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Sutter RW, Eisenhawer M, Molodecky NA, Verma H, Okayasu H. Inactivated Poliovirus Vaccine: Recent Developments and the Tortuous Path to Global Acceptance. Pathogens 2024; 13:224. [PMID: 38535567 PMCID: PMC10974833 DOI: 10.3390/pathogens13030224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/21/2024] Open
Abstract
Inactivated poliovirus vaccine (IPV), available since 1955, became the first vaccine to be used to protect against poliomyelitis. While the immunogenicity of IPV to prevent paralytic poliomyelitis continues to be irrefutable, its requirement for strong containment (due to large quantities of live virus used in the manufacturing process), perceived lack of ability to induce intestinal mucosal immunity, high cost and increased complexity to administer compared to oral polio vaccine (OPV), have limited its use in the global efforts to eradicate poliomyelitis. In order to harvest the full potential of IPV, a program of work has been carried out by the Global Polio Eradication Initiative (GPEI) over the past two decades that has focused on: (1) increasing the scientific knowledge base of IPV; (2) translating new insights and evidence into programmatic action; (3) expanding the IPV manufacturing infrastructure for global demand; and (4) continuing to pursue an ambitious research program to develop more immunogenic and safer-to-produce vaccines. While the knowledge base of IPV continues to expand, further research and product development are necessary to ensure that the program priorities are met (e.g., non-infectious production through virus-like particles, non-transmissible vaccine inducing humoral and intestinal mucosal immunity and new methods for house-to-house administration through micro-needle patches and jet injectors), the discussions have largely moved from whether to how to use this vaccine most effectively. In this review, we summarize recent developments on expanding the science base of IPV and provide insight into policy development and the expansion of IPV manufacturing and production, and finally we provide an update on the current priorities.
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Affiliation(s)
| | - Martin Eisenhawer
- Polio Eradication Department, World Health Organization, 1211 Geneva, Switzerland; (M.E.); (H.V.)
| | - Natalia A. Molodecky
- Polio Surge Capacity Support Program, The Task Force for Global Health, Inc., Decatur, GE 30030, USA;
| | - Harish Verma
- Polio Eradication Department, World Health Organization, 1211 Geneva, Switzerland; (M.E.); (H.V.)
| | - Hiromasa Okayasu
- Division of Healthy Environments and Population, Regional Office for the Western Pacific, World Health Organization, Manila 1000, Philippines
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Polio and Its Epidemiology. Infect Dis (Lond) 2023. [DOI: 10.1007/978-1-0716-2463-0_839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Crothers JW, Ross Colgate E, Cowan KJ, Dickson DM, Walsh M, Carmolli M, Wright PF, Norton EB, Kirkpatrick BD. Intradermal fractional-dose inactivated polio vaccine (fIPV) adjuvanted with double mutant Enterotoxigenic Escherichia coli heat labile toxin (dmLT) is well-tolerated and augments a systemic immune response to all three poliovirus serotypes in a randomized placebo-controlled trial. Vaccine 2022; 40:2705-2713. [PMID: 35367069 PMCID: PMC9024222 DOI: 10.1016/j.vaccine.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
Eradication of poliomyelitis globally is constrained by fecal shedding of live polioviruses, both wild-type and vaccine-derived strains, into the environment. Although inactivated polio vaccines (IPV) effectively protect the recipient from clinical poliomyelitis, fecal shedding of live virus still occurs following infection with either wildtype or vaccine-derived strains of poliovirus. In the drive to eliminate the last cases of polio globally, improvements in both oral polio vaccines (OPV) (to prevent reversion to virulence) and injectable polio vaccines (to improve mucosal immunity and prevent viral shedding) are underway. The E. coli labile toxin with two or "double" attenuating mutations (dmLT) may boost immunologic responses to IPV, including at mucosal sites. We performed a double-blinded phase I controlled clinical trial to evaluate safety, tolerability, as well as systemic and mucosal immunogenicity of IPV adjuvanted with dmLT, given as a fractional (1/5th) dose intradermally (fIPV-dmLT). Twenty-nine volunteers with no past exposure to OPV were randomized to a single dose of fIPV-dmLT or fIPV alone. fIPV-dmLT was well tolerated, although three subjects had mild but persistent induration and hyperpigmentation at the injection site. A ≥ 4-fold rise in serotype-specific neutralizing antibody (SNA) titers to all three serotypes was seen in 84% of subjects receiving fIPV-dmLT vs. 50% of volunteers receiving IPV alone. SNA titers were higher in the dmLT-adjuvanted group, but only differences in serotype 1 were significant. Mucosal immune responses, as measured by polio serotype specific fecal IgA were minimal in both groups and differences were not seen. fIPV-dmLT may offer a benefit over IPV alone. Beyond NAB responses protecting the individual, studies demonstrating the ability of fIPV-dmLT to prevent viral shedding are necessary. Studies employing controlled human infection models, using monovalent OPV post-vaccine are ongoing. Studies specifically in children may also be necessary and additional biomarkers of mucosal immune responses in this population are needed. Clinicaltrials.gov Identifer: NCT03922061.
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Affiliation(s)
- Jessica W Crothers
- Department of Pathology and Laboratory Medicine, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA.
