1
|
Al-Rashdan RA, Ta'an W, Mukattash T, Williams B. Maternal skepticism regarding children's vaccination in Jordan: Investigating the knowledge, attitude, and adherence. PLoS One 2024; 19:e0305209. [PMID: 38985715 PMCID: PMC11236176 DOI: 10.1371/journal.pone.0305209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/25/2024] [Indexed: 07/12/2024] Open
Abstract
Vaccination is critical to every responsible healthcare system, yielding several health and economic benefits. However, skepticism is a major challenge to vaccination adherence among parents globally. Mothers are primary decision-makers on children's vaccination; therefore, this study aims to assess maternal knowledge, attitudes, and adherence to children's routine vaccination in Jordan, identify the main sources of related information, and explore the awareness and hesitancy related to elective vaccination, which is not incorporated into the national vaccination program (e.g., varicella, flu, meningitis, and meningococcal vaccines). A descriptive, cross-sectional design was conducted to collect data from 533 Jordanian mothers between August and November 2023. Participant mothers completed an online self-administered questionnaire comprising demographics, knowledge, attitudes, and adherence to children's vaccination. The surveyed mothers in general exhibited high levels of knowledge, attitudes, and adherence concerning children's vaccination and a relatively moderate level of adherence concerning elective vaccines. The mothers' perspectives of reluctance towards elective vaccines were explored. The primary healthcare center and physicians were the most prevalent sources of mothers' vaccine-related information. Future efforts should implement tailored health education campaigns that address specific knowledge gaps, such as misconceptions about contraindications and side effects, promote awareness about elective vaccines, and engage healthcare providers to facilitate informed decision-making among Jordanian mothers and improve children's vaccination coverage.
Collapse
Affiliation(s)
- Rand A Al-Rashdan
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wafa'a Ta'an
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Mukattash
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Brett Williams
- Department of Paramedicine, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
2
|
Hodel KVS, Fiuza BSD, Conceição RS, Aleluia ACM, Pitanga TN, Fonseca LMDS, Valente CO, Minafra-Rezende CS, Machado BAS. Pharmacovigilance in Vaccines: Importance, Main Aspects, Perspectives, and Challenges-A Narrative Review. Pharmaceuticals (Basel) 2024; 17:807. [PMID: 38931474 PMCID: PMC11206969 DOI: 10.3390/ph17060807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Pharmacovigilance plays a central role in safeguarding public health by continuously monitoring the safety of vaccines, being critical in a climate of vaccine hesitancy, where public trust is paramount. Pharmacovigilance strategies employed to gather information on adverse events following immunization (AEFIs) include pre-registration data, media reports, clinical trials, and societal reporting. Early detection of AEFIs during clinical trials is crucial for thorough safety analysis and preventing serious reactions once vaccines are deployed. This review highlights the importance of societal reporting, encompassing contributions from community members, healthcare workers, and pharmaceutical companies. Technological advancements such as quick response (QR) codes can facilitate prompt AEFI reporting. While vaccines are demonstrably safe, the possibility of adverse events necessitates continuous post-marketing surveillance. However, underreporting remains a challenge, underscoring the critical role of public engagement in pharmacovigilance. This narrative review comprehensively examines and synthesizes key aspects of virus vaccine pharmacovigilance, with special considerations for specific population groups. We explore applicable legislation, the spectrum of AEFIs associated with major vaccines, and the unique challenges and perspectives surrounding pharmacovigilance in this domain.
Collapse
Affiliation(s)
- Katharine Valéria Saraiva Hodel
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Bianca Sampaio Dotto Fiuza
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Rodrigo Souza Conceição
- Department of Medicine, College of Pharmacy, Federal University of Bahia, Salvador 40170-115, Bahia State, Brazil
| | - Augusto Cezar Magalhães Aleluia
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
- Department of Natural Sciences, Southwestern Bahia State University (UESB), Campus Vitória da Conquista, Vitória da Conquista 45031-300, Bahia State, Brazil
| | - Thassila Nogueira Pitanga
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
- Laboratory for Research in Genetics and Translational Hematology, Gonçalo Moniz Institute, FIOCRUZ-BA, Salvador 40296-710, Bahia State, Brazil
| | - Larissa Moraes dos Santos Fonseca
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Camila Oliveira Valente
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | | | - Bruna Aparecida Souza Machado
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| |
Collapse
|
3
|
Principi N, Esposito S. Specific and Nonspecific Effects of Influenza Vaccines. Vaccines (Basel) 2024; 12:384. [PMID: 38675766 PMCID: PMC11054884 DOI: 10.3390/vaccines12040384] [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: 03/04/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
With the introduction of the influenza vaccine in the official immunization schedule of most countries, several data regarding the efficacy, tolerability, and safety of influenza immunization were collected worldwide. Interestingly, together with the confirmation that influenza vaccines are effective in reducing the incidence of influenza virus infection and the incidence and severity of influenza disease, epidemiological data have indicated that influenza immunization could be useful for controlling antimicrobial resistance (AMR) development. Knowledge of the reliability of these findings seems essential for precise quantification of the clinical relevance of influenza immunization. If definitively confirmed, these findings can have a relevant impact on influenza vaccine development and use. Moreover, they can be used to convince even the most recalcitrant health authorities of the need to extend influenza immunization to the entire population. In this narrative review, present knowledge regarding these particular aspects of influenza immunization is discussed. Literature analysis showed that the specific effects of influenza immunization are great enough per se to recommend systematic annual immunization of younger children, old people, and all individuals with severe chronic underlying diseases. Moreover, influenza immunization can significantly contribute to limiting the emergence of antimicrobial resistance. The problem of the possible nonspecific effects of influenza vaccines remains unsolved. The definition of their role as inducers of trained immunity seems essential not only to evaluate how much they play a role in the prevention of infectious diseases but also to evaluate whether they can be used to prevent and treat clinical conditions in which chronic inflammation and autoimmunity play a fundamental pathogenetic role.
Collapse
Affiliation(s)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| |
Collapse
|
4
|
Mathur P, Kottilil S. Novel oral polio vaccine for serotype 2: new hope. THE LANCET. INFECTIOUS DISEASES 2024; 24:223-224. [PMID: 38109920 DOI: 10.1016/s1473-3099(23)00549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Poonam Mathur
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Shyam Kottilil
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| |
Collapse
|
5
|
Schaltz-Buchholzer F, Nielsen S, Sørensen MK, Stjernholm EB, Fabricius RA, Umbasse P, Monteiro I, Cá EJC, Aaby P, Benn CS. Effects of Neonatal BCG-Japan Versus BCG-Russia Vaccination on Overall Mortality and Morbidity: Randomized Controlled Trial From Guinea-Bissau (BCGSTRAIN II). Open Forum Infect Dis 2024; 11:ofae057. [PMID: 38500576 PMCID: PMC10946234 DOI: 10.1093/ofid/ofae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
Background Vaccination with the Danish strain of bacille Calmette-Guérin (BCG) has been associated with pronounced reductions in all-cause neonatal mortality and morbidity. Developing a skin reaction postvaccination is associated with markedly reduced mortality risk. It is unknown whether the beneficial nonspecific effects are maintained across different BCG strains. Methods This was an open-label randomized controlled trial in Guinea-Bissau, comparing BCG-Japan (n = 8754) versus BCG-Russia (n = 8752) for all-cause hospital admission risk by 6 weeks of age (primary outcome) and 6 months of age. Additional secondary outcomes were in-hospital case-fatality risk (CFR), all-cause mortality, and BCG skin reaction prevalence. Participants were followed through telephone calls at 6 weeks and 6 months, with a subgroup also visited at home. We assessed admission and mortality risk in Cox models providing incidence rate ratios (IRRs) and mortality rate ratios. CFR and skin reactions were assessed by binomial regression providing risk ratios. Analyses were done overall and stratified by sex. Results BCG strain was not associated with admission risk, the BCG-Japan/BCG-Russia IRR being 0.92 (95% confidence interval [CI], .81-1.05) by 6 weeks and 0.92 (95% CI, .82-1.02) by 6 months. By 6 months of age, there were significantly fewer BCG-Japan infants with no skin reaction (1%) than for BCG-Russia (2%), the risk ratio being 0.36 (95% CI, .16-.81). BCG-Japan skin reactions were also larger. Conclusions Both vaccines induced a skin reaction in almost all participants. The BCG strains had comparable effects on morbidity and mortality, but BCG-Japan was associated with more and larger skin reactions that are indicators of lower mortality risk. Clinical Trials Registration NCT03400878.
