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Arunachalam AB. Vaccines Induce Homeostatic Immunity, Generating Several Secondary Benefits. Vaccines (Basel) 2024; 12:396. [PMID: 38675778 PMCID: PMC11053716 DOI: 10.3390/vaccines12040396] [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: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The optimal immune response eliminates invading pathogens, restoring immune equilibrium without inflicting undue harm to the host. However, when a cascade of immunological reactions is triggered, the immune response can sometimes go into overdrive, potentially leading to harmful long-term effects or even death. The immune system is triggered mostly by infections, allergens, or medical interventions such as vaccination. This review examines how these immune triggers differ and why certain infections may dysregulate immune homeostasis, leading to inflammatory or allergic pathology and exacerbation of pre-existing conditions. However, many vaccines generate an optimal immune response and protect against the consequences of pathogen-induced immunological aggressiveness, and from a small number of unrelated pathogens and autoimmune diseases. Here, we propose an "immuno-wave" model describing a vaccine-induced "Goldilocks immunity", which leaves fine imprints of both pro-inflammatory and anti-inflammatory milieus, derived from both the innate and the adaptive arms of the immune system, in the body. The resulting balanced, 'quiet alert' state of the immune system may provide a jump-start in the defense against pathogens and any associated pathological inflammatory or allergic responses, allowing vaccines to go above and beyond their call of duty. In closing, we recommend formally investigating and reaping many of the secondary benefits of vaccines with appropriate clinical studies.
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Affiliation(s)
- Arun B Arunachalam
- Analytical Sciences, R&D Sanofi Vaccines, 1 Discovery Dr., Swiftwater, PA 18370, USA
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2
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Xiang J, Chang Q, McLinden JH, Bhattarai N, Welch JL, Kaufman TM, Stapleton JT. Characterization of "Off-Target" Immune Modulation Induced by Live Attenuated Yellow Fever Vaccine. J Infect Dis 2024; 229:786-794. [PMID: 36994927 PMCID: PMC10938199 DOI: 10.1093/infdis/jiad086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Live attenuated vaccines alter immune functions and are associated with beneficial outcomes. We previously demonstrated that live attenuated yellow fever virus (YFV) vaccine (LA-YF-Vax) dampens T-cell receptor (TCR) signaling in vitro via an RNA-based mechanism. We examined study participants before and after LA-YF-Vax to assess TCR-mediated functions in vivo. METHODS Serum samples and peripheral blood mononuclear cells (PBMCs) were obtained before and after LA-YF-Vax (with or without additional vaccines) or quadrivalent influenza vaccine. TCR-mediated activation was determined by interleukin 2 release or phosphorylation of the lymphocyte-specific Src kinase. TCR-regulating phosphatase (protein tyrosine phosphatase receptor type E [PTPRE]) expression was also measured. RESULTS Compared with prevaccination findings, LA-YF-Vax recipient PBMCs demonstrated transient reduction in interleukin 2 release after TCR stimulation and PTPRE levels, unlike in control participants who received quadrivalent influenza vaccine. YFV was detected in 8 of 14 participants after LA-YF-Vax. After incubation of healthy donor PBMCs in serum-derived extracellular vesicles prepared from LA-YF-Vax recipients, TCR signaling and PTPRE levels were reduced after vaccination, even in participants without detectable YFV RNA. CONCLUSIONS LA-YF-Vax reduces TCR functions and PTPRE levels after vaccination. Extracellular vesicles from serum recapitulated this effect in healthy cells. This likely contributes to the reduced immunogenicity for heterologous vaccines after LA-YF-Vax administration. Identification of specific immune mechanisms related to vaccines should contribute to understanding of the "off-target," beneficial effects of live vaccines.
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Affiliation(s)
- J Xiang
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - Q Chang
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - J H McLinden
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - N Bhattarai
- Division of Cellular and Gene Therapies, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - J L Welch
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - T M Kaufman
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - Jack T Stapleton
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
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Kaur A, Vaccari M. Exploring HIV Vaccine Progress in the Pre-Clinical and Clinical Setting: From History to Future Prospects. Viruses 2024; 16:368. [PMID: 38543734 PMCID: PMC10974975 DOI: 10.3390/v16030368] [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: 01/09/2024] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 04/01/2024] Open
Abstract
The human immunodeficiency virus (HIV) continues to pose a significant global health challenge, with millions of people affected and new cases emerging each year. While various treatment and prevention methods exist, including antiretroviral therapy and non-vaccine approaches, developing an effective vaccine remains the most crucial and cost-effective solution to combating the HIV epidemic. Despite significant advancements in HIV research, the HIV vaccine field has faced numerous challenges, and only one clinical trial has demonstrated a modest level of efficacy. This review delves into the history of HIV vaccines and the current efforts in HIV prevention, emphasizing pre-clinical vaccine development using the non-human primate model (NHP) of HIV infection. NHP models offer valuable insights into potential preventive strategies for combating HIV, and they play a vital role in informing and guiding the development of novel vaccine candidates before they can proceed to human clinical trials.
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Affiliation(s)
- Amitinder Kaur
- Division of Immunology, Tulane National Primate Research Center, Covington, LA 70433, USA;
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Monica Vaccari
- Division of Immunology, Tulane National Primate Research Center, Covington, LA 70433, USA;
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Hjelholt AJ, Bergh C, Bhatt DL, Fröbert O, Kjolby MF. Pleiotropic Effects of Influenza Vaccination. Vaccines (Basel) 2023; 11:1419. [PMID: 37766096 PMCID: PMC10536538 DOI: 10.3390/vaccines11091419] [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: 07/06/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Influenza vaccines are designed to mimic natural influenza virus exposure and stimulate a long-lasting immune response to future infections. The evolving nature of the influenza virus makes vaccination an important and efficacious strategy to reduce healthcare-related complications of influenza. Several lines of evidence indicate that influenza vaccination may induce nonspecific effects, also referred to as heterologous or pleiotropic effects, that go beyond protection against infection. Different explanations are proposed, including the upregulation and downregulation of cytokines and epigenetic reprogramming in monocytes and natural killer cells, imprinting an immunological memory in the innate immune system, a phenomenon termed "trained immunity". Also, cross-reactivity between related stimuli and bystander activation, which entails activation of B and T lymphocytes without specific recognition of antigens, may play a role. In this review, we will discuss the possible nonspecific effects of influenza vaccination in cardiovascular disease, type 1 diabetes, cancer, and Alzheimer's disease, future research questions, and potential implications. A discussion of the potential effects on infections by other pathogens is beyond the scope of this review.
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Affiliation(s)
- Astrid Johannesson Hjelholt
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (O.F.); (M.F.K.)
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000 Aarhus, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Cecilia Bergh
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, S-701 82 Örebro, Sweden;
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, One Gustave L. Levi Place, P.O. Box 1030, New York, NY 10029-6574, USA;
| | - Ole Fröbert
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (O.F.); (M.F.K.)
- Department of Clinical Pharmacology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
- Faculty of Health, Department of Cardiology, Örebro University, SE-701 82 Örebro, Sweden
| | - Mads Fuglsang Kjolby
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; (O.F.); (M.F.K.)
