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Caetano DG, Toledo TS, de Lima ACS, Giacoia-Gripp CBW, de Almeida DV, de Lima SMB, Azevedo ADS, Morata M, Grinsztejn B, Cardoso SW, da Costa MD, Brandão LGP, Bispo de Filippis AM, Scott-Algara D, Coelho LE, Côrtes FH. Impact of HIV-Related Immune Impairment of Yellow Fever Vaccine Immunogenicity in People Living with HIV-ANRS 12403. Vaccines (Basel) 2024; 12:578. [PMID: 38932307 PMCID: PMC11209244 DOI: 10.3390/vaccines12060578] [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: 04/12/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
The yellow fever (YF) vaccine is one of the safest and most effective vaccines currently available. Still, its administration in people living with HIV (PLWH) is limited due to safety concerns and a lack of consensus regarding decreased immunogenicity and long-lasting protection for this population. The mechanisms associated with impaired YF vaccine immunogenicity in PLWH are not fully understood, but the general immune deregulation during HIV infection may play an important role. To assess if HIV infection impacts YF vaccine immunogenicity and if markers of immune deregulation could predict lower immunogenicity, we evaluated the association of YF neutralization antibody (NAb) titers with the pre-vaccination frequency of activated and exhausted T cells, levels of pro-inflammatory cytokines, and frequency of T cells, B cells, and monocyte subsets in PLWH and HIV-negative controls. We observed impaired YF vaccine immunogenicity in PLWH with lower titers of YF-NAbs 30 days after vaccination, mainly in individuals with CD4 count <350 cells/mm3. At the baseline, those individuals were characterized by having a higher frequency of activated and exhausted T cells and tissue-like memory B cells. Elevated levels of those markers were also observed in individuals with CD4 count between 500 and 350 cells/mm3. We observed a negative correlation between the pre-vaccination level of CD8+ T cell exhaustion and CD4+ T cell activation with YF-NAb titers at D365 and the pre-vaccination level of IP-10 with YF-NAb titers at D30 and D365. Our results emphasize the impact of immune activation, exhaustion, and inflammation in YF vaccine immunogenicity in PLWH.
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Affiliation(s)
- Diogo Gama Caetano
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro 21040-360, Brazil; (D.G.C.); (T.S.T.); (A.C.S.d.L.); (C.B.W.G.-G.); (D.V.d.A.)
| | - Thais Stelzer Toledo
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro 21040-360, Brazil; (D.G.C.); (T.S.T.); (A.C.S.d.L.); (C.B.W.G.-G.); (D.V.d.A.)
| | - Ana Carolina Souza de Lima
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro 21040-360, Brazil; (D.G.C.); (T.S.T.); (A.C.S.d.L.); (C.B.W.G.-G.); (D.V.d.A.)
| | - Carmem Beatriz Wagner Giacoia-Gripp
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro 21040-360, Brazil; (D.G.C.); (T.S.T.); (A.C.S.d.L.); (C.B.W.G.-G.); (D.V.d.A.)
| | - Dalziza Victalina de Almeida
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro 21040-360, Brazil; (D.G.C.); (T.S.T.); (A.C.S.d.L.); (C.B.W.G.-G.); (D.V.d.A.)
| | - Sheila Maria Barbosa de Lima
- Departamento de Desenvolvimento Experimental e Pré-Clínico (DEDEP), Bio-Manguinhos/Fiocruz, Rio de Janeiro 21040-900, Brazil;
| | - Adriana de Souza Azevedo
- Laboratório de Análise Imunomolecular (LANIM), Bio-Manguinhos/Fiocruz, Rio de Janeiro 21040-900, Brazil;
| | - Michelle Morata
- Instituto Nacional de Infectologia Evandro Chagas/Fiocruz, Rio de Janeiro 21040-360, Brazil; (M.M.); (B.G.); (S.W.C.); (L.E.C.)
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas/Fiocruz, Rio de Janeiro 21040-360, Brazil; (M.M.); (B.G.); (S.W.C.); (L.E.C.)
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas/Fiocruz, Rio de Janeiro 21040-360, Brazil; (M.M.); (B.G.); (S.W.C.); (L.E.C.)
| | - Marcellus Dias da Costa
- Laboratório de Pesquisa em Imunização e Vigilância em Saúde (LIVS), Instituto Nacional de Infectologia Evandro Chagas/Fiocruz, Rio de Janeiro 21040-360, Brazil; (M.D.d.C.); (L.G.P.B.)
| | - Luciana Gomes Pedro Brandão
- Laboratório de Pesquisa em Imunização e Vigilância em Saúde (LIVS), Instituto Nacional de Infectologia Evandro Chagas/Fiocruz, Rio de Janeiro 21040-360, Brazil; (M.D.d.C.); (L.G.P.B.)
| | | | | | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas/Fiocruz, Rio de Janeiro 21040-360, Brazil; (M.M.); (B.G.); (S.W.C.); (L.E.C.)
| | - Fernanda Heloise Côrtes
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro 21040-360, Brazil; (D.G.C.); (T.S.T.); (A.C.S.d.L.); (C.B.W.G.-G.); (D.V.d.A.)
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Cristina Martini Rodrigues C, Caroline Ribeiro Sales A, Marli Christovam Sartori A, de Souza Azevedo A, Maria Barbosa de Lima S, de Melo Picone C, Keiko Sato P, Nazareth Lara A, Takesaki Miyaji K, Sérgio Azevedo L, Caldin B, Camera Pierrotti L, Heloisa Lopes M. Yellow fever neutralizing antibody seroprevalence proportion and titers in previously vaccinated adults with chronic kidney disease. Vaccine 2024; 42:2729-2732. [PMID: 38514353 DOI: 10.1016/j.vaccine.2024.03.029] [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: 09/26/2023] [Revised: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
Studies on yellow fever vaccine (YF) in chronic kidney disease (CKD) patients are scarce. This cross-sectional study aimed to evaluate YF neutralizing antibody seroprevalence and titers in previously vaccinated adults with CKD, on dialysis (D-CKD) or not (ND-CKD), compared to healthy persons. The micro Plaque Reduction Neutralization-Horseradish Peroxidase (μPRN-HP) test was used. Antibody titers were expressed as the reciprocal of the highest dilution that neutralized the challenge virus by 50 % (μPRN50). Seropositivity cut-off was set at ≥ 1:100. We included 153 participants: 46 ND-CKD, 50 D-CKD and 57 healthy adults. Median ages were 58.3, 55 and 52.2 years, respectively. Median time since YF vaccination was 22.3, 18.5 and 48.3 months respectively. There were no statistically significant differences in YF seroprevalence and neutralizing antibodies titers among groups: 100 % of ND-CKD; 96 % of D-CKD and 100 % of healthy participants were seropositive. Geometric mean titers (GMT) were 818.5, 683.0 and 665.5, respectively (p = 0.289).