| | - Elizabeth Ross Colgate
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Kelly J Cowan
- Department of Pediatrics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Dorothy M Dickson
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - MaryClaire Walsh
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Marya Carmolli
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Peter F Wright
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Elizabeth B Norton
- Department of Immunology and Microbiology, Tulane University, New Orleans, LA, USA
| | - Beth D Kirkpatrick
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Jaiswal N, Singh S, Agarwal A, Chauhan A, Thumburu KK, Kaur H, Singh M. Equivalent schedules of intradermal fractional dose versus intramuscular full dose of inactivated polio vaccine for prevention of poliomyelitis. Cochrane Database Syst Rev 2019; 12:CD011780. [PMID: 31858595 PMCID: PMC6923520 DOI: 10.1002/14651858.cd011780.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Poliomyelitis is a debilitating and deadly infection. Despite exponential growth in medical science, there is still no cure for the disease, which is caused by three types of wild polioviruses: types 1, 2, and 3. According to the Global Polio Eradication Initiative (GPEI), wild poliovirus is still in circulation in three countries, and fresh cases have been reported even in the year 2018. Due to the administration of live vaccines, the risk for vaccine-derived poliovirus (VDPV) is high in areas that are free from wild polioviruses. This is evident based on the fact that VDPV caused 20 outbreaks between 2000 and 2011. Recent recommendations from the World Health Organization favoured the inclusion of inactivated poliovirus vaccine (IPV) in the global immunisation schedule. IPV can be delivered in two ways: intramuscularly and intradermally. IPV was previously administered intramuscularly, but shortages in vaccine supplies, coupled with the higher costs of the vaccines, led to the innovation of delivering a fractional dose (one-fifth) of IPV intradermally. However, there is uncertainty regarding the efficacy, immunogenicity, and safety of an intradermal, fractional dose of IPV compared to an intramuscular, full dose of IPV. OBJECTIVES To compare the immunogenicity and efficacy of an inactivated poliovirus vaccine (IPV) in equivalent immunisation schedules using fractional-dose IPV given via the intradermal route versus full-dose IPV given via the intramuscular route. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 10 other databases, and two trial registers up to February 2019. We also searched the GPEI website and scanned the bibliographies of key studies and reviews in order to identify any additional published and unpublished trials in this area not captured by our electronic searches. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of healthy individuals of any age who are eligible for immunisation with IPV, comparing intradermal fractional-dose (one-fifth) IPV to intramuscular full-dose IPV. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 13 RCTs involving a total of 7292 participants, both children (n = 6402) and adults (n = 890). Nine studies were conducted in middle-income countries, three studies in high-income countries, and only one study in a low-income country. Five studies did not report methods of randomisation, and one study failed to conceal the allocations. Eleven studies did not blind participants, and six studies did not blind outcome assessments. Two studies had high attrition rates, and one study selectively reported the results. Three studies were funded by pharmaceutical companies. Paralytic poliomyelitis. No study reported data on this outcome. Seroconversion rates. These were significantly higher for all three types of wild poliovirus for children given intramuscular full-dose IPV after a single primary dose and two primary doses, but only significantly higher for type two wild poliovirus given intramuscularly after three primary doses: • dose one (six studies): poliovirus type 1 (odds ratio (OR) 0.30, 95% confidence interval (CI) 0.22 to 0.41; 2570 children); poliovirus type 2 (OR 0.43, 95% CI 0.31 to 0.60; 2567 children); poliovirus type 3 (OR 0.19, 95% CI 0.12 to 0.30; 2571 children); • dose two (three studies): poliovirus type 1 (OR 0.23, 95% CI 0.16 to 0.33; 981 children); poliovirus type 2 (OR 0.41, 95% CI 0.28 to 0.60; 853 children); and poliovirus type 3 (OR 0.12, 95% CI 0.07 to 0.22; 855 children); and • dose three (three studies): poliovirus type 1 (OR 0.45, 95% CI 0.07 to 3.15; 973 children); poliovirus type 2 (OR 0.34, 95% CI 0.19 to 0.63; 973 children); and poliovirus type 3 (OR 0.18, 95% CI 0.01 to 2.58; 973 children). Using the GRADE approach, we rated the certainty of the evidence as low or very low for seroconversion rate (after a single, two, or three primary doses) for all three poliovirus types due to significant risk of bias, heterogeneity, and indirectness in applicability/generalisability. Geometric mean titres. No study reported mean antibody titres. Median antibody titres were higher for intramuscular full-dose IPV (7 studies with 4887 children); although these studies also reported a rise in antibody titres in the intradermal group, none reported the duration for which the titres remained high. Any vaccine-related adverse event. Five studies (2217 children) reported more adverse events, such as fever and redness, in the intradermal group, whilst two studies (1904 children) reported more adverse events in the intramuscular group. AUTHORS' CONCLUSIONS There is low- and very low-certainty evidence that intramuscular full-dose IPV may result in a slight increase in seroconversion rates for all three types of wild poliovirus, compared with intradermal fractional-dose IPV. We are uncertain whether intradermal fractional-dose (one-fifth) IPV has better protective effects and causes fewer adverse events in children than intramuscular full-dose IPV.
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Affiliation(s)
- Nishant Jaiswal
- Postgraduate Institute of Medical Education and ResearchICMR Advanced Centre for Evidence‐Based Child HealthSector 12ChandigarhIndia160012
| | - Shreya Singh
- Postgraduate Institute of Medical Education and ResearchDepartment of Medical MicrobiologyResearch Block A, Sector 12ChandigarhChandigarhIndia160012
| | - Amit Agarwal
- Postgraduate Institute of Medical Education and ResearchICMR Advanced Centre for Evidence‐Based Child HealthSector 12ChandigarhIndia160012
| | - Anil Chauhan
- Postgraduate Institute of Medical Education and ResearchICMR Advanced Centre for Evidence‐Based Child HealthSector 12ChandigarhIndia160012
| | - Kiran K Thumburu
- Postgraduate Institute of Medical Education and ResearchICMR Advanced Centre for Evidence‐Based Child HealthSector 12ChandigarhIndia160012
| | - Harpreet Kaur
- Panjab UniversityUniversity Business SchoolSector 14ChandigarhIndia160014
| | - Meenu Singh
- Postgraduate Institute of Medical Education and ResearchDepartment of PediatricsSector 12ChandigarhIndia160012