Collapse
Affiliation(s)
- Frederik Schaltz-Buchholzer
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | | | | | | | - Paulo Umbasse
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Ivan Monteiro
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | | | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Danish Institute of Advanced Study, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
6
|
Kleimann P, Irschfeld LM, Grandoch M, Flögel U, Temme S. Trained Innate Immunity in Animal Models of Cardiovascular Diseases. Int J Mol Sci 2024; 25:2312. [PMID: 38396989 PMCID: PMC10889825 DOI: 10.3390/ijms25042312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Acquisition of immunological memory is an important evolutionary strategy that evolved to protect the host from repetitive challenges from infectious agents. It was believed for a long time that memory formation exclusively occurs in the adaptive part of the immune system with the formation of highly specific memory T cells and B cells. In the past 10-15 years, it has become clear that innate immune cells, such as monocytes, natural killer cells, or neutrophil granulocytes, also have the ability to generate some kind of memory. After the exposure of innate immune cells to certain stimuli, these cells develop an enhanced secondary response with increased cytokine secretion even after an encounter with an unrelated stimulus. This phenomenon has been termed trained innate immunity (TI) and is associated with epigenetic modifications (histone methylation, acetylation) and metabolic alterations (elevated glycolysis, lactate production). TI has been observed in tissue-resident or circulating immune cells but also in bone marrow progenitors. Risk-factors for cardiovascular diseases (CVDs) which are associated with low-grade inflammation, such as hyperglycemia, obesity, or high salt, can also induce TI with a profound impact on the development and progression of CVDs. In this review, we briefly describe basic mechanisms of TI and summarize animal studies which specifically focus on TI in the context of CVDs.
Collapse
Affiliation(s)
- Patricia Kleimann
- Institute of Molecular Cardiology, Faculty of Medicine, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (P.K.); (U.F.)
| | - Lisa-Marie Irschfeld
- Department of Radiation Oncology, Faculty of Medicine, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
| | - Maria Grandoch
- Institute of Translational Pharmacology, Faculty of Medicine, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
- Cardiovascular Research Institute Düsseldorf (CARID), University Hospital, 40225 Düsseldorf, Germany
| | - Ulrich Flögel
- Institute of Molecular Cardiology, Faculty of Medicine, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (P.K.); (U.F.)
- Cardiovascular Research Institute Düsseldorf (CARID), University Hospital, 40225 Düsseldorf, Germany
| | - Sebastian Temme
- Cardiovascular Research Institute Düsseldorf (CARID), University Hospital, 40225 Düsseldorf, Germany
- Department of Anesthesiology, Faculty of Medicine, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| |
Collapse
|
7
|
Thysen SM, da Silva Borges I, Martins J, Stjernholm AD, Hansen JS, da Silva LMV, Martins JSD, Jensen A, Rodrigues A, Aaby P, Stabell Benn C, Fisker AB. Can earlier BCG-Japan and OPV vaccination reduce early infant mortality? A cluster-randomised trial in Guinea-Bissau. BMJ Glob Health 2024; 9:e014044. [PMID: 38350670 PMCID: PMC10862335 DOI: 10.1136/bmjgh-2023-014044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/20/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To assess the effect of providing BCG and oral polio vaccine (OPV) at an early home visit after delivery. DESIGN Cluster-randomised trial, randomising 92 geographically defined clusters 1:1 to intervention/control arms. SETTING Bandim Health Project Health and Demographic Surveillance System, Guinea-Bissau. PARTICIPANTS 2226 newborns enrolled between July 2016 and August 2019. INTERVENTIONS In both arms, newborns received a home visit within 72 hours after birth. In intervention clusters (n=46), BCG and OPV were provided at the home visit. MAIN OUTCOME MEASURE Rates of non-accidental mortality were compared in Cox proportional hazards models from (last of) day 1 or enrolment, until (first of) day 60 or registration of non-trial vaccines. RESULTS A total of 35 deaths (intervention: 7, control: 28) were registered during the trial. Providing BCG and OPV reduced non-accidental early infant mortality by 59% (8-82%). The intervention also reduced non-accidental hospital admissions. The intervention had little impact on growth and BCG scarring and tended to increase the risk of consultations. CONCLUSIONS The trial was stopped early due to lower-than-expected enrolment and event rates when 33% of the planned number of newborns had been enrolled. Despite the small size of the trial, the results support that early BCG and OPV vaccinations are beneficial and reduce early child mortality and morbidity. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02504203).
Collapse
Affiliation(s)
- Sanne Marie Thysen
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | | | | | | | | | - Aksel Jensen
- Bandim Health Project, Bissau, Guinea-Bissau
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christine Stabell Benn
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Copenhagen, Denmark
| | - Ane Baerent Fisker
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
8
|
Rubio-Casillas A, Rodriguez-Quintero CM, Redwan EM, Gupta MN, Uversky VN, Raszek M. Do vaccines increase or decrease susceptibility to diseases other than those they protect against? Vaccine 2024; 42:426-440. [PMID: 38158298 DOI: 10.1016/j.vaccine.2023.12.060] [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: 08/29/2023] [Revised: 11/16/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
Contrary to the long-held belief that the effects of vaccines are specific for the disease they were created; compelling evidence has demonstrated that vaccines can exert positive or deleterious non-specific effects (NSEs). In this review, we compiled research reports from the last 40 years, which were found based on the PubMed search for the epidemiological and immunological studies on the non-specific effects (NSEs) of the most common human vaccines. Analysis of information showed that live vaccines induce positive NSEs, whereas non-live vaccines induce several negative NSEs, including increased female mortality associated with enhanced susceptibility to other infectious diseases, especially in developing countries. These negative NSEs are determined by the vaccination sequence, the antigen concentration in vaccines, the type of vaccine used (live vs. non-live), and also by repeated vaccination. We do not recommend stopping using non-live vaccines, as they have demonstrated to protect against their target disease, so the suggestion is that their detrimental NSEs can be minimized simply by changing the current vaccination sequence. High IgG4 antibody levels generated in response to repeated inoculation with mRNA COVID-19 vaccines could be associated with a higher mortality rate from unrelated diseases and infections by suppressing the immune system. Since most COVID-19 vaccinated countries are reporting high percentages of excess mortality not directly attributable to deaths from such disease, the NSEs of mRNA vaccines on overall mortality should be studied in depth.
Collapse
Affiliation(s)
- Alberto Rubio-Casillas
- Autlan Regional Hospital, Health Secretariat, Autlan 48900, Jalisco, Mexico; Biology Laboratory, Autlan Regional Preparatory School, University of Guadalajara, Autlan 48900, Jalisco, Mexico.
| | | | - Elrashdy M Redwan
- Biological Science Department, Faculty of Science, King Abdulaziz University, P.O. Box 80203, Jeddah 21589, Saudi Arabia; Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, New Borg EL-Arab, Alexandria 21934, Egypt.
| | - Munishwar Nath Gupta
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Hauz Khas, New Delhi 110016, India.
| | - Vladimir N Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer's Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.
| | - Mikolaj Raszek
- Merogenomics (Genomic Sequencing Consulting), Edmonton, AB T5J 3R8, Canada.
| |
Collapse
|
9
|
Aamand T, Fisker AB, Correia C, Fernandes M, Clipet-Jensen C, Thysen SM. Do Pentavalent (DTwP-Hib-HBV) vaccines have sex-differential nonspecific effects? An observational study. Hum Vaccin Immunother 2023; 19:2288297. [PMID: 38054431 PMCID: PMC10732639 DOI: 10.1080/21645515.2023.2288297] [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: 09/06/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
Vaccines may alter the ability to combat infections unrelated to the target disease, i.e. have "nonspecific effects." The non-live Diphtheria-Tetanus-Pertussis vaccine (DTP) has been associated with increased child mortality, especially for females. In 2008, the DTP-containing Pentavalent vaccine replaced DTP vaccine in Guinea-Bissau. We investigate female relative to male mortality after Penta vaccination. In Guinea-Bissau, Bandim Health Project (BHP) registered children's vaccination and vital status at biannual village visits and provided vaccines. Among children Penta-vaccinated by BHP, we compared mortality of males and females in Cox proportional hazards models. Children aged 6 weeks to 8 months entered the analysis at the date of vaccination and were followed for up to 6 months. Between September 2008 and December 2017, 33,989 children aged 6 weeks to 8 months were under surveillance. Of these 12,753 (females: 6,363; males: 6,390) received Penta by the BHP and entered the study contributing with 19,667 observations. The mortality rate following Penta vaccination was 25.2 per 1,000 person years for females and 26.6 for males, resulting in an adjusted Female/Male mortality rate ratio of (F/M aMRR) 1.01 (0.82-1.25). The association between sex and mortality differed by timeliness of vaccination, F/M aMRR: 0.62 (0.41-0.93) for children vaccinated below median age, and F/M aMRR: 1.38 (0.90-2.13) for children vaccinated above median age. We did not find higher overall mortality in females than males after Penta vaccination. Our findings suggest that mortality differences between males and females following Penta vaccination may depend on timeliness of Penta vaccination.