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000 Aarhus, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
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5
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Noé A, Dang TD, Axelrad C, Burrell E, Germano S, Elia S, Burgner D, Perrett KP, Curtis N, Messina NL. BNT162b2 COVID-19 vaccination in children alters cytokine responses to heterologous pathogens and Toll-like receptor agonists. Front Immunol 2023; 14:1242380. [PMID: 37691937 PMCID: PMC10485613 DOI: 10.3389/fimmu.2023.1242380] [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: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
Background Vaccines can have beneficial off-target (heterologous) effects that alter immune responses to, and protect against, unrelated infections. The heterologous effects of COVID-19 vaccines have not been investigated in children. Aim To investigate heterologous and specific immunological effects of BNT162b2 COVID-19 vaccination in children. Methods A whole blood stimulation assay was used to investigate in vitro cytokine responses to heterologous stimulants (killed pathogens, Toll-like receptor ligands) and SARS-CoV-2 antigens. Samples from 29 children, aged 5-11 years, before and 28 days after a second BNT162b2 vaccination were analysed (V2 + 28). Samples from eight children were analysed six months after BNT162b2 vaccination. Results At V2 + 28, interferon-γ and monocyte chemoattractant protein-1 responses to S. aureus, E. coli, L. monocytogenes, BCG vaccine, H. influenzae, hepatitis B antigen, poly(I:C) and R848 stimulations were decreased compared to pre-vaccination. For most of these heterologous stimulants, IL-6, IL-15 and IL-17 responses were also decreased. There were sustained decreases in cytokine responses to viral, but not bacterial, stimulants six months after BNT162b2 vaccination. Cytokine responses to irradiated SARS-CoV-2, and spike glycoprotein subunits (S1 and S2) were increased at V2 + 28 for most cytokines and remained higher than pre-vaccination responses 6 months after BNT162b2 vaccination for irradiated SARS-CoV-2 and S1. There was no correlation between BNT162b2 vaccination-induced anti-SARS-CoV2-receptor binding domain IgG antibody titre at V2 + 28 and cytokine responses. Conclusions BNT162b2 vaccination in children alters cytokine responses to heterologous stimulants, particularly one month after vaccination. This study is the first to report the immunological heterologous effects of COVID-19 vaccination in children.
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Affiliation(s)
- Andrés Noé
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital, Melbourne, Parkville, VIC, Australia
| | - Thanh D. Dang
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Christine Axelrad
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Emma Burrell
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Susie Germano
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Sonja Elia
- Infectious Diseases Unit, The Royal Children’s Hospital, Melbourne, Parkville, VIC, Australia
| | - David Burgner
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital, Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Kirsten P. Perrett
- Infectious Diseases Unit, The Royal Children’s Hospital, Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Population Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Nigel Curtis
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Infectious Diseases Unit, The Royal Children’s Hospital, Melbourne, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Nicole L. Messina
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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Sanz-Muñoz I, Sánchez-dePrada L, Sánchez-Martínez J, Rojo-Rello S, Domínguez-Gil M, Hernán-García C, Fernández-Espinilla V, de Lejarazu-Leonardo RO, Castrodeza-Sanz J, Eiros JM. Possible Mpox Protection from Smallpox Vaccine-Generated Antibodies among Older Adults. Emerg Infect Dis 2023; 29:656-658. [PMID: 36732061 PMCID: PMC9973709 DOI: 10.3201/eid2903.221231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Smallpox vaccination may confer cross-protection to mpox. We evaluated vaccinia virus antibodies in 162 persons ≥50 years of age in Spain; 68.5% had detectable antibodies. Highest coverage (78%) was among persons 71-80 years of age. Low antibody levels in 31.5% of this population indicates that addressing their vaccination should be a priority.
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Palmu AAM, Nieminen H, Lahdenkari M, Palmu AA. A retrospective nationwide register-based study to evaluate the non-specific effects of first MMR vaccination among children in Finland. Vaccine 2023; 41:805-811. [PMID: 36526506 DOI: 10.1016/j.vaccine.2022.12.022] [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: 01/26/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND According to earlier studies, live vaccines like measles-mumps-rubella (MMR) vaccine could reduce also other infections than only the infections they are targeted against. This non-specific effect has been seen especially in studies in low-income countries and results from high-income countries have not been unambiguous. In 2011 Finland changed the recommended schedule for the first MMR vaccination from 18 months to 12 months of age. This change created a natural experiment for evaluating the potential non-specific effects. METHODS This is a retrospective nationwide register-based cohort study of Finnish children born between 2008 and 2012. Children were divided into two cohorts by age at MMR vaccination: children administered early MMR vaccination (11 through 12 months of age) and late MMR vaccination (18 through 19 months of age). Morbidity was evaluated during the main follow-up period (from 13 to 17 months of age) and before any MMR vaccination (3 to 10 months) and after all were vaccinated with MMR (20 to 35 months) as control follow-up periods. We analyzed all infections and did additional analyzes for urinary tract infections (UTI) and bronchitis. Injuries were analyzed as a control outcome. RESULTS Early MMR vaccinated children (N = 79949) had fewer infections compared to late MMR vaccinated (N = 60965) during the main follow-up period. The incidence rate ratio (IRR) was 0.84 (95 % confidence interval (95 % CI) 0.81-0.87). However, similar differences were also observed during the control follow-up periods. MMR vaccinated children had less UTI in the main follow-up period (IRR 0.73, 0.60-0.89) but not in the control follow-up periods. When stratified by sex, the difference was observed among girls but not in boys. CONCLUSION No clear evidence was found for non-specific effects in infectious diseases morbidity. However, there could be a nonspecific effect on UTI. Confirmation is needed from other studies, especially from high-income countries.
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Affiliation(s)
- Akseli A M Palmu
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Heta Nieminen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland.
| | - Mika Lahdenkari
- Department of Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Arto A Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
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8
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Lower incidence of hospital-treated infections in infants under 3 months of age vaccinated with BCG. Vaccine 2022; 40:6048-6054. [PMID: 36096971 DOI: 10.1016/j.vaccine.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Live vaccines potentially have non-specific effects that protect against other infections than those the vaccines are targeted against. The national vaccination program (NVP) in Finland was changed on September 1st, 2006: before BCG vaccine was given to all newborn babies and afterwards to babies in risk groups only. We used this natural experiment to study the non-specific effects of BCG in the frame of NVP using before-after design. METHODS We compared the incidence of several outcomes obtained from Finnish health registers between children born between July 1st, 2004, and June 30th, 2006 (BCG-eligible) and an age- and season-matched reference cohort born between July 1st, 2007, and June 30th, 2009 (BCG-non-eligible) using Poisson regression. These cohorts were restricted to full-term children whose parents were born in Finland. Follow-up began at birth and lasted 3 months, which is the scheduled age for DTaP-IPV-Hib vaccination, and from 4 months until first birthday. The outcomes included all infections, pneumonia and injuries as a negative control outcome. RESULTS The incidence rate ratio (IRR) of the BCG-eligible cohort (N = 93,658) compared to BCG-non-eligible cohort (N = 94,712) for hospital-diagnosed infections was 0.89 (95 %Cl 0.86-0.93) for the 3-month follow-up. The decrease was mainly caused by respiratory infections. In 4-12 months follow-up the BCG-eligible had slightly more infections than BCG-non-eligible children (IRR 1.03, 1.01-1.06). CONCLUSIONS BCG vaccination was associated with a lower incidence of all hospital-diagnosed infections during the first three months of life. The difference cannot be attributed to lung tuberculosis, since only few paediatric cases occurred in Finland during 2000s. The disappearance of non-specific effect after administration of an inactivated vaccine is compatible with previous studies.