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Snider CJ, Zaman K, Estivariz CF, Yunus M, Weldon WC, Wannemuehler KA, Oberste MS, Pallansch MA, Wassilak SG, Bari TIA, Anand A. Immunogenicity of full and fractional dose of inactivated poliovirus vaccine for use in routine immunisation and outbreak response: an open-label, randomised controlled trial. Lancet 2019; 393:2624-2634. [PMID: 31104832 PMCID: PMC7069654 DOI: 10.1016/s0140-6736(19)30503-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intradermal administration of fractional inactivated poliovirus vaccine (fIPV) is a dose-sparing alternative to the intramuscular full dose. We aimed to compare the immunogenicity of two fIPV doses versus one IPV dose for routine immunisation, and also assessed the immunogenicity of an fIPV booster dose for an outbreak response. METHODS We did an open-label, randomised, controlled, inequality, non-inferiority trial in two clinics in Dhaka, Bangladesh. Healthy infants were randomly assigned at 6 weeks to one of four groups: group A received IPV at age 14 weeks and IPV booster at age 22 weeks; group B received IPV at age 14 weeks and fIPV booster at age 22 weeks; group C received IPV at age 6 weeks and fIPV booster at age 22 weeks; and group D received fIPV at 6 weeks and 14 weeks and fIPV booster at age 22 weeks. IPV was administered by needle-syringe as an intramuscular full dose (0·5 mL), and fIPV was administered intradermally (0·1 mL of the IPV formulation was administered using the 0·1 mL HelmJect auto-disable syringe with a Helms intradermal adapter). Both IPV and fIPV were administered on the outer, upper right thigh of infants. The primary outcome was vaccine response to poliovirus types 1, 2, and 3 at age 22 weeks (routine immunisation) and age 26 weeks (outbreak response). Vaccine response was defined as seroconversion from seronegative (<1:8) at baseline to seropositive (≥1:8) or four-fold increase in reciprocal antibody titres adjusted for maternal antibody decay and was assessed in the modified intention-to-treat population (infants who received polio vaccines per group assignment and polio antibody titre results to serotypes 1, 2, and 3 at 6, 22, 23, and 26 weeks of age). The non-inferiority margin was 12·5%. This trial is registered with ClinicalTrials.gov, number NCT02847026. FINDINGS Between Sept 1, 2016 and May 2, 2017, 1076 participants were randomly assigned and included in the modified intention-to-treat analysis: 271 in Group A, 267 in group B, 268 in group C, and 270 in group D. Vaccine response at 22 weeks to two doses of fIPV (group D) was significantly higher (p<0·0001) than to one dose of IPV (groups A and B) for all three poliovirus serotypes: the type 1 response comprised 212 (79% [95% CI 73-83]) versus 305 (57% [53-61]) participants, the type 2 response comprised 173 (64% [58-70]) versus 249 (46% [42-51]) participants, and the type 3 response comprised 196 (73% [67-78]) versus 196 (36% [33-41]) participants. At 26 weeks, the fIPV booster was non-inferior to IPV (group B vs group A) for serotype 1 (-1·12% [90% CI -2·18 to -0·06]), serotype 2 (0·40%, [-2·22 to 1·42]), and serotype 3 (1·51% [-3·23 to -0·21]). Of 129 adverse events, 21 were classified as serious including one death; none were attributed to IPV or fIPV. INTERPRETATION fIPV appears to be an effective dose-sparing strategy for routine immunisation and outbreak responses. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Cynthia J Snider
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Mohammad Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | | | | | - Tajul Islam A Bari
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abhijeet Anand
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Safety and immunogenicity of rabies pre- and postexposure intradermal regimens using Abhayrab, a purified vero cell rabies vaccine (PVRV) produced in India in healthy volunteers: towards greater affordability of rabies prophylaxis. ASIAN BIOMED 2018. [DOI: 10.2478/abm-2010-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Background: Rabies is 100% fatal, but is preventable. However, due to the high cost of vaccines and immunoglobulins, as well as their limited availability, many dog-bite victims in the Philippines do not complete the required PEP regimen. This concern may be addressed by the introduction of various new brands of affordable rabies vaccines and biologicals for use with the ID regimen. Objective: Study the safety and immunogenicity of rabies pre- and post-exposure intradermal regimens using Abhayrab, a purified vero cell rabies vaccine (PVRV) produced by the human biological institute of Ooty India in healthy volunteers. Methods: In a randomized, single blind, unicentric trial, 149 healthy volunteers (5 - 50 years in age) were recruited to the study. The subjects were then randomized into two groups. Group 1 (pre-exposure) (73 subjects) followed the standard ID regimen using a dose of 0.1 mL PVRV (Abhayrab) given intradermally on either deltoid on days 0, 7 and 28. Group 2 (post-exposure) (76 Subjects) followed the modified Thai Red Cross ID regimen (2-2-2-0-2) using a dose of 0.1 mL PVRV (Abhayrab) each given intradermally on both deltoids on days 0, 3, 7, and 28. Following administration of vaccine, subjects were observed closely for 30 minutes at the site for adverse reactions. Four ml of blood from each subject was drawn on days 0, 14, and 28 for anti-rabies antibody titres. Safety and immunogenicity were assessed through follow-up of adverse events and anti rabies antibody response, respectively. Results: Eventually, 120 subjects, 60 in each group, completed the day 28 ID immunization. All the 120 subjects demonstrated seroconversions with antibody titers greater than the WHO recommended cut-off level of 0.5 IU/mL on days 14 and 28. The GMC values for Group 1 were 3.30 IU/ml and 4.37 IU/mL on days 14 and 28, respectively, while those of Group 2 were 3.73 IU/mL and 4.82 IU/mL, respectively. These GMC values were within their 95% CIs. Only a few mild adverse events were observed with no incidences of moderate or severe events. Conclusion: Abhayrab is a safe and immunogenic rabies vaccine when administered intradermally.
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Feasibility of conducting intradermal vaccination campaign with inactivated poliovirus vaccine using Tropis intradermal needle free injection system, Karachi, Pakistan. Heliyon 2017; 3:e00395. [PMID: 29333501 PMCID: PMC5750384 DOI: 10.1016/j.heliyon.2017.e00395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/15/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Administration of intradermal fractional dose of inactivated poliovirus vaccine (fIPV) has proven to be safe and immunogenic; however, its intradermal application using needle and syringe is technically difficult and requires trained personnel. Methods We assessed feasibility of conducting an intradermal fIPV campaign in polio high risk neighborhood of Karachi using Tropis needle-free injector. During the one-day fIPV campaign, we measured average “application time” to administer fIPV with Tropis, collected ergonomic information and measured vaccine wastage. Results Eleven vaccinator teams, after two-day training, immunized 582 children between 4 months and 5 years of age. Average “application time” ranged from 35–75 seconds; the “application time” decreased with the number of children vaccinated from 68 to 38 seconds between 1st and 30th child. 10/11 (91%) vaccinator teams found no ergonomic issues; 1/11 (9%) assessed that it was not easy to remove air bubbles when filling the device. There was 0% vaccine loss reported. No adverse events following immunizations were reported. Interpretation We demonstrated that it is feasible, safe and efficient to use Tropis for the administration of fIPV in a campaign setting.