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Affiliation(s)
- Camila Cristina Martini Rodrigues
- Centro de Referencia de Imunobiologicos Especiais (CRIE) - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil; Clinica de Molestias Infecciosas e Parasitarias, HC-FMUSP, Brazil.
| | - Amanda Caroline Ribeiro Sales
- Centro de Referencia de Imunobiologicos Especiais (CRIE) - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil; Departamento de Molestias Infecciosas e Parasitarias, FMUSP, Brazil
| | - Ana Marli Christovam Sartori
- Centro de Referencia de Imunobiologicos Especiais (CRIE) - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil; Clinica de Molestias Infecciosas e Parasitarias, HC-FMUSP, Brazil; Departamento de Molestias Infecciosas e Parasitarias, FMUSP, Brazil
| | | | | | - Camila de Melo Picone
- Centro de Referencia de Imunobiologicos Especiais (CRIE) - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil; Clinica de Molestias Infecciosas e Parasitarias, HC-FMUSP, Brazil
| | - Paula Keiko Sato
- Departamento de Molestias Infecciosas e Parasitarias, FMUSP, Brazil
| | - Amanda Nazareth Lara
- Centro de Referencia de Imunobiologicos Especiais (CRIE) - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil; Clinica de Molestias Infecciosas e Parasitarias, HC-FMUSP, Brazil
| | - Karina Takesaki Miyaji
- Centro de Referencia de Imunobiologicos Especiais (CRIE) - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil; Clinica de Molestias Infecciosas e Parasitarias, HC-FMUSP, Brazil
| | | | | | | | - Marta Heloisa Lopes
- Centro de Referencia de Imunobiologicos Especiais (CRIE) - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil; Departamento de Molestias Infecciosas e Parasitarias, FMUSP, Brazil
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Schnyder JL, de Jong HK, Bache BE, Schaumburg F, Grobusch MP. Long-term immunity following yellow fever vaccination: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e445-e456. [PMID: 38272044 DOI: 10.1016/s2214-109x(23)00556-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Long-term immunity following yellow fever vaccination remains controversial. We aimed to summarise the literature regarding the long-term protection (≥10 years) conveyed by a single dose of yellow fever vaccination. METHODS In this systematic review and meta-analysis, we searched 11 databases from database inception to Aug 24, 2023. We included cohort and cross-sectional studies reporting immunogenicity outcomes for children or adults who received a single dose of yellow fever vaccination 10 or more years ago. Case series and single case reports were excluded. Participants who received more than one dose of yellow fever vaccination before measurement of the outcome were excluded. Identified records were reviewed by two independent reviewers. The primary outcome of the meta-analysis was the pooled seroprotection rate. Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies of Interventions tool, and the Joanna Briggs Institute tool for analytical cross-sectional studies. Studies of moderate or good quality that reported seroprotection were included for random-effects meta-analysis and stratified by endemicity and specific risk groups. The study was registered with PROSPERO, CRD42023384087. FINDINGS Of the 7363 articles identified by our search, 39 were eligible for inclusion for systematic review. These studies comprised 2895 individuals vaccinated 10-60 years ago. 20 studies were included in the meta-analysis. Pooled seroprotection rates were 94% (95% CI 86-99) among healthy adults in a non-endemic setting (mostly travellers) and 76% (65-85) in an endemic setting (all Brazilian studies). The pooled seroprotection rate was 47% (35-60) in children (aged 9-23 months at time of vaccination) and 61% (38-82) in people living with HIV. Reported criteria for seroprotection were highly heterogeneous. INTERPRETATION The gathered evidence suggests that a single dose of yellow fever vaccination provides lifelong protection in travellers. However, in people living with HIV and children (younger than 2 years), booster doses might still be required because lower proportions of vaccinees were seroprotected 10 or more years post-vaccination. Lower observed seroprotection rates among residents of endemic areas were partly explained by the use of a higher cutoff for seroprotection that was applied in Brazil. Studies from sub-Saharan Africa were scarce and of low quality; thus no conclusions could be drawn for this region. FUNDING None.
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Affiliation(s)
- Jenny L Schnyder
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hanna K de Jong
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bache E Bache
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Masanga Medical Research Unit, Masanga, Sierra Leone
| | - Frieder Schaumburg
- Masanga Medical Research Unit, Masanga, Sierra Leone; Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Masanga Medical Research Unit, Masanga, Sierra Leone; Institute of Tropical Medicine, German Centre for Infection Research, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon; Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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Motta E, Camacho LAB, Filippis AMBD, Costa M, Pedro L, Cardoso SW, Souza MCDO, Mendes YDS, Grinsztejn B, Coelho LE. Safety of the yellow fever vaccine in people living with HIV: a longitudinal study exploring post-vaccination viremia and hematological and liver kinetics. Braz J Infect Dis 2024; 28:103719. [PMID: 38341187 PMCID: PMC10904163 DOI: 10.1016/j.bjid.2024.103719] [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: 08/09/2023] [Revised: 01/04/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Safety data on the yellow fever vaccine 17DD in People Living with HIV (PLWH) are limited. This study explored the occurrence of post-vaccination 17DD viremia and the kinetics of hematological and liver laboratorial parameters in PLWH and HIV-uninfected participants [HIV(-) controls]. METHODS We conducted a secondary analysis of a longitudinal interventional trial (NCT03132311) study that enrolled PLWH and HIV(-) controls to receive a single 17DD dose and were followed at 5, 30 and 365 days after vaccination in Rio de Janeiro, Brazil. 17DD viremia (obtained throughreal-time PCR and plaque forming units' assays), hematological (neutrophils, lymphocytes and platelets counts) and liver enzymes (ALT and AST) results were assessed at baseline and Days 5 and 30 post-vaccination. Logistic regression models explored factors associated with the odds of having positive 17DD viremia. Linear regression models explored variables associated with hematological and liver enzymes results at Day 5. RESULTS A total of 202 PLWH with CD4 ≥ 200 cells/µL and 68 HIV(-) controls were included in the analyses. 17DD viremia was found in 20.0 % of the participants and was twice more frequent in PLWH than in HIV(-) controls (22.8% vs. 11.8 %, p-value < 0.001). Neutrophils, lymphocytes and platelets counts dropped at Day 5 and returned to baseline values at Day 30. 17DD viremia was associated with lower nadir of lymphocytes and platelets at Day 5. ALT levels did not increase post-vaccination and were not associated with 17DD viremia. CONCLUSIONS 17DD was safe and well-tolerated in PLWH with CD4 ≥ 200 cells/µL. Post-vaccination viremia was more frequent in PLWH than in controls. Transient and self-limited decreases in lymphocytes and neutrophils occurred early after vaccination. 17DD viremia was associated with lower lymphocytes and platelets nadir after vaccination. We did not observe elevations in ALT after 17DD vaccination.
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Affiliation(s)
- Edwiges Motta
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | - Luiz Antonio B Camacho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca (ENSP), Rio de Janeiro, RJ, Brazil
| | - Ana M Bispo de Filippis
- Fundação Oswaldo Cruz, Laboratório de Arbovírus e Vírus Hemorrágicos, Instituto Oswaldo Cruz (IOC), Rio de Janeiro, RJ, Brazil
| | - Marcellus Costa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | - Luciana Pedro
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | - Sandra W Cardoso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | | | - Ygara da Silva Mendes
- Fundação Oswaldo Cruz, Laboratório de Tecnologia Virológica, Biomanguinhos, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | - Lara E Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil.
