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Curran D, Matthews S, Cabrera ES, Pérez SN, Breva LP, Rämet M, Helman L, Park DW, Schwarz TF, Melendez IMG, Schaefer A, Roy N, Stephan B, Molnar D, Kostanyan L, Powers JH, Hulstrøm V. The respiratory syncytial virus prefusion F protein vaccine attenuates the severity of respiratory syncytial virus-associated disease in breakthrough infections in adults ≥60 years of age. Influenza Other Respir Viruses 2024; 18:e13236. [PMID: 38314063 PMCID: PMC10837780 DOI: 10.1111/irv.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/11/2023] [Accepted: 11/21/2023] [Indexed: 02/06/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) is a contagious pathogen causing acute respiratory infections (ARIs). Symptoms range from mild upper respiratory tract infections to potentially life-threatening lower respiratory tract disease (LRTD). In adults ≥60 years old, vaccine efficacy of a candidate vaccine for older adults (RSVPreF3 OA) was 71.7% against RSV-ARI and 82.6% against RSV-LRTD (AReSVi-006/NCT04886596). We present the patient-reported outcomes (PROs) from the same trial at the end of the first RSV season in the northern hemisphere (April 2022). Methods In this phase 3 trial, adults aged ≥60 years were randomized (1:1) to receive one dose of RSVPreF3 OA vaccine or placebo. PROs were assessed using InFLUenza Patient-Reported Outcome (FLU-PRO), Short Form-12 (SF-12), and EuroQol-5 Dimension (EQ-5D) questionnaires. Peak FLU-PRO Chest/Respiratory scores during the first 7 days from ARI episode onset were compared using a Wilcoxon test. Least squares mean (LSMean) of SF-12 physical functioning (PF) and EQ-5D health utility scores were estimated using mixed effects models. Results In the RSVPreF3 OA group (N = 12,466), 27 first RSV-ARI episodes were observed versus 95 in the Placebo group (N = 12,494). Median peak FLU-PRO Chest/Respiratory scores were lower in RSVPreF3 OA (1.07) versus Placebo group (1.86); p = 0.0258. LSMean group differences for the PF and EQ-5D health utility score were 7.00 (95% confidence interval [CI]: -9.86, 23.85; p = 0.4125) and 0.0786 (95% CI: -0.0340, 0.1913; p = 0.1695). Conclusions The RSVPreF3 OA vaccine, in addition to preventing infection, attenuated the severity of RSV-associated symptoms in breakthrough infections, with trends of reduced impact on PF and health utility.
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Affiliation(s)
| | | | | | | | | | - Mika Rämet
- Finnish Vaccine Research Tampere Finland
| | - Laura Helman
- Department of Clinical Medicine George Washington University School of Medicine & Health Sciences Washington District of Columbia USA
| | - Dae Won Park
- Korea University Ansan Hospital Ansan Republic of Korea
| | - Tino F Schwarz
- Institute of Laboratory Medicine and Vaccination Centre Klinikum Würzburg Mitte Würzburg Germany
| | | | | | | | | | | | | | - John H Powers
- Department of Clinical Medicine George Washington University School of Medicine & Health Sciences Washington District of Columbia USA
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Kallás EG, Cintra MAT, Moreira JA, Patiño EG, Braga PE, Tenório JCV, Infante V, Palacios R, de Lacerda MVG, Batista Pereira D, da Fonseca AJ, Gurgel RQ, Coelho ICB, Fontes CJF, Marques ETA, Romero GAS, Teixeira MM, Siqueira AM, Barral AMP, Boaventura VS, Ramos F, Elias Júnior E, Cassio de Moraes J, Covas DT, Kalil J, Precioso AR, Whitehead SS, Esteves-Jaramillo A, Shekar T, Lee JJ, Macey J, Kelner SG, Coller BAG, Boulos FC, Nogueira ML. Live, Attenuated, Tetravalent Butantan-Dengue Vaccine in Children and Adults. N Engl J Med 2024; 390:397-408. [PMID: 38294972 DOI: 10.1056/nejmoa2301790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Butantan-Dengue Vaccine (Butantan-DV) is an investigational, single-dose, live, attenuated, tetravalent vaccine against dengue disease, but data on its overall efficacy are needed. METHODS In an ongoing phase 3, double-blind trial in Brazil, we randomly assigned participants to receive Butantan-DV or placebo, with stratification according to age (2 to 6 years, 7 to 17 years, and 18 to 59 years); 5 years of follow-up is planned. The objectives of the trial were to evaluate overall vaccine efficacy against symptomatic, virologically confirmed dengue of any serotype occurring more than 28 days after vaccination (the primary efficacy end point), regardless of serostatus at baseline, and to describe safety up to day 21 (the primary safety end point). Here, vaccine efficacy was assessed on the basis of 2 years of follow-up for each participant, and safety as solicited vaccine-related adverse events reported up to day 21 after injection. Key secondary objectives were to assess vaccine efficacy among participants according to dengue serostatus at baseline and according to the dengue viral serotype; efficacy according to age was also assessed. RESULTS Over a 3-year enrollment period, 16,235 participants received either Butantan-DV (10,259 participants) or placebo (5976 participants). The overall 2-year vaccine efficacy was 79.6% (95% confidence interval [CI], 70.0 to 86.3) - 73.6% (95% CI, 57.6 to 83.7) among participants with no evidence of previous dengue exposure and 89.2% (95% CI, 77.6 to 95.6) among those with a history of exposure. Vaccine efficacy was 80.1% (95% CI, 66.0 to 88.4) among participants 2 to 6 years of age, 77.8% (95% CI, 55.6 to 89.6) among those 7 to 17 years of age, and 90.0% (95% CI, 68.2 to 97.5) among those 18 to 59 years of age. Efficacy against DENV-1 was 89.5% (95% CI, 78.7 to 95.0) and against DENV-2 was 69.6% (95% CI, 50.8 to 81.5). DENV-3 and DENV-4 were not detected during the follow-up period. Solicited systemic vaccine- or placebo-related adverse events within 21 days after injection were more common with Butantan-DV than with placebo (58.3% of participants, vs. 45.6%). CONCLUSIONS A single dose of Butantan-DV prevented symptomatic DENV-1 and DENV-2, regardless of dengue serostatus at baseline, through 2 years of follow-up. (Funded by Instituto Butantan and others; DEN-03-IB ClinicalTrials.gov number, NCT02406729, and WHO ICTRP number, U1111-1168-8679.).
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Affiliation(s)
- Esper G Kallás
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Monica A T Cintra
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - José A Moreira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Elizabeth G Patiño
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Patricia Emilia Braga
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Juliana C V Tenório
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Vanessa Infante
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ricardo Palacios
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Marcus Vínicius Guimarães de Lacerda
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Dhelio Batista Pereira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Allex Jardim da Fonseca
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ricardo Queiroz Gurgel
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ivo Castelo-Branco Coelho
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Cor Jesus Fernandes Fontes
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Ernesto T A Marques
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Gustavo Adolfo Sierra Romero
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Mauro Martins Teixeira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - André M Siqueira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Aldina Maria Prado Barral
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Viviane Sampaio Boaventura
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Fabiano Ramos
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Erivaldo Elias Júnior
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - José Cassio de Moraes
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Dimas T Covas
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Jorge Kalil
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Alexander Roberto Precioso
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Stephen S Whitehead
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Alejandra Esteves-Jaramillo
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Tulin Shekar
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Jung-Jin Lee
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Julieta Macey
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Sabrina Gozlan Kelner
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Beth-Ann G Coller
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Fernanda Castro Boulos
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
| | - Mauricio L Nogueira
- From Instituto Butantan (E.G.K., M.A.T.C., J.A.M., E.G.P., P.E.B., J.C.V.T., V.I., R.P., D.T.C., J.K., A.R.P., F.C.B.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (E.G.K.), Departamento de Saúde Coletiva, Faculdade de Ciências Médicas Santa Casa de São Paulo (J.C.M.), and Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo (J.K.), São Paulo, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (M.V.G.L.), Centro de Pesquisa em Medicina Tropical de Rôndonia, Porto Velho (D.B.P.), Universidade Federal de Roraima, Boa Vista (A.J.F.), Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju (R.Q.G.), Faculdade de Medicina da Universidade Federal do Ceará, Fortaleza (I.C.-B.C.), Hospital Universitário Júlio Müller, Cuiabá (C.J.F.F.), Institute Aggeu Magalhães, Fundação Oswaldo Cruz, Recife (E.T.A.M.), Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília (G.A.S.R.), the Center for Advanced and Innovative Therapies, Universidade Federal de Minas Gerais, Belo Horizonte (M.M.T.), Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro (A.M.S.), Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz-Instituto Gonçalo Moniz (IGM/FIOCRUZ), Salvador (A.M.P.B., V.S.B.), Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre (F.R.), Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande (E.E.J.), Faculdade de Medicina de Ribeirão Preto, Universidade of São Paulo, Ribeirão Preto (D.T.C.), and Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (M.L.N.) - all in Brazil; the School of Public Health, University of Pittsburgh, Pittsburgh (E.T.A.M.); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.S.W.); Merck, Rahway, NJ (A.E.-J., T.S., J.-J.L., S.G.K., B.-A.G.C.); Merck Sharp and Dohme, Munro, Argentina (J.M.); and the Department of Pathology, University of Texas Medical Branch, Galveston (M.L.N.)
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Das R, Blázquez-Gamero D, Bernstein DI, Gantt S, Bautista O, Beck K, Conlon A, Rosenbloom DIS, Wang D, Ritter M, Arnold B, Annunziato P, Russell KL. Safety, efficacy, and immunogenicity of a replication-defective human cytomegalovirus vaccine, V160, in cytomegalovirus-seronegative women: a double-blind, randomised, placebo-controlled, phase 2b trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:1383-1394. [PMID: 37660711 DOI: 10.1016/s1473-3099(23)00343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/25/2023] [Accepted: 05/10/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND A vaccine that prevents cytomegalovirus (CMV) infection in women could reduce the incidence of congenital CMV infection, a major cause of neurodevelopmental disability. We aimed to assess the safety and efficacy of a replication-defective investigational CMV vaccine, V160, in CMV-seronegative women. METHODS This phase 2b, randomised, double-blind, placebo-controlled study was conducted at 90 sites in seven countries (USA, Finland, Canada, Israel, Spain, Russia, and Australia). Eligible participants were generally healthy, CMV-seronegative, non-pregnant, 16-35-year-old women of childbearing potential with exposure to children aged 5 years or younger. Participants were randomly assigned using central randomisation via an interactive response technology system 1:1:1 to one of three groups: V160 three-dose regimen (V160 at day 1, month 2, and month 6), V160 two-dose regimen (V160 on day 1, placebo at month 2, and V160 at month 6), or placebo (saline solution at day 1, month 2, and month 6). The primary outcomes were the efficacy of three doses of V160 in reducing the incidence of primary CMV infection during the follow-up period starting 30 days after the last dose of vaccine using a fixed event rate design, and the safety and tolerability of the two-dose and three-dose V160 regimens. We planned to test the efficacy of a two-dose regimen of V160 in reducing the incidence of primary CMV infection only if the primary efficacy hypothesis was met. Analyses for the primary efficacy endpoint were performed on the per-protocol efficacy population; safety analyses included all randomly assigned participants who received study vaccine. The primary efficacy hypothesis was tested at prespecified interim and final analyses. The study was ongoing and efficacy data continued to accrue at the time of final testing of the primary efficacy hypothesis. Vaccine efficacy was re-estimated after final testing of the primary efficacy hypothesis based on all available efficacy data at end of study. This trial is registered at ClinicalTrials.gov (NCT03486834) and EudraCT (2017-004233-86) and is complete. FINDINGS Between April 30, 2018, and Aug 30, 2019, 7458 participants were screened, of whom 2220 were randomly assigned to the V160 three-dose group (n=733), V160 two-dose group (n=733), or placebo group (n=734). A total of 523 participants in the V160 three-dose group and 519 in the placebo group were included in the final hypothesis testing. Of these, there were 11 cases of CMV infection in the V160 three-dose group and 20 cases in the placebo group. The vaccine efficacy for the V160 three-dose group was 44·6% (95% CI -15·2 to 74·8) at the final testing of the primary efficacy hypothesis, a result corresponding to failure to demonstrate the primary efficacy hypothesis. On the basis of this result, the study was terminated for futility. The re-estimate of vaccine efficacy for the V160 three-dose group based on all available efficacy data at end of study (556 participants in the V160 three-dose group and 543 in the placebo group) was 42·4% (95% CI -13·5 to 71·1). A total of 728 participants in the V160 three-dose group, 729 in the V160 two-dose group, and 732 in the placebo group were included in the safety analyses. The most common solicited injection-site adverse event was injection-site pain (680 [93%] in the V160 three-dose group, 659 [90%] in the V160 two-dose group, and 232 [32%] in the placebo group). The most common solicited systemic adverse event was fatigue (457 [63%] in the V160 three-dose group, 461 [63%] in the V160 two-dose group, and 357 [49%] in the placebo group). No vaccine-related serious adverse events or deaths were reported. INTERPRETATION V160 was generally well tolerated and immunogenic; however, three doses of the vaccine did not reduce the incidence of primary CMV infection in CMV-seronegative women compared with placebo. This study provides insights into the design of future CMV vaccine efficacy trials, particularly for the identification of CMV infection using molecular assays. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co, Rahway, NJ, USA (MSD).
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Affiliation(s)
| | - Daniel Blázquez-Gamero
- Instituto de Investigación Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - David I Bernstein
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Soren Gantt
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, QC, Canada
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Bose M, Biswas A. Sample sizes required to estimate the protective efficacy of a vaccine when there is an unequal allocation of individuals across the vaccine and placebo groups. Stat Methods Med Res 2023; 32:1859-1879. [PMID: 37647224 DOI: 10.1177/09622802231176807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The effectiveness of a vaccine is measured by means of protective vaccine efficacy, defined by V E = 1 - A R V A R U , where A R V and A R U are, respectively, the disease attack rates in the vaccinated and the unvaccinated population. For each of the cohoret and case-control designs, methods have been presented in the literature for calculating the required sample size when the desired width of the confidence interval and the probability of coverage are pre-specified, where an equal number of individuals were assumed to be allocated to the vaccine and placebo group. In this article, we present a method for calculating the required sample size with a specified degree of precision when there is an unequal allocation of individuals across the two groups. The sample size required to achieve a desired power for the relevant level α test has also been explored, keeping the unequal allocation proportion in mind. The fraction of individuals allocated to the placebo group (ρ ) can be so chosen that the total sample size or the expected number of people developing the disease or some other criteria of interest is minimized.
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Affiliation(s)
- Meghna Bose
- Applied Statistics Unit, Indian Statistical Institute, Kolkata, India
| | - Atanu Biswas
- Applied Statistics Unit, Indian Statistical Institute, Kolkata, India
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Kampmann B, Madhi SA, Munjal I, Simões EAF, Pahud BA, Llapur C, Baker J, Pérez Marc G, Radley D, Shittu E, Glanternik J, Snaggs H, Baber J, Zachariah P, Barnabas SL, Fausett M, Adam T, Perreras N, Van Houten MA, Kantele A, Huang LM, Bont LJ, Otsuki T, Vargas SL, Gullam J, Tapiero B, Stein RT, Polack FP, Zar HJ, Staerke NB, Duron Padilla M, Richmond PC, Koury K, Schneider K, Kalinina EV, Cooper D, Jansen KU, Anderson AS, Swanson KA, Gruber WC, Gurtman A. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med 2023; 388:1451-1464. [PMID: 37018474 DOI: 10.1056/nejmoa2216480] [Citation(s) in RCA: 211] [Impact Index Per Article: 211.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV)-associated lower respiratory tract illness in newborns and infants is uncertain. METHODS In this phase 3, double-blind trial conducted in 18 countries, we randomly assigned, in a 1:1 ratio, pregnant women at 24 through 36 weeks' gestation to receive a single intramuscular injection of 120 μg of a bivalent RSV prefusion F protein-based (RSVpreF) vaccine or placebo. The two primary efficacy end points were medically attended severe RSV-associated lower respiratory tract illness and medically attended RSV-associated lower respiratory tract illness in infants within 90, 120, 150, and 180 days after birth. A lower boundary of the confidence interval for vaccine efficacy (99.5% confidence interval [CI] at 90 days; 97.58% CI at later intervals) greater than 20% was considered to meet the success criterion for vaccine efficacy with respect to the primary end points. RESULTS At this prespecified interim analysis, the success criterion for vaccine efficacy was met with respect to one primary end point. Overall, 3682 maternal participants received vaccine and 3676 received placebo; 3570 and 3558 infants, respectively, were evaluated. Medically attended severe lower respiratory tract illness occurred within 90 days after birth in 6 infants of women in the vaccine group and 33 infants of women in the placebo group (vaccine efficacy, 81.8%; 99.5% CI, 40.6 to 96.3); 19 cases and 62 cases, respectively, occurred within 180 days after birth (vaccine efficacy, 69.4%; 97.58% CI, 44.3 to 84.1). Medically attended RSV-associated lower respiratory tract illness occurred within 90 days after birth in 24 infants of women in the vaccine group and 56 infants of women in the placebo group (vaccine efficacy, 57.1%; 99.5% CI, 14.7 to 79.8); these results did not meet the statistical success criterion. No safety signals were detected in maternal participants or in infants and toddlers up to 24 months of age. The incidences of adverse events reported within 1 month after injection or within 1 month after birth were similar in the vaccine group (13.8% of women and 37.1% of infants) and the placebo group (13.1% and 34.5%, respectively). CONCLUSIONS RSVpreF vaccine administered during pregnancy was effective against medically attended severe RSV-associated lower respiratory tract illness in infants, and no safety concerns were identified. (Funded by Pfizer; MATISSE ClinicalTrials.gov number, NCT04424316.).
