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Eun BW, Bahar E, Xavier S, Kim H, Borys D. Post-marketing surveillance study of the safety of the HPV-16/18 vaccine in Korea (2017-2021). Hum Vaccin Immunother 2023; 19:2184756. [PMID: 36896702 PMCID: PMC10026934 DOI: 10.1080/21645515.2023.2184756] [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] [Indexed: 03/11/2023] Open
Abstract
Human papillomavirus (HPV) infection is associated with the risk of developing certain cancers, including cancers of the cervix, vulva, vagina, penis, anus, rectum, and oropharynx. In 2016, the bivalent HPV-16/18 vaccine was included in the Korea National Immunization Program. This vaccine protects against HPV types 16 and 18 and other oncogenic HPV types predominant in cervical and anal cancers. This post-marketing surveillance (PMS) study assessed the safety of the HPV-16/18 vaccine in Korea. The study was conducted in males and females aged between 9 and 25 years, from 2017 to 2021. Safety was measured in terms of frequency and intensity of adverse events (AEs), adverse drug reactions (ADRs), and serious adverse events (SAEs) after each vaccine dose. The safety analysis included all participants who were vaccinated as per prescribing information and who completed a 30-day follow-up after at least one dose. Data were collected using individual case report forms. The total safety cohort included 662 participants. A total of 220 AEs were reported in 144 subjects (21.75%), and there were 158 ADRs in 111 subjects (16.77%), with the most common being injection site pain in all cases. No SAEs or serious ADRs were reported. Most AEs were reported after the first dose and were injection site reactions with mild intensity that recovered. No individuals required hospitalization or an emergency department visit. Safety results showed that the HPV-16/18 vaccine was generally well tolerated in the Korean population, and no safety concerns were identified.ClinicalTrials.gov Identifier: NCT03671369.
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Affiliation(s)
- Byung-Wook Eun
- Nowon Eulji University Hospital, Seoul, Republic of Korea
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Affonso de Oliveira JF, Chan SK, Omole AO, Agrawal V, Steinmetz NF. In Vivo Fate of Cowpea Mosaic Virus In Situ Vaccine: Biodistribution and Clearance. ACS NANO 2022; 16:18315-18328. [PMID: 36264973 PMCID: PMC9840517 DOI: 10.1021/acsnano.2c06143] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Cowpea mosaic virus (CPMV) is a nucleoprotein nanoparticle that functions as a highly potent immunomodulator when administered intratumorally and is used as an in situ vaccine. CPMV in situ vaccination remodels the tumor microenvironment and primes a highly potent, systemic, and durable antitumor immune response against the treated and untreated, distant metastatic sites (abscopal effect). Potent efficacy was demonstrated in multiple tumor mouse models and, most importantly, in canine cancer patients with spontaneous tumors. Data indicate that presence of anti-CPMV antibodies are not neutralizing and that in fact opsonization leads to enhanced efficacy. Plant viruses are part of the food chain, but to date, there is no information on human exposure to CPMV. Therefore, patient sera were tested for the presence of immunoglobulins against CPMV, and indeed, >50% of deidentified patient samples tested positive for CPMV antibodies. To get a broader sense of plant virus exposure and immunogenicity in humans, we also tested sera for antibodies against tobacco mosaic virus (>90% patients tested positive), potato virus X (<20% patients tested positive), and cowpea chlorotic mottle virus (no antibodies were detected). Further, patient sera were analyzed for the presence of antibodies against the coliphage Qβ, a platform technology currently undergoing clinical trials for in situ vaccination; we found that 60% of patients present with anti-Qβ antibodies. Thus, data indicate human exposure to CPMV and other plant viruses and phages. Next, we thought to address agronomical safety; i.e., we examined the fate of CPMV after intratumoral treatment and oral gavage (to mimic consumption by food). Because live CPMV is used, an important question is whether there is any evidence of shedding of infectious particles from mice or patients. CPMV is noninfectious toward mammals; however, it is infectious toward plants including black-eyed peas and other legumes. Biodistribution data in tumor-bearing and healthy mice indicate little leaching from tumors and clearance via the reticuloendothelial system followed by biliary excretion. While there was evidence of shedding of RNA in stool, there was no evidence of infectious particles when plants were challenged with stool extracts, thus indicating agronomical safety. Together these data aid the translational development of CPMV as a drug candidate for cancer immunotherapy.