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Macieira KV, Caetano DG, De Lima SMB, Wagner Giacoia-Gripp CB, Côrtes FH, Da Silva Cazote A, De Souza Azevedo Soares A, Dos Santos Alves N, De Souza Borges Quintana M, Costa M, Brandão LGP, De Andrade MM, Grinsztejn B, Coelho LE, De Almeida DV. Differential gene expression of cytokines, receptors, and miRNAs in individuals living with HIV-1 and vaccinated against yellow fever. Mol Immunol 2023; 164:58-65. [PMID: 37952362 DOI: 10.1016/j.molimm.2023.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/10/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
Between 2016 and 2018, Brazil faced a yellow fever (YF) outbreak, which led to an expansion of vaccination coverage. The coexistence of the YF outbreak and the HIV-1 epidemic in Brazil raised concerns regarding the immune response and vaccine effectiveness in individuals living with HIV (PLWH). The aim of this study was to investigate the immune response to YF vaccination in PLWH and HIV-uninfected individuals as controls. Transcript levels of immunomodulatory molecules, including IL-6, IL-10, IL-21, TGF-β, CD19, CD163, miR-21, miR-146, and miR-155, were measured using RTqPCR. TCD4+ cells were evaluated by cytometry, and neutralizing antibody (Nab) titers were detected by a micro plaque-reduction neutralization test. The findings of our study revealed several noteworthy observations. First, there was a notable reduction in the circulation of TCD4+ cells postvaccination. Among people living with HIV (PLWH), we observed an increase in the expression of IL-10 following vaccination, while IL-6 expression was diminished in PLWH with lower TCD4+ counts. Furthermore, we identified the downregulation of CD19 and TGF-β, along with the upregulation of IL-21 and CD163. Notably, we observed positive correlations between the levels of IL-10/IL-21, IL-10/CD163, and IL-6/CD19. Additionally, there was a positive correlation between miRNAs 146 and 155. It is important to emphasize that all participants exhibited robust neutralizing antibody responses after receiving 17DD YF vaccination. In this context, the gene expression data presented can be useful for biomarker studies of protective antibodies induced by YF vaccination. This study sheds light on immune mechanisms in individuals living with HIV and YF vaccination.
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Affiliation(s)
- Karine Venegas Macieira
- Laboratório de Aids e Imunologia Molecular (LABAIDS), Instituto Oswaldo Cruz, Fiocruz, Rio De Janeiro, Brazil
| | - Diogo Gama Caetano
- Laboratório de Aids e Imunologia Molecular (LABAIDS), Instituto Oswaldo Cruz, Fiocruz, Rio De Janeiro, Brazil
| | - Sheila Maria Barbosa De Lima
- Departamento de Desenvolvimento Experimental e pré-Clínico (DEDEP), Bio-Manguinhos/Fiocruz, Rio de Janeiro, Brazil
| | | | - Fernanda Heloise Côrtes
- Laboratório de Aids e Imunologia Molecular (LABAIDS), Instituto Oswaldo Cruz, Fiocruz, Rio De Janeiro, Brazil
| | - Andressa Da Silva Cazote
- Laboratório de Aids e Imunologia Molecular (LABAIDS), Instituto Oswaldo Cruz, Fiocruz, Rio De Janeiro, Brazil
| | | | | | | | - Marcellus Costa
- Instituto Nacional de Infectologia Evandro Chagas (INI) - Fiocruz, Rio De Janeiro, Brazil
| | | | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI) - Fiocruz, Rio De Janeiro, Brazil
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas (INI) - Fiocruz, Rio De Janeiro, Brazil
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Motta E, Camacho LAB, Cunha M, de Filippis AMB, Lima SM, Costa M, Pedro L, Cardoso SW, Cortes FH, Giacoia-Gripp CB, Morata M, Nazer S, Moreira RI, de Oliveira Souza MC, Mendes YS, de Souza Azevedo A, dos Santos Alvez N, Grinsztejn B, Coelho LE. Immunogenicity and reactogenicity of yellow fever vaccine in people with HIV. AIDS 2023; 37:2319-2329. [PMID: 37650759 PMCID: PMC10653289 DOI: 10.1097/qad.0000000000003696] [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: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To evaluate immunogenicity and reactogenicity of yellow fever (YF) vaccine in people with HIV (PWH) compared to HIV-uninfected controls. DESIGN In this longitudinal interventional trial (NCT03132311), PWH with CD4 + cell count ≥200 cells/μl and controls, aged 18-59, without a previous history of YF vaccination received a single standard dose of YF vaccine (17DD) and were followed at Days 5, 30 and Year 1. METHODS YF-neutralization titers were measured at Days 0, 30 and Year 1 and geometric mean titers (GMT) were calculated. Adverse events (AE) and YF virus detection were measured at Days 5 and 30. Linear regression evaluated factors associated with YF-neutralization titers. RESULTS Two hundred and eighteen PWH and 82 controls were included. At baseline, all PWH were using antiretroviral therapy; 92.6% had undetectable HIV viral load (VL) and median CD4 + cell count was 630 cells/μl [interquartile range (IQR) 463-888]. YF vaccine was safe and there were no serious AEs. At Day 30, seroconversion was observed in 98.6% of PWH [95% confidence interval (CI): 95.6-99.6] and in 100% of controls (95% CI: 93.9-100); at Year 1, 94.0% of PWH (95% CI: 89.6-96.7) and 98.4% of controls (95% CI 90.3-99.9) were seropositive. PWH had lower GMTs than controls at Day 30 and Year 1. Baseline VL >1000 copies/ml, low CD4 + cell count and low CD4 + /CD8 + ratio were associated with lower YF-neutralization titers. CONCLUSIONS YF vaccine is safe in PWH with CD4 + cell count ≥200 cells/μl. YF vaccine immunogenicity is impaired in PWH, particularly among those with high VL, low CD4 + cell count and low CD4 + /CD8 + ratio at vaccination and YF-neutralization titers decays over time.