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Affiliation(s)
- Beate Kampmann
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Shabir A Madhi
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Iona Munjal
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Eric A F Simões
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Barbara A Pahud
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Conrado Llapur
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Jeffrey Baker
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Gonzalo Pérez Marc
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - David Radley
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Emma Shittu
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Julia Glanternik
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Hasra Snaggs
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - James Baber
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Philip Zachariah
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Shaun L Barnabas
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Merlin Fausett
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Tyler Adam
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Nicole Perreras
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Marlies A Van Houten
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Anu Kantele
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Li-Min Huang
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Louis J Bont
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Takeo Otsuki
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Sergio L Vargas
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Joanna Gullam
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Bruce Tapiero
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Renato T Stein
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Fernando P Polack
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Heather J Zar
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Nina B Staerke
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - María Duron Padilla
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Peter C Richmond
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Kenneth Koury
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Katherine Schneider
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Elena V Kalinina
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - David Cooper
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Kathrin U Jansen
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Annaliesa S Anderson
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Kena A Swanson
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - William C Gruber
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
| | - Alejandra Gurtman
- From the Medical Research Council Unit the Gambia, London School of Hygiene and Tropical Medicine, Fajara, Gambia (B.K.); the Institute for International Health Charité, Universitätsmedizin, Berlin (B.K.); the South African Medical Research Council (MRC) Vaccines and Infectious Diseases Analytics Research Unit, Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.), and Family Centre for Research with Ubuntu, Department of Paediatrics and Child Health, University of Stellenbosch (S.L.B.), and the Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, South African MRC Unit on Child and Adolescent Health, University of Cape Town (H.J.Z.), Cape Town - all in South Africa; Vaccine Research and Development, Pfizer, Pearl River, NY (I.M., B.A.P., D.R., J. Glanternik, H.S., P.Z., K.K., K.S., E.V.K., D.C., K.U.J., A.S.A., K.A.S., W.C.G., A.G.); Children's Hospital Colorado, Aurora (E.A.F.S.); Instituto de Maternidad y Ginecología Nuestra Señora de Las Mercedes, San Miguel de Tucumán (C.L.), and iTrials-Hospital Militar Central (G.P.M., F.P.P.) and iTrials (S.L.V.), Buenos Aires - all in Argentina; Clinical Research Prime, Idaho Falls, ID (J. Baker); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (E.S.); Vaccine Clinical Research, Pfizer, Sydney, NSW (J. Baber), and the University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, and Perth Children's Hospital, Nedlands, WA (P.C.R.) - all in Australia; Boeson Research, Missoula, MT (M.F.); Meridian Clinical Research, Hastings, NE (T.A.); Asian Hospital and Medical Center, Manila, Philippines (N.P.); the Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp (M.A.V.H.), and the Departments of Pediatrics and Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, and Respiratory Syncytial Virus Network Foundation, Zeist (L.J.B.) - all in the Netherlands; Meilahti Vaccine Research Center, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki (A.K.); National Taiwan University Hospital, Taipei (L.-M.H.); the Department of Obstetrics and Gynecology, Sendai City Hospital, Sendai, Japan (T.O.); the Institute of Biomedical Sciences, University of Chile School of Medicine, Santiago, Chile (S.L.V.); University of Otago and New Zealand Clinical Research - both in Christchurch, New Zealand (J. Gullam); Centre Hospitalier Universitaire Sainte-Justine, Montreal (B.T.); Hospital Moinhos de Vento and Pontifícia Universidade Católica do Rio Grande do Sul - both in Porto Alegre, Brazil (R.T.S.); the Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark (N.B.S.); and Arké Study Management Organization, Mexico City (M.D.P.)
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Papi A, Ison MG, Langley JM, Lee DG, Leroux-Roels I, Martinon-Torres F, Schwarz TF, van Zyl-Smit RN, Campora L, Dezutter N, de Schrevel N, Fissette L, David MP, Van der Wielen M, Kostanyan L, Hulstrøm V. Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults. N Engl J Med 2023; 388:595-608. [PMID: 36791160 DOI: 10.1056/nejmoa2209604] [Citation(s) in RCA: 185] [Impact Index Per Article: 185.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is an important cause of acute respiratory infection, lower respiratory tract disease, clinical complications, and death in older adults. There is currently no licensed vaccine against RSV infection. METHODS In an ongoing, international, placebo-controlled, phase 3 trial, we randomly assigned, in a 1:1 ratio, adults 60 years of age or older to receive a single dose of an AS01E-adjuvanted RSV prefusion F protein-based candidate vaccine (RSVPreF3 OA) or placebo before the RSV season. The primary objective was to show vaccine efficacy of one dose of the RSVPreF3 OA vaccine against RSV-related lower respiratory tract disease, confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), during one RSV season. The criterion for meeting the primary objective was a lower limit of the confidence interval around the efficacy estimate of more than 20%. Efficacy against severe RSV-related lower respiratory tract disease and RSV-related acute respiratory infection was assessed, and analyses according to RSV subtype (A and B) were performed. Safety was evaluated. RESULTS A total of 24,966 participants received one dose of the RSVPreF3 OA vaccine (12,467 participants) or placebo (12,499). Over a median follow-up of 6.7 months, vaccine efficacy against RT-PCR-confirmed RSV-related lower respiratory tract disease was 82.6% (96.95% confidence interval [CI], 57.9 to 94.1), with 7 cases (1.0 per 1000 participant-years) in the vaccine group and 40 cases (5.8 per 1000 participant-years) in the placebo group. Vaccine efficacy was 94.1% (95% CI, 62.4 to 99.9) against severe RSV-related lower respiratory tract disease (assessed on the basis of clinical signs or by the investigator) and 71.7% (95% CI, 56.2 to 82.3) against RSV-related acute respiratory infection. Vaccine efficacy was similar against the RSV A and B subtypes (for RSV-related lower respiratory tract disease: 84.6% and 80.9%, respectively; for RSV-related acute respiratory infection: 71.9% and 70.6%, respectively). High vaccine efficacy was observed in various age groups and in participants with coexisting conditions. The RSVPreF3 OA vaccine was more reactogenic than placebo, but most adverse events for which reports were solicited were transient, with mild-to-moderate severity. The incidences of serious adverse events and potential immune-mediated diseases were similar in the two groups. CONCLUSIONS A single dose of the RSVPreF3 OA vaccine had an acceptable safety profile and prevented RSV-related acute respiratory infection and lower respiratory tract disease and severe RSV-related lower respiratory tract disease in adults 60 years of age or older, regardless of RSV subtype and the presence of underlying coexisting conditions. (Funded by GlaxoSmithKline Biologicals; AReSVi-006 ClinicalTrials.gov number, NCT04886596.).
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Affiliation(s)
- Alberto Papi
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Michael G Ison
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Joanne M Langley
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Dong-Gun Lee
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Isabel Leroux-Roels
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Federico Martinon-Torres
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Tino F Schwarz
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Richard N van Zyl-Smit
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Laura Campora
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Nancy Dezutter
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Nathalie de Schrevel
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Laurence Fissette
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Marie-Pierre David
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Marie Van der Wielen
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Lusine Kostanyan
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
| | - Veronica Hulstrøm
- From the Pulmonary Division, University of Ferrara, St. Anna University Hospital, Ferrara, Italy (A.P.); the Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago (M.G.I.); the Canadian Center for Vaccinology, Dalhousie University, IWK Health and Nova Scotia Health, Halifax, Canada (J.M.L.); the Division of Infectious Diseases, Department of Internal Medicine, the Catholic University of Korea, Seoul, South Korea (D.-G.L.); the Center for Vaccinology, Ghent University, and Ghent University Hospital, Ghent (I.L.-R.), GSK, Wavre (L.C., N.D., L.F., M.-P.D., M.V.W., L.K., V.H.), and GSK, Rixensart (N.S.) - all in Belgium; Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, the Genetics, Vaccines, Infectious Diseases, and Pediatrics Research Group, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (F.M.-T.); the Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Campus Juliusspital, Würzburg, Germany (T.F.S.); and the Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, and Groote Schuur Hospital, Cape Town, South Africa (R.N.Z.-S.)
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Miyake M, Nishimura N, Nakahama T, Nishimoto K, Oyama M, Matsushita Y, Miyake H, Fukuhara H, Inoue K, Kobayashi K, Matsumoto H, Matsuyama H, Fujii T, Hirao Y, Fujimoto K. Additional oncological benefit of photodynamic diagnosis with blue light cystoscopy in transurethral resection for primary non‐muscle‐invasive bladder cancer: A comparative study from experienced institutes. BJUI COMPASS 2023; 4:305-313. [PMID: 37025476 PMCID: PMC10071077 DOI: 10.1002/bco2.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
Objectives The objective of this work is to evaluate the additional oncological benefit of photodynamic diagnosis (PDD) using blue-light cystoscopy in transurethral resection (TURBT) for primary non-muscle-invasive bladder cancer (NMIBC) based on the International Bladder Cancer Group (IBCG)-defined progression and the subsequent pathological pathways. Patients and Methods We reviewed 1578 consecutive primary NMIBC patients undergoing white-light TURBT (WL-TURBT) or PDD-TURBT during 2006-2020. One-to-one propensity score-matching was performed using multivariable logistic regression to obtain balanced groups. IBCG-defined progression of NMIBC included stage-up and grade-up as well as conventional definitions such as the development of muscle-invasive BC or metastatic disease. Nine oncological endpoints were evaluated. Sankey diagrams were generated to visualize follow-up pathological pathways after the initial TURBT. Results Comparison of event-free survival between the matched groups revealed that PDD use decreased the bladder cancer recurrence risk and IBCG-defined progression risk, whereas no significant difference was noted in conventionally defined progression. This was attributable to a reduced risk of stage-up, from Ta to T1, and grade-up. Sankey diagrams of the matched groups showed that patients with primary Ta low-grade tumour and first-recurrence Ta low-grade tumour did not have bladder recurrence or progression, while some of those in the WL-TURBT group developed recurrence after treatment. Conclusions The multiple survival analysis demonstrated that the risk of IBCG-defined progression was significantly decreased by PDD use in NMIBC patients. Sankey diagrams revealed possible differences in pathological pathways after the initial TURBT between the two groups, demonstrating that repeated recurrence could be prevented by PDD use.
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Affiliation(s)
- Makito Miyake
- Department of Urology Nara Medical University Kashihara Nara Japan
| | | | | | - Koshiro Nishimoto
- Department of Uro‐Oncology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Masafumi Oyama
- Department of Uro‐Oncology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Yuto Matsushita
- Department of Urology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Hideaki Miyake
- Department of Urology Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | - Hideo Fukuhara
- Department of Urology Kochi Medical School Nankoku Kochi Japan
| | - Keiji Inoue
- Department of Urology Kochi Medical School Nankoku Kochi Japan
| | - Keita Kobayashi
- Department of Urology, Graduate School of Medicine Yamaguchi University Ube Yamaguchi Japan
| | - Hiroaki Matsumoto
- Department of Urology, Graduate School of Medicine Yamaguchi University Ube Yamaguchi Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine Yamaguchi University Ube Yamaguchi Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology Nara Medical University Kashihara Nara Japan
| | - Yoshihiko Hirao
- Department of Urology Osaka Gyoumeikan Hospital Konohana‐ku Osaka Japan
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8
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Callegaro A, Karkada N, Aris E, Zahaf T. Vaccine clinical trials with dynamic borrowing of historical controls: Two retrospective studies. Pharm Stat 2023; 22:475-491. [PMID: 36606496 DOI: 10.1002/pst.2283] [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: 05/03/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 01/07/2023]
Abstract
Traditional vaccine efficacy trials usually use fixed designs with fairly large sample sizes. Recruiting a large number of subjects requires longer time and higher costs. Furthermore, vaccine developers are more than ever facing the need to accelerate vaccine development to fulfill the public's medical needs. A possible approach to accelerate development is to use the method of dynamic borrowing of historical controls in clinical trials. In this paper, we evaluate the feasibility and the performance of this approach in vaccine development by retrospectively analyzing two real vaccine studies: a relatively small immunological trial (typical early phase study) and a large vaccine efficacy trial (typical Phase 3 study) assessing prophylactic human papillomavirus vaccine. Results are promising, particularly for early development immunological studies, where the adaptive design is feasible, and control of type I error is less relevant.
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Affiliation(s)
| | | | - Emmanuel Aris
- Department of Biostatistics, GSK, Rixensart, Belgium
| | - Toufik Zahaf
- Department of Biostatistics, GSK, Rixensart, Belgium
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9
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Zhao FH, Wu T, Hu YM, Wei LH, Li MQ, Huang WJ, Chen W, Huang SJ, Pan QJ, Zhang X, Hong Y, Zhao C, Li Q, Chu K, Jiang YF, Li MZ, Tang J, Li CH, Guo DP, Ke LD, Wu X, Yao XM, Nie JH, Lin BZ, Zhao YQ, Guo M, Zhao J, Zheng FZ, Xu XQ, Su YY, Zhang QF, Sun G, Zhu FC, Li SW, Li YM, Pan HR, Zhang J, Qiao YL, Xia NS. Efficacy, safety, and immunogenicity of an Escherichia coli-produced Human Papillomavirus (16 and 18) L1 virus-like-particle vaccine: end-of-study analysis of a phase 3, double-blind, randomised, controlled trial. THE LANCET. INFECTIOUS DISEASES 2022; 22:1756-1768. [PMID: 36037823 DOI: 10.1016/s1473-3099(22)00435-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND This Escherichia coli-produced bivalent HPV 16 and 18 vaccine was well tolerated and effective against HPV 16 and 18 associated high-grade genital lesions and persistent infection in interim analysis of this phase 3 trial. We now report data on long-term efficacy and safety after 66 months of follow-up. METHODS This phase 3, double-blind, randomised, controlled trial was done in five study sites in China. Eligible participants were women aged 18-45 years, with intact cervix and 1-4 lifetime sexual partners. Women who were pregnant or breastfeeding, had chronic disease or immunodeficiency, or had HPV vaccination history were excluded. Women were stratified by age (18-26 and 27-45 years) and randomly (1:1) allocated by software (block randomisation with 12 codes to a block) to receive three doses of the E coli-produced HPV 16 and 18 vaccine or hepatitis E vaccine (control) and followed-up for 66 months. The primary outcomes were high-grade genital lesions and persistent infection (longer than 6 months) associated with HPV 16 or 18 in the per-protocol susceptible population. This trial was registered with ClinicalTrials.gov, NCT01735006. FINDINGS Between Nov 22, 2012, and April 1, 2013, 8827 women were assessed for eligibility. 1455 women were excluded, and 7372 women were enrolled and randomly assigned to receive the HPV vaccine (n=3689) or control (n=3683). Vaccine efficacy was 100·0% (95% CI 67·2-100·0) against high-grade genital lesions (0 [0%] of 3310 participants in the vaccine group and 13 [0·4%] of 3302 participants in the control group) and 97·3% (89·9-99·7) against persistent infection (2 [0·1%] of 3262 participants in the vaccine group and 73 [2·2%] of 3271 participants in the control group) in the per-protocol population. Serious adverse events occurred at a similar rate between vaccine (267 [7·2%] of 3691 participants) and control groups (290 [7·9%] of 3681); none were considered related to vaccination. INTERPRETATION The E coli-produced HPV 16 and 18 vaccine was well tolerated and highly efficacious against HPV 16 and 18 associated high-grade genital lesions and persistent infection and would supplement the global HPV vaccine availability and accessibility for cervical cancer prevention. FUNDING National Natural Science Foundation of China, National Key R&D Program of China, Fujian Provincial Project, Fundamental Funds for the Central Universities, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, and Xiamen Innovax.