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Okayasu H, Sein C, Chang Blanc D, Gonzalez AR, Zehrung D, Jarrahian C, Macklin G, Sutter RW. Intradermal Administration of Fractional Doses of Inactivated Poliovirus Vaccine: A Dose-Sparing Option for Polio Immunization. J Infect Dis 2017; 216:S161-S167. [PMID: 28838185 PMCID: PMC5853966 DOI: 10.1093/infdis/jix038] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A fractional dose of inactivated poliovirus vaccine (fIPV) administered by the intradermal route delivers one fifth of the full vaccine dose administered by the intramuscular route and offers a potential dose-sparing strategy to stretch the limited global IPV supply while further improving population immunity. Multiple studies have assessed immunogenicity of intradermal fIPV compared with the full intramuscular dose and demonstrated encouraging results. Novel intradermal devices, including intradermal adapters and disposable-syringe jet injectors, have also been developed and evaluated as alternatives to traditional Bacillus Calmette-Guérin needles and syringes for the administration of fIPV. Initial experience in India, Pakistan, and Sri Lanka suggests that it is operationally feasible to implement fIPV vaccination on a large scale. Given the available scientific data and operational feasibility shown in early-adopter countries, countries are encouraged to consider introducing a fIPV strategy into their routine immunization and supplementary immunization activities.
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MESH Headings
- Antibodies, Viral/immunology
- Child
- Child, Preschool
- Humans
- Immunization, Secondary/economics
- Immunization, Secondary/methods
- Infant
- Injections, Intradermal/instrumentation
- Injections, Intradermal/methods
- Mass Vaccination/economics
- Mass Vaccination/instrumentation
- Mass Vaccination/methods
- Poliovirus/immunology
- Poliovirus Vaccine, Inactivated/administration & dosage
- Poliovirus Vaccine, Inactivated/economics
- Poliovirus Vaccine, Inactivated/immunology
- Poliovirus Vaccine, Inactivated/supply & distribution
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Affiliation(s)
| | - Carolyn Sein
- Research, Policy and Containment, Polio Eradication Department
| | - Diana Chang Blanc
- Expanded Programme on Immunization, Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Alejandro Ramirez Gonzalez
- Expanded Programme on Immunization, Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | | | | | - Grace Macklin
- Research, Policy and Containment, Polio Eradication Department
| | - Roland W Sutter
- Research, Policy and Containment, Polio Eradication Department
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Anand A, Molodecky NA, Pallansch MA, Sutter RW. Immunogenicity to poliovirus type 2 following two doses of fractional intradermal inactivated poliovirus vaccine: A novel dose sparing immunization schedule. Vaccine 2017; 35:2993-2998. [PMID: 28434691 PMCID: PMC10423713 DOI: 10.1016/j.vaccine.2017.03.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The polio eradication endgame strategic plan calls for the sequential removal of Sabin poliovirus serotypes from the trivalent oral poliovirus vaccine (tOPV), starting with type 2, and the introduction of ≥1 dose of inactivated poliovirus vaccine (IPV), to maintain an immunity base against poliovirus type 2. The global removal of oral poliovirus type 2 was successfully implemented in May 2016. However, IPV supply constraints has prevented introduction in 21 countries and led to complete stock-out in >20 countries. METHODS We conducted a literature review and contacted corresponding authors of recent studies with fractional-dose IPV (fIPV), one-fifth of intramuscular dose administered intradermally, to conduct additional type 2 immunogenicity analyses of two fIPV doses compared with one full-dose IPV. RESULTS Four studies were identified that assessed immunogenicity of two fIPV doses compared to one full-dose IPV. Two fractional doses are more immunogenic than 1 full-dose, with type 2 seroconversion rates improving between absolute 19-42% (median: 37%, p<0.001) and relative increase of 53-125% (median: 82%), and antibody titer to type 2 increasing by 2-32-fold (median: 10-fold). Early age of administration and shorter intervals between doses were associated with lower immunogenicity. DISCUSSION Overall, two fIPV doses are more immunogenic than a single full-dose, associated with significantly increased seroconversion rates and antibody titers. Two fIPV doses together use two-fifth of the vaccine compared to one full-dose IPV. In response to the current IPV shortage, a schedule of two fIPV doses at ages 6 and 14weekshas been endorsed by technical oversight committees and has been introduced in some affected countries.
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Affiliation(s)
- Abhijeet Anand
- Centers for Disease Control and Prevention, Atlanta, Georgia.
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Saleem AF, Mach O, Yousafzai MT, Khan A, Weldon WC, Oberste MS, Sutter RW, Zaidi AKM. Needle adapters for intradermal administration of fractional dose of inactivated poliovirus vaccine: Evaluation of immunogenicity and programmatic feasibility in Pakistan. Vaccine 2017; 35:3209-3214. [PMID: 28479178 PMCID: PMC5457301 DOI: 10.1016/j.vaccine.2017.04.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 03/27/2017] [Accepted: 04/25/2017] [Indexed: 10/26/2022]
Abstract
Administration of 1/5th dose of Inactivated poliovirus vaccine intradermally (fIPV) provides similar immune response as full-dose intramuscular IPV, however, fIPV administration with BCG needle and syringe (BCG NS) is technically difficult. We compared immune response after one fIPV dose administered with BCG NS to administration with intradermal devices, referred to as Device A and B; and assessed feasibility of conducting a door-to-door vaccination campaign with fIPV. In Phase I, 452 children 6-12months old from Karachi were randomized to receive one fIPV dose either with BCG NS, Device A or Device B in a health facility. Immune response was defined as seroconversion or fourfold rise in polio neutralizing antibody titer 28days after fIPV among children whose baseline titer ≤362. In Phase II, fIPV was administered during one-day door-to-door campaign to assess programmatic feasibility by evaluating vaccinators' experience. For all three poliovirus (PV) serotypes, the immune response after BCG NS and Device A was similar, however it was lower with Device B (34/44 (77%), 31/45 (69%), 16/30 (53%) respectively for PV1; 53/78 (68%), 61/83 (74%), 42/80 (53%) for PV2; and; 58/76 (76%), 56/80 (70%), 43/77 (56%) for PV3; p<0.05 for all three serotypes). Vaccinators reported problems filling Device B in both Phases; no other operational challenges were reported during Phase II. Use of fIPV offers a dose-saving alternative to full-dose IPV.