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Affiliation(s)
- Edwiges Motta
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | | | - Marcelo Cunha
- Escola Nacional de Saúde Pública Sérgio Arouca - Fundação Oswaldo Cruz
| | | | - Sheila M.B. Lima
- Departamento de Desenvolvimento Experimental e pré-Clínico (DEDEP), Bio-Manguinhos/Fiocruz
| | - Marcellus Costa
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Luciana Pedro
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Sandra W. Cardoso
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | | | | | - Michelle Morata
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Sandro Nazer
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Ronaldo Ismério Moreira
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
- Escola Nacional de Saúde Pública Sérgio Arouca - Fundação Oswaldo Cruz
| | | | - Ygara S. Mendes
- Laboratório de Tecnologia Virológica (LATEV), Bio-Manguinhos/Fiocruz
| | | | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
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Seroconversion and persistence of neutralizing antibody response after yellow fever vaccination in patients with perinatally acquired HIV infection. AIDS 2023; 37:341-346. [PMID: 36541645 DOI: 10.1097/qad.0000000000003433] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe the dynamics of neutralizing antibody (NAbs) response after yellow fever (YF) vaccine in young adults and adolescents with perinatally acquired HIV (pHIV). DESIGN A retrospective cross-sectional study at three time points around YF vaccination and a matched case-control comparison of NAbs titers several years after YF vaccination. METHODS We selected patients who had both documented YF vaccination and perinatally acquired HIV (n = 46). The NAbs titers were measured in plasma samples from the following three time points: during the two years before (TP0), within the year after (TP1) and >1 year after (TP2) administration of the YF vaccine. The impact of perinatal infection was assessed by comparing pHIV YF vaccinees with 44 controls infected with HIV during adulthood. RESULTS The median time between the YF vaccine and TP1 and TP2 was 123 days and 7.3 years, respectively. After YF vaccination, 85% of vaccinees experienced seroconversion. The proportion of pHIV patients with NAbs above the protective threshold was stable between TP1 and TP2 (91% and 86%, respectively) but levels of NAbs decreased significantly between TP1 and TP2 (P = 0.0122). The case-control analysis found slightly higher geometrical mean titers (GMT) in pHIV than patients infected during adulthood. CONCLUSIONS Patients with pHIV showed high seroconversion rate and NAbs persistence at levels above the protective threshold after first YF vaccination. However, a decline in antibody levels over time suggests that at least one revaccination may be necessary to maintain circulating antibodies, contrary to recommendations for the general population.
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Martin C, Florence E, Domingo C, Delforge M, De Wit S, Dauby N. Seroconversion and antibody persistence after yellow fever vaccination in people living with HIV: impact of baseline HIV viral load and yellow fever seropositivity. J Travel Med 2022; 29:6548118. [PMID: 35285913 DOI: 10.1093/jtm/taac024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/01/2022] [Accepted: 11/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Data on seroconversion rates following yellow fever (YF) vaccine and effect of revaccination in people living with HIV (PLWH) are scarce. We aimed at determining key factors for seroconversion after YF vaccine in PLWH and the role of preexisting neutralizing antibodies (NAbs) at vaccination. METHODS A retrospective cross-sectional study at several timepoints in two Belgian AIDS Reference Center. For each individual, plasma samples from three timepoints were selected: Timepoint 0 (TP0) in the year before administration of the YF vaccine, Timepoint 1 (TP1) in the year following the YF vaccine, Timepoint 2 (TP2) >1 year after the YF vaccine. Plasma samples were analysed for YF NAbs by plaque reduction neutralization test. The primary endpoint was the number of patients with protective levels of NAbs ≥ 1/10. A boosted immune response was defined as a 4-fold increase in serologic titres following revaccination. RESULTS Of the 160 PLWH included, protective levels of NAbs were present in 36%, 87% and 72% of subjects at baseline, at a median of 12 months and a median of 96 months after YF vaccination, respectively. Among vaccine recipients negative for YF NAbs at baseline (n = 102), 83% seroconverted. PLWH with undetectable HIV viral load (VL) at baseline were more likely to seroconvert (P < 0·01). A booster response was observed in only 17% of subjects with baseline seropositivity (n = 10 out of 58). In multivariate analysis, undetectable HIV VL at vaccination and baseline YF seropositivity were associated with persistent levels of protective NAbs at a median of 8 years after YF vaccination. CONCLUSION Undetectable HIV VL at baseline is associated with high rates of seroconversion. YF seropositivity before revaccination is associated with low rates of booster effect but a higher chance of long term persistent NAbs response, suggesting a benefit of revaccination in PLWH.
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Affiliation(s)
- Charlotte Martin
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Eric Florence
- Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Cristina Domingo
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens - Highly Pathogenic Viruses- ZBS-1, 13353 Berlin, Germany.,Robert Koch Institute, Centre for International Health Protection (ZIG) -ZIG-4 Public Health Laboratory Support, 13353 Berlin, Germany
| | - Marc Delforge
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Stéphane De Wit
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Nicolas Dauby
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium.,Institute for Medical Immunology, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium.,School of Public Health, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
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9
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Kling K, Domingo C, Bogdan C, Duffy S, Harder T, Howick J, Kleijnen J, McDermott K, Wichmann O, Wilder-Smith A, Wolff R. Duration of Protection After Vaccination Against Yellow Fever: A Systematic Review and Meta-Analysis. Clin Infect Dis 2022; 75:2266-2274. [PMID: 35856638 PMCID: PMC9761887 DOI: 10.1093/cid/ciac580] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/30/2022] [Accepted: 07/13/2022] [Indexed: 01/19/2023] Open
Abstract
The duration of protection after a single dose of yellow fever vaccine is a matter of debate. To summarize the current knowledge, we performed a systematic literature review and meta-analysis. Studies on the duration of protection after 1 and ≥2 vaccine doses were reviewed. Data were stratified by time since vaccination. In our meta-analysis, we used random-effects models. We identified 36 studies from 20 countries, comprising more than 17 000 participants aged 6 months to 85 years. Among healthy adults and children, pooled seroprotection rates after single vaccination dose were close to 100% by 3 months and remained high in adults for 5 to 10 years. In children vaccinated before age 2 years, the seroprotection rate was 52% within 5 years after primary vaccination. For immunodeficient persons, data indicate relevant waning. The extent of waning of seroprotection after yellow fever vaccination depends on age and immune status at primary vaccination.