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Affiliation(s)
- Fang-Hui Zhao
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China; Xiang An Biomedicine Laboratory, Xiamen, Fujian, China
| | - Yue-Mei Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Li-Hui Wei
- Peking University People's Hospital, Beijing, China
| | - Ming-Qiang Li
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Wei-Jin Huang
- National Institute for Food and Drug Control, Beijing, China
| | - Wen Chen
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Shou-Jie Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China; Xiang An Biomedicine Laboratory, Xiamen, Fujian, China
| | - Qin-Jing Pan
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Xun Zhang
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Ying Hong
- the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Chao Zhao
- Peking University People's Hospital, Beijing, China
| | - Qing Li
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Kai Chu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yun-Fei Jiang
- the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ming-Zhu Li
- Peking University People's Hospital, Beijing, China
| | - Jie Tang
- Funing Center for Disease Control and Prevention, Funing, Jiangsu, China
| | - Cai-Hong Li
- Xinmi Maternal and Child Health Hospital, Xinmi, Henan, China
| | - Dong-Ping Guo
- Yangcheng Maternal and Child Health Hospital, Yangcheng, Shanxi, China
| | - Li-Dong Ke
- Fengning Hospital of Traditional Chinese Medicine, Fengning, Hebei, China
| | - Xin Wu
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Xing-Mei Yao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jian-Hui Nie
- National Institute for Food and Drug Control, Beijing, China
| | - Bi-Zhen Lin
- Xiamen Innovax Biotech Xiamen, Fujian, China
| | - Yu-Qian Zhao
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Meng Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | | | - Xiao-Qian Xu
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Ying-Ying Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China; Xiang An Biomedicine Laboratory, Xiamen, Fujian, China
| | | | - Guang Sun
- Xiamen Innovax Biotech Xiamen, Fujian, China
| | - Feng-Cai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Shao-Wei Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China; Xiang An Biomedicine Laboratory, Xiamen, Fujian, China
| | - Yi-Min Li
- Beijing Wantai Biological Pharmacy Enterprise, Beijing, China
| | | | - Jun Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China; Xiang An Biomedicine Laboratory, Xiamen, Fujian, China.
| | - You-Lin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Shao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China; Xiang An Biomedicine Laboratory, Xiamen, Fujian, China; Research Unit of Frontier Technology of Structural Vaccinology of Chinese Academy of Medical Sciences, China
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10
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He X, Su J, Ma Y, Zhang W, Tang S. A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines. Front Immunol 2022; 13:945930. [PMID: 36090988 PMCID: PMC9459021 DOI: 10.3389/fimmu.2022.945930] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
It is urgently needed to update the comprehensive analysis about the efficacy or effectiveness of COVID-19 vaccines especially during the COVID-19 pandemic caused by SARS-CoV-2 Delta and Omicron variants. In general, the current COVID-19 vaccines showed a cumulative efficacy of 66.4%, 79.7%, and 93.6% to prevent SARS-CoV-2 infection, symptomatic COVID-19, and severe COVID-19, respectively, but could not prevent the asymptomatic infection of SARS-CoV-2. Furthermore, the current COVID-19 vaccines could effectively prevent COVID-19 caused by the Delta variant although the incidence of breakthrough infection of the SARS-CoV-2 Delta variant increased when the intervals post full vaccination extended, suggesting the waning effectiveness of COVID-19 vaccines. In addition, one-dose booster immunization showed an effectiveness of 74.5% to prevent COVID-19 caused by the Delta variant. However, current COVID-19 vaccines could not prevent the infection of Omicron sub-lineage BA.1.1.529 and had about 50% effectiveness to prevent COVID-19 caused by Omicron sub-lineage BA.1.1.529. Furthermore, the effectiveness was 87.6% and 90.1% to prevent severe COVID-19 and COVID-19-related death caused by Omicron sub-lineage BA.2, respectively, while one-dose booster immunization could enhance the effectiveness of COVID-19 vaccines to prevent the infection and COVID-19 caused by Omicron sub-lineage BA.1.1.529 and sub-lineage BA.2. Two-dose booster immunization showed an increased effectiveness of 81.8% against severe COVID-19 caused by the Omicron sub-lineage BA.1.1.529 variant compared with one-dose booster immunization. The effectiveness of the booster immunization with RNA-based vaccine BNT162b2 or mRNA-1273 was over 75% against severe COVID-19 more than 17 weeks after booster immunization whereas the heterogenous booster immunization showed better effectiveness than homologous booster immunization. In summary, the current COVID-19 vaccines could effectively protect COVID-19 caused by Delta and Omicron variants but was less effective against Omicron variant infection. One-dose booster immunization could enhance protection capability, and two-dose booster immunization could provide additional protection against severe COVID-19.
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Affiliation(s)
- Xiaofeng He
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
- Institute of Evidence-Based Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Jiao Su
- Department of biochemistry, Changzhi Medical College, Changzhi, China
| | - Yu’nan Ma
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Wenping Zhang
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Shixing Tang,
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11
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Wu Z, Li Q, Liu Y, Lv H, Mo Z, Li F, Yu Q, Jin F, Chen W, Zhang Y, Huang T, Hu X, Xia W, Gao J, Zhou H, Bai X, Liu Y, Liang Z, Jiang Z, Chen Y, Zhang J, Du J, Yang B, Xing B, Xing Y, Dong B, Yang Q, Shi C, Yan T, Ruan B, Shi H, Fan X, Feng D, Lv W, Zhang D, Kong X, Zhou L, Que D, Chen H, Chen Z, Guo X, Zhou W, Wu C, Zhou Q, Liu Y, Qiao J, Wang Y, Li X, Duan K, Zhao Y, Yang X, Xu G. Efficacy, safety and immunogenicity of hexavalent rotavirus vaccine in Chinese infants. Virol Sin 2022; 37:724-730. [PMID: 35926726 PMCID: PMC9583109 DOI: 10.1016/j.virs.2022.07.011] [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: 04/16/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
A randomized, double-blind, placebo-controlled multicenter trial was conducted in healthy Chinese infants to assess the efficacy and safety of a hexavalent live human-bovine reassortant rotavirus vaccine (HRV) against rotavirus gastroenteritis (RVGE). A total of 6400 participants aged 6–12 weeks were enrolled and randomly assigned to either HRV (n = 3200) or placebo (n = 3200) group. All the subjects received three oral doses of vaccine four weeks apart. The vaccine efficacy (VE) against RVGE caused by rotavirus serotypes contained in HRV was evaluated from 14 days after three doses of administration up until the end of the second rotavirus season. VE against severe RVGE, VE against RVGE hospitalization caused by serotypes contained in HRV, and VE against RVGE, severe RVGE, and RVGE hospitalization caused by natural infection of any serotype of rotavirus were also investigated. All adverse events (AEs) were collected for 30 days after each dose. Serious AEs (SAEs) and intussusception cases were collected during the entire study. Our data showed that VE against RVGE caused by serotypes contained in HRV was 69.21% (95%CI: 53.31–79.69). VE against severe RVGE and RVGE hospitalization caused by serotypes contained in HRV were 91.36% (95%CI: 78.45–96.53) and 89.21% (95%CI: 64.51–96.72) respectively. VE against RVGE, severe RVGE, and RVGE hospitalization caused by natural infection of any serotype of rotavirus were 62.88% (95%CI: 49.11–72.92), 85.51% (95%CI: 72.74–92.30) and 83.68% (95%CI: 61.34–93.11). Incidences of AEs from the first dose to one month post the third dose in HRV and placebo groups were comparable. There was no significant difference in incidences of SAEs in HRV and placebo groups. This study shows that this hexavalent reassortant rotavirus vaccine is an effective, well-tolerated, and safe vaccine for Chinese infants. A multicenter, double-blind, phase III clinical trial for the efficacy and safety of hexavalent rotavirus vaccine (HRV). The vaccine efficacy against rotavirus gastroenteritis caused by serotypes contained in HRV was 69.21%. The efficacy against severe rotavirus gastroenteritis and hospitalization caused by serotypesin HRV were 91.36% and 89.21%. No significant difference between the incidences of adverse events and severe adverse events in HRV and placebo group. This hexavalent live human-bovine reassortant rotavirus vaccine iseffective, well tolerated and safe in Chinese infants.
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Affiliation(s)
- Zhiwei Wu
- Hebei Center for Disease Control and Prevention, Shijiazhuang, 050021, China
| | - Qingliang Li
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yan Liu
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Huakun Lv
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Zhaojun Mo
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Fangjun Li
- Hunan Center for Disease Control and Prevention, Changsha, 410005, China
| | - Qingchuan Yu
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Fei Jin
- Hebei Center for Disease Control and Prevention, Shijiazhuang, 050021, China
| | - Wei Chen
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yong Zhang
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Teng Huang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Xiaosong Hu
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Wei Xia
- Hunan Center for Disease Control and Prevention, Changsha, 410005, China
| | - Jiamei Gao
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Haisong Zhou
- Zhengding County Center for Disease Control and Prevention, Shijiazhuang, 050800, China
| | - Xuan Bai
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yueyue Liu
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Zhenzhen Liang
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Zhijun Jiang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yingping Chen
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Jiuwei Zhang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Jialiang Du
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Biao Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Bo Xing
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Yantao Xing
- Daming County Center for Disease Control and Prevention, Handan, 056900, China
| | - Ben Dong
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Qinghai Yang
- Liucheng County Center for Disease Control and Prevention, Liuzhou, 545200, China
| | - Chen Shi
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Tingdong Yan
- Xiangtan County Center for Disease Control and Prevention, Xiangtan, 411228, China
| | - Bo Ruan
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Haiyun Shi
- Yuhuan County Center for Disease Control and Prevention, Taizhou, 317600, China
| | - Xingliang Fan
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Dongyang Feng
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Weigang Lv
- Yongnian County Center for Disease Control and Prevention, Handan, 056000, China
| | - Dong Zhang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Xiangchu Kong
- Rongshui Miao Autonomous County Center for Disease Control and Prevention, Liuzhou, 545300, China
| | - Liuyifan Zhou
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Dinghong Que
- You County Center for Disease Control and Prevention, Zhuzhou, 412315, China
| | - Hong Chen
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Zhongbing Chen
- Longyou County Center for Disease Control and Prevention, Quzhou, 324400, China
| | - Xiang Guo
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Weiwei Zhou
- Laishui County Center for Disease Control and Prevention, Baoding 074100, China
| | - Cong Wu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Qingrong Zhou
- Jiangshan County Center for Disease Control and Prevention, Quzhou, 324100, China
| | - Yuqing Liu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Jian Qiao
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Ying Wang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Xinguo Li
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Kai Duan
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yuliang Zhao
- Hebei Center for Disease Control and Prevention, Shijiazhuang, 050021, China.
| | - Xiaoming Yang
- China National Biotec Group Company Limited, National Engineering Technology Research Center for Combined Vaccines, Wuhan, 430207, China.
| | - Gelin Xu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China.
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12
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Dai L, Gao L, Tao L, Hadinegoro SR, Erkin M, Ying Z, He P, Girsang RT, Vergara H, Akram J, Satari HI, Khaliq T, Sughra U, Celi AP, Li F, Li Y, Jiang Z, Dalimova D, Tuychiev J, Turdikulova S, Ikram A, Flores Lastra N, Ding F, Suhardono M, Fadlyana E, Yan J, Hu Z, Li C, Abdurakhmonov IY, Gao GF. Efficacy and Safety of the RBD-Dimer-Based Covid-19 Vaccine ZF2001 in Adults. N Engl J Med 2022; 386:2097-2111. [PMID: 35507481 PMCID: PMC9127771 DOI: 10.1056/nejmoa2202261] [Citation(s) in RCA: 134] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The ZF2001 vaccine, which contains a dimeric form of the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 and aluminum hydroxide as an adjuvant, was shown to be safe, with an acceptable side-effect profile, and immunogenic in adults in phase 1 and 2 clinical trials. METHODS We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to investigate the efficacy and confirm the safety of ZF2001. The trial was performed at 31 clinical centers across Uzbekistan, Indonesia, Pakistan, and Ecuador; an additional center in China was included in the safety analysis only. Adult participants (≥18 years of age) were randomly assigned in a 1:1 ratio to receive a total of three 25-μg doses (30 days apart) of ZF2001 or placebo. The primary end point was the occurrence of symptomatic coronavirus disease 2019 (Covid-19), as confirmed on polymerase-chain-reaction assay, at least 7 days after receipt of the third dose. A key secondary efficacy end point was the occurrence of severe-to-critical Covid-19 (including Covid-19-related death) at least 7 days after receipt of the third dose. RESULTS Between December 12, 2020, and December 15, 2021, a total of 28,873 participants received at least one dose of ZF2001 or placebo and were included in the safety analysis; 25,193 participants who had completed the three-dose regimen, for whom there were approximately 6 months of follow-up data, were included in the updated primary efficacy analysis that was conducted at the second data cutoff date of December 15, 2021. In the updated analysis, primary end-point cases were reported in 158 of 12,625 participants in the ZF2001 group and in 580 of 12,568 participants in the placebo group, for a vaccine efficacy of 75.7% (95% confidence interval [CI], 71.0 to 79.8). Severe-to-critical Covid-19 occurred in 6 participants in the ZF2001 group and in 43 in the placebo group, for a vaccine efficacy of 87.6% (95% CI, 70.6 to 95.7); Covid-19-related death occurred in 2 and 12 participants, respectively, for a vaccine efficacy of 86.5% (95% CI, 38.9 to 98.5). The incidence of adverse events and serious adverse events was balanced in the two groups, and there were no vaccine-related deaths. Most adverse reactions (98.5%) were of grade 1 or 2. CONCLUSIONS In a large cohort of adults, the ZF2001 vaccine was shown to be safe and effective against symptomatic and severe-to-critical Covid-19 for at least 6 months after full vaccination. (Funded by the National Science and Technology Major Project and others; ClinicalTrials.gov number, NCT04646590.).
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Affiliation(s)
- Lianpan Dai
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Lidong Gao
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Lifeng Tao
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Sri R Hadinegoro
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Musabaev Erkin
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Zhifang Ying
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Peng He
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Rodman T Girsang
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Hugo Vergara
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Javed Akram
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Hindra I Satari
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Tanwir Khaliq
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Ume Sughra
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Ana P Celi
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Fangjun Li
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Yan Li
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Zhiwei Jiang
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Dilbar Dalimova
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Jaloliddin Tuychiev
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Shahlo Turdikulova
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Aamer Ikram
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Nancy Flores Lastra
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Fan Ding
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Mahendra Suhardono
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Eddy Fadlyana
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Jinghua Yan
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Zhongyu Hu
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Changgui Li
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Ibrokhim Y Abdurakhmonov
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - George F Gao
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
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13
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Billard MN, Wildenbeest J, Bont LJ, Nair H, McCracken JP, Oude Rengerink K. Year-to-year variation in attack rates could result in underpowered RSV vaccine efficacy trials. J Clin Epidemiol 2022; 147:11-20. [PMID: 35217153 DOI: 10.1016/j.jclinepi.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Year-to-year variation of respiratory viruses may result in lower attack rates than expected. We aimed to illustrate the impact of year-to-year variation in attack rates on the likelihood of demonstrating vaccine efficacy (VE) . STUDY DESIGN AND SETTING We considered an individually randomized maternal vaccine trial against respiratory syncytial virus-associated hospitalisations (RSVH). For 10 RSVH per 1,000 infants, sample size to have 80% power for true VE of 50% and 70% was 9,846 and 4,424 participants. We reported power to show VE for varying attack rates, selected to reflect realistic year-to-year variation using observational studies. Eight scenarios including varying number of countries and seasons were developed to assess the influence of these trial parameters. RESULTS Including up to three seasons decreased the width of the interquartile range for power. Including more seasons concentrated statistical power closer to 80%. Least powered trials had higher statistical power with more seasons. In all scenarios, at least half of the trials had <80% power. For three-season trials, increasing the sample size by 10% reduced the percentage of underpowered trials to less than one-quarter of trials. CONCLUSION Year-to-year variation in RSV attack rates should be accounted for during trial design. Mitigation strategies include recruiting over more seasons, or adaptive trial designs.
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Affiliation(s)
- Marie-Noëlle Billard
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
| | - Joanne Wildenbeest
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Louis J Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - John P McCracken
- Global Health Institute and Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA; Center for Health Studies, Universidad del Valle de Guatemala, Guatemala
| | - Katrien Oude Rengerink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Lakhashe SK, Amacker M, Hariraju D, Vyas HK, Morrison KS, Weiner JA, Ackerman ME, Roy V, Alter G, Ferrari G, Montefiori DC, Tomaras GD, Sawant S, Yates NL, Gast C, Fleury S, Ruprecht RM. Cooperation Between Systemic and Mucosal Antibodies Induced by Virosomal Vaccines Targeting HIV-1 Env: Protection of Indian Rhesus Macaques Against Low-Dose Intravaginal SHIV Challenges. Front Immunol 2022; 13:788619. [PMID: 35273592 PMCID: PMC8902080 DOI: 10.3389/fimmu.2022.788619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
A virosomal vaccine inducing systemic/mucosal anti-HIV-1 gp41 IgG/IgA had previously protected Chinese-origin rhesus macaques (RMs) against vaginal SHIVSF162P3 challenges. Here, we assessed its efficacy in Indian-origin RMs by intramuscular priming/intranasal boosting (n=12/group). Group K received virosome-P1-peptide alone (harboring the Membrane Proximal External Region), Group L combined virosome-rgp41 plus virosome-P1, and Group M placebo virosomes. Vaccination induced plasma binding but no neutralizing antibodies. Five weeks after boosting, all RMs were challenged intravaginally with low-dose SHIVSF162P3 until persistent systemic infection developed. After SHIV challenge #7, six controls were persistently infected versus only one Group L animal (vaccine efficacy 87%; P=0.0319); Group K was not protected. After a 50% SHIV dose increase starting with challenge #8, protection in Group L was lost. Plasmas/sera were analyzed for IgG phenotypes and effector functions; the former revealed that protection in Group L was significantly associated with increased binding to FcγR2/3(A/B) across several time-points, as were some IgG measurements. Vaginal washes contained low-level anti-gp41 IgGs and IgAs, representing a 1-to-5-fold excess over the SHIV inoculum's gp41 content, possibly explaining loss of protection after the increase in challenge-virus dose. Virosomal gp41-vaccine efficacy was confirmed during the initial seven SHIV challenges in Indian-origin RMs when the SHIV inoculum had at least 100-fold more HIV RNA than acutely infected men's semen. Vaccine protection by virosome-induced IgG and IgA parallels the cooperation between systemically administered IgG1 and mucosally applied dimeric IgA2 monoclonal antibodies that as single-agents provided no/low protection - but when combined, prevented mucosal SHIV transmission in all passively immunized RMs.