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Affiliation(s)
| | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | | | - Asia Khan
- Aga Khan University, Karachi, Pakistan
| | - William C Weldon
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, USA
| | - M Steven Oberste
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, USA
| | - Roland W Sutter
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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Kraan H, van der Stel W, Kersten G, Amorij JP. Alternative administration routes and delivery technologies for polio vaccines. Expert Rev Vaccines 2016; 15:1029-40. [DOI: 10.1586/14760584.2016.1158650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Heleen Kraan
- Department of Research, Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands
| | - Wanda van der Stel
- Division of Drug Delivery Technology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Gideon Kersten
- Department of Research, Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands
- Division of Drug Delivery Technology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Jean-Pierre Amorij
- Department of Research, Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands
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Parker EPK, Molodecky NA, Pons-Salort M, O’Reilly KM, Grassly NC. Impact of inactivated poliovirus vaccine on mucosal immunity: implications for the polio eradication endgame. Expert Rev Vaccines 2015; 14:1113-23. [PMID: 26159938 PMCID: PMC4673562 DOI: 10.1586/14760584.2015.1052800] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The polio eradication endgame aims to bring transmission of all polioviruses to a halt. To achieve this aim, it is essential to block viral replication in individuals via induction of a robust mucosal immune response. Although it has long been recognized that inactivated poliovirus vaccine (IPV) is incapable of inducing a strong mucosal response on its own, it has recently become clear that IPV may boost immunity in the intestinal mucosa among individuals previously immunized with oral poliovirus vaccine. Indeed, mucosal protection appears to be stronger following a booster dose of IPV than oral poliovirus vaccine, especially in older children. Here, we review the available evidence regarding the impact of IPV on mucosal immunity, and consider the implications of this evidence for the polio eradication endgame. We conclude that the implementation of IPV in both routine and supplementary immunization activities has the potential to play a key role in halting poliovirus transmission, and thereby hasten the eradication of polio.
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Affiliation(s)
- Edward PK Parker
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
| | - Natalie A Molodecky
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
| | - Margarita Pons-Salort
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
| | - Kathleen M O’Reilly
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, London, UK
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Whole Tumor Antigen Vaccines: Where Are We? Vaccines (Basel) 2015; 3:344-72. [PMID: 26343191 PMCID: PMC4494356 DOI: 10.3390/vaccines3020344] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 12/19/2022] Open
Abstract
With its vast amount of uncharacterized and characterized T cell epitopes available for activating CD4+ T helper and CD8+ cytotoxic lymphocytes simultaneously, whole tumor antigen represents an attractive alternative source of antigens as compared to tumor-derived peptides and full-length recombinant tumor proteins for dendritic cell (DC)-based immunotherapy. Unlike defined tumor-derived peptides and proteins, whole tumor lysate therapy is applicable to all patients regardless of their HLA type. DCs are essentially the master regulators of immune response, and are the most potent antigen-presenting cell population for priming and activating naïve T cells to target tumors. Because of these unique properties, numerous DC-based immunotherapies have been initiated in the clinics. In this review, we describe the different types of whole tumor antigens that we could use to pulse DCs ex vivo and in vivo. We also discuss the different routes of delivering whole tumor antigens to DCs in vivo and activating them with toll-like receptor agonists.
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Bandyopadhyay AS, Garon J, Seib K, Orenstein WA. Polio vaccination: past, present and future. Future Microbiol 2015; 10:791-808. [PMID: 25824845 DOI: 10.2217/fmb.15.19] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Live attenuated oral polio vaccine (OPV) and inactivated polio vaccine (IPV) are the tools being used to achieve eradication of wild polio virus. Because OPV can rarely cause paralysis and generate revertant polio strains, IPV will have to replace OPV after eradication of wild polio virus is certified to sustain eradication of all polioviruses. However, uncertainties remain related to IPV's ability to induce intestinal immunity in populations where fecal-oral transmission is predominant. Although substantial effectiveness and safety data exist on the use and delivery of OPV and IPV, several new research initiatives are currently underway to fill specific knowledge gaps to inform future vaccination policies that would assure polio is eradicated and eradication is maintained.
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Affiliation(s)
| | - Julie Garon
- 2Division of Infectious Diseases, Emory University School of Medicine, 1462 Clifton Road, Room 446, Atlanta, GA 30322, USA
| | - Katherine Seib
- 2Division of Infectious Diseases, Emory University School of Medicine, 1462 Clifton Road, Room 446, Atlanta, GA 30322, USA
| | - Walter A Orenstein
- 2Division of Infectious Diseases, Emory University School of Medicine, 1462 Clifton Road, Room 446, Atlanta, GA 30322, USA
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15
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Levin Y, Kochba E, Hung I, Kenney R. Intradermal vaccination using the novel microneedle device MicronJet600: Past, present, and future. Hum Vaccin Immunother 2015; 11:991-7. [PMID: 25745830 PMCID: PMC4514308 DOI: 10.1080/21645515.2015.1010871] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/24/2014] [Accepted: 01/06/2015] [Indexed: 02/08/2023] Open
Abstract
Intradermal immunization has become a forefront of vaccine improvement, both scientifically and commercially. Newer technologies are being developed to address the need to reduce the dose required for vaccination and to improve the reliability and ease of injection, which have been major hurdles in expanding the number of approved vaccines using this route of administration. In this review, 7 y of clinical experience with a novel intradermal delivery device, the MicronJet600, which is a registered hollow microneedle that simplifies the delivery of liquid vaccines, are summarized. This device has demonstrated both significant dose-sparing and superior immunogenicity in various vaccine categories, as well as in diverse subject populations and age groups. These studies have shown that intradermal delivery using this device is safe, effective, and preferred by the subjects. Comparison with other intradermal devices and potential new applications for intradermal delivery that could be pursued in the future are also discussed.