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De Zuani M, Frič J. Train the Trainer: Hematopoietic Stem Cell Control of Trained Immunity. Front Immunol 2022; 13:827250. [PMID: 35154147 PMCID: PMC8828730 DOI: 10.3389/fimmu.2022.827250] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 01/14/2023] Open
Abstract
Recent evidence shows that innate immune cells, in addition to B and T cells, can retain immunological memory of their encounters and afford long-term resistance against infections in a process known as 'trained immunity'. However, the duration of the unspecific protection observed in vivo is poorly compatible with the average lifespan of innate immune cells, suggesting the involvement of long-lived cells. Accordingly, recent studies demonstrate that hematopoietic stem and progenitor cells (HSPCs) lay at the foundation of trained immunity, retaining immunological memory of infections and giving rise to a "trained" myeloid progeny for a long time. In this review, we discuss the research demonstrating the involvement of HSPCs in the onset of long-lasting trained immunity. We highlight the roles of specific cytokines and Toll-like receptor ligands in influencing HSPC memory phenotypes and the molecular mechanisms underlying trained immunity HSPCs. Finally, we discuss the potential benefits and drawbacks of the long-lasting trained immune responses, and describe the challenges that the field is facing.
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Affiliation(s)
- Marco De Zuani
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
| | - Jan Frič
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czechia
- Institute of Hematology and Blood Transfusion, Prague, Czechia
- *Correspondence: Jan Frič,
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10
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Murphy DM, Mills KHG, Basdeo SA. The Effects of Trained Innate Immunity on T Cell Responses; Clinical Implications and Knowledge Gaps for Future Research. Front Immunol 2021; 12:706583. [PMID: 34489958 PMCID: PMC8417102 DOI: 10.3389/fimmu.2021.706583] [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: 05/07/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022] Open
Abstract
The burgeoning field of innate immune training, also called trained immunity, has given immunologists new insights into the role of innate responses in protection against infection and in modulating inflammation. Moreover, it has led to a paradigm shift in the way we think about immune memory and the interplay between innate and adaptive immune systems in conferring immunity against pathogens. Trained immunity is the term used to describe the medium-term epigenetic and metabolic reprogramming of innate immune cells in peripheral tissues or in the bone marrow stem cell niche. It is elicited by an initial challenge, followed by a significant period of rest that results in an altered response to a subsequent, unrelated challenge. Trained immunity can be associated with increased production of proinflammatory mediators, such as IL-1β, TNF and IL-6, and increased expression of markers on innate immune cells associated with antigen presentation to T cells. The microenvironment created by trained innate immune cells during the secondary challenge may have profound effects on T cell responses, such as altering the differentiation, polarisation and function of T cell subtypes, including Th17 cells. In addition, the Th1 cytokine IFN-γ plays a critical role in establishing trained immunity. In this review, we discuss the evidence that trained immunity impacts on or can be impacted by T cells. Understanding the interplay between innate immune training and how it effects adaptive immunity will give insights into how this phenomenon may affect the development or progression of disease and how it could be exploited for therapeutic interventions or to enhance vaccine efficacy.
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Affiliation(s)
- Dearbhla M Murphy
- Human and Translational Immunology Group, Department of Clinical Medicine, Trinity Translational Medicine Institute, St James's Hospital, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Kingston H G Mills
- Immune Regulation Research Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Sharee A Basdeo
- Human and Translational Immunology Group, Department of Clinical Medicine, Trinity Translational Medicine Institute, St James's Hospital, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Sharma D. Repurposing of the childhood vaccines: could we train the immune system against the SARS-CoV-2. Expert Rev Vaccines 2021; 20:1051-1057. [PMID: 34313516 PMCID: PMC8425442 DOI: 10.1080/14760584.2021.1960161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The COVID-19 pandemic is a globalized health concern caused by a beta-coronavirus named Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Since December 2019, when this outbreak flared in Wuhan, China, COVID-19 cases have been continuously rising all over the world. Due to the emergence of SARS-CoV-2 mutants, subsequent waves are flowing in a faster manner as compared to the primary wave, which is more contagious and causing higher mortality. Recently, India has emerged as the new epicenter of the second wave by mutants of SARS-CoV-2. After almost eighteen months of this outbreak, some COVID-19 dedicated therapeutics and vaccines are available, and a few are under trial, but the situation is still uncontrolled. AREA COVERED This perspective article covers the repurposing of childhood vaccines like Bacille Calmette-Guerin (BCG), Measles, Mumps, Rubella (MMR), and Oral Polio Vaccine (OPV), which are live attenuated vaccines and have been shown the protective effect through 'trained immunity and 'crossreactivity.' EXPERT OPINION This perspective article has suggested that combinatorial use of these childhood vaccines might exert a better protective effect along with the available COVID-19 therapeutic and vaccines which could be considered as a preventive option against SARS-CoV-2 infection as well as its subsequent waves.
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Affiliation(s)
- Divakar Sharma
- Hericure Healthcare Pvt Ltd, Pune, India.,Present affiliation: Department of Microbiology, Maulana Azad Medical College, New Delhi, India
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12
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Andersen A, Fisker AB, Nielsen S, Rodrigues A, Benn CS, Aaby P. National Immunization Campaigns With Oral Polio Vaccine May Reduce All-cause Mortality: An Analysis of 13 Years of Demographic Surveillance Data From an Urban African Area. Clin Infect Dis 2021; 72:e596-e603. [PMID: 32949460 DOI: 10.1093/cid/ciaa1351] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Between 2002 and 2014, Guinea-Bissau had 17 national campaigns with oral polio vaccine (OPV) as well as campaigns with vitamin A supplementation (VAS), measles vaccine (MV), and H1N1 influenza vaccine. We examined the impact of these campaigns on child survival. METHODS We examined the mortality rate between 1 day and 3 years of age of all children in the study area. We used Cox models with age as underlying time to calculate adjusted mortality rate ratios (MRRs) between "after-campaign" mortality and "before-campaign" mortality, adjusted for temporal change in mortality and stratified for season at risk. RESULTS Mortality was lower after OPV-only campaigns than before, with an MRR for after-campaign vs before-campaign being 0.75 (95% confidence interval [CI], .67-.85). Other campaigns did not have similar effects, the MRR being 1.22 (95% CI, 1.04-1.44) for OPV + VAS campaigns, 1.39 (95% CI, 1.20-1.61) for VAS-only campaigns, 1.32 (95% CI, 1.09-1.60) for MV + VAS campaigns, and 1.13 (95% CI, .86-1.49) for the H1N1 campaign. Thus, all other campaigns differed significantly from the effect of OPV-only campaigns. Effects did not differ for trivalent, bivalent, or monovalent strains of OPV. With each additional campaign of OPV only, the mortality rate declined further (MRR, 0.86 [95% CI, .81-.92] per campaign). With follow-up to 3 years of age, the number needed to treat to save 1 life with the OPV-only campaign was 50 neonates. CONCLUSIONS OPV campaigns can have a much larger effect on child survival than otherwise assumed. Stopping OPV campaigns in low-income countries as part of the endgame for polio infection may increase child mortality.