Collapse
Affiliation(s)
- Thomas Aamand
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Ane Bærent Fisker
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | | | | | | | - Sanne Marie Thysen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| |
Collapse
|
10
|
Lee MH, Kim BR, Seo H, Oh J, Kim HL, Kim BJ. Live Mycobacterium paragordonae induces heterologous immunity of natural killer cells by eliciting type I interferons from dendritic cells via STING-dependent sensing of cyclic-di-GMP. Microbes Infect 2023; 25:105144. [PMID: 37120009 DOI: 10.1016/j.micinf.2023.105144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
Exploiting the heterologous effects of vaccines is a feasible strategy to combat different pathogens. These effects have been explained by enhanced immune responses of innate immune cells. Mycobacterium paragordonae is a rare nontuberculosis mycobacterium that has temperature-sensitive properties. Although natural killer (NK) cells exhibit heterologous immunity features, the cellular crosstalk between NK cells and dendritic cells (DCs) during live mycobacterial infection has remained elusive. We show that live but not dead M. paragordonae enhances heterologous immunity against unrelated pathogens in NK cells by IFN-β of DCs in both mouse models and primary human immune cells. C-di-GMP from live M. paragordonae acted as a viability-associated pathogen-associated molecular pattern (Vita-PAMP), leading to STING-dependent type I IFN production in DCs via the IRE1α/XBP1s pathway. Also, increased cytosolic 2'3'-cGAMP by cGAS can induce type I IFN response in DCs by live M. paragordonae infection. We found that DC-derived IFN-β plays a pivotal role in NK cell activation by live M. paragordonae infection, showing NK cell-mediated nonspecific protective effects against Candida albicans infection in a mouse model. Our findings indicate that the heterologous effect of live M. paragordonae vaccination is mediated by NK cells based on the crosstalk between DCs and NK cells.
Collapse
Affiliation(s)
- Mi-Hyun Lee
- Department of Microbiology and Immunology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Bo-Ram Kim
- Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
| | - Hyejun Seo
- Department of Microbiology and Immunology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
| | - Jaehun Oh
- Department of Microbiology and Immunology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hye Lin Kim
- Department of Microbiology and Immunology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
| | - Bum-Joon Kim
- Department of Microbiology and Immunology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Liver Research Institute, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; Cancer Research Institute, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
| |
Collapse
|
11
|
Aaby P, Netea MG, Benn CS. Beneficial non-specific effects of live vaccines against COVID-19 and other unrelated infections. THE LANCET. INFECTIOUS DISEASES 2023; 23:e34-e42. [PMID: 36037824 PMCID: PMC9417283 DOI: 10.1016/s1473-3099(22)00498-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 12/25/2022]
Abstract
Live attenuated vaccines could have beneficial, non-specific effects of protecting against vaccine-unrelated infections, such as BCG protecting against respiratory infection. During the COVID-19 pandemic, testing of these effects against COVID-19 was of interest to the pandemic control programme. Non-specific effects occur due to the broad effects of specific live attenuated vaccines on the host immune system, relying on heterologous lymphocyte responses and induction of trained immunity. Knowledge of non-specific effects has been developed in randomised controlled trials and observational studies with children, but examining of whether the same principles apply to adults and older adults was of interest to researchers during the pandemic. In this Personal View, we aim to define a framework for the analysis of non-specific effects of live attenuated vaccines against vaccine-unrelated infections with pandemic potential using several important concepts. First, study endpoints should prioritise severity of infection and overall patient health rather than incidence of infection only (eg, although several trials found no protection of the BCG vaccine against COVID-19 infection, it is associated with lower overall mortality than placebo). Second, revaccination of an individual with the same live attenuated vaccine could be the most effective strategy against vaccine-unrelated infections. Third, coadministration of several live attenuated vaccines might enhance beneficial non-specific effects. Fourth, the sequence of vaccine administration matters; the live attenuated vaccine should be the last vaccine administered before exposure to the pandemic infection and non-live vaccines should not be administered afterwards. Fifth, live attenuated vaccines could modify the immune response to specific COVID-19 vaccines. Finally, non-specific effects of live attenuated vaccines should always be analysed with subgroup analysis by sex of individuals receiving the vaccines.
Collapse
Affiliation(s)
- Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau, University of Southern Denmark, Odense, Denmark; Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Mihai G Netea
- Radboud Center for Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands; Department of Immunology and Metabolism, Life and Medical Science Institute, University of Bonn, Bonn, Germany
| | - Christine S Benn
- Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Danish Institute of Advanced Science, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
12
|
St Clair LA, Chaulagain S, Klein SL, Benn CS, Flanagan KL. Sex-Differential and Non-specific Effects of Vaccines Over the Life Course. Curr Top Microbiol Immunol 2023; 441:225-251. [PMID: 37695431 PMCID: PMC10917449 DOI: 10.1007/978-3-031-35139-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Biological sex and age have profound effects on immune responses throughout the lifespan and impact vaccine acceptance, responses, and outcomes. Mounting evidence from epidemiological, clinical, and animal model studies show that males and females respond differentially to vaccination throughout the lifespan. Within age groups, females tend to produce greater vaccine-induced immune responses than males, with sex differences apparent across all age groups, but are most pronounced among reproductive aged individuals. Females report more adverse effects following vaccination than males. Females, especially among children under 5 years of age, also experience more non-specific effects of vaccination. Despite these known sex- and age-specific differences in vaccine-induced immune responses and outcomes, sex and age are often ignored in vaccine research. Herein, we review the known sex differences in the immunogenicity, effectiveness, reactogenicity, and non-specific effects of vaccination over the lifespan. Ways in which these data can be leveraged to improve vaccine research are described.
Collapse
Affiliation(s)
- Laura A St Clair
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabal Chaulagain
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Stabell Benn
- Institute of Clinical Research and Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Katie L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia.
| |
Collapse
|
13
|
Kouladoum JC. Inclusive Education and Health Performance in Sub Saharan Africa. SOCIAL INDICATORS RESEARCH 2022; 165:879-900. [PMID: 36536614 PMCID: PMC9750046 DOI: 10.1007/s11205-022-03046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
The study assesses the effect of inclusive education on health performance in 48 Sub Saharan African countries from 2000 to 2020. The study adopted the Driscoll/Kraay technique to address cross-sectional dependence and the GMM strategy to address potential endogeneity. The study employed three indicators of health performance which are the total life expectancy, the female life expectancy and the male life expectancy. Three gender parity index of educational enrolments are employed: primary education, secondary and the tertiary education as indicators of inclusive education. The findings of the study reveal that inclusive education enhances the health situation of individuals in Sub Saharan Africa. The findings further show that the health situation of both the male and the female are improved by inclusive education. The study recommends policymakers in this region to invest more in the education and the health sector so as to enhance the health performance of the citizens.