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Affiliation(s)
- Kerstin Kling
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Cristina Domingo
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Steven Duffy
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | - Thomas Harder
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jeremy Howick
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Ole Wichmann
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Annelies Wilder-Smith
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Robert Wolff
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
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10
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Durier C, Mercier-Delarue S, Verdière NCD, Meiffrédy V, Matheron S, Samri A, Resch M, Marchand L, Autran B, Launay O, Simon F. A 5-year neutralizing immune response to yellow fever vaccine in HIV-infected and HIV-uninfected adults. AIDS 2022; 36:319-321. [PMID: 34934023 DOI: 10.1097/qad.0000000000003114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | - Sophie Matheron
- AP-HP Nord Hôpital Bichat - Claude-Bernard, Faculté de Médecine, Université de Paris, INSERM UMR 1137 IAME
| | - Assia Samri
- Sorbonne Université, INSERM 1135, CNRS ERL 8255, Centre d'immunologie et des maladies infectieuses, Cimi-Paris
| | | | | | - Brigitte Autran
- Sorbonne Université, INSERM 1135, CNRS ERL 8255, Centre d'immunologie et des maladies infectieuses, Cimi-Paris
| | - Odile Launay
- AP-HP, Hôpital Cochin Broca Hôtel-Dieu, INSERM, CIC 1417, F-CRIN, I-REIVAC, Université de Paris, Paris, France
| | - François Simon
- AP-HP, Hôpital Saint-Louis, Faculté de Médecine, Université de Paris
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11
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Tonacio AC, do Nascimento Pedrosa T, Borba EF, Aikawa NE, Pasoto SG, Filho JCRF, Sampaio Barros MM, Leon EP, Lombardi SCFS, Junior AM, Azevedo ADS, Schwarcz WD, Fuller R, Yuki EFN, Ugolini Lopes MR, Rodrigues Pereira RM, Sampaio Barros PD, de Andrade DCO, de Medeiros-Ribeiro AC, de Moraes JCB, Shinjo SK, Miossi R, da Silva Duarte AJ, Lopes MH, Kallás EG, Almeida da Silva CA, Bonfá E. Immunogenicity and safety of primary fractional-dose yellow fever vaccine in autoimmune rheumatic diseases. PLoS Negl Trop Dis 2021; 15:e0010002. [PMID: 34843469 PMCID: PMC8659329 DOI: 10.1371/journal.pntd.0010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 12/09/2021] [Accepted: 11/16/2021] [Indexed: 12/05/2022] Open
Abstract
Background Brazil faced a yellow fever(YF) outbreak in 2016–2018 and vaccination was considered for autoimmune rheumatic disease patients(ARD) with low immunosuppression due to YF high mortality. Objective This study aimed to evaluate, prospectively for the first time, the short-term immunogenicity of the fractional YF vaccine(YFV) immunization in ARD patients with low immunossupression. Methods and Results A total of 318 participants(159 ARD and 159 age- and sex-matched healthy controls) were vaccinated with the fractional-dose(one fifth) of 17DD-YFV. All subjects were evaluated at entry(D0), D5, D10, and D30 post-vaccination for clinical/laboratory and disease activity parameters for ARD patients. Post-vaccination seroconversion rate(83.7%vs.96.6%, p = 0.0006) and geometric mean titers(GMT) of neutralizing antibodies[1143.7 (95%CI 1012.3–1292.2) vs.731 (95%CI 593.6–900.2), p<0.001] were significantly lower in ARD compared to controls. A lower positivity rate of viremia was also identified for ARD patients compared to controls at D5 (53%vs.70%, p = 0.005) and the levels persisted in D10 for patients and reduced for controls(51%vs.19%, p = 0.0001). The viremia was the only variable associated with seroconvertion. No serious adverse events were reported. ARD disease activity parameters remained stable at D30(p>0.05). Conclusion Fractional-dose 17DD-YF vaccine in ARD patients resulted in a high rate of seroconversion rate(>80%) but lower than controls, with a longer but less intense viremia. This vaccine was immunogenic, safe and did not induce flares in ARD under low immunosuppression and may be indicated in YF outbreak situations and for patients who live or travel to endemic areas. Trial registration This clinical trial was registered with Clinicaltrials.gov (#NCT03430388). Yellow fever is a viral hemorragic fever with high mortality rate and the vaccine is a remarkably successful way of preventing it. As a live attenuated virus vaccine, it is not recommended for rheumatic and other immunossupressed patients in general. However, in an outbreak scenario, the risk of dying of the disease can be higher than the risk of a vaccine serious adverse event. In 2018, the fractional-dose yellow fever vaccine was offered to the hospital employees and to the rheumatic patients without or with low immunossupression therapy in Hospital das Clinicas of University of São Paulo, during the yellow fever outbreak in São Paulo, Brazil. In order to optimize the yellow fever vaccine (YFV) supply, the fractional-dose (corresponding to one fifth) was adopted in the public vaccine campaign. This is the first study evaluating the primary vaccination with fractional-dose YFV in autoimmune rheumatic diseases(ARD) patients (n = 159) under low immunosuppression. Most vaccinated participants were able to produce enough neutralizing antibodies to be protected against yellow fever (seroconversion rate of 84% versus 96% in healthy controls). Neither activity of the rheumatic disease or serious adverse event was identified during the 30 days of followup after the vaccination.
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Affiliation(s)
- Adriana Coracini Tonacio
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Tatiana do Nascimento Pedrosa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo Ferreira Borba
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nadia Emi Aikawa
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra Gofinet Pasoto
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Elaine Pires Leon
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Alfredo Mendrone Junior
- Laboratório de Segurança Transfusional, Divisão de Pesquisa e Ensino, Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, Brazil
| | - Adriana de Souza Azevedo
- Institute of Technology in Immunobiologicals, Bio-Manguinhos, Fundação Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Brazil
| | - Waleska Dias Schwarcz
- Institute of Technology in Immunobiologicals, Bio-Manguinhos, Fundação Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, Brazil
| | - Ricardo Fuller
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily Figueiredo Neves Yuki
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Michelle Remião Ugolini Lopes
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa Maria Rodrigues Pereira
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | - Samuel Katsuyuki Shinjo
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renata Miossi
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alberto José da Silva Duarte
- Clinical Laboratory Division—Department of Pathology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marta Heloisa Lopes
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Esper Georges Kallás
- Department of Infectious and Parasitic Diseases, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clovis Artur Almeida da Silva
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfá
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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12
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Hansen CA, Barrett ADT. The Present and Future of Yellow Fever Vaccines. Pharmaceuticals (Basel) 2021; 14:ph14090891. [PMID: 34577591 PMCID: PMC8468696 DOI: 10.3390/ph14090891] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/05/2022] Open
Abstract
The disease yellow fever (YF) is prevented by a live-attenuated vaccine, termed 17D, which has been in use since the 1930s. One dose of the vaccine is thought to give lifelong (35+ years) protective immunity, and neutralizing antibodies are the correlate of protection. Despite being a vaccine-preventable disease, YF remains a major public health burden, causing an estimated 109,000 severe infections and 51,000 deaths annually. There are issues of supply and demand for the vaccine, and outbreaks in 2016 and 2018 resulted in fractional dosing of the vaccine to meet demand. The World Health Organization (WHO) has established the “Eliminate Yellow Fever Epidemics” (EYE) initiative to reduce the burden of YF over the next 10 years. As with most vaccines, the WHO has recommendations to assure the quality, safety, and efficacy of the YF vaccine. These require the use of live 17D vaccine only produced in embryonated chicken eggs, and safety evaluated in non-human primates only. Thus, any second-generation vaccines would require modification of WHO recommendations if they were to be used in endemic countries. There are multiple second-generation YF vaccine candidates in various stages of development that must be shown to be non-inferior to the current 17D vaccine in terms of safety and immunogenicity to progress through clinical trials to potential licensing. The historic 17D vaccine continues to shape the global vaccine landscape in its use in the generation of multiple licensed recombinant chimeric live vaccines and vaccine candidates, in which its structural protein genes are replaced with those of other viruses, such as dengue and Japanese encephalitis. There is no doubt that the YF 17D live-attenuated vaccine will continue to play a role in the development of new vaccines for YF, as well as potentially for many other pathogens.