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Affiliation(s)
| | - Soo Khim Chan
- Department of NanoEngineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
| | - Anthony O Omole
- Department of NanoEngineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
| | - Vanshika Agrawal
- Department of NanoEngineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
| | - Nicole F Steinmetz
- Department of NanoEngineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
- Center for Nano-ImmunoEngineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
- Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
- Moores Cancer Center, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
- Institute for Materials Discovery and Design, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92039, United States
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Lehtinen M, Gray P, Louvanto K, Vänskä S. In 30 years, gender-neutral vaccination eradicates oncogenic human papillomavirus (HPV) types while screening eliminates HPV-associated cancers. Expert Rev Vaccines 2022; 21:735-738. [PMID: 35404177 DOI: 10.1080/14760584.2022.2064279] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Tampere University Hospital, Tampere, Finland
| | - Penelope Gray
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Tampere University, Tampere, Finland
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Boender TS, Bartmeyer B, Coole L, Wichmann O, Harder T. Risk of Guillain-Barré syndrome after vaccination against human papillomavirus: a systematic review and meta-analysis, 1 January 2000 to 4 April 2020. Euro Surveill 2022; 27:2001619. [PMID: 35086611 PMCID: PMC8796292 DOI: 10.2807/1560-7917.es.2022.27.4.2001619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
BackgroundGuillain-Barré syndrome (GBS) is a rare autoimmune disease that can follow viral infections and has in a few cases been linked to vaccinations. Pre-licensure clinical trials did not observe an association between human papillomavirus (HPV) vaccination and GBS, a post-marketing study from 2017 reported an increased relative risk.AimWe assessed the risk of GBS after HPV vaccination through a systematic literature review and meta-analysis.MethodsWe searched Embase, MEDLINE and Cochrane for studies reporting on the risk of GBS after HPV vaccination in individuals aged ≥ 9 years, published between 1 January 2000 and 4 April 2020, excluding studies without a comparator group. Seven studies reporting relative effect sizes were pooled using random-effects meta-analysis. We assessed quality of evidence using the GRADE approach. Study protocol was registered (PROSPERO No. #CRD42019123533).ResultsOf 602 identified records, we included 25 studies. Based on over 10 million reports, cases of GBS were rare. In 22 studies no increased risk was observed, while in three studies a signal of increased risk of GBS after HPV vaccination was identified. Meta-analysis yielded a pooled random-effects ratio of 1.21 (95% CI: 0.60-2.43); I2 = 72% (95% CI: 36-88). This translates to a number needed to harm of one million to be vaccinated to generate one GBS case. Quality of evidence was very low.ConclusionsThe absolute and relative risk of GBS after HPV vaccination is very low and lacks statistical significance. This is reassuring for the already implemented vaccination programmes and should be used in respective communication activities.