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Key Words
- AE, adverse event
- BCG, Bacillus Calmette–Guérin
- BD, Becton Dickinson
- CDC, Center of Disease Control
- DTP, diphtheria, pertussis and tetanus
- EMEA, European Medicines Agency
- FDA, Food and Drug Administration
- GMT, geometric mean titer
- HA, hemagglutinin
- HBV, hepatitis B virus
- HIV, Human immunodeficiency virus
- HPV, human papilloma virus
- ID, intradermal
- IM, Intramuscular
- IPV, inactivated polio vaccine
- MEMS, Micro Electro Mechanical System
- Mantoux
- PPD, Purified protein derivative
- SAGE, Strategic Advisory Group of Experts
- SQ, subcutaneous
- WHO, World Health Organization
- dose-sparing
- icddr,b, International Center for Diarrheal Disease Research, Bangladesh
- immunogenicity
- influenza vaccine
- intradermal
- microneedles
- vaccine delivery
- vaccine device
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Affiliation(s)
| | | | - Ivan Hung
- State Key Laboratory for Emerging Infectious Diseases; Carol Yu's Center for Infection and Division of Infectious Diseases; The University of Hong Kong; Queen Mary Hospital;Hong Kong Special Administrative Region; Hong Kong, China
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16
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Okayasu H, Sutter RW, Jafari HS, Takane M, Aylward RB. Affordable inactivated poliovirus vaccine: strategies and progress. J Infect Dis 2014; 210 Suppl 1:S459-64. [PMID: 25316868 DOI: 10.1093/infdis/jiu128] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
After polio eradication is achieved, the use of live-attenuated oral poliovirus vaccine (OPV) must be discontinued because of the inherent risk of the Sabin strains to revert to neurovirulence and reacquire greater transmissibility that could potentially result in the reestablishment of polio transmission. In 2008, the World Health Assembly mandated that the World Health Organization establish a strategy for developing more-affordable inactivated poliovirus vaccine (IPV) options for low-income countries. In 2012, the Strategic Advisory Group of Experts (SAGE) on Immunization recommended universal IPV introduction as a risk-mitigation strategy before the phased cessation of OPV (starting with Sabin type 2) and emphasized the need for affordable IPV options. In 2013, SAGE reiterated the importance of attaining the long-term target price of IPV at approximately $0.5 per immunizing dose and encouraged accelerated efforts to develop lower-cost IPV options. This article outlines the 4-pronged approach that is being pursued to develop affordable options and provides an update on the current status and plans to make IPV affordable for developing-country use.
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Affiliation(s)
- Hiromasa Okayasu
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Roland W Sutter
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Hamid S Jafari
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Marina Takane
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - R Bruce Aylward
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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17
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Filippelli M, Lionetti E, Gennaro A, Lanzafame A, Arrigo T, Salpietro C, La Rosa M, Leonardi S. Hepatitis B vaccine by intradermal route in non responder patients: An update. World J Gastroenterol 2014; 20:10383-10394. [PMID: 25132754 PMCID: PMC4130845 DOI: 10.3748/wjg.v20.i30.10383] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/12/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus (HBV) infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90% of general population. Individuals who develop an anti-HBs titer less than 10 mIU/mL after primary vaccination cycle are defined “no responders”. Many factors could cause a non response to the HBV vaccination, such as administration of the vaccine in buttocks, impaired vaccine storage conditions, drug abuse, smoking, infections and obesity. Moreover there are some diseases, like chronic kidney disease, human immunodeficiency virus infection, chronic liver disease, celiac disease, thalassaemia, type I diabetes mellitus, down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects. To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection. Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route. This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients. A comprehensive review of the literature using PubMed database, with appropriate terms, was undertaken for articles in English published since 1983. The literature search was undertaken in September 2013.
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Herzog C. Influence of parenteral administration routes and additional factors on vaccine safety and immunogenicity: a review of recent literature. Expert Rev Vaccines 2014; 13:399-415. [DOI: 10.1586/14760584.2014.883285] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Verdijk P, Rots NY, Bakker WAM. Clinical development of a novel inactivated poliomyelitis vaccine based on attenuated Sabin poliovirus strains. Expert Rev Vaccines 2014; 10:635-44. [DOI: 10.1586/erv.11.51] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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20
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Kwon KC, Verma D, Singh ND, Herzog R, Daniell H. Oral delivery of human biopharmaceuticals, autoantigens and vaccine antigens bioencapsulated in plant cells. Adv Drug Deliv Rev 2013; 65:782-99. [PMID: 23099275 PMCID: PMC3582797 DOI: 10.1016/j.addr.2012.10.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/26/2012] [Accepted: 10/17/2012] [Indexed: 12/19/2022]
Abstract
Among 12billion injections administered annually, unsafe delivery leads to >20million infections and >100million reactions. In an emerging new concept, freeze-dried plant cells (lettuce) expressing vaccine antigens/biopharmaceuticals are protected in the stomach from acids/enzymes but are released to the immune or blood circulatory system when plant cell walls are digested by microbes that colonize the gut. Vaccine antigens bioencapsulated in plant cells upon oral delivery after priming, conferred both mucosal and systemic immunity and protection against bacterial, viral or protozoan pathogens or toxin challenge. Oral delivery of autoantigens was effective against complications of type 1 diabetes and hemophilia, by developing tolerance. Oral delivery of proinsulin or exendin-4 expressed in plant cells regulated blood glucose levels similar to injections. Therefore, this new platform offers a low cost alternative to deliver different therapeutic proteins to combat infectious or inherited diseases by eliminating inactivated pathogens, expensive purification, cold storage/transportation and sterile injections.
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Affiliation(s)
- Kwang-Chul Kwon
- Department of Molecular Biology and Microbiology, College of Medicine, University of Central Florida, Biomolecular Science Building, Orlando, FL 32816-2364, USA
| | - Dheeraj Verma
- Department of Molecular Biology and Microbiology, College of Medicine, University of Central Florida, Biomolecular Science Building, Orlando, FL 32816-2364, USA
| | - Nameirakpam D. Singh
- Department of Molecular Biology and Microbiology, College of Medicine, University of Central Florida, Biomolecular Science Building, Orlando, FL 32816-2364, USA
| | - Roland Herzog
- Department of Pediatrics, College of Medicine, University of Florida, Cancer and Genetics Research Complex, 2033 Mowry Road, Gainesville, FL 32610, USA
| | - Henry Daniell
- Department of Molecular Biology and Microbiology, College of Medicine, University of Central Florida, Biomolecular Science Building, Orlando, FL 32816-2364, USA
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21
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Thompson KM, Pallansch MA, Duintjer Tebbens RJ, Wassilak SG, Kim JH, Cochi SL. Preeradication vaccine policy options for poliovirus infection and disease control. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2013; 33:516-43. [PMID: 23461599 PMCID: PMC7941951 DOI: 10.1111/risa.12019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more than a decade after the original goal of eradicating all three types of WPVs by 2000, policymakers consider many immunization options as they strive to stop transmission in the remaining endemic and outbreak areas and prevent reintroductions of live polioviruses into nonendemic areas. While polio vaccination choices may appear simple, our analysis of current options shows remarkable complexity. We offer important context for current and future polio vaccine decisions and policy analyses by developing decision trees that clearly identify potential options currently used by countries as they evaluate national polio vaccine choices. Based on a comprehensive review of the literature we (1) identify the current vaccination options that national health leaders consider for polio vaccination, (2) characterize current practices and factors that appear to influence national and international choices, and (3) assess the evidence of vaccine effectiveness considering sources of variability between countries and uncertainties associated with limitations of the data. With low numbers of cases occurring globally, the management of polio risks might seem like a relatively low priority, but stopping live poliovirus circulation requires making proactive and intentional choices to manage population immunity in the remaining endemic areas and to prevent reestablishment in nonendemic areas. Our analysis shows remarkable variability in the current national polio vaccine product choices and schedules, with combination vaccine options containing inactivated poliovirus vaccine and different formulations of oral poliovirus vaccine making choices increasingly difficult for national health leaders.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc., , 10524 Moss Park Rd., Ste. 204-364, Orlando, FL 32832, USA.
