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El Hayek P, Boueri M, Nasr L, Aoun C, Sayad E, Jallad K. Cholera Infection Risks and Cholera Vaccine Safety in Pregnancy. Infect Dis Obstet Gynecol 2023; 2023:4563797. [PMID: 37260611 PMCID: PMC10228220 DOI: 10.1155/2023/4563797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Discuss the impact of cholera infection on pregnant women, fetus, and neonates and review the safety of cholera vaccines in pregnancy. Methods This study was carried out as a narrative review during November 2022. A thorough literature review was conducted on the following databases: PubMed, Scopus, SciELO, CINAHL, Web of Science, and ScienceDirect. The following parameters were assessed from the included studies: type of cholera vaccine, cholera symptoms, cholera treatment, effect of cholera on pregnancy, effect of cholera treatment on pregnancy, effect of cholera vaccine on pregnancy, risk factors for fetuses and neonates, and prevention of cholera. The authors independently extracted data from the 24 included studies. Results Cholera infection is a serious threat on pregnancy as it could lead to increased stillbirths and neonatal death. Fetal death was shown to occur mainly in the third trimester as most of the pregnant women infected with cholera had spontaneous abortions even after controlling for other confounding variables such as maternal age, dehydration level, and vomiting. Neonatal death was attributed mainly to congenital malformations and low Apgar scores with no improvements. Besides, cholera vaccines have shown to be safe in pregnancy and have proven to lower fetal and neonatal malformations among vaccinated compared to nonvaccinated pregnant women. Conclusion This narrative summarizes the different complications due to cholera infection in pregnancy. It also reviews the safety of cholera vaccine administration in pregnant women.
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Affiliation(s)
- Pamela El Hayek
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
- Department of Obstetrics and Gynecology, Lebanese American University School of Medicine, Lebanon
| | - Myriam Boueri
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
| | - Leah Nasr
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
| | - Christine Aoun
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
| | - Edouard Sayad
- Department of Pediatrics, Division of General Pediatrics, Division of Pediatric Pulmonology, Lebanese American University Medical Center LAUMCRH, Beirut, Lebanon
| | - Karl Jallad
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Lebanese American University School of Medicine, Lebanon
- Department of Obstetrics and Gynecology, Lebanese American University School of Medicine, Lebanon
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Voss G, Jacquet JM, Tornieporth N, Kampmann B, Karron R, Meulen AST, Chen R, Gruber M, Lurie N, Weller C, Cramer JP, Saville M, Darko M. Meeting report: CEPI consultation on accelerating access to novel vaccines against emerging infectious diseases for pregnant and lactating women, London, 12-13 February 2020. Vaccine 2021; 39:7357-7362. [PMID: 34799142 PMCID: PMC8595925 DOI: 10.1016/j.vaccine.2021.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/28/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Abstract
Infectious diseases may cause serious morbidity and mortality in pregnant women, their foetuses, and infants; the risk associated with any newly emerging infectious disease (EID) is likely unknown at the time of its emergence. While the ongoing SARS-CoV-2 pandemic shows that the development of vaccines against new pathogens can be considerably accelerated, the immunization of pregnant women generally lags behind the general population. Guided by the priority pathogen list for WHO's R&D Blueprint for Action to Prevent Epidemics, this workshop sought to define the evidence needed for use of vaccines against EIDs in pregnant and lactating women, using Lassa fever as a model. Close to 60 maternal immunization (MI) and vaccine safety experts, regulators, vaccine developers, Lassa fever experts, and investigators from Lassa-affected countries examined the critical steps for vaccine development and immunization decisions for pregnant and lactating women. This paper reports on key themes and recommendations from the workshop. Current practice still assumes the exclusion of pregnant women from early vaccine trials. A shift in paradigm is needed to progress towards initial inclusion of pregnant women in Phase 2 and 3 trials. Several practical avenues were delineated. Participants agreed that vaccine platforms should be assessed early for their suitability for maternal immunization. It was noted that, in some cases, nonclinical data derived from assessing a given platform using other antigens may be adequate evidence to proceed to a first clinical evaluation and that concurrence from regulators may be sought with supporting rationale. For clinical trials, essential prerequisites such as documenting the disease burden in pregnant women, study site infrastructure, capabilities, and staff experience were noted. Early and sustained communication with the local community was considered paramount in any program for the conduct of MI trials and planned vaccine introduction.