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Affiliation(s)
| | - Mario Amacker
- Department of Pulmonary Medicine, Bern University Hospital, University of Bern, Bern, Switzerland,Mymetics SA, Epalinges, Switzerland
| | - Dinesh Hariraju
- Texas Biomedical Research Institute, San Antonio, TX, United States,New Iberia Research Center, University of Louisiana at Lafayette, Lafayette, LA, United States,Department of Biology, University of Louisiana at Lafayette, Lafayette, LA, United States
| | - Hemant K. Vyas
- Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Kyle S. Morrison
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Joshua A. Weiner
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Margaret E. Ackerman
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States,Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Vicky Roy
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, United States
| | - Galit Alter
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, United States,Massachusetts Consortium on Pathogen Readiness, Boston, MA, United States
| | - Guido Ferrari
- Department of Surgery, Duke University, Durham, NC, United States,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, United States
| | - David C. Montefiori
- Department of Surgery, Duke University, Durham, NC, United States,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, United States
| | - Georgia D. Tomaras
- Department of Surgery, Duke University, Durham, NC, United States,Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, United States,Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States,Department of Immunology, Duke University, Durham, NC, United States
| | - Sheetal Sawant
- Department of Surgery, Duke University, Durham, NC, United States
| | - Nicole L. Yates
- Department of Surgery, Duke University, Durham, NC, United States
| | | | | | - Ruth M. Ruprecht
- Texas Biomedical Research Institute, San Antonio, TX, United States,New Iberia Research Center, University of Louisiana at Lafayette, Lafayette, LA, United States,Department of Biology, University of Louisiana at Lafayette, Lafayette, LA, United States,*Correspondence: Ruth M. Ruprecht,
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15
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Goldstone SE, Giuliano AR, Palefsky JM, Lazcano-Ponce E, Penny ME, Cabello RE, Moreira ED, Baraldi E, Jessen H, Ferenczy A, Kurman R, Ronnett BM, Stoler MH, Bautista O, Das R, Group T, Luxembourg A, Zhou HJ, Saah A. Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 trial. THE LANCET. INFECTIOUS DISEASES 2021; 22:413-425. [PMID: 34780705 DOI: 10.1016/s1473-3099(21)00327-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The quadrivalent human papillomavirus (HPV) vaccine was shown to prevent infections and lesions related to HPV6, 11, 16, and 18 in a randomised, placebo-controlled study in men aged 16-26 years. We assessed the incidences of external genital warts related to HPV6 or 11, and external genital lesions and anal dysplasia related to HPV6, 11, 16, or 18, over 10 years of follow-up. METHODS The 3-year base study was an international, multicentre, double-blind, randomised, placebo-controlled trial done at 71 sites in 18 countries. Eligible participants were heterosexual men (aged 16-23 years) or men who have sex with men (MSM; aged 16-26 years). Men who had clinically detectable anogenital warts or genital lesions at screening that were suggestive of infection with non-HPV sexually transmitted diseases, or who had a history of such findings, were excluded. Eligible participants were randomly assigned (1:1) to receive three doses of either quadrivalent HPV vaccine or placebo on day 1, month 2, and month 6, administered as a 0·5-mL injection into the deltoid muscle. The 7-year, open-label, long-term follow-up extension study was done at 46 centres in 16 countries. Participants who received one or more doses of the quadrivalent HPV vaccine in the base study were eligible for enrolment into the long-term follow-up study (early vaccination group). Placebo recipients were offered the three-dose quadrivalent HPV vaccine at the end of the base study; those who received one or more quadrivalent HPV vaccine doses were eligible for enrolment into the long-term follow-up study (catch-up vaccination group). The primary efficacy endpoints were the incidence of external genital warts related to HPV6 or 11 and the incidence of external genital lesions related to HPV6, 11, 16, or 18 in all participants and the incidence of anal intraepithelial neoplasia (including anal warts and flat lesions) or anal cancer related to HPV6, 11, 16, or 18 in MSM only. The primary efficacy analysis was done in the per-protocol population for the early vaccination group, which included participants who received all three vaccine doses, were seronegative at day 1 and PCR-negative from day 1 through month 7 of the base study for the HPV type being analysed, had no protocol violations that could affect evaluation of vaccine efficacy, and had attended at least one visit during the long-term follow-up study. For the catch-up vaccination group, efficacy was assessed in the modified intention-to-treat population, which included participants who had received at least one vaccine dose, were seronegative and PCR-negative for HPV types analysed from day 1 of the base study to the final follow-up visit before receiving the quadrivalent HPV vaccine, and had at least one long-term follow-up visit. Safety was assessed in all randomised participants who received at least one vaccine dose. This study is registered with ClinicalTrials.gov, NCT00090285. FINDINGS Between Aug 10, 2010, and April 3, 2017, 1803 participants were enrolled in the long-term follow-up study, of whom 936 (827 heterosexual men and 109 MSM) were included in the early vaccination group and 867 (739 heterosexual men and 128 MSM) were included in the catch-up vaccination group. Participants in the early vaccination group were followed up for a median of 9·5 years (range 0·1-11·5) after receiving the third dose of the quadrivalent HPV vaccine, and participants in the catch-up vaccination group were followed up for a median of 4·7 years (0·0-6·6) after receiving the third dose. In early vaccine group participants during long-term follow-up compared with the placebo group in the base study, the incidence per 10 000 person-years of external genital warts related to HPV6 or 11 was 0·0 (95% CI 0·0-8·7) versus 137·3 (83·9-212·1), of external genital lesions related to HPV6, 11, 16, or 18 was 0·0 (0·0-7·7) versus 140·4 (89·0-210·7), and of anal intraepithelial neoplasia or anal cancer related to HPV6, 11, 16, or 18 in MSM only was 20·5 (0·5-114·4) versus 906·2 (553·5-1399·5). Compared with during the base study (ie, before quadrivalent HPV vaccine administration), during the long-term follow-up period, participants in the catch-up vaccination group had no new reported cases of external genital warts related to HPV6 or 11 (149·6 cases per 10 000 person-years [95% CI 101·6-212·3] vs 0 cases per 10 000 person-years [0·0-13·5]) or external genital lesions related to HPV6, 11, 16, or 18 (155·1 cases per 10 000 person-years [108·0-215·7] vs 0 cases per 10 000 person-years [0·0-10·2]), and a lower incidence of anal intraepithelial neoplasia or anal cancer related to HPV6, 11, 16, or 18 (886·0 cases per 10 000 person-years [583·9-1289·1] vs 101·3 cases per 10 000 person-years [32·9-236·3]). No vaccine-related serious adverse events were reported. INTERPRETATION The quadrivalent HPV vaccine provides durable protection against anogenital disease related to HPV6, 11, 16, and 18. The results support quadrivalent HPV vaccination in men, including catch-up vaccination. FUNDING Merck Sharp & Dohme.
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Affiliation(s)
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Joel M Palefsky
- Department of Medicine, University of California at San Francisco, CA, USA
| | | | - Mary E Penny
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Ezio Baraldi
- Trialtech Research Institute, Pretoria, South Africa
| | | | - Alex Ferenczy
- McGill University Health Center, Montreal, QC, Canada
| | - Robert Kurman
- Department of Gynecology and Obstetrics and Department of Pathology Johns Hopkins University, Baltimore, MD, USA
| | - Brigitte M Ronnett
- Department of Gynecology and Obstetrics and Department of Pathology Johns Hopkins University, Baltimore, MD, USA
| | - Mark H Stoler
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | - Hao Jin Zhou
- MSD China, Beijing, China; Sun Yat-sen University, Guangzhou, China
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16
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Giuliano AR, Wilkin T, Bautista OM, Cheon K, Connor L, Dubey S, Luxembourg A, Rawat S, Shaw A, Velicer C, Vendetti N, Tu Y. Design of a Phase III efficacy, immunogenicity, and safety study of 9-valent human papillomavirus vaccine in prevention of oral persistent infection in men. Contemp Clin Trials 2021; 115:106592. [PMID: 34678491 DOI: 10.1016/j.cct.2021.106592] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/01/2021] [Accepted: 10/05/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Seven high-risk human papillomavirus (HPV) types (16/18/31/33/45/52/58) covered by the 9-valent HPV (9vHPV) vaccine cause >90% of HPV-related head and neck cancers (HNCs). An ongoing clinical trial (NCT04199689) was designed to evaluate 9vHPV vaccine efficacy against HPV oral persistent infection, a surrogate endpoint for HPV-related HNCs. METHODS In this double-blind, placebo-controlled, international trial, men aged 20-45 years (N = 6000) are randomized 1:1 to receive 9vHPV vaccine or placebo on day 1, month 2, and month 6. The primary objective is to demonstrate whether 9vHPV vaccination reduces incidence of HPV16/18/31/33/45/52/58-related 6-month oral persistent infection. Incidence of HPV6/11-related 6-month oral persistent infection will be evaluated as a secondary endpoint. Oral rinse and gargle samples will be collected on day 1, month 7, month 12, and every 6 months thereafter for HPV detection by PCR. Primary analyses will be performed in per-protocol populations. Efficacy in this case-driven study will be analyzed upon accrual of ≥20 primary efficacy endpoint cases. Serum will be collected at day 1 and months 7, 12, 24, 36, and 42; anti-HPV antibody titers will be measured by competitive Luminex immunoassay. Data will be summarized as geometric mean titers and seropositivity rates. Injection-site and systemic adverse events (AEs) will be collected for 15 days post-any vaccination and serious AEs through 6 months after the last vaccination; deaths and vaccine-related serious AEs will be collected throughout the study. DISCUSSION This trial is expected to generate important data regarding the potential for 9vHPV vaccine to prevent HPV-related head and neck disease.
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Affiliation(s)
- Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Timothy Wilkin
- Weill Cornell Medicine, 53 W. 23(rd) St., New York, NY 10010, USA
| | - Oliver M Bautista
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Kyeongmi Cheon
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Laurie Connor
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Sheri Dubey
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
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- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Alain Luxembourg
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Sonali Rawat
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Anita Shaw
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Christine Velicer
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Neika Vendetti
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Yingmei Tu
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA.
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17
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Al Kaabi N, Zhang Y, Xia S, Yang Y, Al Qahtani MM, Abdulrazzaq N, Al Nusair M, Hassany M, Jawad JS, Abdalla J, Hussein SE, Al Mazrouei SK, Al Karam M, Li X, Yang X, Wang W, Lai B, Chen W, Huang S, Wang Q, Yang T, Liu Y, Ma R, Hussain ZM, Khan T, Saifuddin Fasihuddin M, You W, Xie Z, Zhao Y, Jiang Z, Zhao G, Zhang Y, Mahmoud S, ElTantawy I, Xiao P, Koshy A, Zaher WA, Wang H, Duan K, Pan A, Yang X. Effect of 2 Inactivated SARS-CoV-2 Vaccines on Symptomatic COVID-19 Infection in Adults: A Randomized Clinical Trial. JAMA 2021; 326:35-45. [PMID: 34037666 PMCID: PMC8156175 DOI: 10.1001/jama.2021.8565] [Citation(s) in RCA: 517] [Impact Index Per Article: 172.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Although effective vaccines against COVID-19 have been developed, additional vaccines are still needed. OBJECTIVE To evaluate the efficacy and adverse events of 2 inactivated COVID-19 vaccines. DESIGN, SETTING, AND PARTICIPANTS Prespecified interim analysis of an ongoing randomized, double-blind, phase 3 trial in the United Arab Emirates and Bahrain among adults 18 years and older without known history of COVID-19. Study enrollment began on July 16, 2020. Data sets used for the interim analysis of efficacy and adverse events were locked on December 20, 2020, and December 31, 2020, respectively. INTERVENTIONS Participants were randomized to receive 1 of 2 inactivated vaccines developed from SARS-CoV-2 WIV04 (5 µg/dose; n = 13 459) and HB02 (4 µg/dose; n = 13 465) strains or an aluminum hydroxide (alum)-only control (n = 13 458); they received 2 intramuscular injections 21 days apart. MAIN OUTCOMES AND MEASURES The primary outcome was efficacy against laboratory-confirmed symptomatic COVID-19 14 days following a second vaccine dose among participants who had no virologic evidence of SARS-CoV-2 infection at randomization. The secondary outcome was efficacy against severe COVID-19. Incidence of adverse events and reactions was collected among participants who received at least 1 dose. RESULTS Among 40 382 participants randomized to receive at least 1 dose of the 2 vaccines or alum-only control (mean age, 36.1 years; 32 261 [84.4%] men), 38 206 (94.6%) who received 2 doses, contributed at least 1 follow-up measure after day 14 following the second dose, and had negative reverse transcriptase-polymerase chain reaction test results at enrollment were included in the primary efficacy analysis. During a median (range) follow-up duration of 77 (1-121) days, symptomatic COVID-19 was identified in 26 participants in the WIV04 group (12.1 [95% CI, 8.3-17.8] per 1000 person-years), 21 in the HB02 group (9.8 [95% CI, 6.4-15.0] per 1000 person-years), and 95 in the alum-only group (44.7 [95% CI, 36.6-54.6] per 1000 person-years), resulting in a vaccine efficacy, compared with alum-only, of 72.8% (95% CI, 58.1%-82.4%) for WIV04 and 78.1% (95% CI, 64.8%-86.3%) for HB02 (P < .001 for both). Two severe cases of COVID-19 occurred in the alum-only group and none occurred in the vaccine groups. Adverse reactions 7 days after each injection occurred in 41.7% to 46.5% of participants in the 3 groups; serious adverse events were rare and similar in the 3 groups (WIV04: 64 [0.5%]; HB02: 59 [0.4%]; alum-only: 78 [0.6%]). CONCLUSIONS AND RELEVANCE In this prespecified interim analysis of a randomized clinical trial, treatment of adults with either of 2 inactivated SARS-CoV-2 vaccines significantly reduced the risk of symptomatic COVID-19, and serious adverse events were rare. Data collection for final analysis is pending. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04510207; Chinese Clinical Trial Registry: ChiCTR2000034780.
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Affiliation(s)
- Nawal Al Kaabi
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Yuntao Zhang
- China National Biotec Group Company Limited, Beijing, China
| | - Shengli Xia
- Henan Province Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Yunkai Yang
- China National Biotec Group Company Limited, Beijing, China
| | - Manaf M. Al Qahtani
- Bahrain Defence Force Royal Medical Services, Military Hospital, Kingdom of Bahrain
| | | | | | | | | | - Jehad Abdalla
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Salah Eldin Hussein
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Shamma K. Al Mazrouei
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Maysoon Al Karam
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Xinguo Li
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co, Ltd, Wuhan, Hubei, China
| | - Xuqin Yang
- China National Biotec Group Company Limited, Beijing, China
| | - Wei Wang
- Beijing Institute of Biological Products Co, Ltd, Beijing, China
| | - Bonan Lai
- China National Biotec Group Company Limited, Beijing, China
| | - Wei Chen
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co, Ltd, Wuhan, Hubei, China
| | - Shihe Huang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co, Ltd, Wuhan, Hubei, China
| | - Qian Wang
- China National Biotec Group Company Limited, Beijing, China
| | - Tian Yang
- China National Biotec Group Company Limited, Beijing, China
| | - Yang Liu
- China National Biotec Group Company Limited, Beijing, China
| | - Rui Ma
- Beijing Institute of Biological Products Co, Ltd, Beijing, China
| | - Zaidoon M. Hussain
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Tehmina Khan
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | | | - Wangyang You
- Henan Province Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Zhiqiang Xie
- Henan Province Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Yuxiu Zhao
- Beijing Institute of Biological Products Co, Ltd, Beijing, China
| | - Zhiwei Jiang
- Beijing Key-Tech Statistical Consulting Co, Ltd, Beijing, China
| | - Guoqing Zhao
- Beijing Key-Tech Statistical Consulting Co, Ltd, Beijing, China
| | - Yanbo Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | | | - Peng Xiao
- G42 Healthcare, Abu Dhabi, United Arab Emirates
| | - Ashish Koshy
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Hui Wang
- Beijing Institute of Biological Products Co, Ltd, Beijing, China
| | - Kai Duan
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co, Ltd, Wuhan, Hubei, China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoming Yang
- China National Biotec Group Company Limited, Beijing, China
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co, Ltd, Wuhan, Hubei, China
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18
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Miyake M, Nishimura N, Nakai Y, Fujii T, Owari T, Hori S, Morizawa Y, Gotoh D, Anai S, Torimoto K, Tanaka N, Hirao Y, Fujimoto K. Photodynamic Diagnosis-Assisted Transurethral Resection Using Oral 5-Aminolevulinic Acid Decreases the Risk of Repeated Recurrence in Non-Muscle-Invasive Bladder Cancer: A Cumulative Incidence Analysis by the Person-Time Method. Diagnostics (Basel) 2021; 11:diagnostics11020185. [PMID: 33525423 PMCID: PMC7911613 DOI: 10.3390/diagnostics11020185] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Abstract
Clinical evidence regarding risk reduction of repeated bladder recurrence after initial photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT) is still limited in patients with non-muscle-invasive bladder cancer (NMIBC). We analyzed patients with primary NMIBC undergoing TURBT without any adjuvant treatment to compare the risk of cumulative recurrence between the conventional white-light (WL)-TURBT and PDD-TURBT. Out of 430 patients diagnosed with primary NMIBC from 2010 to 2019, 40 undergoing WL-TURBT and 60 undergoing PDD-TURBT were eligible. Multivariate Cox regression analysis for time to the first recurrence demonstrated that PDD assistance was an independent prognostic factor with better outcome (p = 0.038, hazard ratio = 0.39, and 95% confidence interval 0.16–0.95). While no patient experienced more than one recurrence within 1000 postoperative days in the PDD-TURBT group, five out of 40 patients treated by WL-TURBT experienced repeated recurrence. The comparison of cumulative incidence per 10,000 person-days between the two groups revealed that PDD assistance decreased by 6.6 recurrences per 10,000 person-days (exact p = 0.011; incidence rate ratio 0.37, Clopper–Pearson confidence interval 0.15–0.82). This is the first study addressing PDD assistance-induced risk reduction of repeated bladder recurrence using the person-time method. Our findings could support clinical decision making, especially on adjuvant therapy after TURBT.