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Affiliation(s)
- Andreas Andersen
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Ane Bærent Fisker
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,OPEN, Institute for Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Sebastian Nielsen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,OPEN, Institute for Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | | | - Christine Stabell Benn
- OPEN, Institute for Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Peter Aaby
- Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,OPEN, Institute for Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
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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.
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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
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14
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Marín-Hernández D, Nixon DF, Hupert N. Heterologous vaccine interventions: boosting immunity against future pandemics. Mol Med 2021; 27:54. [PMID: 34058986 PMCID: PMC8165337 DOI: 10.1186/s10020-021-00317-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/20/2021] [Indexed: 12/14/2022] Open
Abstract
While vaccines traditionally have been designed and used for protection against infection or disease caused by one specific pathogen, there are known off-target effects from vaccines that can impact infection from unrelated pathogens. The best-known non-specific effects from an unrelated or heterologous vaccine are from the use of the Bacillus Calmette-Guérin (BCG) vaccine, mediated partly through trained immunity. Other vaccines have similar heterologous effects. This review covers molecular mechanisms behind the heterologous effects, and the potential use of heterologous vaccination in the current COVID-19 pandemic. We then discuss novel pandemic response strategies based on rapidly deployed, widespread heterologous vaccination to boost population-level immunity for initial, partial protection against infection and/or clinical disease, while specific vaccines are developed.
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Affiliation(s)
- Daniela Marín-Hernández
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, Belfer Research Building, Room 530, 413 E. 69th street, New York, NY 10065 USA
| | - Douglas F. Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, Belfer Research Building, Room 530, 413 E. 69th street, New York, NY 10065 USA
| | - Nathaniel Hupert
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E. 67th Street, New York, NY 10065 USA
- Cornell Institute for Disease and Disaster Preparedness, Weill Cornell Medicine, 402 E. 67th Street, New York, NY 10065 USA
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15
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Basak P, Sachdeva N, Dayal D. Can BCG vaccine protect against COVID-19 via trained immunity and tolerogenesis? Bioessays 2020; 43:e2000200. [PMID: 33169410 DOI: 10.1002/bies.202000200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022]
Abstract
As the number of infections and mortalities from the SARS-CoV-2 pandemic continues to rise, the development of an effective therapy against COVID-19 becomes ever more urgent. A few reports showing a positive correlation between BCG vaccination and reduced COVID-19 mortality have ushered in some hope. BCG has been suggested to confer a broad level of nonspecific protection against several pathogens, mainly via eliciting "trained immunity" in innate immune cells. Secondly, BCG has also been proven to provide benefits in autoimmune diseases by inducing tolerogenicity. Being an acute inflammatory disease, COVID-19 requires a therapy that induces early priming of anti-viral immune responses and regulates aberrant hyperactivity of innate-immune cells. Here, we hypothesize that BCG can offer reliable spatiotemporal protection from COVID-19 by triggering trained immunity and tolerogenesis, through multiple cellular pathways. We propose further research on BCG-mediated immunoprotection, especially in vulnerable individuals, as a strategy to halt the progress of the SARS-CoV-2 pandemic. Also see the video abstract here https://youtu.be/P2D2RXfq6Vg.
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Affiliation(s)
- Preetam Basak
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Devi Dayal
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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16
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Liu Q, Song H, Andersson TML, Magnusson PKE, Zhu J, Smedby KE, Fang F. Psychiatric Disorders Are Associated with Increased Risk of Sepsis Following a Cancer Diagnosis. Cancer Res 2020; 80:3436-3442. [PMID: 32532824 DOI: 10.1158/0008-5472.can-20-0502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/08/2020] [Accepted: 06/09/2020] [Indexed: 02/05/2023]
Abstract
Psychiatric disorders and infections are both common comorbidities among patients with cancer. However, little is known about the role of precancer psychiatric disorders on the subsequent risk of sepsis as a complication of infections among patients with cancer. We conducted a cohort study of 362,500 patients with newly diagnosed cancer during 2006-2014 in Sweden. We used flexible parametric models to calculate the HRs of sepsis after cancer diagnosis in relation to precancer psychiatric disorders and the analyses were performed in two models. In model 1, analyses were adjusted for sex, age at cancer diagnosis, calendar period, region of residence, and type of cancer. In model 2, further adjustments were made for marital status, educational level, cancer stage, infection history, and Charlson Comorbidity Index score. During a median follow-up of 2.6 years, we identified 872 cases of sepsis among patients with cancer with precancer psychiatric disorders (incidence rate, IR, 14.8 per 1,000 person-years) and 12,133 cases among patients with cancer without such disorders (IR, 11.6 per 1000 person-years), leading to a statistically significant association between precancer psychiatric disorders and sepsis in both the simplified (HR, 1.31; 95% CI, 1.22-1.40) and full (HR, 1.26; 95% CI, 1.18-1.35) models. The positive association was consistently noted among patients with different demographic factors or cancer characteristics, for most cancer types, and during the entire follow-up after cancer diagnosis. Collectively, preexisting psychiatric disorders were associated with an increased risk of sepsis after cancer diagnosis, suggesting a need of heightened clinical awareness in this patient group. SIGNIFICANCE: These results call for extended prevention and surveillance of sepsis among patients with cancer with psychiatric comorbidities.
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Affiliation(s)
- Qianwei Liu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jianwei Zhu
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Karin E Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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17
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Agrawal B. Heterologous Immunity: Role in Natural and Vaccine-Induced Resistance to Infections. Front Immunol 2019; 10:2631. [PMID: 31781118 PMCID: PMC6856678 DOI: 10.3389/fimmu.2019.02631] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/23/2019] [Indexed: 12/11/2022] Open
Abstract
The central paradigm of vaccination is to generate resistance to infection by a specific pathogen when the vacinee is re-exposed to that pathogen. This paradigm is based on two fundamental characteristics of the adaptive immune system, specificity and memory. These characteristics come from the clonal specificity of T and B cells and the long-term survival of previously-encountered memory cells which can rapidly and specifically expand upon re-exposure to the same specific antigen. However, there is an increasing awareness of the concept, as well as experimental documentation of, heterologous immunity and cross-reactivity of adaptive immune lymphocytes in protection from infection. This awareness is supported by a number of human epidemiological studies in vaccine recipients and/or individuals naturally-resistant to certain infections, as well as studies in mouse models of infections, and indeed theoretical considerations regarding the disproportional repertoire of available T and B cell clonotypes compared to antigenic epitopes found on pathogens. Heterologous immunity can broaden the protective outcomes of vaccinations, and natural resistance to infections. Besides exogenous microbes/pathogens and/or vaccines, endogenous microbiota can also impact the outcomes of an infection and/or vaccination through heterologous immunity. Moreover, utilization of viral and/or bacterial vaccine vectors, capable of inducing heterologous immunity may also influence the natural course of many infections/diseases. This review article will briefly discuss these implications and redress the central dogma of specificity in the immune system.