Collapse
|
14
|
Medeiros MM, Ingham AC, Nanque LM, Correia C, Stegger M, Andersen PS, Fisker AB, Benn CS, Lanaspa M, Silveira H, Abrantes P. Oral polio revaccination is associated with changes in gut and upper respiratory microbiomes of infants. Front Microbiol 2022; 13:1016220. [PMID: 36386704 PMCID: PMC9649904 DOI: 10.3389/fmicb.2022.1016220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
After the eradication of polio infection, the plan is to phase-out the live-attenuated oral polio vaccine (OPV). Considering the protective non-specific effects (NSE) of OPV on unrelated pathogens, the withdrawal may impact child health negatively. Within a cluster-randomized trial, we carried out 16S rRNA deep sequencing analysis of fecal and nasopharyngeal microbial content of Bissau–Guinean infants aged 4–8 months, before and after 2 months of OPV revaccination (revaccinated infants = 47) vs. no OPV revaccination (control infants = 47). The aim was to address changes in the gut and upper respiratory bacterial microbiotas due to revaccination. Alpha-diversity for both microbiotas increased similarly over time in OPV-revaccinated infants and controls, whereas greater changes over time in the bacterial composition of gut (padjusted < 0.001) and upper respiratory microbiotas (padjusted = 0.018) were observed in the former. Taxonomic analysis of gut bacterial microbiota revealed a decrease over time in the median proportion of Bifidobacterium longum for all infants (25–14.3%, p = 0.0006 in OPV-revaccinated infants and 25.3–11.6%, p = 0.01 in controls), compatible with the reported weaning. Also, it showed a restricted increase in the median proportion of Prevotella_9 genus in controls (1.4–7.1%, p = 0.02), whereas in OPV revaccinated infants an increase over time in Prevotellaceae family (7.2–17.4%, p = 0.005) together with a reduction in median proportion of potentially pathogenic/opportunistic genera such as Escherichia/Shigella (5.8–3.4%, p = 0.01) were observed. Taxonomic analysis of upper respiratory bacterial microbiota revealed an increase over time in median proportions of potentially pathogenic/opportunistic genera in controls, such as Streptococcus (2.9–11.8%, p = 0.001 and Hemophilus (11.3–20.5%, p = 0.03), not observed in OPV revaccinated infants. In conclusion, OPV revaccination was associated with a healthier microbiome composition 2 months after revaccination, based on a more abundant and diversified bacterial community of Prevotellaceae and fewer pathogenic/opportunistic organisms. Further information on species-level differentiation and functional analysis of microbiome content are warranted to elucidate the impact of OPV-associated changes in bacterial microbiota on child health.
Collapse
Affiliation(s)
- Márcia Melo Medeiros
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
- *Correspondence: Márcia Melo Medeiros,
| | - Anna Cäcilia Ingham
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Line Møller Nanque
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | | | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Paal Skyt Andersen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Ane Baerent Fisker
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
| | - Christine Stabell Benn
- Bandim Health Project, Bissau, Guinea-Bissau
- Bandim Health Project, Odense Patient Data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark, Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Miguel Lanaspa
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
| | - Henrique Silveira
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
| | - Patrícia Abrantes
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
| |
Collapse
|
15
|
Chang AY, Aaby P, Avidan MS, Benn CS, Bertozzi SM, Blatt L, Chumakov K, Khader SA, Kottilil S, Nekkar M, Netea MG, Sparrow A, Jamison DT. One vaccine to counter many diseases? Modeling the economics of oral polio vaccine against child mortality and COVID-19. Front Public Health 2022; 10:967920. [PMID: 36276367 PMCID: PMC9580701 DOI: 10.3389/fpubh.2022.967920] [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: 06/13/2022] [Accepted: 08/31/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Recent reviews summarize evidence that some vaccines have heterologous or non-specific effects (NSE), potentially offering protection against multiple pathogens. Numerous economic evaluations examine vaccines' pathogen-specific effects, but less than a handful focus on NSE. This paper addresses that gap by reporting economic evaluations of the NSE of oral polio vaccine (OPV) against under-five mortality and COVID-19. Materials and methods We studied two settings: (1) reducing child mortality in a high-mortality setting (Guinea-Bissau) and (2) preventing COVID-19 in India. In the former, the intervention involves three annual campaigns in which children receive OPV incremental to routine immunization. In the latter, a susceptible-exposed-infectious-recovered model was developed to estimate the population benefits of two scenarios, in which OPV would be co-administered alongside COVID-19 vaccines. Incremental cost-effectiveness and benefit-cost ratios were modeled for ranges of intervention effectiveness estimates to supplement the headline numbers and account for heterogeneity and uncertainty. Results For child mortality, headline cost-effectiveness was $650 per child death averted. For COVID-19, assuming OPV had 20% effectiveness, incremental cost per death averted was $23,000-65,000 if it were administered simultaneously with a COVID-19 vaccine <200 days into a wave of the epidemic. If the COVID-19 vaccine availability were delayed, the cost per averted death would decrease to $2600-6100. Estimated benefit-to-cost ratios vary but are consistently high. Discussion Economic evaluation suggests the potential of OPV to efficiently reduce child mortality in high mortality environments. Likewise, within a broad range of assumed effect sizes, OPV (or another vaccine with NSE) could play an economically attractive role against COVID-19 in countries facing COVID-19 vaccine delays. Funding The contribution by DTJ was supported through grants from Trond Mohn Foundation (BFS2019MT02) and Norad (RAF-18/0009) through the Bergen Center for Ethics and Priority Setting.
Collapse
Affiliation(s)
- Angela Y. Chang
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark,*Correspondence: Angela Y. Chang
| | - Peter Aaby
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark, Odense, Denmark,Bandim Health Project, Bissau, Guinea-Bissau
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States
| | - Christine S. Benn
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark,Bandim Health Project, Department of Clinical Research, University of Southern Denmark, Odense, Denmark,Bandim Health Project, Bissau, Guinea-Bissau
| | - Stefano M. Bertozzi
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States,School of Public Health, University of Washington, Seattle, WA, United States,Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Lawrence Blatt
- Aligos Therapeutics, South San Francisco, CA, United States,Global Virus Network, Baltimore, MD, United States
| | - Konstantin Chumakov
- Global Virus Network, Baltimore, MD, United States,Food and Drug Administration Office of Vaccine Research and Review, Silver Spring, MD, United States
| | - Shabaana A. Khader
- Department of Molecular Microbiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Shyam Kottilil
- Global Virus Network, Baltimore, MD, United States,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Madhav Nekkar
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Mihai G. Netea
- Global Virus Network, Baltimore, MD, United States,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands,Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Annie Sparrow
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dean T. Jamison
- Department of Epidemiology and Biostatistics and Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
16
|
Fisker AB, Martins JSD, Nanque LM, Jensen AM, Ca EJC, Nielsen S, Martins CL, Rodrigues A. Oral Polio Vaccine to Mitigate the Risk of Illness and Mortality During the Coronavirus Disease 2019 Pandemic: A Cluster-Randomized Trial in Guinea-Bissau. Open Forum Infect Dis 2022; 9:ofac470. [PMID: 36193229 PMCID: PMC9494416 DOI: 10.1093/ofid/ofac470] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/08/2022] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
Oral polio vaccine (OPV) may improve resistance to non-polio-infections. We tested whether OPV reduced the risk of illness and mortality before coronavirus disease 2019 (COVID-19) vaccines were available.
Methods
During the early COVID-19 pandemic, houses in urban Guinea-Bissau were randomized 1:1 to intervention or control. Residents aged 50+ years were invited to participate. Participants received bivalent OPV (single dose) or nothing. Rates of mortality, admissions, and consultation for infections (primary composite outcome) during 6 months of follow-up were compared in Cox proportional hazards models adjusted for age and residential area. Secondary outcomes included mortality, admissions, consultations, and symptoms of infection.
Results
We followed 3726 participants (OPV, 1580; control, 2146) and registered 66 deaths, 97 admissions, and 298 consultations for infections. OPV did not reduce the risk of the composite outcome overall (hazard ratio [HR] = 0.97; 95% confidence interval [CI], .79–1.18). OPV reduced the risk in males (HR = 0.71; 95% CI, .51–.98) but not in females (HR = 1.18; 95% CI, .91–1.52) (P for same effect = .02). OPV also reduced the risk in Bacillus Calmette-Guérin scar-positive (HR = 0.70; 95% CI, .49–.99) but not in scar-negative participants (HR = 1.13; 95% CI, .89–1.45) (P = .03). OPV had no overall significant effect on mortality (HR = 0.96; 95% CI, .59–1.55), admissions (HR = 0.76; 95% CI, .49–1.17) or recorded consultations (HR = 0.99; 95% CI, .79–1.25), but the OPV group reported more episodes with symptoms of infection (6050 episodes; HR = 1.10 [95% CI, 1.03–1.17]).
Conclusions
In line with previous studies, OPV had beneficial nonspecific effects in males.