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Affiliation(s)
- T Sonia Boender
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Barbara Bartmeyer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Louise Coole
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Field Service, UK Health Security Agency, Leeds, United Kingdom
| | - Ole Wichmann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Lehtinen M, Apter D, Eriksson T, Harjula K, Hokkanen M, Natunen K, Nieminen P, Paavonen J, Palmroth J, Petäjä T, Pukkala E, Vänskä S, Cheuvart B, Soila M, Bi D, Struyf F. Effectiveness of various human papillomavirus vaccination strategies: A community randomized trial in Finland. Cancer Med 2021; 10:7759-7771. [PMID: 34581025 PMCID: PMC8559511 DOI: 10.1002/cam4.4299] [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: 05/20/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION We conducted a community-randomized trial (NCTBLINDED) in Finland to assess gender-neutral and girls-only vaccination strategies with the AS04-adjuvanted human papillomavirus (HPV)-16/18 (AS04-HPV-16/18)vaccine. METHODS Girls and boys (12-15 years) were invited. We randomized 33 communities (1:1:1 ratio): Arm A: 90% of randomly selected girls and boys received AS04-HPV-16/18 vaccine and 10% received hepatitis B vaccine (HBV); Arm B: 90% of randomly selected girls received AS04-HPV-16/18 vaccine, 10% of girls received HBV, and all boys received HBV; Arm C: all participants received HBV. Effectiveness measurements against prevalence of HPV-16/18 cervical infection were estimated in girls at 18.5 years. The main measures were: (1) overall effectiveness comparing Arms A or B, regardless of vaccination status, vs Arm C; (2) total effectiveness comparing AS04-HPV-16/18 vaccinated girls in pooled Arms A/B vs Arm C; (3) indirect effectiveness (herd effect) comparing girls receiving HBV or unvaccinated in Arm A vs Arm C. Co-primary objectives were overall effectiveness following gender-neutral or girls-only vaccination. RESULTS Of 80,272 adolescents invited, 34,412 were enrolled. Overall effectiveness was 23.8% (95% confidence interval: -19.0, 51.1; P = 0.232) with gender-neutral vaccination. Following girls-only vaccination, overall effectiveness was 49.6% (20.1, 68.2; P = 0.004). Total effectiveness was over 90% regardless of vaccination strategy. No herd effect was found. Immunogenicity of the AS04-HPV-16/18 vaccine was high in both sexes. CONCLUSIONS This study illustrates the difficulty in conducting community randomized trials. It is not plausible that vaccinating boys would reduce overall effectiveness, and the apparent lack of herd effect was unexpected given findings from other studies. This analysis was likely confounded by several factors but confirms the vaccine's high total effectiveness as in clinical trials.
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Affiliation(s)
- Matti Lehtinen
- Department of Vaccines, National Institute for Health & Welfare, Helsinki, Finland.,Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Dan Apter
- VL-Medi Clinical Research Center, Helsinki, Finland
| | - Tiina Eriksson
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Katja Harjula
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mari Hokkanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Kari Natunen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Johanna Palmroth
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tiina Petäjä
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Eero Pukkala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Simopekka Vänskä
- Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
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Infante V, Miyaji KT, Soarez PC, Sartori AMC. Systematic review and meta-analysis of HPV vaccination in women with systemic lupus erythematosus (SLE). Expert Rev Vaccines 2021; 20:309-318. [PMID: 33573404 DOI: 10.1080/14760584.2021.1889375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to access HPV vaccines' safety and immunogenicity in Systemic Lupus Erythematosus (SLE) women. METHODS The search was conducted in the most relevant databases. Meta-analyses to evaluate seroconversion rates for each HPV vaccine type and SLE flare rates after vaccination were performed. RESULTS We identified 3,467 articles; six papers referring to SLE population were included. Five articles that evaluated vaccine immunogenicity at 7th month after enrollment were included in the meta-analysis. Overall seroconversion rates among SLE participants were 89.3% (95%CI, 0.76-1.00) for HPV6; 92.4% (95%CI, 0.82-1.00) for HPV11; 96.4% (95%CI, 0.93-1.00) for HPV16; and 91.8% (95%CI, 0.85-1.00) for HPV18. Five studies were included in the qualitative analysis of vaccines safety. Pain at the injection site was the most common adverse event (AE). Just one study reported serious AE not related to the vaccine. Flare rate after HPV vaccination was 12,6% (95% CI, 0.04-0.21). CONCLUSION Few studies, small sample size, evaluated HPV vaccines in SLE women. Seroconversion rates in SLE women were like healthy women, but anti-HPV geometric mean titers (GMT) were slightly lower in SLE women. HPV vaccines were safe in this population.
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Affiliation(s)
- Vanessa Infante
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Karina Takesaki Miyaji
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Patricia Coelhode Soarez
- Departamento De Medicina Preventiva, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
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