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Affiliation(s)
- Clairissa A. Hansen
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-4036, USA;
| | - Alan D. T. Barrett
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-4036, USA;
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX 77555-4036, USA
- Correspondence:
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13
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Cohen KW, Linderman SL, Moodie Z, Czartoski J, Lai L, Mantus G, Norwood C, Nyhoff LE, Edara VV, Floyd K, De Rosa SC, Ahmed H, Whaley R, Patel SN, Prigmore B, Lemos MP, Davis CW, Furth S, O’Keefe JB, Gharpure MP, Gunisetty S, Stephens K, Antia R, Zarnitsyna VI, Stephens DS, Edupuganti S, Rouphael N, Anderson EJ, Mehta AK, Wrammert J, Suthar MS, Ahmed R, McElrath MJ. Longitudinal analysis shows durable and broad immune memory after SARS-CoV-2 infection with persisting antibody responses and memory B and T cells. Cell Rep Med 2021; 2:100354. [PMID: 34250512 PMCID: PMC8253687 DOI: 10.1016/j.xcrm.2021.100354] [Citation(s) in RCA: 254] [Impact Index Per Article: 84.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/27/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
Ending the COVID-19 pandemic will require long-lived immunity to SARS-CoV-2. Here, we evaluate 254 COVID-19 patients longitudinally up to 8 months and find durable broad-based immune responses. SARS-CoV-2 spike binding and neutralizing antibodies exhibit a bi-phasic decay with an extended half-life of >200 days suggesting the generation of longer-lived plasma cells. SARS-CoV-2 infection also boosts antibody titers to SARS-CoV-1 and common betacoronaviruses. In addition, spike-specific IgG+ memory B cells persist, which bodes well for a rapid antibody response upon virus re-exposure or vaccination. Virus-specific CD4+ and CD8+ T cells are polyfunctional and maintained with an estimated half-life of 200 days. Interestingly, CD4+ T cell responses equally target several SARS-CoV-2 proteins, whereas the CD8+ T cell responses preferentially target the nucleoprotein, highlighting the potential importance of including the nucleoprotein in future vaccines. Taken together, these results suggest that broad and effective immunity may persist long-term in recovered COVID-19 patients.
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Affiliation(s)
- Kristen W. Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Susanne L. Linderman
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Zoe Moodie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Julie Czartoski
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Lilin Lai
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
- Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Grace Mantus
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Carson Norwood
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Lindsay E. Nyhoff
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
| | - Venkata Viswanadh Edara
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
- Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Katharine Floyd
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
- Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Stephen C. De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
- Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, WA 98195, USA
| | - Hasan Ahmed
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Rachael Whaley
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Shivan N. Patel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Brittany Prigmore
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Maria P. Lemos
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Carl W. Davis
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Sarah Furth
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - James B. O’Keefe
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Mohini P. Gharpure
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Sivaram Gunisetty
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Kathy Stephens
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
| | - Rustom Antia
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Veronika I. Zarnitsyna
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - David S. Stephens
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Srilatha Edupuganti
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
- Hope Clinic of Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA 30330, USA
| | - Nadine Rouphael
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
- Hope Clinic of Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA 30330, USA
| | - Evan J. Anderson
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
| | - Aneesh K. Mehta
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Jens Wrammert
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
| | - Mehul S. Suthar
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
- Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
- Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
- Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, WA 98195, USA
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14
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Cohen KW, Linderman SL, Moodie Z, Czartoski J, Lai L, Mantus G, Norwood C, Nyhoff LE, Edara VV, Floyd K, De Rosa SC, Ahmed H, Whaley R, Patel SN, Prigmore B, Lemos MP, Davis CW, Furth S, O’Keefe J, Gharpure MP, Gunisetty S, Stephens KA, Antia R, Zarnitsyna VI, Stephens DS, Edupuganti S, Rouphael N, Anderson EJ, Mehta AK, Wrammert J, Suthar MS, Ahmed R, McElrath MJ. Longitudinal analysis shows durable and broad immune memory after SARS-CoV-2 infection with persisting antibody responses and memory B and T cells. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.19.21255739. [PMID: 33948610 PMCID: PMC8095229 DOI: 10.1101/2021.04.19.21255739] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ending the COVID-19 pandemic will require long-lived immunity to SARS-CoV-2. Here, we evaluate 254 COVID-19 patients longitudinally up to eight months and find durable broad-based immune responses. SARS-CoV-2 spike binding and neutralizing antibodies exhibit a bi-phasic decay with an extended half-life of >200 days suggesting the generation of longer-lived plasma cells. SARS-CoV-2 infection also boosts antibody titers to SARS-CoV-1 and common betacoronaviruses. In addition, spike-specific IgG+ memory B cells persist, which bodes well for a rapid antibody response upon virus re-exposure or vaccination. Virus-specific CD4+ and CD8+ T cells are polyfunctional and maintained with an estimated half-life of 200 days. Interestingly, CD4+ T cell responses equally target several SARS-CoV-2 proteins, whereas the CD8+ T cell responses preferentially target the nucleoprotein, highlighting the potential importance of including the nucleoprotein in future vaccines. Taken together, these results suggest that broad and effective immunity may persist long-term in recovered COVID-19 patients.
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Affiliation(s)
- Kristen W. Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Susanne L. Linderman
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Zoe Moodie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Julie Czartoski
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Lilin Lai
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA,Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Grace Mantus
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
| | - Carson Norwood
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
| | - Lindsay E. Nyhoff
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA,Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Venkata Viswanadh Edara
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA,Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Katharine Floyd
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA,Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Stephen C. De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA,Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, WA 98195, USA
| | - Hasan Ahmed
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Rachael Whaley
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Shivan N. Patel
- Department of Medicine, Division of Infectious Diseases, Hope Clinic of Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Brittany Prigmore
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Maria P. Lemos
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Carl W. Davis
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Sarah Furth
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - James O’Keefe
- Emory University School of Medicine, Department of Medicine, Atlanta, GA 30322, USA
| | - Mohini P. Gharpure
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - Sivaram Gunisetty
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | | | - Rustom Antia
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Veronika I. Zarnitsyna
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA,Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - David S. Stephens
- Emory University School of Medicine, Department of Medicine, Atlanta, GA 30322, USA
| | - Srilatha Edupuganti
- Department of Medicine, Division of Infectious Diseases, Hope Clinic of Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Nadine Rouphael
- Department of Medicine, Division of Infectious Diseases, Hope Clinic of Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Evan J. Anderson
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA,Emory University School of Medicine, Department of Medicine, Atlanta, GA 30322, USA
| | - Aneesh K. Mehta
- Emory University School of Medicine, Department of Medicine, Atlanta, GA 30322, USA
| | - Jens Wrammert
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA
| | - Mehul S. Suthar
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta, Emory University Department of Pediatrics Department of Medicine, Atlanta, GA 30322, USA,Yerkes National Primate Research Center, Atlanta, GA 30329, USA
| | - Rafi Ahmed
- Emory Vaccine Center and Department of Microbiology and Immunology, Emory University, Atlanta, GA 30322, USA
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA,Departments of Laboratory Medicine and Medicine, University of Washington, Seattle, WA 98195, USA
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15
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Atkinson A, Miro JM, Mocroft A, Reiss P, Kirk O, Morlat P, Ghosn J, Stephan C, Mussini C, Antoniadou A, Doerholt K, Girardi E, De Wit S, Kraus D, Zwahlen M, Furrer H. No need for secondary Pneumocystis jirovecii pneumonia prophylaxis in adult people living with HIV from Europe on ART with suppressed viraemia and a CD4 cell count greater than 100 cells/µL. J Int AIDS Soc 2021; 24:e25726. [PMID: 34118121 PMCID: PMC8196713 DOI: 10.1002/jia2.25726] [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: 12/16/2020] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Since the beginning of the HIV epidemic in resource-rich countries, Pneumocystis jirovecii pneumonia (PjP) is one of the most frequent opportunistic AIDS-defining infections. The Collaboration of Observational HIV Epidemiological Research Europe (COHERE) has shown that primary Pneumocystis jirovecii Pneumonia (PjP) prophylaxis can be safely withdrawn in patients with CD4 counts of 100 to 200 cells/µL if plasma HIV-RNA is suppressed on combination antiretroviral therapy. Whether this holds true for secondary prophylaxis is not known, and this has proved difficult to determine due to the much lower population at risk. METHODS We estimated the incidence of secondary PjP by including patient data collected from 1998 to 2015 from the COHERE cohort collaboration according to time-updated CD4 counts, HIV-RNA and use of PjP prophylaxis in persons >16 years of age. We fitted a Poisson generalized additive model in which the smoothed effect of CD4 was modelled by a restricted cubic spline, and HIV-RNA was stratified as low (<400), medium (400 to 10,000) or high (>10,000copies/mL). RESULTS There were 373 recurrences of PjP during 74,295 person-years (py) in 10,476 patients. The PjP incidence in the different plasma HIV-RNA strata differed significantly and was lowest in the low stratum. For patients off prophylaxis with CD4 counts between 100 and 200 cells/µL and HIV-RNA below 400 copies/mL, the incidence of recurrent PjP was 3.9 (95% CI: 2.0 to 5.8) per 1000 py, not significantly different from patients on prophylaxis in the same stratum (1.9, 95% CI: 0.1 to 3.7). CONCLUSIONS HIV viraemia importantly affects the risk of recurrent PjP. In virologically suppressed patients on ART with CD4 counts of 100 to 200/µL, the incidence of PjP off prophylaxis is below 10/1000 py. Secondary PjP prophylaxis may be safely withheld in such patients. While European guidelines recommend discontinuing secondary PjP prophylaxis only if CD4 counts rise above 200 cells/mL, the latest US Guidelines consider secondary prophylaxis discontinuation even in patients with a CD4 count above 100 cells/µL and suppressed viral load. Our results strengthen and support this US recommendation.