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Affiliation(s)
- Babita Agrawal
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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18
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Rieckmann A, Meyle KD, Rod NH, Baker JL, Benn CS, Aaby P, Sørup S. Smallpox and BCG vaccination in childhood and cutaneous malignant melanoma in Danish adults followed from 18 to 49 years. Vaccine 2019; 37:6730-6736. [PMID: 31537447 DOI: 10.1016/j.vaccine.2019.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/30/2019] [Accepted: 09/06/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Early smallpox and Bacillus Calmette-Guérin (BCG) vaccinations have been associated with reduced risk of cutaneous malignant melanoma (CMM). We assessed the association between pre-school smallpox vaccination and early-school BCG vaccination and CMM in a young Danish population. METHODS We conducted a register-based case-cohort study of individuals growing up during the phase-out period of smallpox and BCG vaccination in Denmark (born 1965-1976) utilising the decrease in vaccination during this period. Information on childhood vaccinations and potential confounders from Copenhagen school health records were linked with nationwide registers on cancer (CMM diagnoses), migrations and deaths by personal identification numbers. RESULTS The individuals were followed from age 18 until 31/12/2014 (maximum age at end of follow-up, 49 years). 188 cases of CMM occurred in the background population of 46,239 individuals; 172 CMM cases (91%) had full information and were analysed. The adjusted hazard ratio (HR) for CMM by BCG and/or smallpox vaccination compared with neither vaccine was 1.29 (95% confidence interval (CI) 0.72-2.31). For smallpox vaccination only, HR = 1.23 (95% CI 0.53-2.86) for BCG vaccination only, HR = 1.13 (95% CI 0.61-2.09) and for both smallpox and BCG vaccination, HR = 1.75 (95% CI 0.87-3.48) compared with none of these. Vaccination below the age of one year gave similar results. CONCLUSIONS We found no strong beneficial effect of smallpox and BCG vaccination against CMM among young adult Danes and with broad confidence intervals our data alone could be compatible with both modest preventive effects, no effects, and modest harmful effects. Our estimates do not contradict a potential modest beneficial effect of neonatal vaccination.
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Affiliation(s)
- Andreas Rieckmann
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; OPEN, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Kathrine Damm Meyle
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer Lyn Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Christine Stabell Benn
- OPEN, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Signe Sørup
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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19
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Søegaard SH, Rostgaard K, Skogstrand K, Wiemels JL, Schmiegelow K, Hjalgrim H. Neonatal Inflammatory Markers Are Associated with Childhood B-cell Precursor Acute Lymphoblastic Leukemia. Cancer Res 2019; 78:5458-5463. [PMID: 30217873 DOI: 10.1158/0008-5472.can-18-0831] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/24/2018] [Accepted: 07/05/2018] [Indexed: 12/25/2022]
Abstract
It has been proposed that children with acute lymphoblastic leukemia (ALL) are born with a dysregulated immune function that together with postnatal environmental exposures causes childhood ALL. Despite its importance for the understanding of ALL etiology, this hypothesis has been inadequately explored. In a population-based case-control study, we measured the concentrations of 10 cytokines and other inflammatory markers on neonatal dried blood spots from 178 children who at ages 1 to 9 years were diagnosed with B-cell precursor ALL and 178 matched controls. Through linkage with Danish nationwide registers, we also assessed whether neonatal inflammatory markers were associated with previously demonstrated risk factors for childhood ALL. Children who developed B-cell precursor ALL had significantly lower neonatal concentrations of IL8, soluble IL6 receptor (sIL6R) α, TGFβ1, monocyte chemotactic protein (MCP)-1, and C-reactive protein (CRP) and higher concentrations of IL6, IL17, and IL18 compared with matched controls. Concentrations of IL10 were below the detection level for both patients and controls. Birth order (IL18 and CRP), gestational age (sIL6Rα, TGFβ1, and CRP), and sex (sIL6Rα, IL8, and CRP), but not maternal age, infections during pregnancy, birth weight nor mode of delivery were significantly associated with the neonatal concentrations of inflammatory markers. Our findings support the hypothesis that children who later develop B-cell precursor ALL are born with a dysregulated immune function.Significance: Children who develop acute lymphoblastic leukemia are immunologically distinct at birth and could potentially react abnormally to infections in early childhood. Cancer Res; 78(18); 5458-63. ©2018 AACR.
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Affiliation(s)
- Signe Holst Søegaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Kristin Skogstrand
- Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Joseph Leo Wiemels
- Department of Preventative Medicine, University of Southern California, Los Angeles
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Hematology, University Hospital Rigshospitalet, Copenhagen, Denmark
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20
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Jensen A, Andersen PK, Stensballe LG. Early childhood vaccination and subsequent mortality or morbidity: are observational studies hampered by residual confounding? A Danish register-based cohort study. BMJ Open 2019; 9:e029794. [PMID: 31537568 PMCID: PMC6756458 DOI: 10.1136/bmjopen-2019-029794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To estimate the association between childhood vaccination and subsequent morbidity and mortality by adjusting for environmental and host factors. Further, to examine the degree of residual confounding in such observational studies. DESIGN Register-based cohort study including 1 122 929 Danish children. PARTICIPANTS All children born in Denmark in the period 1999-2016 who survived until 16 months of age without prior migration followed from 16 months until the first of the following: event of interest, migration, 5 years of age or 31 December 2016. MAIN OUTCOME MEASURES Adjusted HRs (aHRs) and absolute risks were calculated for the three outcomes: mortality, hospitalisation for infection and asthma using register data on deaths, specific hospital contacts and dispensed prescribed medication. The exposure was the combination of the routine vaccines against diphteria-tetanus-pertussis-polio-Haemophilus influenzae type b and measles-mumps-rubella (DTP and MMR in short) administered in early childhood. Hospitalisation due to accidents was analysed as a negative control outcome to examine residual confounding. RESULTS Children with 3DTP+MMR had a lower hazard of mortality than the reference group with 3DTP, adjusted HR (aHR)=0.45 (95% CI: 0.35 to 0.57), whereas the children with 1 or 2 DTP had higher hazards of dying, aHR=1.55 (95% CI: 1.14 to 2.13) and aHR=1.96 (95% CI: 1.34 to 2.89). The vaccination group 3DTP+MMR was associated with a reduced hazard of asthma aHR=0.94 (95% CI: 0.92 to 0.96). Also, the vaccination group 3DTP+MMR was associated with a reduced hazard of hospitalisation due to accidents, aHR=0.83 (0.80 to 0.85) compared with the reference group with 3 DTP. CONCLUSIONS The results suggested a beneficial impact of MMR on under-five mortality but did not support the hypothesis that DTP is detrimental, since the group of children with fewer DTP vaccinations experienced increased mortality. The results of the study may to some degree be prone to residual confounding since an unexpected association between MMR vaccination and hospitalisation for accidents was observed.