Collapse
Affiliation(s)
- Ane B Fisker
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | | | - Line M Nanque
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | - Andreas M Jensen
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | - Elsi J C Ca
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | | | | |
Collapse
|
17
|
Aaby P, Nielsen S, Fisker AB, Pedersen LM, Welaga P, Hanifi SMA, Martins CL, Rodrigues A, Chumakov K, Benn CS. Stopping oral polio vaccine (OPV) after defeating poliomyelitis in low-and-middle-income countries: Harmful unintended consequences? Open Forum Infect Dis 2022; 9:ofac340. [PMID: 35937644 PMCID: PMC9348612 DOI: 10.1093/ofid/ofac340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The live vaccines bacille Calmette-Guérin (BCG) and measles vaccine have beneficial nonspecific effects (NSEs) reducing mortality, more than can be explained by prevention of tuberculosis or measles infection. Live oral polio vaccine (OPV) will be stopped after polio eradication; we therefore reviewed the potential NSEs of OPV. Methods OPV has been provided in 3 contexts: (1) coadministration of OPV and diphtheria-tetanus-pertussis (DTP) vaccine at 6, 10, and 14 weeks of age; (2) at birth (OPV0) with BCG; and (3) in OPV campaigns (C-OPVs) initiated to eradicate polio infection. We searched PubMed and Embase for studies of OPV with mortality as an outcome. We used meta-analysis to obtain the combined relative risk (RR) of mortality associated with different uses of OPV. Results First, in natural experiments when DTP was missing, OPV-only compared with DTP + OPV was associated with 3-fold lower mortality in community studies (RR, 0.33 [95% confidence interval {CI}, .14–.75]) and a hospital study (RR, 0.29 [95% CI, .11–.77]). Conversely, when OPV was missing, DTP-only was associated with 3-fold higher mortality than DTP + OPV (RR, 3.23 [95% CI, 1.27–8.21]). Second, in a randomized controlled trial, BCG + OPV0 vs BCG + no OPV0 was associated with 32% (95% CI, 0–55%) lower infant mortality. Beneficial NSEs were stronger with early use of OPV0. Third, in 5 population-based studies from Guinea-Bissau and Bangladesh, the mortality rate was 24% (95% CI, 17%–31%) lower after C-OPVs than before C-OPVs. Conclusions There have been few clinical polio cases reported in this century, and no confounding factors or bias would explain all these patterns. The only consistent interpretation is that OPV has beneficial NSEs, reducing nonpolio child mortality.
Collapse
Affiliation(s)
- Peter Aaby
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
- OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark , Denmark
| | - Ane B Fisker
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
- OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark , Denmark
| | - Line M Pedersen
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
- OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark , Denmark
| | - Paul Welaga
- Navrongo Health Research Centre , P. O. Box 114, Navrongo , Ghana
| | - Syed M A Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research , Bangladesh (icddr, b)
| | - Cesario L Martins
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
| | - Amabelia Rodrigues
- Bandim Health Project, Indepth Network , Apartado 861, Bissau, Guinea-Bissau
| | - Konstantin Chumakov
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring , MD , USA
| | - Christine S Benn
- OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, University of Southern Denmark , Denmark
- Danish Institute of Advanced Science, Odense University Hospital/University of Southern Denmark , Denmark
| |
Collapse
|
18
|
Nielsen S, Fisker AB, da Silva I, Byberg S, Biering-Sørensen S, Balé C, Barbosa A, Bjerregaard-Andersen M, Hansen NS, Do VA, Bæk O, Rasmussen SM, Damkjær L, Hvidt S, Baltzersen O, Rodrigues A, Martins C, Jensen KJ, Whittle HC, Smits G, van der Klis F, Aaby P, Benn CS. Effect of early two-dose measles vaccination on childhood mortality and modification by maternal measles antibody in Guinea-Bissau, West Africa: A single-centre open-label randomised controlled trial. EClinicalMedicine 2022; 49:101467. [PMID: 35747181 PMCID: PMC9156892 DOI: 10.1016/j.eclinm.2022.101467] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early 2-dose measles vaccine (MV) at 4 and 9 months of age vs. the WHO strategy of MV at 9 months of age reduced all-cause child mortality in a previous trial. We aimed to test two hypotheses: 1) a 2-dose strategy reduces child mortality between 4 and 60 months of age by 30%; 2) receiving early MV at 4 months in the presence versus absence of maternal measles antibodies (MatAb) reduces child mortality by 35%. METHODS Single-centre open-label community-based randomised controlled trial in Guinea-Bissau, with 2:1 block-randomisation by sex to a 2-dose (4 + 9 months) vs. 1-dose (9 months) MV strategy. Healthy children were eligible 4 weeks after the 3rd diphtheria-tetanus-pertussis-containing vaccine. Before randomisation a blood sample was collected to determine MatAb level. The primary outcome was all-cause mortality. Hazard ratios (HR) were derived from Cox regression in the per protocol population. We tested for interactions with national campaigns with oral polio vaccine (C-OPV). Trial registration: NCT01486355. FINDINGS Between August 2011-April 17th 2015, 6,636 children were enroled, 6,598[n2-dose=4,397; n1-dose=2,201] were included in the analysis of the primary outcome, The HR(2-dose/1-dose) between 4 and 60 months was 1.38 (95%CI: 0.92-2.06) [deaths: n2-dose=90; n1-dose=33]. Before the 9-month MV and the HR(1-dose/no dose) was 0.94 (0.45-1.96) [deaths: n2-dose=21; n1-dose=11]. The HR(2-dose/1-dose) was 0.81 (0.29-2.22) for children, who received no C-OPV [deaths/children: n2-dose=10/2,801; n1-dose=6/1,365], and 4.73 (1.44-15.6) for children, who received C-OPV before and after enrolment (p for interaction=0.027) [deaths/children: n2-dose=27/1,602; n1-dose=3/837]. In the 2-dose group receiving early MV at 4 months, mortality was 50% (20-68%) lower for those vaccinated in the presence of MatAb vs. the absence of MatAb [deaths/children: nMatAb=51/3,132; nnoMatAb=31/1,028]. INTERPRETATION The main result contrasts with previous findings but may, though based on a small number of events, be explained by frequent OPV campaigns that reduced the mortality rate, but apparently interacted negatively with early MV. The beneficial non-specific effects of MV in the presence of MatAb should be investigated further. FUNDING ERC, Danish National Research Foundation, the Danish Council for Development Research, Ministry of Foreign Affairs, Novo Nordisk Foundation, European Union and the Lundbeck Foundation.
Collapse
Affiliation(s)
- Sebastian Nielsen
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
| | - Ane B Fisker
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
| | - Isaquel da Silva
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Stine Byberg
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | | | - Carlitos Balé
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Amarildo Barbosa
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | | | | | - Vu An Do
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Ole Bæk
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | | | - Lone Damkjær
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Sophus Hvidt
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Olga Baltzersen
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Amabelia Rodrigues
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Cesario Martins
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Kristoffer J Jensen
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
| | - Hilton C Whittle
- London School of Hygiene and Topical Medicine, Keppel Street, London, UK
| | - Gaby Smits
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona van der Klis
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
| | - Christine S. Benn
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, and Danish Institute of Advanced Science, Odense University Hospital/ University of Southern Denmark, Denmark
- Corresponding author at: Studiestræde 6, 1455 Copenhagen K, Denmark.