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22
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23
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24
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25
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Hawken J, Troy SB. Adjuvants and inactivated polio vaccine: a systematic review. Vaccine 2012; 30:6971-9. [PMID: 23041122 DOI: 10.1016/j.vaccine.2012.09.059] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 09/10/2012] [Accepted: 09/22/2012] [Indexed: 11/17/2022]
Abstract
Poliomyelitis is nearing universal eradication; in 2011, there were 650 cases reported globally. When wild polio is eradicated, global oral polio vaccine (OPV) cessation followed by use of universal inactivated polio vaccine (IPV) is believed to be the safest vaccination strategy as IPV does not mutate or run the risk of vaccine derived outbreaks that OPV does. However, IPV is significantly more expensive than OPV. One strategy to make IPV more affordable is to reduce the dose by adding adjuvants, compounds that augment the immune response to the vaccine. No adjuvants are currently utilized in stand-alone IPV; however, several have been explored over the past six decades. From aluminum, used in many licensed vaccines, to newer and more experimental adjuvants such as synthetic DNA, a diverse group of compounds has been assessed with varying strengths and weaknesses. This review summarizes the studies to date evaluating the efficacy and safety of adjuvants used with IPV.
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Estívariz CF, Jafari H, Sutter RW, John TJ, Jain V, Agarwal A, Verma H, Pallansch MA, Singh AP, Guirguis S, Awale J, Burton A, Bahl S, Chatterjee A, Aylward RB. Immunogenicity of supplemental doses of poliovirus vaccine for children aged 6–9 months in Moradabad, India: a community-based, randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2012; 12:128-35. [DOI: 10.1016/s1473-3099(11)70190-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Icardi G, Orsi A, Ceravolo A, Ansaldi F. Current evidence on intradermal influenza vaccines administered by Soluvia™ licensed micro injection system. Hum Vaccin Immunother 2012; 8:67-75. [PMID: 22293531 PMCID: PMC3350142 DOI: 10.4161/hv.8.1.18419] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Among the several strategies explored for (1) the enhancement of the immune response to influenza immunization, (2) the improvement of the vaccine acceptability and (3) the overcoming of the egg-dependency for vaccine production, intradermal administration of influenza vaccine emerges as a promising alternative to conventional intramuscular route, thanks to the recent availability of new delivery devices and the perception of advantages in terms of immunogenicity, safety, reduction of antigen content and acceptability.
Data from clinical trials performed in children, adults <60 y and elderly people and post-marketing surveillance demonstrate that actually, licensed intradermal influenza vaccines, Intanza™ 9 and 15 µg and Fluzone™ Intradermal, administered by the microinjection system Soluvia™, show an excellent acceptability, tolerability and safety profile. Formulations containing 9 and 15 μg per strain demonstrate, respectively, comparable and superior immunogenicity than conventional intramuscular vaccines. Licensed intradermal influenza vaccines can be considered a valid alternative to standard intramuscular vaccination offering significant advantages in low-responder populations and helping to increase influenza vaccination coverage rates especially in people with fear of needles or high apprehension associated with annual vaccination.
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Affiliation(s)
- Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy.
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28
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Nelson KS, Janssen JM, Troy SB, Maldonado Y. Intradermal fractional dose inactivated polio vaccine: A review of the literature. Vaccine 2012; 30:121-5. [DOI: 10.1016/j.vaccine.2011.11.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 11/04/2011] [Accepted: 11/06/2011] [Indexed: 11/26/2022]
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Cadorna-Carlos J, Vidor E, Bonnet MC. Randomized controlled study of fractional doses of inactivated poliovirus vaccine administered intradermally with a needle in the Philippines. Int J Infect Dis 2011; 16:e110-6. [PMID: 22153001 DOI: 10.1016/j.ijid.2011.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 09/14/2011] [Accepted: 10/04/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Comparison of a fractional inactivated poliovirus vaccine (IPV) dose administered intradermally (ID) to a full dose administered intramuscularly (IM). METHODS Healthy Filipino infants were randomized to receive IPV as either a fractional (1/5(th)) dose ID by needle injection or a full dose IM at 6, 10, and 14 weeks and a booster at 15-18 months of age. Pre- and post-vaccination anti-polio 1, 2, and 3 titers were estimated. Adverse events were monitored throughout the study. RESULTS Following primary series vaccination, anti-polio 1, 2, and 3 titers were ≥8 (1/dil) in 99-100% of participants, and the ID route was non-inferior to the IM route. Depending on the study group, antibody persistence was detected in 83-100% of participants, and the booster dose resulted in a strong anamnestic response in all groups. The incidence of adverse events in each group was similar, except for injection-site erythema (higher in the ID group). CONCLUSIONS Primary series and booster vaccination of a fractional IPV dose administered by the ID route was highly immunogenic and well tolerated. These data confirm the medical validity of using fractional ID doses of IPV. The programmatic feasibility of implementing affordable mass vaccination programs based on this delivery mode has yet to be established.
