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Hausdorff WP, Madhi SA, Kang G, Kaboré L, Tufet Bayona M, Giersing BK. Facilitating the development of urgently required combination vaccines. Lancet Glob Health 2024; 12:e1059-e1067. [PMID: 38636529 PMCID: PMC11099297 DOI: 10.1016/s2214-109x(24)00092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 04/20/2024]
Abstract
The essence of a vaccine lies in its ability to elicit a set of immune responses specifically directed at a particular pathogen. Accordingly, vaccines were historically designed, developed, registered, recommended, procured, and administered as monopathogen formulations. Nonetheless, the control and elimination of an astonishing number of diseases was realised only after several once-separate vaccines were provided as combinations. Unfortunately, the current superabundance of recommended and pipeline vaccines is now at odds with the number of acceptable vaccine administrations and feasible health-care visits for vaccine recipients and health-care providers. Yet, few new combinations are in development because, in addition to the scientific and manufacturing hurdles intrinsic to coformulation, developers face a gauntlet of regulatory, policy, and commercialisation obstacles in a milieu still largely designed for monopathogen vaccines. We argue here that national policy makers and public health agencies should prospectively identify and advocate for the development of new multipathogen combination vaccines, and suggest ways to accelerate the regulatory pathways to licensure of combinations and other concrete, innovative steps to mitigate current obstacles.
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Affiliation(s)
- William P Hausdorff
- Center for Vaccine Innovation and Access, PATH, Washington, DC, USA; Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Lassané Kaboré
- PATH, Center for Vaccine Innovation and Access, Dakar, Senegal; Gavi, The Vaccine Alliance, Geneva, Switzerland
| | | | - Birgitte K Giersing
- WHO Department of Immunization, Vaccines and Biologicals, Geneva, Switzerland
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2
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McNamara LA, Neatherlin J. WHO Strategic Advisory Group of Experts on Immunization recommendations for use of a novel pentavalent meningococcal ACWXY vaccine: a critical step towards ending meningococcal epidemics in Africa. J Travel Med 2024; 31:taae002. [PMID: 38195714 DOI: 10.1093/jtm/taae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/04/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024]
Abstract
A new pentavalent meningococcal ACWXY vaccine is poised to have a dramatic impact on the burden of meningococcal disease in the meningitis belt of Africa. Implementation of this vaccine is a critical step towards the first visionary goal of WHO's roadmap to defeat meningitis by 2030: eliminating bacterial meningitis epidemics.
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Affiliation(s)
- Lucy A McNamara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, GA 30329, USA
| | - John Neatherlin
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, GA 30329, USA
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3
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Steffen R, Caumes E. Three novel pentavalent meningococcal vaccines. J Travel Med 2024; 31:taad152. [PMID: 38006362 DOI: 10.1093/jtm/taad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
Invasive meningococcal disease (IMD) is rare in travellers but associated with high mortality and long-term sequelae. Six serogroups (MenABCWXY) account for more than 90% of IMD. Three pentavalent vaccines are on the horizon: two MenABCWY, both with a 0–6 month schedule, highly immunogenic and well tolerated, and one single-dose MenACWXY.
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Affiliation(s)
- Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Zurich, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - Eric Caumes
- Infectious and Tropical Diseases, Sorbonne University, Paris, France
- Centre de diagnostic et de thérapeutique, Hôpital de l'Hôtel-Dieu., Paris, France
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Oduoye MO, Akanbi-Hakeem HB, Muzammil MA, Arama UO, Abbasi HQ, Farhan K, Fariha FNU, Modupeoluwa OO, Paul HW, Badarou ADE, Akilimali A. Meningitis in Niger Republic amidst COVID-19: current issues and novel recommendations. Ann Med Surg (Lond) 2024; 86:345-352. [PMID: 38222679 PMCID: PMC10783331 DOI: 10.1097/ms9.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/05/2023] [Indexed: 01/16/2024] Open
Abstract
Amidst coronavirus disease 2019 (COVID-19), there has been a misplaced priority on meningitis in the Niger Republic, thus refocusing resources and attention away from the continuing meningitis campaign in the Niger Republic. The over-strained state of public health resources and staff has also led to decreased surveillance, postponed diagnoses, and constrained immunization efforts in Niger Republic. This review aims to bridge the gaps regarding meningitis amid COVID-19 in Niger Republic and offer recommendations to government to mitigate meningitis in the country, with the hope of finding a permanent solution to this debilitating disease. The authors reviewed 45 past and present pieces of literature on meningitis and COVID-19 from 2013 to 2023 in well-renowned scientific databases such as PubMed, ResearchGate, Google Scholar, African Journals Online, Medline, and Embase. Since 2015, Niger Republic has experienced multiple meningitis epidemics that have resulted in 20, 789 cases and 1, 369 deaths [a case fatality rate (CFR) of 6.6%]. A total of 231 cases of meningitis were reported from 1 November 2021 to 31 January 2022. And recently, 559 cases of meningitis (of which 111 are laboratory confirmed), including 18 deaths (overall CFR 3.2%), occurred in the Zinder region, southeast of Niger Republic, from 1 November 2022 to 27 January 2023. Meningitis remains a public health concern in the world, especially in Niger Republic, which could lead to serious long-term complications. Therefore, adequate and novel measures and therapeutic actions should be implemented by the Niger Government to lessen the burden of the disease in the country.