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Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
- Correspondence: (M.M.); (K.F.); Tel.: +81-744-22-3051 (M.M.)
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara 634-8522, Japan;
| | - Takuya Owari
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
| | - Nobumichi Tanaka
- Department of Prostate Brachytherapy Nara Medical University, Kashihara, Nara 634-8522, Japan;
| | - Yoshihiko Hirao
- Department of Urology, Osaka Gyoumeikan Hospital, Konohana-ku, Osaka 554-0012, Japan;
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan; (N.N.); (Y.N.); (T.O.); (S.H.); (Y.M.); (D.G.); (S.A.); (K.T.)
- Correspondence: (M.M.); (K.F.); Tel.: +81-744-22-3051 (M.M.)
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19
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Qiao YL, Wu T, Li RC, Hu YM, Wei LH, Li CG, Chen W, Huang SJ, Zhao FH, Li MQ, Pan QJ, Zhang X, Li Q, Hong Y, Zhao C, Zhang WH, Li YP, Chu K, Li M, Jiang YF, Li J, Zhao H, Lin ZJ, Cui XL, Liu WY, Li CH, Guo DP, Ke LD, Wu X, Tang J, Gao GQ, Li BY, Zhao B, Zheng FX, Dai CH, Guo M, Zhao J, Su YY, Wang JZ, Zhu FC, Li SW, Pan HR, Li YM, Zhang J, Xia NS. Efficacy, Safety, and Immunogenicity of an Escherichia coli-Produced Bivalent Human Papillomavirus Vaccine: An Interim Analysis of a Randomized Clinical Trial. J Natl Cancer Inst 2020; 112:145-153. [PMID: 31086947 DOI: 10.1093/jnci/djz074] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The high cost and insufficient supply of human papillomavirus (HPV) vaccines have slowed the pace of controlling cervical cancer. A phase III clinical trial was conducted to evaluate the efficacy, safety, and immunogenicity of a novel Escherichia coli-produced bivalent HPV-16/18 vaccine. METHODS A multicenter, randomized, double-blind trial started on November 22, 2012 in China. In total, 7372 eligible women aged 18-45 years were age-stratified and randomly assigned to receive three doses of the test or control (hepatitis E) vaccine at months 0, 1, and 6. Co-primary endpoints included high-grade genital lesions and persistent infection (over 6 months) associated with HPV-16/18. The primary analysis was performed on a per-protocol susceptible population of individuals who were negative for relevant HPV type-specific neutralizing antibodies (at day 0) and DNA (at day 0 through month 7) and who received three doses of the vaccine. This report presents data from a prespecified interim analysis used for regulatory submission. RESULTS In the per-protocol cohort, the efficacies against high-grade genital lesions and persistent infection were 100.0% (95% confidence interval = 55.6% to 100.0%, 0 of 3306 in the vaccine group vs 10 of 3296 in the control group) and 97.8% (95% confidence interval = 87.1% to 99.9%, 1 of 3240 vs 45 of 3246), respectively. The side effects were mild. No vaccine-related serious adverse events were noted. Robust antibody responses for both types were induced and persisted for at least 42 months. CONCLUSIONS The E coli-produced HPV-16/18 vaccine is well tolerated and highly efficacious against HPV-16/18-associated high-grade genital lesions and persistent infection in women.
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Affiliation(s)
- You-Lin Qiao
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Ting Wu
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Rong-Cheng Li
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Yue-Mei Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Li-Hui Wei
- Peking University People's Hospital, Beijing, China
| | - Chang-Gui Li
- National Institute for Food and Drug Control, Beijing, China
| | - Wen Chen
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Shou-Jie Huang
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Fang-Hui Zhao
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Ming-Qiang Li
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Qin-Jing Pan
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Xun Zhang
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.,Xinmi Maternal and Child Health Hospital, Xinmi, Henan, China
| | - Qing Li
- Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Ying Hong
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Chao Zhao
- Peking University People's Hospital, Beijing, China
| | - Wen-Hua Zhang
- National Cancer Center, National Center for Cancer Clinical Research, The Cancer Institute, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Yan-Ping Li
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Kai Chu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Mei Li
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yun-Fei Jiang
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Juan Li
- National Institute for Food and Drug Control, Beijing, China
| | - Hui Zhao
- National Institute for Food and Drug Control, Beijing, China
| | - Zhi-Jie Lin
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Xue-Lian Cui
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Wen-Yu Liu
- Funing Center for Disease Control and Prevention, Funing, Jiangsu, China
| | - Cai-Hong Li
- Xinmi Maternal and Child Health Hospital, Xinmi, Henan, China
| | - Dong-Ping Guo
- Yangcheng Maternal and Child Health Hospital, Yangcheng, Shanxi, China
| | - Li-Dong Ke
- Fengning Hospital of Traditional Chinese Medicine, Fengning, Hebei, China
| | - Xin Wu
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, China
| | - Jie Tang
- Funing Center for Disease Control and Prevention, Funing, Jiangsu, China
| | - Guo-Qi Gao
- Xinmi Maternal and Child Health Hospital, Xinmi, Henan, China
| | - Ba-Yi Li
- Yangcheng Maternal and Child Health Hospital, Yangcheng, Shanxi, China
| | - Bin Zhao
- Fengning Hospital of Traditional Chinese Medicine, Fengning, Hebei, China
| | - Feng-Xian Zheng
- Xinmi Maternal and Child Health Hospital, Xinmi, Henan, China
| | - Cui-Hong Dai
- Fengning Hospital of Traditional Chinese Medicine, Fengning, Hebei, China
| | - Meng Guo
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun Zhao
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ying-Ying Su
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jun-Zhi Wang
- National Institute for Food and Drug Control, Beijing, China
| | - Feng-Cai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Shao-Wei Li
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Hui-Rong Pan
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Yi-Min Li
- Xiamen Innovax Biotech Company, Xiamen, Fujian, China
| | - Jun Zhang
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ning-Shao Xia
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University, Xiamen, Fujian, China
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20
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Measuring vaccine effectiveness against persistent HPV infections: a comparison of different statistical approaches. BMC Infect Dis 2020; 20:482. [PMID: 32640998 PMCID: PMC7341660 DOI: 10.1186/s12879-020-05083-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent high-risk human papillomavirus (HPV) infection is endorsed by the World Health Organization as an intermediate endpoint for evaluating HPV vaccine effectiveness/efficacy. There are different approaches to estimate the vaccine effectiveness/efficacy against persistent HPV infections. METHODS We performed a systematic literature search in Pubmed to identify statistical approaches that have been used to estimate the vaccine effectiveness/efficacy against persistent HPV infections. We applied these methods to data of a longitudinal observational study to assess their performance and compare the obtained vaccine effectiveness (VE) estimates. RESULTS Our literature search identified four approaches: the conditional exact test for comparing two independent Poisson rates using a binomial distribution, Generalized Estimating Equations for Poisson regression, Prentice Williams and Peterson total time (PWP-TT) and Cox proportional hazards regression. These approaches differ regarding underlying assumptions and provide different effect measures. However, they provided similar effectiveness estimates against HPV16/18 and HPV31/33/45 persistent infections in a cohort of young women eligible for routine HPV vaccination (range VE 93.7-95.1% and 60.4-67.7%, respectively) and seemed robust to violations of underlying assumptions. CONCLUSIONS As the rate of subsequent infections increased in our observational cohort, we recommend PWP-TT as the optimal approach to estimate the vaccine effectiveness against persistent HPV infections in young women. Confirmation of our findings should be undertaken by applying these methods after longer follow-up in our study, as well as in different populations.
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Casula D, Callegaro A, Nakanwagi P, Weynants V, Arora AK. Evaluation of an Adaptive Seamless Design for a Phase II/III Clinical Trial in Recurrent Events Data to Demonstrate Reduction in Number of Acute Exacerbations in Patients With Chronic Obstructive Pulmonary Disease (COPD). Stat Biopharm Res 2020. [DOI: 10.1080/19466315.2020.1764382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Jin M, Feng D, Liu G. Bayesian Approaches on Borrowing Historical Data for Vaccine Efficacy Trials. Stat Biopharm Res 2020. [DOI: 10.1080/19466315.2020.1736617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Man Jin
- AbbVie Inc., North Chicago, IL
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23
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Garland SM, Pitisuttithum P, Ngan HYS, Cho CH, Lee CY, Chen CA, Yang YC, Chu TY, Twu NF, Samakoses R, Takeuchi Y, Cheung TH, Kim SC, Huang LM, Kim BG, Kim YT, Kim KH, Song YS, Lalwani S, Kang JH, Sakamoto M, Ryu HS, Bhatla N, Yoshikawa H, Ellison MC, Han SR, Moeller E, Murata S, Ritter M, Sawata M, Shields C, Walia A, Perez G, Luxembourg A. Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries. J Infect Dis 2019; 218:95-108. [PMID: 29767739 PMCID: PMC5989602 DOI: 10.1093/infdis/jiy133] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/16/2018] [Indexed: 01/17/2023] Open
Abstract
Background A 9-valent human papillomavirus-6/11/16/18/31/33/45/52/58 (9vHPV) vaccine extends coverage to 5 next most common oncogenic types (31/33/45/52/58) in cervical cancer versus quadrivalent HPV (qHPV) vaccine. We describe efficacy, immunogenicity, and safety in Asian participants (India, Hong Kong, South Korea, Japan, Taiwan, and Thailand) from 2 international studies: a randomized, double-blinded, qHPV vaccine-controlled efficacy study (young women aged 16–26 years; NCT00543543; Study 001); and an immunogenicity study (girls and boys aged 9–15 years; NCT00943722; Study 002). Methods Participants (N = 2519) were vaccinated at day 1 and months 2 and 6. Gynecological samples (Study 001 only) and serum were collected for HPV DNA and antibody assessments, respectively. Injection-site and systemic adverse events (AEs) were monitored. Data were analyzed by country and vaccination group. Results 9vHPV vaccine prevented HPV-31/33/45/52/58–related persistent infection with 90.4%–100% efficacy across included countries. At month 7, ≥97.9% of participants seroconverted for each HPV type. Injection-site AEs occurred in 77.7%–83.1% and 81.9%–87.5% of qHPV and 9vHPV vaccine recipients in Study 001, respectively, and 62.4%–85.7% of girls/boys in Study 002; most were mild to moderate. Conclusions The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Asian participants. Data support 9vHPV vaccination programs in Asia. Clinical Trials Registration NCT00543543; NCT00943722.
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Affiliation(s)
- S M Garland
- Western Pacific Regional HPV Labnet Reference Laboratory, Department of Infectious Disease and Microbiology, Royal Women's Hospital, Murdoch Children's Research Institute, Royal Children's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | | | - H Y S Ngan
- Department of Obstetrics and Gynaecology, the University of Hong Kong, China
| | - C-H Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, South Korea
| | - C-Y Lee
- Department of Gynecology, Chang Gung Memorial Hospital, Chiayi Branch, Taipei
| | - C-A Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei
| | - Y C Yang
- MacKay Memorial Hospital, Taipei
| | - T-Y Chu
- Tzu Chi Medical Center, Hualien
| | - N-F Twu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - R Samakoses
- Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | | | - T H Cheung
- Department of Obstetric and Gynaecology, Chinese University of Hong Kong, China
| | - S C Kim
- Division of Gynecologic Oncology, Ewha Womans University Mokdong Hospital, School of Medicine Ewha Womans University, Seoul, South Korea
| | - L-M Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - B-G Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Y-T Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asian Medical Center, Seoul, South Korea
| | - K-H Kim
- Department of Pediatrics and Center for Vaccine Evaluation and Study, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Y-S Song
- Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, South Korea
| | - S Lalwani
- Bharati Vidyapeeth Deemed University Medical College and Hospital, Pune, India
| | - J-H Kang
- Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, South Korea
| | - M Sakamoto
- Department of Gynaecology, Sasaki Foundation Kyoundo Hospital and Department of Obstetrics and Gynaecology, School of Medicine, the Jikei University, Tokyo, Japan
| | - H-S Ryu
- Department of Obstetrics and Gynecology, School of Medicine, Ajou University, Suwon, South Korea
| | - N Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - H Yoshikawa
- Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | | | | | - E Moeller
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - M Ritter
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | - C Shields
- Merck & Co., Inc., Kenilworth, New Jersey
| | - A Walia
- Merck & Co., Inc., Kenilworth, New Jersey
| | - G Perez
- Merck & Co., Inc., Kenilworth, New Jersey
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24
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Ruiz-Sternberg ÁM, Moreira ED, Restrepo JA, Lazcano-Ponce E, Cabello R, Silva A, Andrade R, Revollo F, Uscanga S, Victoria A, Guevara AM, Luna J, Plata M, Dominguez CN, Fedrizzi E, Suarez E, Reina JC, Ellison MC, Moeller E, Ritter M, Shields C, Cashat M, Perez G, Luxembourg A. Efficacy, immunogenicity, and safety of a 9-valent human papillomavirus vaccine in Latin American girls, boys, and young women. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2018; 5:63-74. [PMID: 29269325 PMCID: PMC5887018 DOI: 10.1016/j.pvr.2017.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND A 9-valent human papillomavirus (HPV6/11/16/18/31/33/45/52/58; 9vHPV) vaccine was developed to expand coverage of the previously developed quadrivalent (HPV6/11/16/18; qHPV) vaccine. METHODS Efficacy, immunogenicity, and safety outcomes were assessed in Latin American participants enrolled in 2 international studies of the 9vHPV vaccine, including a randomized, double-blinded, controlled with qHPV vaccine, efficacy, immunogenicity, and safety study in young women aged 16-26 years, and an immunogenicity and safety study in girls and boys aged 9-15 years. Participants (N=5312) received vaccination at Day 1, Month 2, and Month 6. Gynecological swabs were collected regularly in young women for cytological and HPV DNA testing. Serum was analyzed for HPV antibodies in all participants. Adverse events (AEs) were also monitored in all participants. RESULTS The 9vHPV vaccine prevented HPV 31-, 33-, 45-, 52-, and 58-related high-grade cervical, vulvar, and vaginal dysplasia with 92.3% efficacy (95% confidence interval 54.4, 99.6). Anti-HPV6, 11, 16, and 18 geometric mean titers at Month 7 were similar in the 9vHPV and qHPV vaccination groups. Anti-HPV antibody responses following vaccination were higher among girls and boys than in young women. Most (>99%) 9vHPV vaccine recipients seroconverted for all 9 HPV types at Month 7. Antibody responses to the 9 HPV types persisted over 5 years. The most common AEs were injection-site related, mostly of mild to moderate intensity. CONCLUSIONS The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Latin American young women, girls, and boys. These data support 9vHPV vaccination programs in Latin America, a region with substantial cervical cancer burden.