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Abstract
Intradermal (ID) vaccination can offer improved immunity and simpler logistics of delivery, but its use in medicine is limited by the need for simple, reliable methods of ID delivery. ID injection by the Mantoux technique requires special training and may not reliably target skin, but is nonetheless used currently for BCG and rabies vaccination. Scarification using a bifurcated needle was extensively used for smallpox eradication, but provides variable and inefficient delivery into the skin. Recently, ID vaccination has been simplified by introduction of a simple-to-use hollow microneedle that has been approved for ID injection of influenza vaccine in Europe. Various designs of hollow microneedles have been studied preclinically and in humans. Vaccines can also be injected into skin using needle-free devices, such as jet injection, which is receiving renewed clinical attention for ID vaccination. Projectile delivery using powder and gold particles (i.e., gene gun) have also been used clinically for ID vaccination. Building off the scarification approach, a number of preclinical studies have examined solid microneedle patches for use with vaccine coated onto metal microneedles, encapsulated within dissolving microneedles or added topically to skin after microneedle pretreatment, as well as adapting tattoo guns for ID vaccination. Finally, technologies designed to increase skin permeability in combination with a vaccine patch have been studied through the use of skin abrasion, ultrasound, electroporation, chemical enhancers, and thermal ablation. The prospects for bringing ID vaccination into more widespread clinical practice are encouraging, given the large number of technologies for ID delivery under development.
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Affiliation(s)
- Marcel B.M. Teunissen
- , Department of Dermatology, University of Amsterdam, Academic Medica, Meibergdreef 9, Amsterdam, 1105 AZ Netherlands
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31
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Changes in human Langerhans cells following intradermal injection of influenza virus-like particle vaccines. PLoS One 2010; 5:e12410. [PMID: 20811642 PMCID: PMC2928298 DOI: 10.1371/journal.pone.0012410] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 07/29/2010] [Indexed: 12/25/2022] Open
Abstract
There is a significant gap in our fundamental understanding of early morphological and migratory changes in human Langerhans cells (LCs) in response to vaccine stimulation. As the vast majority of LCs studies are conducted in small animal models, substantial interspecies variation in skin architecture and immunity must be considered when extrapolating the results to humans. This study aims to determine whether excised human skin, maintained viable in organ culture, provides a useful human model for measuring and understanding early immune response to intradermally delivered vaccine candidates. Excised human breast skin was maintained viable in air-liquid-interface organ culture. This model was used for the first time to show morphological changes in human LCs stimulated with influenza virus-like particle (VLP) vaccines delivered via intradermal injection. Immunohistochemistry of epidermal sheets and skin sections showed that LCs in VLP treated skin lost their typical dendritic morphology. The cells were more dispersed throughout the epidermis, often in close proximity to the basement membrane, and appeared vertically elongated. Our data provides for increased understanding of the complex morphological, spatial and temporal changes that occur to permit LC migration through the densely packed keratinocytes of the epidermis following exposure to vaccine. Significantly, the data not only supports previous animal data but also provides new and essential evidence of host response to this vaccination strategy in the real human skin environment.
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Mohammed AJ, AlAwaidy S, Bawikar S, Kurup PJ, Elamir E, Shaban MMA, Sharif SM, van der Avoort HGAM, Pallansch MA, Malankar P, Burton A, Sreevatsava M, Sutter RW. Fractional doses of inactivated poliovirus vaccine in Oman. N Engl J Med 2010; 362:2351-9. [PMID: 20573923 DOI: 10.1056/nejmoa0909383] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND We conducted a clinical trial of fractional doses of inactivated poliovirus vaccine administered to infants in Oman, in order to evaluate strategies for making the vaccine affordable for use in developing countries. METHODS We compared fractional doses of inactivated poliovirus vaccine (0.1 ml, representing one fifth of a full dose) given intradermally with the use of a needle-free jet injector device, with full doses of vaccine given intramuscularly, with respect to immunogenicity and reactogenicity. Infants were randomly assigned at birth to receive either a fractional dose or a full dose of inactivated poliovirus vaccine at 2, 4, and 6 months. We also administered a challenge dose of monovalent type 1 oral poliovirus vaccine at 7 months and collected stool samples before and 7 days after administration of the challenge dose. RESULTS A total of 400 infants were randomized, of whom 373 (93.2%) fulfilled the study requirements. No significant baseline differences between the groups were detected. Thirty days after completion of the three-dose schedule, the rates of seroconversion to types 1, 2, and 3 poliovirus were 97.3%, 95.7%, and 97.9%, respectively, in the fractional-dose group, as compared with 100% seroconversion to all serotypes in the full-dose group (P=0.01 for the comparison with respect to type 2 poliovirus; results with respect to types 1 and 3 poliovirus were not significant). The median titers were significantly lower in the fractional-dose group than in the full-dose group (P<0.001 for all three poliovirus serotypes). At 7 months, 74.8% of the infants in the fractional-dose group and 63.1% of those in full-dose group excreted type 1 poliovirus (P=0.03). Between birth and 7 months, 42 hospitalizations were reported, all related to infectious causes, anemia, or falls, with no significant difference between vaccination groups. CONCLUSIONS These data show that fractional doses of inactivated poliovirus vaccine administered intradermally at 2, 4, and 6 months, as compared with full doses of inactivated poliovirus vaccine given intramuscularly on the same schedule, induce similar levels of seroconversion but significantly lower titers. (Current Controlled Trials number, ISRCTN17418767.)
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Intradermal vaccine delivery: will new delivery systems transform vaccine administration? Vaccine 2008; 26:3197-208. [PMID: 18486285 DOI: 10.1016/j.vaccine.2008.03.095] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 03/17/2008] [Accepted: 03/24/2008] [Indexed: 11/23/2022]
Abstract
There has been a recent resurgence of interest in intradermal vaccine delivery. The physiological advantages of intradermal vaccine delivery have been known for some time, but the difficulties associated with performing an intradermal injection have historically limited its use. New delivery systems currently in development facilitate convenient intradermal vaccination, unlocking the potential advantages of this delivery route, and potentially transforming vaccine delivery.
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Kim JS, Hong YJ, Kim JD, Jang YT, Kang JH. Immunogenicity and safety of enhanced-inactivated poliovaccine(eIPV) in healthy Korean infants. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.8.864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jung Soo Kim
- Department of Pediatrics, Chonbuk National University Medical School, Chonbuk, Korea
| | - Young Jin Hong
- Department of Pediatrics, College of Medicine, Inha University, Incheon, Korea
| | - Jong Duk Kim
- Department of Pediatrics, Scool of Medicine, Wonkwang University, Chonbuk, Korea
| | - Young Taek Jang
- Department of Pediatrics, Jeonju Presbyterian Medical Center, Jeonju, Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Korea
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Bompart F. Éradication mondiale de la poliomyélite et stratégies vaccinales. Med Mal Infect 2003. [DOI: 10.1016/s0399-077x(03)00016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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