| |
Collapse
|
19
|
Engineering immunity via skin-directed drug delivery devices. J Control Release 2022; 345:385-404. [DOI: 10.1016/j.jconrel.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 12/18/2022]
|
20
|
Berendsen MLT, Silva I, Balé C, Nielsen S, Hvidt S, Martins CL, Benn CS, Aaby P. The Effect of a Second Dose of Measles Vaccine at 18 Months of Age on Nonaccidental Deaths and Hospital Admissions in Guinea-Bissau: Interim Analysis of a Randomized Controlled Trial. Clin Infect Dis 2022; 75:1370-1378. [PMID: 35218356 PMCID: PMC9797043 DOI: 10.1093/cid/ciac155] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The world is set on the eradication of measles. Continuation of the measles vaccine (MV) after eradication could still reduce morbidity because the MV has so-called beneficial nonspecific effects. We evaluated the effect of a "booster" dose of the MV on overall severe morbidity. METHODS We conducted a randomized controlled trial among children aged 17.5 to 48 months in Guinea-Bissau, where the MV is recommended only at 9 months of age. At the time of this interim analysis, 3164 children had been allocated 1:1 to a second dose of measles vaccine (MV2) at 18 months of age or to no vaccine. Severe morbidity (a composite outcome of nonaccidental deaths and hospital admissions) rate ratios (SMRRs) were calculated by Cox regression analysis censored for national oral polio vaccine (OPV) campaigns. RESULTS There were no measles cases during the trial period. There were 43 nonaccidental deaths or hospital admissions during follow-up. Severe morbidity was 2.6 per 100 person-years in the MV2 group and 3.6 per 100 person-years among controls; hence, the estimated effect of MV2 on severe morbidity was 28% (SMRR, 0.72; 95% confidence interval [CI], .38-1.38). At 12 months of follow-up, the number needed to treat to prevent 1 severe morbidity event was 137 children. After OPV campaigns, the estimated effect of MV2 was reduced to 9% (SMRR, 0.91; 95% CI, .46-1.81). CONCLUSIONS MV2 may reduce nonmeasles severe morbidity by 28% (-38% to 62%), although this did not achieve statistical significance in this study. If significant in higher powered studies, this has major implications for child health, even after measles eradication. CLINICAL TRIALS REGISTRATION NCT02943681.
Collapse
Affiliation(s)
- Mike L T Berendsen
- Correspondence: M. Berendsen, Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands ()
| | - Isaquel Silva
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Carlitos Balé
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Sophus Hvidt
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | | | - Christine S Benn
- Bandim Health Project, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark,Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| |
Collapse
|
21
|
Contopoulos-Ioannidis DG, Altamirano J, Maldonado Y. Infectious Diseases-Related Hospitalizations During Oral Polio Vaccine(OPV) and non-OPV immunization periods: An Empirical Evaluation of all Hospital Discharges in California(1985-2010). Clin Infect Dis 2022; 75:1123-1130. [PMID: 35139187 DOI: 10.1093/cid/ciac114] [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: 08/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Live attenuated vaccines such as oral polio vaccine (OPV) can stimulate innate immunity and may have off-target protective effects on other pathogens. We aimed to address this hypothesis by examining changes in infectious diseases (ID)-related hospitalizations in all hospital discharges in California during OPV-(1985-1996) and non-OPV-immunization periods (2000-2010). METHODS We searched the OSHPD (Office of Statewide Health Planning and Development) database for all hospital discharges with any ID-related discharge diagnosis code during 1985-2010. We compared the proportion of ID-related hospitalizations (with at least one ID-related discharge diagnosis) among total hospitalizations during OPV immunization (1985-1996) vs non-OPV immunization (2000-2010) periods. RESULTS There were 19,281,039 ID-related hospitalizations (8,464,037 with an ID-related discharge-diagnosis as the principal discharge diagnosis for the hospitalization) among 98,117,475 hospitalizations in 1985-2010; 9,520,810 ID-hospitalizations/43,456,484 total hospitalizations in 2000-2010 vs 7,526,957/43,472,796 in 1985-1996. The RR for ID-related hospitalizations in 2000-2010 vs 1985-1996 was 1.27(95% CI: 1.26-1.27) for all diagnoses and 1.15(95% CI: 1.15-1.16) for principal diagnoses. Increases also existed in the proportion of lower respiratory and gastrointestinal infections. DISCUSSION The proportion of ID-related hospitalizations was lower in the OPV-immunization period compared to the period after OPV was discontinued. When focused only on hospitalizations with ID as the principal discharge diagnosis the signal remained significant but was smaller. These findings require replication in additional studies.
Collapse
Affiliation(s)
- Despina G Contopoulos-Ioannidis
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jonathan Altamirano
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Yvonne Maldonado
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America.,Senior Associate Dean for Faculty Development and Diversity, Stanford University, Stanford, CA, United States of America.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States of America
| |
Collapse
|
22
|
Hupert N, Marín-Hernández D, Gao B, Águas R, Nixon DF. Heterologous vaccination interventions to reduce pandemic morbidity and mortality: Modeling the US winter 2020 COVID-19 wave. Proc Natl Acad Sci U S A 2022; 119:e2025448119. [PMID: 35012976 PMCID: PMC8784160 DOI: 10.1073/pnas.2025448119] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 remains a stark health threat worldwide, in part because of minimal levels of targeted vaccination outside high-income countries and highly transmissible variants causing infection in vaccinated individuals. Decades of theoretical and experimental data suggest that nonspecific effects of non-COVID-19 vaccines may help bolster population immunological resilience to new pathogens. These routine vaccinations can stimulate heterologous cross-protective effects, which modulate nontargeted infections. For example, immunization with Bacillus Calmette-Guérin, inactivated influenza vaccine, oral polio vaccine, and other vaccines have been associated with some protection from SARS-CoV-2 infection and amelioration of COVID-19 disease. If heterologous vaccine interventions (HVIs) are to be seriously considered by policy makers as bridging or boosting interventions in pandemic settings to augment nonpharmaceutical interventions and specific vaccination efforts, evidence is needed to determine their optimal implementation. Using the COVID-19 International Modeling Consortium mathematical model, we show that logistically realistic HVIs with low (5 to 15%) effectiveness could have reduced COVID-19 cases, hospitalization, and mortality in the United States fall/winter 2020 wave. Similar to other mass drug administration campaigns (e.g., for malaria), HVI impact is highly dependent on both age targeting and intervention timing in relation to incidence, with maximal benefit accruing from implementation across the widest age cohort when the pandemic reproduction number is >1.0. Optimal HVI logistics therefore differ from optimal rollout parameters for specific COVID-19 immunizations. These results may be generalizable beyond COVID-19 and the US to indicate how even minimally effective heterologous immunization campaigns could reduce the burden of future viral pandemics.
Collapse
Affiliation(s)
- Nathaniel Hupert
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065;
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
- Cornell Institute for Disease and Disaster Preparedness, Cornell University, New York, NY 10065
| | - Daniela Marín-Hernández
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
| | - Bo Gao
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Ricardo Águas
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Douglas F Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
| |
Collapse
|
23
|
Schaltz-Buchholzer F, Bjerregård Øland C, Berendsen M, Bjerregaard-Andersen M, Stjernholm EB, Golding CN, Monteiro I, Aaby P, Benn CS. Does maternal BCG prime for enhanced beneficial effects of neonatal BCG in the offspring? J Infect 2021; 84:321-328. [PMID: 34958808 DOI: 10.1016/j.jinf.2021.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/22/2021] [Accepted: 12/15/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Bacille Calmette-Guérin (BCG) vaccination lowers the risk of severe infection; we tested whether effects are modulated by maternal BCG in a large cohort of BCG-vaccinated newborns from Guinea-Bissau. METHODS Maternal BCG scar status were inspected at enrolment in a BCG trial conducted from 2014-17 in Bissau, Guinea-Bissau. We tested associations with background factors for potential confounding; maternal age affected effect estimates >5% and accordingly, all analyses were adjusted for maternal age. Hospitalization data was collected prospectively and assessed in Cox-models providing adjusted Incidence Rate Ratios (aIRRs). In-hospital risk of death (case-fatality) risk was assessed using binomial regression providing adjusted Risk Ratios (aRRs). RESULTS 60% (6,309/10,598) of mothers had a scar. The maternal-scar/no-scar admission aIRR was 0.96 (0.81-1.14) from 0-6 weeks and 1.12 (0.97-1.28) for 6 weeks-3 years. The 6-week in-hospital case-fatality infection aRR was 0.59 (0.34-1.05); 0.40 (0.17-0.91) for males and 0.86 (0.38-1.94) for females. Protection was especially evident against sepsis, the overall 6-week aRR=0.49 (0.26-0.91); no effect was observed for non-infectious deaths or after 6 weeks of age. Effects were similar across BCG strains and multivariate models adjusted for socioeconomic status did not affect estimates. CONCLUSION Among BCG-vaccinated newborns, there was a trend for fewer in-hospital deaths from infection associated with maternal BCG priming, especially for males. Providing BCG to adults without a vaccination scar might enhance their offspring's capacity to handle severe infections.