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Affiliation(s)
- Malik Olatunde Oduoye
- Ahmadu Bello University, Zaria, Kaduna State
- Department of Research, Medical Research Circle, Bukavu
| | | | | | | | | | - Kanza Farhan
- Medical College, Jinnah Sindh Medical University, Karachi
| | | | | | - Houessou W. Paul
- Faculty of Health Sciences of Andre Salifou Zinder University, Niger Republic
| | - Achiraf-deen E. Badarou
- Department of General Medicine, FSS-Cotonou, Association of Medical Students of Cotonou, Cotonou, Littoral, Benin
| | - Aymar Akilimali
- Department of Research, Medical Research Circle, Bukavu
- Faculty of Medicine, University of Goma, Goma, Democratic Republic of Congo
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5
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van de Beek D, Brouwer MC. Neurological infections in 2023: surveillance and prevention. Lancet Neurol 2024; 23:30-32. [PMID: 38101896 DOI: 10.1016/s1474-4422(23)00445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, Netherlands.
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, Netherlands
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Hossain MJ, Svennerholm AM, Carlin N, D’Alessandro U, Wierzba TF. A Perspective on the Strategy for Advancing ETVAX ®, An Anti-ETEC Diarrheal Disease Vaccine, into a Field Efficacy Trial in Gambian Children: Rationale, Challenges, Lessons Learned, and Future Directions. Microorganisms 2023; 12:90. [PMID: 38257916 PMCID: PMC10819518 DOI: 10.3390/microorganisms12010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
For the first time in over 20 years, an Enterotoxigenic Escherichia coli (ETEC) vaccine candidate, ETVAX®, has advanced into a phase 2b field efficacy trial for children 6-18 months of age in a low-income country. ETVAX® is an inactivated whole cell vaccine that has gone through a series of clinical trials to provide a rationale for the design elements of the Phase 2b trial. This trial is now underway in The Gambia and will be a precursor to an upcoming pivotal phase 3 trial. To reach this point, numerous findings were brought together to define factors such as safe and immunogenic doses for children, and the possible benefit of a mucosal adjuvant, double mutant labile toxin (dmLT). Considering the promising but still underexplored potential of inactivated whole cells in oral vaccination, we present a perspective compiling key observations from past ETVAX® trials that informed The Gambian trial design. This report will update the trial's status and explore future directions for ETEC vaccine trials. Our aim is to provide not only an update on the most advanced ETEC vaccine candidate but also to offer insights beneficial for the development of other much-needed oral whole-cell vaccines against enteric and other pathogens.
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Affiliation(s)
- M. Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Banjul P.O. Box 273, The Gambia
| | - Ann-Mari Svennerholm
- Department of Microbiology and Immunology, Gothenburg University Research Institute (GUVAX), Gothenburg University, 40530 Gothenburg, Sweden
| | - Nils Carlin
- Scandinavian Biopharma, Industrivägen 1, 17148 Solna, Sweden
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Banjul P.O. Box 273, The Gambia
| | - Thomas F. Wierzba
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC 27157, USA
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Mikucki A, Kahler CM. Microevolution and Its Impact on Hypervirulence, Antimicrobial Resistance, and Vaccine Escape in Neisseria meningitidis. Microorganisms 2023; 11:3005. [PMID: 38138149 PMCID: PMC10745880 DOI: 10.3390/microorganisms11123005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Neisseria meningitidis is commensal of the human pharynx and occasionally invades the host, causing the life-threatening illness invasive meningococcal disease. The meningococcus is a highly diverse and adaptable organism thanks to natural competence, a propensity for recombination, and a highly repetitive genome. These mechanisms together result in a high level of antigenic variation to invade diverse human hosts and evade their innate and adaptive immune responses. This review explores the ways in which this diversity contributes to the evolutionary history and population structure of the meningococcus, with a particular focus on microevolution. It examines studies on meningococcal microevolution in the context of within-host evolution and persistent carriage; microevolution in the context of meningococcal outbreaks and epidemics; and the potential of microevolution to contribute to antimicrobial resistance and vaccine escape. A persistent theme is the idea that the process of microevolution contributes to the development of new hyperinvasive meningococcal variants. As such, microevolution in this species has significant potential to drive future public health threats in the form of hypervirulent, antibiotic-resistant, vaccine-escape variants. The implications of this on current vaccination strategies are explored.
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Affiliation(s)
- August Mikucki
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia;
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia
| | - Charlene M. Kahler
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, WA 6009, Australia;
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia
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Griffin DWJ, Hoy JF, McMahon JH. Meningococcal Vaccine in Mali and Gambia. N Engl J Med 2023; 389:577. [PMID: 37590458 DOI: 10.1056/nejmc2307375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
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9
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Kwambana-Adams B. Global burden of meningitis and implications for strategy. Lancet Neurol 2023; 22:646-648. [PMID: 37479364 DOI: 10.1016/s1474-4422(23)00244-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Brenda Kwambana-Adams
- Pneumonia and Meningitis Pathogens Associate Research Group, Malawi Liverpool Wellcome Programme, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Division of Infection and Immunity, University College London, London, UK.
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10
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Foster T, Mooranian A, Al-Salami H. Industry news update, May 2023. Ther Deliv 2023; 14:331-336. [PMID: 37401362 DOI: 10.4155/tde-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Thomas Foster
- The Biotechnology & Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Perth, Western Australia, Australia
- Department of Clinical Biochemistry, Pathwest Laboratory Medicine, Royal Perth Hospital, Perth, 6000, Western Australia, Australia
| | - Armin Mooranian
- The Biotechnology & Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Perth, Western Australia, Australia
- School of Pharmacy, University of Otago, Dunedin, 9016, Otago, New Zealand
| | - Hani Al-Salami
- The Biotechnology & Drug Development Research Laboratory, Curtin Medical School & Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, 6000, Western Australia, Australia
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