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Affiliation(s)
| | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil
| | | | - Eduardo Lazcano-Ponce
- Research Center on Public Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | - Rosires Andrade
- Departamento de Tocoginecologia da Universidade Federal do Paraná, Curitiba, Brazil
| | - Francisco Revollo
- Centro de Investigaciones, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Santos Uscanga
- Arké Estudios Clínicos S.A. de C.V., Mexico City, Mexico
| | - Alejandro Victoria
- Department of Obstetrics and Gynecology, Fundacion Valle del Lili, Cali, Colombia
| | | | - Joaquín Luna
- Departamento de Ginecología y Obstetricia Clínica Colsanitas, Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Manuel Plata
- Department of Gynecology, Fundación Cardioinfantil, Bogotá, Colombia
| | | | - Edison Fedrizzi
- Department of Gynecology and Obstetrics, University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Eugenio Suarez
- Gynecological Oncology Division Hospital Clinico San Borja Arriaran Universidad de Chile Campus Centro, Santiago, Chile
| | - Julio C Reina
- Department of Pediatrics, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia
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A public health evaluation of 13-valent pneumococcal conjugate vaccine impact on adult disease outcomes from a randomized clinical trial in the Netherlands. Vaccine 2018; 37:5777-5787. [PMID: 29861177 DOI: 10.1016/j.vaccine.2018.05.097] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/16/2018] [Accepted: 05/19/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND We conducted a post-hoc analysis of a double blind, randomized, placebo-controlled trial of 13-valent pneumococcal conjugate vaccine (PCV13) among adults aged 65 years or older to assess public health impact. METHODS For all outcomes, we included all randomized subjects, using a modified intention-to-treat (mITT) approach to determine vaccine efficacy (VE), vaccine preventable disease incidence (VPDI) defined as control minus vaccinated group incidence, and numbers needed to vaccinate (NNV) (based on a five-year duration of protection). RESULTS Results are reported for, in order, clinical, adjudicated (clinical plus radiologic infiltrate determined by committee), pneumococcal, and vaccine-type pneumococcal (VT-Sp) community-acquired pneumonia; invasive pneumococcal disease (IPD) and VT-IPD. VEs (95% CI) for all hospital episodes were 8.1% (-0.6%, 16.1%), 6.7% (-4.1%, 16.3%), 22.2% (2.0%, 38.3%), 37.5% (14.3%, 54.5%), 49.3% (23.2%, 66.5%), and 75.8% (47.6%, 88.8%). VPDIs per 100,000 person-years of observation (PYOs) were 72, 37, 25, 25, 20, and 15 with NNVs of 277, 535, 816, 798, 1016, and 1342. For clinical CAP, PCV13 was associated with a reduction of 909 (-115, 2013) hospital days per 100,000 PYOs translating to a reduction over 5 years of one hospital day for every 22 people vaccinated. When comparing at-risk persons (defined by self-report of diabetes, chronic lung disease, or other underlying conditions) to not at-risk persons, VEs were similar or lower, but because baseline incidences were higher the VPDIs were approximately 2-10 times higher and NNVs 50-90% lower. CONCLUSION A public health analysis of pneumonia and IPD outcomes in a randomized controlled trial found substantial burden reduction following adult PCV13 immunization implemented in a setting with an ongoing infant PCV7-PCV10 program. VPDIs were higher among at-risk adults. FUNDING The original study and the current analysis were funded by Pfizer.
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Falloon J, Yu J, Esser MT, Villafana T, Yu L, Dubovsky F, Takas T, Levin MJ, Falsey AR. An Adjuvanted, Postfusion F Protein-Based Vaccine Did Not Prevent Respiratory Syncytial Virus Illness in Older Adults. J Infect Dis 2017; 216:1362-1370. [PMID: 29029260 PMCID: PMC5853767 DOI: 10.1093/infdis/jix503] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/18/2017] [Indexed: 12/26/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is an important cause of illness in older adults. This study assessed efficacy of a vaccine for prevention of RSV-associated acute respiratory illness (ARI), defined by specified symptoms with virologic confirmation. Methods This phase 2b study evaluated RSV postfusion F protein (120 µg) with glucopyranosyl lipid adjuvant (5 µg) in 2% stable emulsion. Subjects aged ≥60 years were randomly assigned at a ratio of 1:1 to receive vaccine or placebo (all received inactivated influenza vaccine). Ill subjects recorded symptoms and provided blood and nasal swab samples. Results In the per-protocol population (n = 1894), the incidence of RSV-associated ARI occurring ≥14 days after dosing was 1.7% and 1.6% in the vaccine and placebo groups, respectively, for a vaccine efficacy (VE) of –7.1% (90% confidence interval [CI], –106.9%–44.3%). Efficacy was not observed in secondary analyses that included seroresponse to nonvaccine RSV antigens (VE, 8.9%; 90% CI, –28.5%–35.4%) or symptoms combined with seroresponse (VE, 10.0%; 90% CI, –45.4%–44.4%). On day 29, 92.9% of vaccinees had an anti-F immunoglobulin G antibody seroresponse. Overall, 48.5% and 30.9% of RSV vaccine recipients reported local and systemic solicited symptoms, respectively. Conclusion The RSV vaccine was immunogenic but did not protect older adults from RSV illness. Clinical Trials Registration NCT02508194.
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Affiliation(s)
| | - Jing Yu
- MedImmune, Gaithersburg, Maryland
| | | | | | - Li Yu
- MedImmune, Gaithersburg, Maryland
| | | | | | - Myron J Levin
- University of Colorado Anschutz Medical Campus, Aurora
| | - Ann R Falsey
- Rochester General Hospital and University of Rochester, New York
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27
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Huh WK, Joura EA, Giuliano AR, Iversen OE, de Andrade RP, Ault KA, Bartholomew D, Cestero RM, Fedrizzi EN, Hirschberg AL, Mayrand MH, Ruiz-Sternberg AM, Stapleton JT, Wiley DJ, Ferenczy A, Kurman R, Ronnett BM, Stoler MH, Cuzick J, Garland SM, Kjaer SK, Bautista OM, Haupt R, Moeller E, Ritter M, Roberts CC, Shields C, Luxembourg A. Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial. Lancet 2017; 390:2143-2159. [PMID: 28886907 DOI: 10.1016/s0140-6736(17)31821-4] [Citation(s) in RCA: 255] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/08/2017] [Accepted: 06/15/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary analyses of a study in young women aged 16-26 years showed efficacy of the nine-valent human papillomavirus (9vHPV; HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58) vaccine against infections and disease related to HPV 31, 33, 45, 52, and 58, and non-inferior HPV 6, 11, 16, and 18 antibody responses when compared with quadrivalent HPV (qHPV; HPV 6, 11, 16, and 18) vaccine. We aimed to report efficacy of the 9vHPV vaccine for up to 6 years following first administration and antibody responses over 5 years. METHODS We undertook this randomised, double-blind, efficacy, immunogenicity, and safety study of the 9vHPV vaccine study at 105 study sites in 18 countries. Women aged 16-26 years old who were healthy, with no history of abnormal cervical cytology, no previous abnormal cervical biopsy results, and no more than four lifetime sexual partners were randomly assigned (1:1) by central randomisation and block sizes of 2 and 2 to receive three intramuscular injections over 6 months of 9vHPV or qHPV (control) vaccine. All participants, study investigators, and study site personnel, laboratory staff, members of the sponsor's study team, and members of the adjudication pathology panel were masked to vaccination groups. The primary outcomes were incidence of high-grade cervical disease (cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, invasive cervical carcinoma), vulvar disease (vulvar intraepithelial neoplasia grade 2/3, vulvar cancer), and vaginal disease (vaginal intraepithelial neoplasia grade 2/3, vaginal cancer) related to HPV 31, 33, 45, 52, and 58 and non-inferiority (excluding a decrease of 1·5 times) of anti-HPV 6, 11, 16, and 18 geometric mean titres (GMT). Tissue samples were adjudicated for histopathology diagnosis and tested for HPV DNA. Serum antibody responses were assessed by competitive Luminex immunoassay. The primary evaluation of efficacy was a superiority analysis in the per-protocol efficacy population, supportive efficacy was analysed in the modified intention-to-treat population, and the primary evaluation of immunogenicity was a non-inferiority analysis. The trial is registered with ClinicalTrials.gov, number NCT00543543. FINDINGS Between Sept 26, 2007, and Dec 18, 2009, we recruited and randomly assigned 14 215 participants to receive 9vHPV (n=7106) or qHPV (n=7109) vaccine. In the per-protocol population, the incidence of high-grade cervical, vulvar and vaginal disease related to HPV 31, 33, 45, 52, and 58 was 0·5 cases per 10 000 person-years in the 9vHPV and 19·0 cases per 10 000 person-years in the qHPV groups, representing 97·4% efficacy (95% CI 85·0-99·9). HPV 6, 11, 16, and 18 GMTs were non-inferior in the 9vHPV versus qHPV group from month 1 to 3 years after vaccination. No clinically meaningful differences in serious adverse events were noted between the study groups. 11 participants died during the study follow-up period (six in the 9vHPV vaccine group and five in the qHPV vaccine group); none of the deaths were considered vaccine-related. INTERPRETATION The 9vHPV vaccine prevents infection, cytological abnormalities, high-grade lesions, and cervical procedures related to HPV 31, 33, 45, 52, and 58. Both the 9vHPV vaccine and qHPV vaccine had a similar immunogenicity profile with respect to HPV 6, 11, 16, and 18. Vaccine efficacy was sustained for up to 6 years. The 9vHPV vaccine could potentially provide broader coverage and prevent 90% of cervical cancer cases worldwide. FUNDING Merck & Co, Inc.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Viral/blood
- Dose-Response Relationship, Drug
- Double-Blind Method
- Female
- Follow-Up Studies
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/administration & dosage
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/immunology
- Human papillomavirus 6/immunology
- Humans
- Immunoassay
- Immunogenicity, Vaccine/immunology
- Injections, Intramuscular
- Papillomavirus Infections/epidemiology
- Papillomavirus Infections/prevention & control
- Patient Compliance/statistics & numerical data
- Patient Safety
- Primary Prevention/methods
- Treatment Outcome
- Uterine Cervical Neoplasms/epidemiology
- Uterine Cervical Neoplasms/prevention & control
- Uterine Cervical Neoplasms/virology
- Vaccination/methods
- Young Adult
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Affiliation(s)
- Warner K Huh
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Elmar A Joura
- Department of Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Centre, Tampa, FL, USA
| | - Ole-Erik Iversen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Rosires Pereira de Andrade
- CERHFAC/Universidade Federal do Paraná, Setor de Ciências da Saúde, Departamento de Tocoginecologia, Paraná, Brazil
| | - Kevin A Ault
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Deborah Bartholomew
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ramon M Cestero
- Department of Obstetrics and Gynecology, University of California Irvine School of Medicine, UC Irvine Health Orange, CA, USA
| | - Edison N Fedrizzi
- Department of Obstetrics and Gynecology of The Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Angelica L Hirschberg
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Stockholm, Sweden
| | - Marie-Hélène Mayrand
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal [CRCHUM], Montreal, QC, Canada
| | | | - Jack T Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Iowa City VA Medical Center, Iowa City, IA, USA
| | - Dorothy J Wiley
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Alex Ferenczy
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Robert Kurman
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Brigitte M Ronnett
- Department of Pathology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - Mark H Stoler
- Department of Pathology, University of Virginia School of Medicine Charlottesville, VA, USA
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Suzanne M Garland
- The University of Melbourne, Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society and Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Zaman K, Sack DA, Neuzil KM, Yunus M, Moulton LH, Sugimoto JD, Fleming JA, Hossain I, Arifeen SE, Azim T, Rahman M, Lewis KDC, Feller AJ, Qadri F, Halloran ME, Cravioto A, Victor JC. Effectiveness of a live oral human rotavirus vaccine after programmatic introduction in Bangladesh: A cluster-randomized trial. PLoS Med 2017; 14:e1002282. [PMID: 28419095 PMCID: PMC5395158 DOI: 10.1371/journal.pmed.1002282] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rotavirus vaccines are now globally recommended by the World Health Organization (WHO), but in early 2009 WHO's Strategic Advisory Group of Experts on Immunization reviewed available data and concluded that there was no evidence for the efficacy or effectiveness of a two-dose schedule of the human rotavirus vaccine (HRV; Rotarix) given early at 6 and 10 wk of age. Additionally, the effectiveness of programmatic rotavirus vaccination, including possible indirect effects, has not been assessed in low-resource populations in Asia. METHODS AND FINDINGS In Bangladesh, we cluster-randomized (1:1) 142 villages of the Matlab Health and Demographic Surveillance System to include two doses of HRV with the standard infant vaccines at 6 and 10 wk of age or to provide standard infant vaccines without HRV. The study was initiated November 1, 2008, and surveillance was conducted concurrently at Matlab Diarrhoea Hospital and two community treatment centers to identify children less than 2 y of age presenting with acute rotavirus diarrhea (ARD) through March 31, 2011. Laboratory confirmation was made by enzyme immunoassay detection of rotavirus antigen in stool specimens. Overall effectiveness of the HRV vaccination program (primary objective) was measured by comparing the incidence rate of ARD among all children age-eligible for vaccination in villages where HRV was introduced to that among such children in villages where HRV was not introduced. Total effectiveness among vaccinees and indirect effectiveness were also evaluated. In all, 6,527 infants were age-eligible for vaccination in 71 HRV villages, and 5,791 in 71 non-HRV villages. In HRV villages, 4,808 (73.7%) infants received at least one dose of HRV. The incidence rate of ARD was 4.10 cases per 100 person-years in non-HRV villages compared to 2.8 per 100 person-years in HRV villages, indicating an overall effectiveness of 29.0% (95% CI, 11.3% to 43.1%). The total effectiveness of HRV against ARD among vaccinees was 41.4% (95% CI, 23.2% to 55.2%). The point estimate for total effectiveness was higher against ARD during the first year of life than during the second (45.2% versus 28.9%), but estimates for the second year of life lacked precision and did not reach statistical significance. Indirect effects were not detected. To check for bias in presentation to treatment facilities, we evaluated the effectiveness of HRV against acute diarrhea associated with enterotoxigenic Escherichia coli; it was 4.0% (95% CI, -46.5% to 37.1%), indicating that bias likely was not introduced. Thirteen serious adverse events were identified among recipients of HRV, but none were considered related to receipt of study vaccine. The main limitation of this study is that it was an open-label study with an observed-only control group (no placebo). CONCLUSIONS The two-dose HRV rotavirus vaccination program significantly reduced medically attended ARD in this low-resource population in Asia. Protection among vaccinees was similar to that in other low-resource settings. In low-resource populations with high rotavirus incidence, large-scale vaccination across a wide population may be required to obtain the full benefit of rotavirus vaccination, including indirect effects. TRIAL REGISTRATION ClinicalTrials.gov NCT00737503.
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Affiliation(s)
- K. Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - David A. Sack
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Mohammad Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Lawrence H. Moulton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jonathan D. Sugimoto
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | - Ilias Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tasnim Azim
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Andrea J. Feller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Biostatistics Department, University of Washington, Seattle, Washington, United States of America
| | - Alejandro Cravioto
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - John C. Victor
- PATH, Seattle, Washington, United States of America
- * E-mail:
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Lin M, Lee S, Zhen B, Scott J, Horne A, Solomon G, Russek-Cohen E. CBER's Experience With Adaptive Design Clinical Trials. Ther Innov Regul Sci 2016; 50:195-203. [PMID: 30227002 DOI: 10.1177/2168479015604181] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is considerable interest among pharmaceutical and other medical product developers in adaptive clinical trials, in which knowledge learned during the course of a trial affects ongoing conduct or analysis of the trial. When the FDA released a draft Guidance document on adaptive design clinical trials in early 2010, expectations were high that it would lead to an increase in regulatory submissions involving adaptive design features, particularly for confirmatory trials. A 6-year (2008-2013) retrospective survey was performed within the Center for Biologics Evaluation and Research (CBER) at the FDA to gather information regarding the submission and evaluation of adaptive design trial proposals. We present an up-to-date summary of adaptive design proposals seen in CBER and provide an overview of our experiences. We share our concerns regarding the statistical issues and operational challenges raised during the review process for adaptive design trials. We also provide general recommendations for developing proposals for such trials. Our motivation in writing this paper was to encourage the best study design proposals to be submitted to CBER. Sometimes these can be adaptive, and sometimes a simpler design is most efficient.
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Affiliation(s)
- Min Lin
- 1 Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Shiowjen Lee
- 1 Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Boguang Zhen
- 1 Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - John Scott
- 1 Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Amelia Horne
- 1 Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Ghideon Solomon
- 1 Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Estelle Russek-Cohen
- 1 Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
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Luxembourg A, Kjaer SK, Nygard M, Ellison MC, Group T, Marshall JB, Radley D, Saah A. Design of a long-term follow-up effectiveness, immunogenicity and safety study of women who received the 9-valent human papillomavirus vaccine. Contemp Clin Trials 2016; 52:54-61. [PMID: 27777126 DOI: 10.1016/j.cct.2016.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
The 9-valent human papillomavirus (HPV) (9vHPV) vaccine targets four HPV types (6/11/16/18) also covered by the quadrivalent HPV (qHPV) vaccine and five additional types (31/33/45/52/58). Vaccine efficacy to prevent HPV infection and disease was established in a Phase III clinical study in women 16-26years of age. A long-term follow-up (LTFU) study has been initiated as an extension of the Phase III clinical study to assess effectiveness of the 9vHPV vaccine up to at least 14years after the start of vaccination. It includes participants from Denmark, Norway and Sweden and uses national health registries from these countries to assess incidence of cervical pre-cancers and cancers due to the 7 oncogenic types in the vaccine (HPV 16/18/31/33/45/52/58). Incidences will be compared to the estimated incidence rate in an unvaccinated cohort of similar age and risk level. This LTFU study uses a unique design: it is an extension of a Phase III clinical study and also has elements of an epidemiological study (i.e., endpoints based on standard clinical practice; surveillance using searches from health registries); it uses a control chart method to determine whether vaccine effectiveness may be waning. Control chart methods which were developed in industrial and manufacturing settings for process and production monitoring, can be used to monitor disease incidence in real-time and promptly detect a decrease in vaccine effectiveness. Experience from this innovative study design may be applicable to other medicinal products when long-term outcomes need to be assessed, there is no control group, or outcomes are rare.