Collapse
Affiliation(s)
- Frederik Schaltz-Buchholzer
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, OPEN, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark.
| | | | - Mike Berendsen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, OPEN, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark; Department of Internal Medicine, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | | | - Ivan Monteiro
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Bandim Health Project, OPEN, Institute of Clinical Research, Uni. Southern Denmark and Odense University Hospital, Odense, Denmark; Danish Institute of Advanced Science, Uni. Southern Denmark, Odense, Denmark.
| |
Collapse
|
24
|
Hansen KP, Benn CS, Aamand T, Buus M, da Silva I, Aaby P, Fisker AB, Thysen SM. Does Influenza Vaccination during Pregnancy Have Effects on Non-Influenza Infectious Morbidity? A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Vaccines (Basel) 2021; 9:vaccines9121452. [PMID: 34960198 PMCID: PMC8707251 DOI: 10.3390/vaccines9121452] [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: 10/25/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 12/21/2022] Open
Abstract
The recommendation to provide inactivated influenza vaccine (IIV) to pregnant women is based on observed protection against influenza-related morbidity in mother and infant. Non-live vaccines may have non-specific effects (NSEs), increasing the risk of non-targeted infections in females. We reviewed the evidence from available randomised controlled trials (RCTs) of IIV to pregnant women, to assess whether IIV may have NSEs. Four RCTs, all conducted in low- and middle-income settings, were identified. We extracted information on all-cause and infectious mortality and adverse events in women and their infants. We conducted meta-analyses providing risk ratios (RR). The meta-analysis for maternal all-cause mortality provided a RR of 1.48 (95% CI = 0.52–4.16). The estimates for miscarriage/stillbirth and infant all-cause mortality up to 6 months of age were 1.06 (0.78–1.44) and 1.11 (0.87–1.41), respectively. IIV was associated with a higher risk of non-influenza infectious adverse events, with meta-estimates of 2.01 (1.15–3.50) in women and 1.36 (1.12–1.67) in infants up to 6 months of age. Thus, following a pattern seen for other non-live vaccines, IIV was associated with a higher risk of non-influenza infectious adverse events. To ensure that scarce resources are used well, and no harm is inflicted, further RCTs are warranted.
Collapse
Affiliation(s)
- Katrine Pedersbæk Hansen
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (K.P.H.); (T.A.); (M.B.); (P.A.); (A.B.F.); (S.M.T.)
| | - Christine Stabell Benn
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (K.P.H.); (T.A.); (M.B.); (P.A.); (A.B.F.); (S.M.T.)
- Danish Institute of Advanced Science, University of Southern Denmark, Fioniavej 34, 5230 Odense, Denmark
- Bandim Health Project, Indepth Network, Apartado 861, Bissau 1004, Guinea-Bissau;
- Correspondence:
| | - Thomas Aamand
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (K.P.H.); (T.A.); (M.B.); (P.A.); (A.B.F.); (S.M.T.)
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
| | - Martin Buus
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (K.P.H.); (T.A.); (M.B.); (P.A.); (A.B.F.); (S.M.T.)
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
| | - Isaquel da Silva
- Bandim Health Project, Indepth Network, Apartado 861, Bissau 1004, Guinea-Bissau;
| | - Peter Aaby
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (K.P.H.); (T.A.); (M.B.); (P.A.); (A.B.F.); (S.M.T.)
- Bandim Health Project, Indepth Network, Apartado 861, Bissau 1004, Guinea-Bissau;
| | - Ane Bærent Fisker
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (K.P.H.); (T.A.); (M.B.); (P.A.); (A.B.F.); (S.M.T.)
- Bandim Health Project, Indepth Network, Apartado 861, Bissau 1004, Guinea-Bissau;
| | - Sanne Marie Thysen
- Bandim Health Project, OPEN, Department of Clinical Research, Odense University Hospital/University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; (K.P.H.); (T.A.); (M.B.); (P.A.); (A.B.F.); (S.M.T.)
- Bandim Health Project, Indepth Network, Apartado 861, Bissau 1004, Guinea-Bissau;
| |
Collapse
|
25
|
Oral Polio Vaccine Campaigns May Reduce the Risk of Death from Respiratory Infections. Vaccines (Basel) 2021; 9:vaccines9101133. [PMID: 34696241 PMCID: PMC8537441 DOI: 10.3390/vaccines9101133] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Oral polio vaccine (OPV) campaigns, but not other campaigns, have been associated with major reductions in child mortality. Studies have shown that OPV reduces the risk of respiratory infections. We analysed the causes of death at 0–2 years of age in Chakaria, a health and demographic surveillance Systems in Bangladesh, in the period 2012–2019 where 13 national campaigns with combinations of OPV (n = 4), vitamin A supplementation (n = 9), measles vaccine (MV) (n = 2), and albendazole (n = 2) were implemented. OPV-only campaigns reduced overall mortality by 30% (95% confidence interval: −10–56%). Deaths from respiratory infections were reduced by 62% (20–82%, p = 0.01) in the post-neonatal period (1–35 months), whereas there was as slight increase of 19% (−37–127%, p = 0.54) for deaths from other causes. There was no benefit of other types of campaigns. Hence, the hypothesis that OPV may have beneficial non-specific effects, protecting particularly against respiratory infections, was confirmed.
Collapse
|
26
|
Malave Sanchez M, Saleeb P, Kottilil S, Mathur P. Oral Polio Vaccine to Protect Against COVID-19: Out of the Box Strategies? Open Forum Infect Dis 2021; 8:ofab367. [PMID: 34381846 PMCID: PMC8344522 DOI: 10.1093/ofid/ofab367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022] Open
Abstract
The global coronavirus disease 2019 pandemic has raised significant concerns of developing rapid, broad strategies to protect the vulnerable population and prevent morbidity and mortality. However, even with an aggressive approach, controlling the pandemic has been challenging, with concerns of emerging variants that likely escape vaccines, nonadherence of social distancing/preventive measures by the public, and challenges in rapid implementation of a global vaccination program that involves mass production, distribution, and execution. In this review, we revisit the utilization of attenuated vaccinations, such as the oral polio vaccine, which are safe, easy to administer, and likely provide cross-protection against respiratory pathogens. We discuss the rationale and data supporting its use and detail description of available vaccines that could be repurposed for curtailing the pandemic.
Collapse
Affiliation(s)
- Melanie Malave Sanchez
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul Saleeb
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Poonam Mathur
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
27
|
Nielsen S, Khalek M, Benn CS, Aaby P, Hanifi SMA. National immunisation campaigns with oral polio vaccine may reduce all-cause mortality: Analysis of 2004-2019 demographic surveillance data in rural Bangladesh. EClinicalMedicine 2021; 36:100886. [PMID: 34041458 PMCID: PMC8144662 DOI: 10.1016/j.eclinm.2021.100886] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND West African studies have suggested that national immunisation campaigns with oral polio vaccine (C-OPV) may non-specifically reduce all-cause child mortality rate by 15-25%. We investigated whether C-OPVs had similar non-specific effects in rural Bangladesh from 2004 to 2019. METHODS Chakaria, is a health and demographic surveillance system (HDSS) in Southern Bangladesh. From 2004-2011 the HDSS covered a random sample of households; from 2012 to 2019 it covered a random sample of villages. Using Cox proportional hazards models, we calculated hazard ratios (HR) comparing mortality for children under 3 years of age after C-OPV versus before C-OPV to assess the effect of receiving a C-OPV. We allowed for different baseline hazard function in the two periods (2004-2011, 2012-2019), with separate models for each period. FINDINGS There were 768 deaths (2.1%) amongst 36,176 children. The HR after C-OPV was 0.69 (95% confidence interval: 0.52-0.90). National campaigns providing vitamin A or measles vaccine did not have similar effects. Each additional dose of C-OPV was associated with a reduction in the mortality rate by 6% (-2 to 13%). The number needed to treat with C-OPV to save one life between 0 and 35 months of age was 88 (81-96). INTERPRETATION This is the fourth study to show that C-OPV has beneficial non-specific effects on child survival. All studies have shown a beneficial effect of C-OPV on child health. Stopping OPV as planned after polio eradication without any mitigation plan could have detrimental effects for overall child health in low-income countries. FUNDING The Chakaria HDSS was funded by international sponsors. No sponsor had any influence on the preparation of the article.