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Affiliation(s)
- Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | - Peter Reiss
- Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, and HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Ole Kirk
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Philippe Morlat
- Internal Medicine and Infectious Diseases Department, University Hospital of Bordeaux, Bordeaux, France
| | - Jade Ghosn
- Service des Maladies Infectieuses et Tropicales, Groupe Hospitalier Universitaire Bichat-Claude Bernard, Paris, France.,INSERM U 1137 IAME, Université de Paris, Paris, France
| | - Christoph Stephan
- Infectious Diseases Unit at Medical Center no.2, Frankfurt University Hospital, Goethe University, Frankfurt, Germany
| | - Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katja Doerholt
- Paediatric Infectious Diseases Unit, St. George's University Hospital, London, UK
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases L. Spallanzani-IRCCS, Rome, Italy
| | - Stéphane De Wit
- Department of Infectious Diseases, St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - David Kraus
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Department of Mathematics and Statistics, Masaryk University, Brno, Czech Republic
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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16
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Martin C, Domingo C, Bottieau E, Buonfrate D, De Wit S, Van Laethem Y, Dauby N. Immunogenicity and duration of protection after yellow fever vaccine in people living with human immunodeficiency virus: a systematic review. Clin Microbiol Infect 2021; 27:958-967. [PMID: 33813107 DOI: 10.1016/j.cmi.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND We lack the rationale on which to base the development of a yellow fever (YF) vaccination schedule for people living with human immunodeficiency virus (PLWHIV). OBJECTIVES To report on the current evidence regarding the seroconversion rate and the duration of humoral protection after YF vaccine, as well as the impact of revaccination in PLWHIV. DATA SOURCES MEDLINE, Google Scholar, LILACS and Cochrane CENTRAL were searched. METHODS We selected studies on PLWHIV of all ages (including perinatally HIV-infected patients) and all settings (YF endemic and non-endemic zones). Intervention investigated was vaccination against YF, at least once after the HIV diagnosis. The research questions were the seroconversion rate, duration of humoral immunity after YF vaccine and impact of revaccination in PLWHIV. Selected studies were assessed for quality using the Newcastle-Ottawa scale. RESULTS Ten, six and six studies were selected for the systematic review of each question, respectively. Only one study addressed the first question in perinatally HIV-infected children. The quality of the studies was assessed as Poor (n = 16), Fair (n = 2) or Good (n = 4). A meta-analysis demonstrated that 97.6% (95% CI 91.6%-100%) of the included population seroconverted. Between 1 and 10 years after YF vaccine, reported persistence of neutralizing antibodies was 72% (95% CI 53.6%-91%), and it was 62% (95% CI 45.4%-78.6%) more than 10 years after YF vaccine. No conclusions could be drawn on impact of revaccination because of the small number of patients. CONCLUSIONS The current evidence regarding seroconversion rate, duration of humoral protection after YF vaccine and impact of revaccination in PLWHIV is limited by the low number and quality of studies. Based on the presently available data, it is difficult to rationally develop yellow fever vaccination guidelines for PLWHIV.
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Affiliation(s)
- Charlotte Martin
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint-Pierre-Université Libre de Bruxelles, Brussels, Belgium.
| | - Cristina Domingo
- Robert Koch Institute, Highly Pathogenic Viruses (ZBS 1), Centre for Biological Threats and Special Pathogens, WHO Collaborating Centre for Emerging Infections and Biological Threats, Berlin, Germany
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Stéphane De Wit
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint-Pierre-Université Libre de Bruxelles, Brussels, Belgium
| | - Yves Van Laethem
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint-Pierre-Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Dauby
- Infectious Diseases Department, Centre Hospitalier Universitaire Saint-Pierre-Université Libre de Bruxelles, Brussels, Belgium; Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium; Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles, Brussels, Belgium
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17
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Lecomte E, Laureys G, Verbeke F, Domingo Carrasco C, Van Esbroeck M, Huits R. A clinician's perspective on yellow fever vaccine-associated neurotropic disease. J Travel Med 2020; 27:taaa172. [PMID: 32965473 PMCID: PMC7649383 DOI: 10.1093/jtm/taaa172] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/13/2023]
Abstract
Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%. YF vaccination results in long-lasting protective immunity. Serious adverse events (SAEs), such as YF vaccine-associated neurotropic disease (YEL-AND) are rare. We present a case of a 56-year-old Caucasian man with fever, headache, cognitive problems at the emergency department. He received a primary YF vaccination 4 weeks prior to symptom onset. Cerebrospinal fluid tested positive (POS) for YF virus by reverse transcriptase polymerase chain reaction and confirmed diagnosis of YEL-AND. The patient recovered with symptomatic treatment. We reviewed published clinical reports on YEL-AND indexed for MEDLINE. We identified and analyzed 53 case reports. Forty-five patients were male and eight were female. Twenty-nine cases met criteria for definite YEL-AND and twenty-four for suspected YEL-AND according to YF Vaccine Safety Working Group. We applied the Brighton Collaboration diagnostic criteria to assess the diagnostic accuracy of the clinical diagnoses and found meningoencephalitis in 38 reported YEL-AND cases, Guillain Barré Syndrome (GBS) in seven, Acute Disseminated Encephalomyelitis (ADEM) in six and myelitis in five. Thirty-five patients recovered or improved; however, not all cases had a complete follow-up. The prognosis of YEL-AND presenting with GBS, ADEM or myelitis was poor. Fourteen patients received therapy (corticosteroids, intravenous immunoglobulins and/or plasmapheresis). In conclusion, YF vaccine-associated neurotropic disease is a very rare but SAE after YF vaccination. We described a case of YEL-AND and propose a standardized clinical workup of this condition based on a review of the literature. Centralized registration of complications of YF vaccination is encouraged.