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Affiliation(s)
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mari Nygard
- Department of Research, Cancer Registry of Norway, Oslo, Norway
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Fay MP, Huang CY, Twum-Danso NAY. Monitoring rare serious adverse events from a new treatment and testing for a difference from historical controls. Clin Trials 2016; 4:598-610. [DOI: 10.1177/1740774507084978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We detail the design of a study to monitor the safety of including albendazole to an existing treatment regimen to eliminate lymphatic filariasis. We wish to show that this new regimen does not increase the rate of a rare serious adverse event (SAE) compared to the old regimen. Controlled but small clinical trials have not detected any increase in the SAE using albendazole, and it is known to have added benefits; therefore, it is unethical to randomize patients to the old regimen. Purpose A sample size for the new regimen is needed to test that the new rate of SAE is noninferior to the historic rate. If the new regimen does have an inferior rate of SAE then we wish to stop the study early. This setup is different from traditional early stopping for efficacy and futility. In that traditional case, the two stopping decisions are relative to the same null hypothesis of equality, while in our setup, we have two different null hypotheses: the noninferiority null and the equality null. When testing the former, we need not stop early if the new regimen appears better because no subjects are receiving the old regimen anymore anyway. When testing the equality of SAE rates, however, we want to stop early if the new regimen has a significantly higher rate of SAE. Methods We create a design that uses an exact difference in proportions test for testing noninferiority, but calculates maximal sample size based on conditional power which treats the historical rates as true rates. The design allows for early stopping if the new treatment appears inferior with respect to SAE rate but makes no corrections for multiple testing. We explore the properties of this naive design without assuming the historical rates are known. Results For our example, we show that our naive design strategy bounds the type I error of the noninferiority hypothesis in all cases and bounds it for the equality hypothesis at 0.05, as long as the true SAE rate is <0.00015. The same design has unconditional power for the noninferiority hypothesis greater than the nominal 80% as long as the true SAE rate for both regimens are <0.00025. Limitations The type I and power results above hold only for our historical sample size of 17 877. We expect similar type I and power properties to hold with studies with SAE rates similar or less (i.e., < 0.00015) and historical sample sizes similar or smaller. Conclusions Our design for comparing very rare historical SAE rates to SAE rates of a new treatment has large power to conclude noninferiority of the new treatment SAE rate when both rates are equal, but allows early stopping if the new SAE rates are worse. Clinical Trials 2007; 4: 598—610. http://ctj.sagepub.com
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Affiliation(s)
- Michael P. Fay
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, 6700B Rockledge Drive, Bethesda, MD 20892-7609, USA,
| | - Chiung-Yu Huang
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, 6700B Rockledge Drive, Bethesda, MD 20892-7609, USA
| | - Nana A. Y. Twum-Danso
- The Task Force for Child Survival and Development, 750 Commerce Drive, Suite 400, Decatur, GA 30030, USA
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Heyse J, Chan I. Review of Statistical Innovations in Trials Supporting Vaccine Clinical Development. Stat Biopharm Res 2016. [DOI: 10.1080/19466315.2015.1093540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Alemayehu D, Utt E, Knirsch C. Vaccines: A review of immune-based interventions to prevent and treat disease. J Clin Pharmacol 2015; 55 Suppl 3:S93-102. [PMID: 25707968 DOI: 10.1002/jcph.397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/05/2014] [Indexed: 01/01/2023]
Abstract
The enormous gains made in public health during the 20th century, through the prevention and treatment of infectious disease, have contributed to dramatic improvements in the quality and length of the human lifespan. Continued advances in medicine are dependent on addressing several challenges including the increase in existing and new resistance to antibiotics, the decrease in productivity of the research and development (R&D) ecosystem, uncertain regulatory pathways, and an economic environment that rewards innovation for developing therapeutics that involve long cycle times from idea to a product. In this article, we consider important issues pertaining to the development of vaccines with particular emphasis on preclinical requirements, optimal dose selection, design, execution, and reporting of clinical trials for regulatory submission, planning and implementation of post-approval life-cycle programs, and emerging themes in therapeutic vaccines.
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Heimann G, Von Tress M, Gasparini M. Exact and asymptotic inference in clinical trials with small event rates under inverse sampling. Stat Med 2015; 34:2708-24. [PMID: 25872880 DOI: 10.1002/sim.6511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/24/2015] [Accepted: 03/29/2015] [Indexed: 11/12/2022]
Abstract
In this paper, we discuss statistical inference for a 2 × 2 table under inverse sampling, where the total number of cases is fixed by design. We demonstrate that the exact unconditional distributions of some relevant statistics differ from the distributions under conventional sampling, where the sample size is fixed by design. This permits us to define a simple unconditional alternative to Fisher's exact test. We provide an asymptotic argument including simulations to demonstrate that there is little power loss associated with the alternative test when the expected event rates are very small. We then apply the method to design a clinical trial in cataract surgery, where a rare side effect occurs in one in 1000 patients. The objective of the trial is to demonstrate that adjuvant treatment with an antibiotic will reduce this risk to one in 2000. We use an inverse sampling design and demonstrate how to set this up in a sequential manner. Particularly simple stopping rules can be defined when using the unconditional alternative to Fisher's exact test.
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Affiliation(s)
- Günter Heimann
- Pharmacometrics, Oncology Clinical Pharmacology, Novartis Pharma AGBasel, Switzerland
| | | | - Mauro Gasparini
- Department of Mathematical Sciences, Politecnico di TorinoTorino, Italy
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Gasparini M, Von Tress M, Heimann G. Comparative randomized inverse sampling. STAT NEERL 2015. [DOI: 10.1111/stan.12049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mauro Gasparini
- Department of Mathematical Sciences; Politecnico di Torino; Torino Italy
| | | | - Guenter Heimann
- Pharmacometrics, Oncology Clinical Pharmacology; Novartis Pharma AG; Basel Switzerland
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Zhang J, Zhang XF, Huang SJ, Wu T, Hu YM, Wang ZZ, Wang H, Jiang HM, Wang YJ, Yan Q, Guo M, Liu XH, Li JX, Yang CL, Tang Q, Jiang RJ, Pan HR, Li YM, Shih JWK, Ng MH, Zhu FC, Xia NS. Long-term efficacy of a hepatitis E vaccine. N Engl J Med 2015; 372:914-22. [PMID: 25738667 DOI: 10.1056/nejmoa1406011] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatitis E virus (HEV) is a leading cause of acute hepatitis. The long-term efficacy of a hepatitis E vaccine needs to be determined. METHODS In an initial efficacy study, we randomly assigned healthy adults 16 to 65 years of age to receive three doses of either a hepatitis E vaccine (vaccine group; 56,302 participants) or a hepatitis B vaccine (control group; 56,302 participants). The vaccines were administered at 0, 1, and 6 months, and the participants were followed for 19 months. In this extended follow-up study, the treatment assignments of all participants remained double-blinded, and follow-up assessments of efficacy, immunogenicity, and safety were continued for up to 4.5 years. RESULTS During the 4.5-year study period, 60 cases of hepatitis E were identified; 7 cases were confirmed in the vaccine group (0.3 cases per 10,000 person-years), and 53 cases in the control group (2.1 cases per 10,000 person-years), representing a vaccine efficacy of 86.8% (95% confidence interval, 71 to 94) in the modified intention-to-treat analysis, rather than (95% confidence interval, 71 to 84) [corrected]. Of the participants who were assessed for immunogenicity and were seronegative at baseline, 87% of those who received three doses of the hepatitis E vaccine maintained antibodies against HEV for at least 4.5 years; HEV antibody titers developed in 9% in the control group. The rate of adverse events was similar in the two groups. CONCLUSIONS Immunization with this hepatitis E vaccine induced antibodies against HEV and provided protection against hepatitis E for up to 4.5 years. (Funded by the Chinese Ministry of Science and Technology and others; ClinicalTrials.gov number, NCT01014845.).
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Affiliation(s)
- Jun Zhang
- From the State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Collaborative Innovation Center of Biologic Products, School of Public Health, Xiamen University (J.Z., S.-J.H., T.W., J.W.-K.S., M.-H.N., N.-S.X.), and Xiamen Innovax Biotech Company (Q.Y., M.G., X.-H.L., H.-R.P., Y.-M.L.), Xiamen, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing (X.-F.Z., Y.-M.H., H.W., J.-X.L., F.-C.Z.), Dongtai Center for Disease Control and Prevention, Dongtai (Z.-Z.W., H.-M.J., Y.-J.W., C.-L.Y.), and Yancheng Center for Disease Control and Prevention, Yancheng (Q.T., R.-J.J.) - all in China
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Design of a large outcome trial for a multivalent human papillomavirus L1 virus-like particle vaccine. Contemp Clin Trials 2015; 42:18-25. [PMID: 25749310 DOI: 10.1016/j.cct.2015.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The 9-valent human papillomavirus (HPV) (9vHPV) vaccine targets the four HPV types (6/11/16/18) covered by the licensed quadrivalent HPV (qHPV) vaccine and five additional types (31/33/45/52/58). A large outcome trial of 9vHPV vaccine was conducted. METHODS An active control (qHPV vaccine) was used because a placebo is not ethically acceptable. Since qHPV vaccine is (and 9vHPV vaccine was anticipated to be) highly efficacious against HPV 6/11/16/18, low incidence of HPV 6/11/16/18-associated disease was expected. Consequently, an efficacy comparison of 9vHPV versus qHPV vaccine for HPV 6/11/16/18 would have been prohibitively large in size. Moreover, no minimum antibody level predicting protection against infection or disease is defined for HPV vaccination. As an alternative approach, the two vaccines were compared using immunogenicity bridging for HPV 6/11/16/18 and clinical efficacy for HPV 31/33/45/52/58. RESULTS The two co-primary objectives were to demonstrate: (1) non-inferior anti-HPV 6/11/16/18 antibody response; and (2) superior efficacy in HPV 31/33/45/52/58-related clinical outcome, for 9vHPV vaccine versus qHPV vaccine. For HPV 6/11/16/18, supportive analyses included a non-inferiority assessment of the percent risk reduction (compared to historical placebo) for 9vHPV versus qHPV vaccine. CONCLUSIONS A Phase III study of 9vHPV vaccine was successfully implemented. Experience from this study design may be applicable when developing a multivalent vaccine covering the same serotypes as an existing vaccine plus additional serotypes and there is no immune correlate of protection. Also, this study established that efficacy of a new HPV vaccine may be demonstrated using immunogenicity endpoints, which may open new options in HPV vaccine development.
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Joura EA, Giuliano AR, Iversen OE, Bouchard C, Mao C, Mehlsen J, Moreira ED, Ngan Y, Petersen LK, Lazcano-Ponce E, Pitisuttithum P, Restrepo JA, Stuart G, Woelber L, Yang YC, Cuzick J, Garland SM, Huh W, Kjaer SK, Bautista OM, Chan ISF, Chen J, Gesser R, Moeller E, Ritter M, Vuocolo S, Luxembourg A. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med 2015; 372:711-23. [PMID: 25693011 DOI: 10.1056/nejmoa1405044] [Citation(s) in RCA: 886] [Impact Index Per Article: 98.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The investigational 9-valent viruslike particle vaccine against human papillomavirus (HPV) includes the HPV types in the quadrivalent HPV (qHPV) vaccine (6, 11, 16, and 18) and five additional oncogenic types (31, 33, 45, 52, and 58). Here we present the results of a study of the efficacy and immunogenicity of the 9vHPV vaccine in women 16 to 26 years of age. METHODS We performed a randomized, international, double-blind, phase 2b-3 study of the 9vHPV vaccine in 14,215 women. Participants received the 9vHPV vaccine or the qHPV vaccine in a series of three intramuscular injections on day 1 and at months 2 and 6. Serum was collected for analysis of antibody responses. Swabs of labial, vulvar, perineal, perianal, endocervical, and ectocervical tissue were obtained and used for HPV DNA testing, and liquid-based cytologic testing (Papanicolaou testing) was performed regularly. Tissue obtained by means of biopsy or as part of definitive therapy (including a loop electrosurgical excision procedure and conization) was tested for HPV. RESULTS The rate of high-grade cervical, vulvar, or vaginal disease irrespective of HPV type (i.e., disease caused by HPV types included in the 9vHPV vaccine and those not included) in the modified intention-to-treat population (which included participants with and those without prevalent infection or disease) was 14.0 per 1000 person-years in both vaccine groups. The rate of high-grade cervical, vulvar, or vaginal disease related to HPV-31, 33, 45, 52, and 58 in a prespecified per-protocol efficacy population (susceptible population) was 0.1 per 1000 person-years in the 9vHPV group and 1.6 per 1000 person-years in the qHPV group (efficacy of the 9vHPV vaccine, 96.7%; 95% confidence interval, 80.9 to 99.8). Antibody responses to HPV-6, 11, 16, and 18 were noninferior to those generated by the qHPV vaccine. Adverse events related to injection site were more common in the 9vHPV group than in the qHPV group. CONCLUSIONS The 9vHPV vaccine prevented infection and disease related to HPV-31, 33, 45, 52, and 58 in a susceptible population and generated an antibody response to HPV-6, 11, 16, and 18 that was noninferior to that generated by the qHPV vaccine. The 9vHPV vaccine did not prevent infection and disease related to HPV types beyond the nine types covered by the vaccine. (Funded by Merck; ClinicalTrials.gov number, NCT00543543).
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Affiliation(s)
- Elmar A Joura
- From the Medical University of Vienna, Comprehensive Cancer Center, Vienna (E.A.J.); Moffitt Cancer Center, Tampa, FL (A.R.G.); Department of Clinical Medicine, University of Bergen-Haukeland University Hospital, Bergen, Norway (O.-E.I.); Université Laval, Québec, QC (C.B.), and University of British Columbia, Vancouver (G.S.) - both in Canada; University of Washington, Seattle (C.M.); Coordinating Research Center, Frederiksberg Hospital, University of Copenhagen (J.M.), and Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet (S.K.K.) - all in Copenhagen; Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil (E.D.M.); University of Hong Kong, Hong Kong (Y.N.); Aarhus University Hospital, Department of Obstetrics and Gynecology, Aarhus, Denmark (L.K.P.); Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico (E.L.-P.); Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand (P.P.); Investigación Clínica, Medellín, Colombia (J.A.R.); Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.W.); Mackay Memorial Hospital, Taipei, Taiwan (Y.C.Y.); Wolfson Institute of Preventive Medicine, London (J. Cuzick); Royal Women's Hospital, University of Melbourne and Murdoch Childrens Research Institute, Parkville, VIC, Australia (S.M.G.); Division of Gynecologic Oncology, University of Alabama, Birmingham (W.H.); and Merck, Whitehouse Station, NJ (O.M.B., I.S.F.C., J. Chen, R.G., E.M., M.R., S.V., A.L.)
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Multiplicity Adjustment in Seamless Phase II/III Adaptive Trials Using Biomarkers for Dose Selection. ICSA BOOK SERIES IN STATISTICS 2015. [DOI: 10.1007/978-3-319-12694-4_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Chen YHJ, Gesser R, Luxembourg A. A seamless phase IIB/III adaptive outcome trial: design rationale and implementation challenges. Clin Trials 2014; 12:84-90. [PMID: 25278227 DOI: 10.1177/1740774514552110] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The licensed four-valent prophylactic human papillomavirus vaccine is highly efficacious in preventing cervical, vulvar, vaginal, and anal cancers and related precancers caused by human papillomavirus types 6, 11, 16, and 18. These four types account for approximately 70% of cervical cancers. A nine-valent human papillomavirus vaccine, including the four original types (6, 11, 16, and 18) plus the next five most prevalent types in cervical cancer (31, 33, 45, 52, and 58) could provide approximately 90% overall cervical cancer coverage. To expedite the nine-valent human papillomavirus vaccine clinical development, an adaptive, seamless Phase IIB/III outcome trial with ∼ 15,000 subjects was conducted to facilitate dose formulation selection and provide pivotal evidence of safety and efficacy for regulatory registrations. PURPOSE We discuss the design rationale and implementation challenges of the outcome trial, focusing on the adaptive feature of the seamless Phase IIB/III design. METHODS Subjects were enrolled in two parts (Part A and Part B). Approximately 1240 women, 16-26 years of age, were enrolled in Part A for Phase IIB evaluation and equally randomized to one of three dose formulations of the nine-valent human papillomavirus vaccine or the four-valent human papillomavirus vaccine (active control). Based on an interim analysis of immunogenicity and safety, one dose formulation of the nine-valent human papillomavirus vaccine was selected for evaluation in the Phase III part of the study. Subjects enrolled in Part A who received the selected dose formulation of the nine-valent human papillomavirus vaccine or four-valent human papillomavirus vaccine continued to be followed up and contributed to the final efficacy and safety analyses. In addition, ∼ 13,400 women 16-26 years of age were enrolled in Part B, randomized to nine-valent human papillomavirus vaccine at the selected dose formulation or four-valent human papillomavirus vaccine, and followed for immunogenicity, efficacy, and safety. RESULTS A seamless Phase IIB/III design was justified by the extensive pre-existing knowledge of the licensed four-valent human papillomavirus vaccine and the development objectives for the nine-valent human papillomavirus vaccine. Subjects enrolled in Part A who received either the selected nine-valent human papillomavirus formulation or four-valent human papillomavirus vaccine contributed ∼ 10% of person-years of follow-up due to its earlier start-thereby maximizing the overall efficiency of the trial. Some of the challenges encountered in the implementation of the adaptive design included practical considerations during Phase IIB formulation selection by internal and external committees, End-of-Phase II discussion with health authorities and managing changes in the assay for immunological endpoints. LIMITATIONS Application of the experience and lesson learned from this seamless adaptive design to other clinical programs may depend on case-by-case consideration. CONCLUSION A seamless Phase IIB/III adaptive design was successfully implemented in this large outcome study. The development time of the second-generation nine-valent human papillomavirus vaccine was shortened due to improved statistical efficiency.