Collapse
Affiliation(s)
- Sebastian Nielsen
- Bandim Health Project, OPEN (Odense Patient data Explorative Network), Institute of Clinical Research, WP 9, J. B. Winsløws Vej 9a, 5000 Odense, Denmark
- Bandim Health Project, Indepth Network, Apartado 861, Bissau
- Corresponding author at: Studiestræde 6, 1455-Copenhagen K, Denmark.
| | - Md.Abdul Khalek
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, BD 1212, Bangladesh
| | - Christine Stabell Benn
- Bandim Health Project, OPEN (Odense Patient data Explorative Network), Institute of Clinical Research, WP 9, J. B. Winsløws Vej 9a, 5000 Odense, Denmark
- Danish Institute of Advanced Science, Odense University Hospital and University of Southern Denmark, Campusvej 55, 5230Odense, Denmark
| | - Peter Aaby
- Bandim Health Project, OPEN (Odense Patient data Explorative Network), Institute of Clinical Research, WP 9, J. B. Winsløws Vej 9a, 5000 Odense, Denmark
- Bandim Health Project, Indepth Network, Apartado 861, Bissau
| | - Syed Manzoor Ahmed Hanifi
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, BD 1212, Bangladesh
| |
Collapse
|
28
|
Chumakov K, Avidan MS, Benn CS, Bertozzi SM, Blatt L, Chang AY, Jamison DT, Khader SA, Kottilil S, Netea MG, Sparrow A, Gallo RC. Old vaccines for new infections: Exploiting innate immunity to control COVID-19 and prevent future pandemics. Proc Natl Acad Sci U S A 2021; 118:e2101718118. [PMID: 34006644 PMCID: PMC8166166 DOI: 10.1073/pnas.2101718118] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic triggered an unparalleled pursuit of vaccines to induce specific adaptive immunity, based on virus-neutralizing antibodies and T cell responses. Although several vaccines have been developed just a year after SARS-CoV-2 emerged in late 2019, global deployment will take months or even years. Meanwhile, the virus continues to take a severe toll on human life and exact substantial economic costs. Innate immunity is fundamental to mammalian host defense capacity to combat infections. Innate immune responses, triggered by a family of pattern recognition receptors, induce interferons and other cytokines and activate both myeloid and lymphoid immune cells to provide protection against a wide range of pathogens. Epidemiological and biological evidence suggests that the live-attenuated vaccines (LAV) targeting tuberculosis, measles, and polio induce protective innate immunity by a newly described form of immunological memory termed "trained immunity." An LAV designed to induce adaptive immunity targeting a particular pathogen may also induce innate immunity that mitigates other infectious diseases, including COVID-19, as well as future pandemic threats. Deployment of existing LAVs early in pandemics could complement the development of specific vaccines, bridging the protection gap until specific vaccines arrive. The broad protection induced by LAVs would not be compromised by potential antigenic drift (immune escape) that can render viruses resistant to specific vaccines. LAVs might offer an essential tool to "bend the pandemic curve," averting the exhaustion of public health resources and preventing needless deaths and may also have therapeutic benefits if used for postexposure prophylaxis of disease.
Collapse
Affiliation(s)
- Konstantin Chumakov
- Food and Drug Administration Office of Vaccine Research and Review, Global Virus Network Center of Excellence, Silver Spring, MD 20993
| | - Michael S Avidan
- Department of Anesthesiology, Washington University in St. Louis, St Louis, MO 63130
| | - Christine S Benn
- Department of Clinical Research, Global Virus Network Center of Excellence, University of Southern Denmark, 5230 Odense, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, 5230 Odense, Denmark
| | - Stefano M Bertozzi
- School of Public Health, Global Virus Network, University of California, Berkeley, CA 94704
- School of Public Health, University of Washington, Seattle, WA 98195
- El Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, 62100 Cuernavaca, Mexico
| | - Lawrence Blatt
- Aligos Therapeutics, Global Virus Network Center of Excellence, San Francisco, CA 94080
| | - Angela Y Chang
- Danish Institute for Advanced Study, University of Southern Denmark, 5230 Odense, Denmark
| | - Dean T Jamison
- Institute for Global Health Sciences, Global Virus Network, University of California, San Francisco, CA 94158
| | - Shabaana A Khader
- Department of Molecular Microbiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63130
| | - Shyam Kottilil
- Institute of Human Virology, Global Virus Network Center of Excellence, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Mihai G Netea
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Global Virus Network Center of Excellence, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, 53113 Bonn, Germany
| | - Annie Sparrow
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Robert C Gallo
- Institute of Human Virology, Global Virus Network Center of Excellence, University of Maryland School of Medicine, Baltimore, MD 21201;
| |
Collapse
|
29
|
Byberg S, Aaby P, Rodrigues A, Stabell Benn C, Fisker AB. The mortality effects of disregarding the strategy to save doses of measles vaccine: a cluster-randomised trial in Guinea-Bissau. BMJ Glob Health 2021; 6:e004328. [PMID: 33941513 PMCID: PMC8098964 DOI: 10.1136/bmjgh-2020-004328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Measles vaccine (MV) may improve health beyond measles protection. To avoid wastage from multi-dose vials, children in Guinea-Bissau are only measles vaccinated when aged 9-11 months and when six or more children are present. We assessed health impacts of providing MV to all measles-unvaccinated children 9-35 months. METHODS We cluster-randomised 182 village clusters under demographic surveillance in rural Guinea-Bissau to an 'MV-for-all-policy' arm where we offered MV regardless of age and number of children present at our bi-annual village visits, or a 'Restrictive-MV-policy' arm where we followed national policy. Measles-unvaccinated children aged 9-35 months were eligible for enrolment and followed to 5 years of age. In intention-to-treat analyses, we compared mortality using Cox regression analyses with age as underlying timescale. The primary analysis was for children aged 12-35 months at eligibility assessment. Interactions with several background factors were explored. RESULTS Between 2011 and 2016, we followed 2778 children in the primary analysis. MV coverage by 3 years was 97% among children eligible for enrolment under the MV-for-all-policy, and 48% under the Restrictive-MV-policy. Mortality was 59% lower than anticipated and did not differ by trial arm (MV-for-all-policy: 45/1405: Restrictive-MV-policy: 44/1373; HR: 0.95 (95% CI 0.64 to 1.43)). The effect of MV-for-all changed over time: The HR was 0.53 (95% CI 0.27 to 1.07) during the first 1½ years of enrolment but 1.47 (95% CI 0.87 to 2.50) later (p=0.02, test of interaction). Explorative analyses indicated that the temporal change may be related to interactions with other childhood interventions. CONCLUSION The MV-for-all-policy increased MV coverage but had no overall effect on overall mortality. TRIAL REGISTRATION NUMBER NCT01306006.
Collapse
Affiliation(s)
- Stine Byberg
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | | | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Ane Baerent Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Bandim Health Project, OPEN, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|
30
|
Aaby P, Benn CS. Stopping live vaccines after disease eradication may increase mortality. Vaccine 2019; 38:10-14. [PMID: 31648913 DOI: 10.1016/j.vaccine.2019.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022]
Abstract
Several live vaccines may have beneficial non-specific effects (NSEs) reducing mortality more than can be explained by the prevention of the target infection, a phenomenon which has been linked to innate immune training. Most randomised controlled trials (RCTs) of oral polio vaccine (OPV) and measles vaccine (MV) have shown a large reduction in mortality that must have been at least partly nonspecific because it was much larger than the reduction explained by prevention of the target disease. Hence, stopping a live vaccine after disease-eradication could have negative health effects if the potential beneficial NSEs are not considered. We reviewed one eradicated disease, smallpox, and two infections likely to be eradicated in coming decades, polio and measles. No study was made of unintended effects of stopping smallpox vaccination when it happened in 1980. We have subsequently documented in both Guinea-Bissau and Denmark that smallpox-vaccinated individuals continued to have a survival advantage long after smallpox had been eradicated. The few studies which have examined the effect of OPV on survival all suggest strong beneficial NSEs; in RCTs, OPV compared with inactivated polio vaccine (IPV) has been associated with non-specific reductions in morbidity. RCTs, natural experiments and observational studies have found strong beneficial NSEs for MV. Hence, the imminent eradication of polio and the planned stop of OPV in 2024 and the subsequent eradication of measles infection and the possible stop to live MV could have negative effects for child survival. Before live vaccines are phased out, potential unintended effects of stopping these vaccines should be thoroughly studied.
Collapse
Affiliation(s)
- Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau; Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Christine S Benn
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Denmark
| |
Collapse
|