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Affiliation(s)
- Gerald Voss
- Coalition for Epidemic Preparedness and Innovation, London, UK.
| | | | | | - Beate Kampmann
- The Vaccine Centre, Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Karron
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Robert Chen
- Brighton Collaboration, Task Force for Global Health, Decatur, GA, USA
| | - Marion Gruber
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nicole Lurie
- Coalition for Epidemic Preparedness and Innovation, London, UK
| | | | - Jakob P Cramer
- Coalition for Epidemic Preparedness and Innovation, London, UK
| | - Melanie Saville
- Coalition for Epidemic Preparedness and Innovation, London, UK
| | - Mimi Darko
- Food and Drugs Authority, Cantonments, Accra, Ghana
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A phase I/II study to evaluate safety, tolerability and immunogenicity of Hillchol®, an inactivated single Hikojima strain based oral cholera vaccine, in a sequentially age descending population in Bangladesh. Vaccine 2021; 39:4450-4457. [PMID: 34218960 DOI: 10.1016/j.vaccine.2021.06.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends the use of oral cholera vaccines (OCVs) as part of an integrated control program, both in highly endemic settings and during cholera epidemics. The available and internationally recommended WHO-prequalified OCVs (Dukoral, Shanchol, Euvichol) contain multiple heat and formalin-killed V. cholerae strains of Inaba and Ogawa serotypes. MSD Wellcome Trust Hilleman Laboratories Pvt. Ltd. in technical collaboration with University of Gothenburg, Sweden has developed a new single strain OCV, Hillchol. This vaccine consists of formaldehyde-inactivated whole cell El Tor V. cholerae O1 bacteria engineered into the Hikojima serotype for stable expression of both the Ogawa (AB) and Inaba (AC) LPS antigens on the bacterial surface. We evaluated the safety and immunogenicity of this novel and potentially much less expensive OCV in comparison with Shanchol. METHODS We conducted a randomized, non-inferiority, age-descending clinical trial of OCV (Hillchol vs. Shanchol) in the Mirpur area of Dhaka city from July 2016 to May 2017. This study was carried out in three different age cohorts (1-<5, 5-17 and ≥18 years old). Two doses of vaccine were given at 14 days intervals to 560 healthy participants. FINDINGS No serious adverse events were reported. There were no significant differences in the rates of adverse events between the test vaccine (Hillchol) and the comparator (Shanchol) group. Serum vibriocidal antibody responses in all age groups combined were comparable for all the O1 Ogawa (59% vs. 67%; 90% CI of difference: -14.55, -0.84) and Inaba (70% vs. 71%; 90% CI of difference: -7.24, 5.77) serotypes, showing that the Hillchol vaccine was non-inferior to Shanchol. This new vaccine was also non-inferior to Shanchol in the different age strata. CONCLUSION The safety and immunogenicity profile of the new OCV Hillchol is comparable to Shanchol in persons residing in a cholera-endemic setting. ClinicalTrials.gov number: NCT02823899.
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Khan IA, Khan AI, Rahman A, Siddique SA, Islam MT, Bhuiyan MAI, Chowdhury AI, Saha NC, Biswas PK, Saha A, Chowdhury F, Clemens JD, Qadri F. Organization and implementation of an oral cholera vaccination campaign in an endemic urban setting in Dhaka, Bangladesh. Glob Health Action 2019; 12:1574544. [PMID: 30764750 PMCID: PMC6383613 DOI: 10.1080/16549716.2019.1574544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/17/2019] [Indexed: 11/13/2022] Open
Abstract
Bangladesh has historically been cholera endemic, with seasonal cholera outbreaks occurring each year. In collaboration with the government of Bangladesh, the Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) initiated operational research to test strategies to reach the high-risk urban population with an affordable oral cholera vaccine (OCV) "ShancholTM" and examine its effectiveness in reducing diarrhea due to cholera. Here we report a sub-analysis focusing on the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. We described how the vaccination program was planned, prepared and implemented using different strategies to deliver oral cholera vaccine to a high-risk urban population in Dhaka, Bangladesh based on administrative data and observations made during the program. The objective of this study is to evaluate the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. OCV administration by trained local volunteers through outreach sites and mop-up activities yielded high coverage of 82% and 72% of 172,754 targeted individuals for the first and second dose respectively, using national Expanded Program on Immunization (EPI) campaign mechanisms without disrupting routine immunization activities. The cost of delivery was low. Safety and cold chain requirements were adequately managed. The adopted strategies were technically and programmatically feasible. Current evidence on implementation strategies in different settings together with available OCV stockpiles should encourage at-risk countries to use OCV along with other preventive and control measures.
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Affiliation(s)
- Iqbal Ansary Khan
- Medical Social Science, Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Anisur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Shah Alam Siddique
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Md. Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Md. Amirul Islam Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Atique Iqbal Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Nirod Chandra Saha
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Prasanta Kumar Biswas
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Amit Saha
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - John D. Clemens
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research (ICDDR), Dhaka, Bangladesh
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