SD=4.6). Of the 263 travellers, all had some level of detectable antibodies. The overall seroconversion rate was 95.1%. CONCLUSIONS ID rabies immunisation appears effective, when given according to the standard WHO protocol, in New Zealand. ID rabies immunisation is also more affordable for travellers, especially those on a restrictive budget. ID rabies immunisation can continue to be recommended, particularly where follow-up serology can be done before travel and where there are staff who are experienced in ID immunisation.
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Affiliation(s)
- Marc M Shaw
- Worldwise Travellers Health Centres of New Zealand, 72 Remuera Road, Newmarket, Auckland, New Zealand.
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Beran J, Honegr K, Banzhoff A, Malerczyk C. Potency requirements of rabies vaccines administered intradermally using the Thai Red Cross regimen: investigation of the immunogenicity of serially diluted purified chick embryo cell rabies vaccine. Vaccine 2005; 23:3902-7. [PMID: 15917111 DOI: 10.1016/j.vaccine.2005.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 03/11/2005] [Accepted: 03/23/2005] [Indexed: 10/25/2022]
Abstract
To determine the minimum vaccine potency per intradermal dose required to elicit an adequate immune response using the Thai Red Cross (TRC) regimen (2-2-2-0-1-1), healthy volunteers received 0.1 mL volumes of PCECV containing decreasing amounts of antigen. Subjects also received HRIG to evaluate potential interference with antibody production. Results indicated that when each 0.1 mL intradermal dose of PCECV contained antigen corresponding to 0.32 IU per intramuscular dose, every subject had titers above 0.5 IU/mL by day 14. These results confirm that the current World Health Organization (WHO) recommendations for vaccine potency (2.5 IU per intramuscular dose) are sufficient for use in the Thai Red Cross intradermal regimen.
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Affiliation(s)
- Jiri Beran
- Department of Infectious Diseases, University Hospital, Hradec Kralove, Czech Republic
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Fletcher MA, Fabre P, Debois H, Saliou P. Vaccines administered simultaneously: directions for new combination vaccines based on an historical review of the literature. Int J Infect Dis 2004; 8:328-38. [PMID: 15494254 DOI: 10.1016/j.ijid.2004.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2003] [Revised: 03/03/2004] [Accepted: 03/09/2004] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The recognized benefits of administering vaccines simultaneously has encouraged vaccine producers to develop combination vaccines. If contemporary research and development can realize vaccines that achieve the current standards for safety, immunogenicity, and efficacy, other specific vaccine associations may also merit reconsideration as combination vaccines. METHODS An historical review of the vaccine association literature reveals two important themes: first, the programs of mass vaccination, in particular, the eradication of smallpox, sessions where multiple vaccines (other than the smallpox vaccine) were given concurrently, and the Expanded Programme on Immunization (EPI); and, second, the domain of travel vaccines, including travellers to a disease-endemic country (such as migrants, tourists, military personnel, or expatriates) and WHO requirements for international travellers. RESULTS/CONCLUSIONS Based on this historical review, combination vaccines worth reconsideration could fill epidemiologic niches in the EPI with, for instance, a measles--yellow fever, a measles--Japanese encephalitis or a pertussis-based paediatric combination rabies vaccine. Furthermore, other combinations could broaden protection against the pathogens responsible for meningitis, pneumonia, or enteric diseases. Nevertheless, complex issues such as necessity, feasibility, or affordability will ultimately determine if any one of these becomes a combination vaccine.
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Affiliation(s)
- Mark A Fletcher
- Wyeth Vaccines Research, Coeur Défense-Tour A, 110 esplanade du Général de Gaulle, 92931 Paris la Défense, Cedex, France.
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Lau C, Sisson J. The effectiveness of intradermal pre-exposure rabies vaccination in an Australian travel medicine clinic. J Travel Med 2002; 9:285-8. [PMID: 12962581 DOI: 10.2310/7060.2002.30088] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of the study was to assess the effectiveness of intradermal (ID) rabies vaccination and to determine whether any difference in response with age or gender exists. No published Australian data on the subject is available and controversy continues to surround the use of ID rabies vaccination for pre-exposure prophylaxis. Vaccinated travelers requiring postexposure treatment are sometimes considered unvaccinated. By confirming their immunity prior to travel, this problem may be avoided. METHODS The data was collected by retrospective analysis over 2 years at a specialized travel medicine clinic in Perth, Western Australia. The standard protocol is three ID injections of 0.1 mL, given on days 0, 7, and 28 with a booster after 12 months. The vaccine used was the Pasteur Merieux human diploid cell vaccine. Serology was performed 3 weeks after completion of the primary course or after a booster. Antibody levels were measured using the rapid fluorescent focus inhibition test, and levels of >0.5 IU/mL were considered protective. RESULTS A total of 164 travelers were included in the study, of which 144 had completed the three primary ID doses, and 20 had received an ID booster after a previous primary ID course. The mean age was 34.75 years, and gender distribution was equal. The median time between vaccination and serology was 23 days. The antibody levels ranged from 0 to 50 IU/mL with a mean of 8.42 IU/mL. Three travelers had no detectable antibodies giving a seroconversion rate of 98.2%. No statistically significant correlation between age or gender and antibody levels was present. CONCLUSION We have found that ID rabies vaccination is effective in a travel clinic with nurses experienced in the technique. The lower cost of ID rabies vaccination makes it accessible to a larger number of travelers. Further studies will be required to determine the duration of protection after ID vaccination and antibody response after postexposure boosters. We will continue to recommend ID rabies vaccination if there is sufficient time for serology to be performed and for results to be available prior to departure.
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Affiliation(s)
- Colleen Lau
- Travel Medicine Centre, Perth, WA, Australia
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Abstract
Rabies is an acute, progressive, incurable viral encephalitis. The causative agents are neurotropic RNA viruses in the family Rhabdoviridae, genus Lyssavirus. Mammalian reservoirs include the Carnivora and Chiroptera, but rabid dogs still pose the greatest hazard worldwide. Viral transmission occurs mainly via animal bite, and once the virus is deposited in peripheral wounds, centripetal passage occurs towards the central nervous system. After viral replication, there is centrifugal spread to major exit portals, the salivary glands. The epidemiological significance of any host "carrier" state remains highly speculative. Although incubation periods average 1-3 months, disease occurrence days or years after exposure has been documented. Rabies should be suspected in patients with a concomitant history of animal bite and traditional clinical presentation, but a lack of such clues makes antemortem diagnosis a challenge. Pathogenetic mechanisms remain poorly understood, and current care entails palliative measures only. Current medical emphasis relies heavily on prevention of exposure and intervention before clinical onset. Prophylaxis encompasses thorough wound treatment, vaccine administration, and inoculation of rabies immunoglobulin. Although it is a major zoonosis, canine rabies can be eliminated, and application of new vaccine technologies permits significant disease control among wildlife species. Nevertheless, despite much technical progress in the past century, rabies is a disease of neglect and presents a modern public-health conundrum.
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Affiliation(s)
- Charles E Rupprecht
- Rabies Section, WHO Collaborating Centre for Reference and Research on Rabies, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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