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Affiliation(s)
- Andreas Jensen
- The Child and Adolescent Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Kragh Andersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Graff Stensballe
- The Child and Adolescent Clinic, Copenhagen University Hospital, Copenhagen, Denmark
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21
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Messina NL, Zimmermann P, Curtis N. The impact of vaccines on heterologous adaptive immunity. Clin Microbiol Infect 2019; 25:1484-1493. [PMID: 30797062 DOI: 10.1016/j.cmi.2019.02.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaccines induce antigen-specific memory in adaptive immune cells that enables long-lived protection against the target pathogen. In addition to this, several vaccines have beneficial effects greater than protection against their target pathogen. These non-specific effects are proposed to be the result of vaccine-induced immunomodulation. In the case of bacille Calmette-Guérin (BCG) vaccine, this involves induction of innate immune memory, termed 'trained immunity', in monocytes and natural killer cells. OBJECTIVES This review discusses current evidence for vaccine-induced immunomodulation of adaptive immune cells and heterologous adaptive immune responses. CONTENT The three vaccines that have been associated with changes in all-cause infant mortality: BCG, diphtheria-tetanus-pertussis (DTP) and measles-containing vaccines (MCV) alter T-cell and B-cell immunity. The majority of studies that investigated non-specific effects of these vaccines on the adaptive immune system report changes in numbers or proportions of adaptive immune cell populations. However, there is also evidence for effects of these vaccines on adaptive immune cell function and responses to heterologous stimuli. There is some evidence that, in addition to BCG, DTP and MCV, other vaccines (that have not been associated with changes in all-cause mortality) may alter adaptive immune responses to unrelated stimuli. IMPLICATIONS This review concludes that vaccines alter adaptive immune cell populations and heterologous immune responses. The non-specific effects differ between various vaccines and their effects on heterologous adaptive immune responses may also involve bystander activation, cross-reactivity and other as yet undefined mechanisms. This has major implications for future vaccine design and vaccination scheduling.
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Affiliation(s)
- N L Messina
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
| | - P Zimmermann
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - N Curtis
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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22
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Beck KB, Hønge BL, Olesen JS, Petersen MS, Jespersen S, Wejse C, da Silva ZJ, Medina C, Té DDS, Moeller BK, Benn CS, Aaby P, Erikstrup C. Long-term effects of smallpox vaccination on expression of the HIV-1 co-receptor CCR5 in women. PLoS One 2018; 13:e0207259. [PMID: 30440008 PMCID: PMC6237380 DOI: 10.1371/journal.pone.0207259] [Citation(s) in RCA: 2] [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: 11/14/2017] [Accepted: 10/29/2018] [Indexed: 01/16/2023] Open
Abstract
Background Smallpox vaccinations were stopped globally in 1980. Recent studies have shown that in women, being smallpox vaccinated was associated with a reduced risk of HIV infection compared with not being smallpox vaccinated. At the initial infection, HIV-1 most often uses CCR5 as a co-receptor to infect the T-lymphocytes. We therefore investigated whether smallpox vaccination is associated with a down-regulation of CCR5 on the surface of peripheral T-lymphocytes in healthy women in Guinea-Bissau. Methods We included HIV seronegative women from Bissau, Guinea-Bissau, born before 1974, with and without a smallpox vaccination scar. Blood samples were stabilised in a TransFix buffer solution and stained for flow cytometry according to a T-cell maturation profile. Results Ninety-seven women were included in the study; 52 with a smallpox vaccination scar and 45 without a scar. No association between smallpox vaccination scar and CCR5 expression was found in any T-lymphocyte subtype. Conclusion Among HIV seronegative women, being smallpox vaccinated more than 40 years ago was not associated with a down-regulation of CCR5 receptors on the surface of peripheral T-lymphocytes.
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Affiliation(s)
- K. B. Beck
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - B. L. Hønge
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - J. S. Olesen
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - M. S. Petersen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - S. Jespersen
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - C. Wejse
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- GloHAU, Center for Global Health, Dept of Public Health, Aarhus University, Aarhus, Denmark
| | - Z. J. da Silva
- National HIV programme, Ministry of Health, Bissau, Guinea-Bissau
| | - C. Medina
- National HIV programme, Ministry of Health, Bissau, Guinea-Bissau
| | - D. D. S. Té
- National HIV programme, Ministry of Health, Bissau, Guinea-Bissau
| | - B. K. Moeller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - C. S. Benn
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - P. Aaby
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - C. Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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23
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Rieckmann A, Villumsen M, Sørup S, Haugaard LK, Ravn H, Roth A, Baker JL, Benn CS, Aaby P. Vaccinations against smallpox and tuberculosis are associated with better long-term survival: a Danish case-cohort study 1971-2010. Int J Epidemiol 2018; 46:695-705. [PMID: 27380797 PMCID: PMC5837789 DOI: 10.1093/ije/dyw120] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/23/2022] Open
Abstract
Background: When vaccinations with vaccinia against smallpox and Bacillus Calmette-Guérin (BCG) against tuberculosis were phased out in some high-income countries around 1980, the impact on overall mortality was not examined. Recent studies from low-income countries have suggested that these vaccines are associated with mortality reductions, not explained by specific disease protection. We examined whether vaccinia and BCG administered in childhood were associated with long-term mortality reductions in a high-income population. Methods: In this case-cohort study, we followed 47 622 schoolchildren from Copenhagen, Denmark, born 1965 to 1976, from their first health examination to 2010. This cohort experienced the phase-out of vaccinia and BCG vaccination programmes. Results: A sub-cohort of 5 316 individuals (699 excluded) was followed for 164 450 person-years (0.2% were lost to follow-up), and 401 deaths due to natural causes (841 deaths in total) occurred in the full cohort. Compared with individuals who had not received vaccinia or BCG, those who had received both vaccinia and BCG had an adjusted hazard ratio (aHR) of 0.54 [95% confidence interval (CI): 0.36–0.81] for mortality due to natural causes of death; those who only received BCG had an aHR of 0.58 (95% CI: 0.39–0.85). Vaccinia and BCG were not associated with any protection against deaths by accidents, suicide or murder, the combined aHR being 0.94 (95% CI: 0.62–1.42). Conclusions: Vaccinia and BCG vaccinations were associated with better long-term survival, which was not explained by specific protection. Vaccines with beneficial non-specific effects may reduce overall mortality even after the target diseases are eradicated.