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Affiliation(s)
- Elien Lecomte
- Department of Neurology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Guy Laureys
- Department of Neurology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederick Verbeke
- Department of Clinical Biology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Cristina Domingo Carrasco
- Centre for Biological Threats and Special Pathogens, Highly Pathogenic Viruses- ZBS-1, Robert Koch Institute, Seestraβe 10, 13353, Berlin, Germany
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium
| | - Ralph Huits
- Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium
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18
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Chen LH, Wilson ME. Yellow fever control: current epidemiology and vaccination strategies. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2020; 6:1. [PMID: 31938550 PMCID: PMC6954598 DOI: 10.1186/s40794-020-0101-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/05/2020] [Indexed: 12/16/2022]
Abstract
Yellow fever (YF) outbreaks continue, have expanded into new areas and threaten large populations in South America and Africa. Predicting where epidemics might occur must take into account local mosquito populations and specific YF virus strain, as well as ecoclimatic conditions, sociopolitical and demographic factors including population size, density, and mobility, and vaccine coverage. Populations of Aedes aegypti and Aedes albopictus from different regions vary in susceptibility to and capacity to transmit YF virus. YF virus cannot be eliminated today because the virus circulates in animal reservoirs, but human disease could be eliminated with wide use of the vaccine. WHO EYE (Eliminate Yellow Fever Epidemics) is a welcome plan to control YF, with strategies to be carried out from 2017 to 2026: to expand use of YF vaccine, to prevent international spread, and to contain outbreaks rapidly. YF vaccination is the mainstay in controlling YF outbreaks, but global supply is insufficient. Therefore, dose-sparing strategies have been proposed including fractional dosing and intradermal administration. Fractional dosing has been effectively used in outbreak control but currently does not satisfy International Health Regulations; special documentation is needed for international travel. Vector control is another facet in preventing YF outbreaks, and novel methods are being considered and proposed.
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Affiliation(s)
- Lin H Chen
- 1Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02138 USA.,2Harvard Medical School, Boston, MA USA
| | - Mary E Wilson
- 3Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA.,4Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, USA
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19
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Burkhard J, Ciurea A, Gabay C, Hasler P, Müller R, Niedrig M, Fehr J, Villiger P, Visser LG, de Visser AW, Walker UA, Hatz C, Bühler S. Long-term immunogenicity after yellow fever vaccination in immunosuppressed and healthy individuals. Vaccine 2020; 38:3610-3617. [PMID: 31911033 DOI: 10.1016/j.vaccine.2019.12.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The live-attenuated yellow fever vaccine (YFV) is generally contraindicated in immunosuppressed patients. Our aim was to investigate if immunosuppressive therapy impairs the long-term protection against yellow fever virus in patients who had received YFV prior to the start of their immunosuppressive therapy. METHODS Our study examined 35 healthy individuals and 40 immunosuppressed patients with autoimmune diseases or organ transplants. All individuals had received YFV prior to the onset of their immunosuppression. We analysed the long-term influence of the immunosuppressive therapy on the YFV protective immunity by measuring neutralising antibodies (NA) with the Plaque Reduction Neutralisation Test (PRNT). We assessed risk factors for a negative PRNT result (titre below 1: 10) and their influence on the magnitude of the NA. RESULTS A median time interval of 21.1 years (interquartile range 14.4-31.3 years) after the YFV in all patients, a total of 35 immunosuppressed patients (88%) were seropositive (PRNT ≥ 1:10) compared to 31 patients (89%) in the control group. The geometric mean titres of NA did not differ between the groups. The duration of an underlying rheumatic disease was the only risk factor found for a lower magnitude of NA. An insufficient level of NA was found in nine subjects (12%) who had received a single dose of YFV (in one subject, the number of YFV doses was unknown). CONCLUSION The use of an immunosuppressive drug started after the administration of the YFV did not affect long-term persistence of NA. A second dose of YFV may be necessary to secure long-term immunity.
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Affiliation(s)
- J Burkhard
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - A Ciurea
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - C Gabay
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - P Hasler
- Department of Rheumatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - R Müller
- Division of Rheumatology, Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Division of Rheumatology and Clinical Immunology, Department of Internal Medicine Ludwig-Maximilians-University Munich, Germany
| | - M Niedrig
- Robert Koch-Institut (RKI), Berlin, Germany
| | - J Fehr
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - P Villiger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland
| | - L G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - A W de Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - U A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - C Hatz
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland; Division of Infectious Diseases & Hospital Epidemiology, Kantonsspital St. Gallen, Switzerland
| | - S Bühler
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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20
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Rothe C, Boecken G. Reiseimpfungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:74-84. [DOI: 10.1007/s00103-019-03064-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Chang L, Lim BCW, Flaherty GT, Torresi J. Travel vaccination recommendations and infection risk in HIV-positive travellers. J Travel Med 2019; 26:5486056. [PMID: 31066446 DOI: 10.1093/jtm/taz034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND With the advent of highly active antiretroviral drugs for the treatment of human immunodeficiency virus (HIV) it has become possible for people with HIV to travel to destinations that may place them at risk of a number of infectious diseases. Prevention of infections by vaccination is therefore of paramount importance for these travellers. However, vaccine responsiveness in HIV-positive individuals is not infrequently reduced compared to HIV-negative individuals. An understanding of the expected immune responses to vaccines in HIV-positive travellers is therefore important in planning the best approach to a pretravel consultation. METHODS A PubMed search was performed on HIV or acquired immune deficiency syndrome together with a search for specific vaccines. Review of the literature was performed to develop recommendations on vaccinations for HIV-positive travellers to high-risk destinations. RESULTS The immune responses to several vaccines are reduced in HIV-positive people. In the case of vaccines for hepatitis A, hepatitis B, influenza, pneumococcus, meningococcus and yellow fever there is a good body of data in the literature showing reduced immune responsiveness and also to help guide appropriate vaccination strategies. For other vaccines like Japanese encephalitis, rabies, typhoid fever, polio and cholera the data are not as robust; however, it is still possible to gain some understanding of the reduced responses seen with these vaccines. CONCLUSION This review provides a summary of the immunological responses to commonly used vaccines for the HIV-positive travellers. This information will help guide travel medicine practitioners in making decisions about vaccination and boosting of travellers with HIV.
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Affiliation(s)
- Lisa Chang
- Department of Microbiology, Dorevitch Pathology, Melbourne, Victoria, Australia
| | - Bryan Chang Wei Lim
- School of Medicine, National University of Ireland, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Joseph Torresi
- Department of Microbiology and Immunology, Peter Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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22
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Clark E, Serpa JA. Tropical Diseases in HIV. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-00194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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