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Affiliation(s)
| | - Richard Gesser
- Merck & Co., Inc., Whitehouse Station, NJ, USA Sanofi-Pasteur, Swiftwater, PA, USA
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Fay MP, Brittain EH, Proschan MA. Pointwise confidence intervals for a survival distribution with small samples or heavy censoring. Biostatistics 2013; 14:723-36. [PMID: 23632624 DOI: 10.1093/biostatistics/kxt016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We propose a beta product confidence procedure (BPCP) that is a non-parametric confidence procedure for the survival curve at a fixed time for right-censored data assuming independent censoring. In such situations, the Kaplan-Meier estimator is typically used with an asymptotic confidence interval (CI) that can have coverage problems when the number of observed failures is not large, and/or when testing the latter parts of the curve where there are few remaining subjects at risk. The BPCP guarantees central coverage (i.e. ensures that both one-sided error rates are no more than half of the total nominal rate) when there is no censoring (in which case it reduces to the Clopper-Pearson interval) or when there is progressive type II censoring (i.e. when censoring only occurs immediately after failures on fixed proportions of the remaining individuals). For general independent censoring, simulations show that the BPCP maintains central coverage in many situations where competing methods can have very substantial error rate inflation for the lower limit. The BPCP gives asymptotically correct coverage and is asymptotically equivalent to the CI on the Kaplan-Meier estimator using Greenwood's variance. The BPCP may be inverted to create confidence procedures for a quantile of the underlying survival distribution. Because the BPCP is easy to implement, offers protection in settings when other methods fail, and essentially matches other methods when they succeed, it should be the method of choice.
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Affiliation(s)
- Michael P Fay
- National Institute of Allergy and Infectious Diseases, 6700B Rockledge Dr. MSC 7630, Bethesda, MD 20892-7630, USA
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Clark LR, Myers ER, Huh W, Joura EA, Paavonen J, Perez G, James MK, Sings HL, Haupt RM, Saah AJ, Garner EIO. Clinical trial experience with prophylactic human papillomavirus 6/11/16/18 vaccine in young black women. J Adolesc Health 2013; 52:322-9. [PMID: 23299013 DOI: 10.1016/j.jadohealth.2012.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/29/2012] [Accepted: 07/03/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Human papillomavirus (HPV) is the causative agent of cervical cancer. Black women are disproportionally diagnosed and have higher mortality from cervical cancer in the United States. Here we describe the prophylactic efficacy and safety of a quadrivalent HPV-6/11/16/18 vaccine in black women. METHODS A total of 700 black women from Latin America, Europe, and North America (aged 16-24 years) received the vaccine or placebo in one of two studies. Analyses focused on the efficacy and safety of the vaccine. RESULTS Baseline rates of Chlamydia trachomatis infection and history of past pregnancy were more than twice as high in black women compared with the non-black women who were enrolled in these trials. HPV-6/11/16 or 18 DNA was detected in 18% of black women versus 14.6% in non-black women at day 1. For black women, vaccine efficacy against disease caused by HPV-6/11/16/18 was 100% for cervical intraepithelial neoplasia (0 vs. 15 cases; 95% confidence interval, 64.5%-100%) and 100% for vulvar and vaginal intraepithelial neoplasia and condylomata acuminata (0 vs. 17 cases; 95% confidence interval, 69.3%-100%). There were no serious vaccine-related adverse experiences. A similar proportion of pregnancies resulted in live births (75.8% vaccine; 72.7% placebo) and fetal loss (24.2% vaccine; 27.3% placebo). CONCLUSIONS Prophylactic quadrivalent HPV-6/11/16/18 vaccination of young black women demonstrated high efficacy, safety, and tolerability. HPV vaccination has the potential to reduce cervical cancer-related health disparities both in the United States and around the world.
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Affiliation(s)
- Liana R Clark
- Department of Global Medical Affairs and Policy, Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA.
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Rana MM, Huhtala H, Apter D, Eriksson T, Luostarinen T, Natunen K, Paavonen J, Pukkala E, Lehtinen M. Understanding long-term protection of human papillomavirus vaccination against cervical carcinoma: Cancer registry-based follow-up. Int J Cancer 2012. [PMID: 23180157 DOI: 10.1002/ijc.27971] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Phase III clinical trials of human papilloma virus (HPV) vaccination have shown ≥95% efficacy against HPV16/18 associated cervical intraepithelial neoplasia (CIN) Grade 2/3. Long-term surveillance is, however, needed to determine the overall vaccine efficacy (VE) against CIN3 and invasive cervical carcinoma (ICC). During population-based recruitment between September 2002 and March 2003, 1,749 16- to 17-year old Finns participated in a multi-national randomized Phase III HPV6/11/16/18 vaccine (FUTURE II) trial for the determination of VE against HPV16/18 positive CIN2/3. The passive follow-up started at the country-wide, population-based Finnish Cancer Registry (FCR) six months after the active follow-up and voluntary cross-vaccination in April 2007. A cluster randomized, population-based reference cohort of 15,744 unvaccinated, originally 18-19 year old Finns was established in two phases in 2003 and 2005 after the FUTURE II recruitment. We linked these cohorts with the FCR in 2007-2011 (HPV vaccine and placebo cohorts) and 2006-2010 and 2008-2012 (unvaccinated reference cohorts 1 and 2) to compare their incidences of CIN3 and ICC. The four years passive follow-up resulted in 3,464, 3,444 and 62,876 person years for the HPV6/11/16/18, original placebo and reference cohorts, after excluding cases discovered during the clinical follow-up and individuals not at risk. The numbers of CIN3 and ICC cases identified were 0 and 0, 3 and 0, 59 and 3 for the HPV6/11/16/18, placebo and the unvaccinated reference cohorts. The corresponding CIN3 incidence rates were 0/100,000 (95% confidence interval 0.0-106.5), 87.1/100,000 (95% CI 17.9-254.5) and 93.8/100,000 (95% CI 71.4-121), respectively. Long-term surveillance up to 8 years (and longer) post vaccination of the HPV6/11/16/18 vaccine and placebo cohorts, and the unvaccinated reference cohort (not exposed to interventions) for the most stringent efficacy end-points by passive cancer registry-based follow-up is feasible.
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Schmader KE, Levin MJ, Gnann JW, McNeil SA, Vesikari T, Betts RF, Keay S, Stek JE, Bundick ND, Su SC, Zhao Y, Li X, Chan ISF, Annunziato PW, Parrino J. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis 2012; 54:922-8. [PMID: 22291101 DOI: 10.1093/cid/cir970] [Citation(s) in RCA: 314] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ) adversely affects individuals aged 50-59, but vaccine efficacy has not been assessed in this population. This study was designed to determine the efficacy, safety, and tolerability of zoster vaccine for preventing HZ in persons aged 50-59 years. METHODS This was a randomized, double-blind, placebo-controlled study of 22 439 subjects aged 50-59 years conducted in North America and Europe. Subjects were given 1 dose of licensed zoster vaccine (ZV) (Zostavax; Merck) and followed for occurrence of HZ for ≥1 year (mean, 1.3 years) postvaccination until accrual of ≥96 confirmed HZ cases (as determined by testing lesions swabs for varicella zoster virus DNA by polymerase chain reaction). Subjects were followed for all adverse events (AEs) from day 1 to day 42 postvaccination and for serious AEs (SAEs) through day 182 postvaccination. RESULTS The ZV reduced the incidence of HZ (30 cases in vaccine group, 1.99/1000 person-years vs 99 cases in placebo group, 6.57/1000 person-years). Vaccine efficacy for preventing HZ was 69.8% (95% confidence interval, 54.1-80.6). AEs were reported by 72.8% of subjects in the ZV group and 41.5% in the placebo group, with the difference primarily due to higher rates of injection-site AEs and headache. The proportion of subjects reporting SAEs occurring within 42 days postvaccination (ZV, 0.6%; placebo, 0.5%) and 182 days postvaccination (ZV, 2.1%; placebo, 1.9%) was similar between groups. CONCLUSIONS In subjects aged 50-59 years, the ZV significantly reduced the incidence of HZ and was well tolerated. CLINICAL TRIALS REGISTRATION NCT00534248.
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Nam JS, Kang SH. Statistical Consideration of Vaccine Clinical Trials. KOREAN JOURNAL OF APPLIED STATISTICS 2011. [DOI: 10.5351/kjas.2011.24.4.633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zhu FC, Zhang J, Zhang XF, Zhou C, Wang ZZ, Huang SJ, Wang H, Yang CL, Jiang HM, Cai JP, Wang YJ, Ai X, Hu YM, Tang Q, Yao X, Yan Q, Xian YL, Wu T, Li YM, Miao J, Ng MH, Shih JWK, Xia NS. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 2010; 376:895-902. [PMID: 20728932 DOI: 10.1016/s0140-6736(10)61030-6] [Citation(s) in RCA: 486] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Seroprevalence data suggest that a third of the world's population has been infected with the hepatitis E virus. Our aim was to assess efficacy and safety of a recombinant hepatitis E vaccine, HEV 239 (Hecolin; Xiamen Innovax Biotech, Xiamen, China) in a randomised, double-blind, placebo-controlled, phase 3 trial. METHODS Healthy adults aged 16-65 years in, Jiangsu Province, China were randomly assigned in a 1:1 ratio to receive three doses of HEV 239 (30 microg of purified recombinant hepatitis E antigen adsorbed to 0.8 mg aluminium hydroxide suspended in 0.5 mL buffered saline) or placebo (hepatitis B vaccine) given intramuscularly at 0, 1, and 6 months. Randomisation was done by computer-generated permuted blocks and stratified by age and sex. Participants were followed up for 19 months. The primary endpoint was prevention of hepatitis E during 12 months from the 31st day after the third dose. Analysis was based on participants who received all three doses per protocol. Study participants, care givers, and investigators were all masked to group and vaccine assignments. This trial is registered with ClinicalTrials.gov, number NCT01014845. FINDINGS 11,165 of the trial participants were tested for hepatitis E virus IgG, of which 5285 (47%) were seropositive for hepatitis E virus. Participants were randomly assigned to vaccine (n=56,302) or placebo (n=56,302). 48,693 (86%) participants in the vaccine group and 48,663 participants (86%) in the placebo group received three vaccine doses and were included in the primary efficacy analysis. During the 12 months after 30 days from receipt of the third dose 15 per-protocol participants in the placebo group developed hepatitis E compared with none in the vaccine group. Vaccine efficacy after three doses was 100.0% (95% CI 72.1-100.0). Adverse effects attributable to the vaccine were few and mild. No vaccination-related serious adverse event was noted. INTERPRETATION HEV 239 is well tolerated and effective in the prevention of hepatitis E in the general population in China, including both men and women age 16-65 years. FUNDING Chinese National High-tech R&D Programme (863 programme), Chinese National Key Technologies R&D Programme, Chinese National Science Fund for Distinguished Young Scholars, Fujian Provincial Department of Sciences and Technology, Xiamen Science and Technology Bureau, and Fujian Provincial Science Fund for Distinguished Young Scholars.
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Affiliation(s)
- Feng-Cai Zhu
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu Province, China
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Zaman K, Dang DA, Victor JC, Shin S, Yunus M, Dallas MJ, Podder G, Vu DT, Le TPM, Luby SP, Le HT, Coia ML, Lewis K, Rivers SB, Sack DA, Schödel F, Steele AD, Neuzil KM, Ciarlet M. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in Asia: a randomised, double-blind, placebo-controlled trial. Lancet 2010; 376:615-23. [PMID: 20692031 DOI: 10.1016/s0140-6736(10)60755-6] [Citation(s) in RCA: 527] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rotavirus vaccine has proved effective for prevention of severe rotavirus gastroenteritis in infants in developed countries, but no efficacy studies have been done in developing countries in Asia. We assessed the clinical efficacy of live oral pentavalent rotavirus vaccine for prevention of severe rotavirus gastroenteritis in infants in Bangladesh and Vietnam. METHODS In this multicentre, double-blind, placebo-controlled trial, undertaken in rural Matlab, Bangladesh, and urban and periurban Nha Trang, Vietnam, infants aged 4-12 weeks without symptoms of gastrointestinal disorders were randomly assigned (1:1) to receive three oral doses of pentavalent rotavirus vaccine 2 mL or placebo at around 6 weeks, 10 weeks, and 14 weeks of age, in conjunction with routine infant vaccines including oral poliovirus vaccine. Randomisation was done by computer-generated randomisation sequence in blocks of six. Episodes of gastroenteritis in infants who presented to study medical facilities were reported by clinical staff and from parent recollection. The primary endpoint was severe rotavirus gastroenteritis (Vesikari score >or=11) arising 14 days or more after the third dose of placebo or vaccine to end of study (March 31, 2009; around 21 months of age). Analysis was per protocol; infants who received scheduled doses of vaccine or placebo without intervening laboratory-confirmed naturally occurring rotavirus disease earlier than 14 days after the third dose and had complete clinical and laboratory results were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT00362648. FINDINGS 2036 infants were randomly assigned to receive pentavalent rotavirus vaccine (n=1018) or placebo (n=1018). 991 infants assigned to pentavalent rotavirus vaccine and 978 assigned to placebo were included in the per-protocol analysis. Median follow up from 14 days after the third dose of placebo or vaccine until final disposition was 498 days (IQR 480-575). 38 cases of severe rotavirus gastroenteritis (Vesikari score >or=11) were reported during more than 1197 person-years of follow up in the vaccine group, compared with 71 cases in more than 1156 person years in the placebo group, resulting in a vaccine efficacy of 48.3% (95% CI 22.3-66.1) against severe disease (p=0.0005 for efficacy >0%) during nearly 2 years of follow-up. 25 (2.5%) of 1017 infants assigned to receive vaccine and 20 (2.0%) of 1018 assigned to receive placebo had a serious adverse event within 14 days of any dose. The most frequent serious adverse event was pneumonia (vaccine 12 [1.2%]; placebo 15 [1.5%]). INTERPRETATION In infants in developing countries in Asia, pentavalent rotavirus vaccine is safe and efficacious against severe rotavirus gastroenteritis, and our results support expanded WHO recommendations to promote its global use. FUNDING PATH (GAVI Alliance grant) and Merck.
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Affiliation(s)
- K Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Lazcano-Ponce E, Pérez G, Cruz-Valdez A, Zamilpa L, Aranda-Flores C, Hernández-Nevarez P, Viramontes JL, Salgado-Hernández J, James M, Lu S, Sattler C, Haupt RM, Hernández-Avila M. Impact of a quadrivalent HPV6/11/16/18 vaccine in Mexican women: public health implications for the region. Arch Med Res 2010; 40:514-24. [PMID: 19853193 DOI: 10.1016/j.arcmed.2009.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/08/2009] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Recognition of human papillomavirus (HPV) as a necessary cause of cervical cancer (CC) led to new perspectives for its control and the demonstration of an effective primary prevention strategy through vaccination. We undertook this study to evaluate the safety, efficacy and immunogenicity of a quadrivalent HPV6/11/16/18 vaccine in Mexican women. METHODS A total of 679 Mexican women between 18 and 23 years old participated in two Phase III double-blind, randomized, placebo-controlled clinical trials of a quadrivalent HPV 6/11/16/18 vaccine. Women were enrolled who tested negative for pregnancy and reported having four or less sexual partners during their lifetime. Vaccine or placebo was administered at day 1, month 2 and month 6. RESULTS Among Mexican women who were naïve to the respective vaccine type at enrollment, the quadrivalent vaccine was highly efficacious, preventing 100% of HPV6/11/16/18-related cervical intraepithelial neoplasia grade 2/3, adenocarcinoma in situ, condyloma and vaginal intraepithelial neoplasia. Statistical significance was not reached for every endpoint due to the limited sample size. Vaccination was generally well tolerated and immunogenic. DISCUSSION To widely administer the vaccine, collaborative efforts should be coordinated among public, private and local community sectors. In light of the scarce knowledge of many health professionals with respect to the primary prevention of CC, it will be necessary to educate health providers on the advantages and specific recommendations of HPV vaccines and secondary prevention. Decision making should be based on scientific evidence, allowing health professionals to provide an organized social response that supports the universal right to health.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública de México, México, D.F., Mexico.
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Muñoz N, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, Perez G, Brown DR, Koutsky LA, Tay EH, Garcia PJ, Ault KA, Garland SM, Leodolter S, Olsson SE, Tang GWK, Ferris DG, Paavonen J, Steben M, Bosch FX, Dillner J, Huh WK, Joura EA, Kurman RJ, Majewski S, Myers ER, Villa LL, Taddeo FJ, Roberts C, Tadesse A, Bryan JT, Lupinacci LC, Giacoletti KED, Sings HL, James MK, Hesley TM, Barr E, Haupt RM. Impact of Human Papillomavirus (HPV)-6/11/16/18 Vaccine on All HPV-Associated Genital Diseases in Young Women. ACTA ACUST UNITED AC 2010; 102:325-39. [PMID: 20139221 DOI: 10.1093/jnci/djp534] [Citation(s) in RCA: 372] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nubia Muñoz
- Division of Research and Public Health, National Institute of Cancer, Bogotá, Colombia .
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Chan ISF, Wang WWB. On Analysis of the Difference of Two Exposure-Adjusted Poisson Rates with Stratification: From Asymptotic to Exact Approaches. STATISTICS IN BIOSCIENCES 2009. [DOI: 10.1007/s12561-009-9007-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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