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Affiliation(s)
- Andreas Rieckmann
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Marie Villumsen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Signe Sørup
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Line Klingen Haugaard
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Henrik Ravn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Adam Roth
- Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia and.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jennifer Lyn Baker
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Peter Aaby
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
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Andersen A, Fisker AB, Rodrigues A, Martins C, Ravn H, Lund N, Biering-Sørensen S, Benn CS, Aaby P. National Immunization Campaigns with Oral Polio Vaccine Reduce All-Cause Mortality: A Natural Experiment within Seven Randomized Trials. Front Public Health 2018; 6:13. [PMID: 29456992 PMCID: PMC5801299 DOI: 10.3389/fpubh.2018.00013] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A recent WHO review concluded that live BCG and measles vaccine (MV) may have beneficial non-specific effects (NSEs) reducing mortality from non-targeted diseases. NSEs of oral polio vaccine (OPV) were not examined. If OPV vaccination campaigns reduce the mortality rate, it would suggest beneficial NSEs. SETTING Between 2002 and 2014, Guinea-Bissau had 15 general OPV campaigns and other campaigns with OPV plus vitamin A supplementation (VAS), VAS-only, MV, and H1N1 vaccine. In this period, we conducted seven randomized controlled trials (RCTs) with mortality as main outcome. METHODS Within these RCTs, we assessed whether the mortality rate was lower after-campaign than before-campaign. We used Cox models with age as underlying time and further adjusted for low birth-weight, season and time trend in mortality. We calculated the adjusted mortality rate ratio (MRR) for after-campaign vs before-campaign. RESULTS The mortality rate was lower after OPV-only campaigns than before, the MRR being 0.81 (95% CI = 0.68-0.95). With each additional dose of campaign-OPV the mortality rate declined further (MRR = 0.87 (95% CI: 0.79-0.96) per dose) (test for trend, p = 0.005). No other type of campaign had similar beneficial effects. Depending on initial age and with follow-up to 3 years of age, the number needed to treat with campaign-OPV-only to save one life was between 68 and 230 children. CONCLUSION Bissau had no case of polio infection so the results suggest that campaign-OPV has beneficial NSEs. Discontinuation of OPV-campaigns in low-income countries may affect general child mortality levels negatively.
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Affiliation(s)
- Andreas Andersen
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Ane Baerent Fisker
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | | | - Cesario Martins
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Henrik Ravn
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Institute for Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Najaaraq Lund
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Sofie Biering-Sørensen
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Christine Stabell Benn
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Institute for Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Peter Aaby
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Institute for Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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25
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Does smallpox vaccination modify HIV disease progression among ART-naive people living with HIV in Africa? Epidemiol Infect 2017; 146:218-226. [PMID: 29235428 PMCID: PMC5791884 DOI: 10.1017/s0950268817002795] [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] [Indexed: 11/06/2022] Open
Abstract
We examined the association between a history of smallpox vaccination and immune activation (IA) in a population of antiretroviral therapy-naïve people living with HIV (PLHIV). A cross-sectional study was conducted in Senegal from July 2015 to March 2017. Smallpox vaccination was ascertained by the presence of smallpox vaccine scar and IA by the plasma level of β-2-microglobulin (β2m). The association was analysed using logistic regression and linear regression models. The study population comprised 101 PLHIV born before 1980 with a median age of 47 years (interquartile range (IQR) = 42-55); 57·4% were women. Smallpox vaccine scar was present in 65·3% and the median β2m level was 2·59 mg/l (IQR = 2·06-3·86). After adjustment, the presence of smallpox vaccine scar was not associated with a β2m level ⩾2·59 mg/l (adjusted odds ratio 0·94; 95% confidence interval 0·32-2·77). This result was confirmed by the linear regression model. Our study does not find any association between the presence of smallpox vaccine scar and the β2m level and does not support any association between a previous smallpox vaccination and HIV disease progression. In this study, IA is not a significant determinant of the reported non-targeted effect of smallpox vaccination in PLHIV.
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26
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Rieckmann A, Villumsen M, Jensen ML, Ravn H, da Silva ZJ, Sørup S, Baker JL, Rodrigues A, Benn CS, Roth AE, Aaby P. The Effect of Smallpox and Bacillus Calmette-Guérin Vaccination on the Risk of Human Immunodeficiency Virus-1 Infection in Guinea-Bissau and Denmark. Open Forum Infect Dis 2017; 4:ofx130. [PMID: 28852677 PMCID: PMC5569962 DOI: 10.1093/ofid/ofx130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/19/2017] [Indexed: 02/03/2023] Open
Abstract
Background The live smallpox and Bacillus Calmette-Guérin (BCG) vaccinations have been associated with better adult survival in both Guinea-Bissau and Denmark. In Guinea-Bissau, human immunodeficiency virus (HIV)-1 became an important cause of death after smallpox vaccination was phased out globally in 1980. We hypothesised that smallpox and BCG vaccinations were associated with a lower prevalence of HIV-1 infection, and we tested this hypothesis in both Guinea-Bissau and Denmark. Methods We conducted 2 studies: (1) a cross-sectional study of HIV infection and vaccination scars in Guinea-Bissau including 1751 individuals and (2) a case-base study with a background population of 46239 individuals in Denmark. In Guinea-Bissau, HIV-1 transmission was almost exclusively sexually transmitted. In Denmark, we excluded intravenous drug users. Data were analyzed using logistic regression. Results Bacillus Calmette-Guérin and/or smallpox vaccination compared with neither of these vaccines was associated with an adjusted odds ratio (aOR) for HIV-1 of 0.62 (95% confidence interval [CI], 0.36–1.07) in Guinea-Bissau and 0.70 (95% CI, 0.43–1.15) in Denmark. We combined the results from both settings in a meta-analysis (aOR = 0.66; 95% CI, 0.46–0.96). Data from Guinea-Bissau indicated a stronger effect of multiple smallpox vaccination scars (aOR = 0.27; 95% CI, 0.10–0.75) as follows: women, aOR = 0.18 (95% CI, 0.05–0.64); men, aOR = 0.52 (95% CI, 0.12–2.33); sex-differential effect, P = .29. Conclusions The studies from Guinea-Bissau and Denmark, 2 very different settings, both suggest that the BCG and smallpox vaccines could be associated with a decreased risk of sexually transmitted HIV-1. It might be informative to pursue this observation and explore possible protective mechanisms as part of the search for an HIV-1 vaccine.
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Affiliation(s)
- Andreas Rieckmann
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen.,OPEN, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark
| | - Marie Villumsen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen.,Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospital
| | | | | | | | - Signe Sørup
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen
| | - Jennifer Lyn Baker
- Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospital.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen.,OPEN, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark
| | - Adam E Roth
- Department of Translational Medicine, Lund University, Malmö, Sweden;and
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
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27
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Hansen NS, Byberg S, Hervig Jacobsen L, Bjerregaard-Andersen M, Jensen AKG, Martins C, Aaby P, Skov Jensen J, Stabell Benn C, Whittle H. Effect of early measles vaccine on pneumococcal colonization: A randomized trial from Guinea-Bissau. PLoS One 2017; 12:e0177547. [PMID: 28545041 PMCID: PMC5435222 DOI: 10.1371/journal.pone.0177547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/27/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Measles vaccine (MV) may have non-specific beneficial effects for child health and particularly seems to prevent respiratory infections. Streptococcus pneumoniae is the leading cause of bacterial pneumonia among children worldwide, and nasopharyngeal colonization precedes infection. OBJECTIVE We investigated whether providing early MV at 18 weeks of age reduced pneumococcal colonization and/or density up to 9 months of age. METHOD The study was conducted in 2013-2014 in Guinea-Bissau. Pneumococcal vaccine was not part of the vaccination program. Infants aged 18 weeks were block-randomized 2:1 to early or no early MV; at age 9 months, all children were offered MV as per current policy. Nasopharyngeal swabs were taken at baseline, age 6.5 months, and age 9 months. Pneumococcal density was determined by q-PCR. Prevalence ratios of pneumococcal colonization and recent antibiotic treatment (yes/no) by age 6.5 months (PR6.5) and age 9 months (PR9) were estimated using Poisson regression with robust variance estimates while the pneumococcal geometric mean ratio (GMR6.5 and GMR9) was obtained using OLS regression. RESULTS Analyses included 512 children; 346 early MV-children and 166 controls. At enrolment, the pneumococcal colonization prevalence was 80% (411/512). Comparing early MV-children with controls, the PR6.5 was 1.02 (95%CI = 0.94-1.10), and the PR9 was 1.04 (0.96-1.12). The GMR6.5 was 1.02 (0.55-1.89), and the GMR9 was 0.69 (0.39-1.21). Early MV-children tended to be less frequently treated with antibiotics prior to follow up (PR6.5 0.60 (0.34-1.05) and PR9 0.87 (0.50-1.53)). Antibiotic treatment was associated with considerably lower colonization rates, PR6.5 0.85 (0.71-1.01) and PR9 0.66 (0.52-0.84), as well as lower pneumococcal density, GMR6.5 0.32 (0.12-0.86) and GMR9 0.52 (0.18-1.52). CONCLUSION Early MV at age 18 weeks had no measurable effect on pneumococcal colonization prevalence or density. Higher consumption of antibiotics among controls may have blurred an effect of early MV. TRIAL REGISTRATION clinicaltrials.gov NCT01486355.
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Affiliation(s)
- Nadja Skadkær Hansen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Stine Byberg
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Lars Hervig Jacobsen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Morten Bjerregaard-Andersen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Aksel Karl Georg Jensen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Cesario Martins
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Peter Aaby
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Jørgen Skov Jensen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hilton Whittle
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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28
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Stevens WBC, Netea MG, Kater AP, van der Velden WJFM. 'Trained immunity': consequences for lymphoid malignancies. Haematologica 2016; 101:1460-1468. [PMID: 27903713 DOI: 10.3324/haematol.2016.149252] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 06/29/2016] [Indexed: 12/15/2022] Open
Abstract
In hematological malignancies complex interactions exist between the immune system, microorganisms and malignant cells. On one hand, microorganisms can induce cancer, as illustrated by specific infection-induced lymphoproliferative diseases such as Helicobacter pylori-associated gastric mucosa-associated lymphoid tissue lymphoma. On the other hand, malignant cells create an immunosuppressive environment for their own benefit, but this also results in an increased risk of infections. Disrupted innate immunity contributes to the neoplastic transformation of blood cells by several mechanisms, including the uncontrolled clearance of microbial and autoantigens resulting in chronic immune stimulation and proliferation, chronic inflammation, and defective immune surveillance and anti-cancer immunity. Restoring dysfunction or enhancing responsiveness of the innate immune system might therefore represent a new angle for the prevention and treatment of hematological malignancies, in particular lymphoid malignancies and associated infections. Recently, it has been shown that cells of the innate immune system, such as monocytes/macrophages and natural killer cells, harbor features of immunological memory and display enhanced functionality long-term after stimulation with certain microorganisms and vaccines. These functional changes rely on epigenetic reprogramming and have been termed 'trained immunity'. In this review the concept of 'trained immunity' is discussed in the setting of lymphoid malignancies. Amelioration of infectious complications and hematological disease progression can be envisioned to result from the induction of trained immunity, but future studies are required to prove this exciting new hypothesis.
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Affiliation(s)
- Wendy B C Stevens
- Department of Hematology, Radboud University Medical Centre, Nijmegen
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Centre, and Radboud Center for Infectious Diseases, Nijmegen.,Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen
| | - Arnon P Kater
- Department of Hematology, Lymphoma and Myeloma Center Amsterdam (LYMMCARE) Academic Medical Center, University of Amsterdam, The Netherlands
| | - Walter J F M van der Velden
- Department of Hematology, Radboud University Medical Centre, Nijmegen .,Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen
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29
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Flanagan KL, Plebanski M. Sex-differential heterologous (non-specific) effects of vaccines: an emerging public health issue that needs to be understood and exploited. Expert Rev Vaccines 2016; 16:5-13. [DOI: 10.1080/14760584.2016.1203260] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Katie L. Flanagan
- Vaccine and Infectious Diseases Laboratory, Department of Immunology and Pathology, Monash University, Prahran, Australia
| | - Magdalena Plebanski
- Vaccine and Infectious Diseases Laboratory, Department of Immunology and Pathology, Monash University, Prahran, Australia
- Monash Institute of Medical Engineering, Monash University, Prahran, Australia
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30
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Unravelling the nature of non-specific effects of vaccines-A challenge for innate immunologists. Semin Immunol 2016; 28:377-83. [PMID: 27354354 DOI: 10.1016/j.smim.2016.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 01/29/2023]
Abstract
Epidemiological observations have shown that vaccines can influence morbidity and mortality more than can be ascribed to target-disease immunity. A growing number of immunological studies have helped identify possible biological mechanisms to explain these so-called nonspecific effects (NSE) of vaccines, including heterologous T-cell reactivity and innate immune memory or 'trained innate immunity', which involves epigenetic reprogramming of innate immune cells. Here, we review the epidemiological evidence for NSE as well as human, animal and in vitro immunological data that could explain these NSE, and discuss priorities for future epidemiologic and immunologic studies to further unravel the biology and optimize the benefits of current and new vaccines.
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31
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Saadatian-Elahi M, Aaby P, Shann F, Netea MG, Levy O, Louis J, Picot V, Greenberg M, Warren W. Heterologous vaccine effects. Vaccine 2016; 34:3923-30. [PMID: 27312214 DOI: 10.1016/j.vaccine.2016.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/25/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022]
Abstract
The heterologous or non-specific effects (NSEs) of vaccines, at times defined as "off-target effects" suggest that they can affect the immune response to organisms other than their pathogen-specific intended purpose. These NSEs have been the subject of clinical, immunological and epidemiological studies and are increasingly recognized as an important biological process by a growing group of immunologists and epidemiologists. Much remain to be learned about the extent and underlying mechanisms for these effects. The conference "Off-target effects of vaccination" held in Annecy-France (June 8-10 2015) intended to take a holistic approach drawing from the fields of immunology, systems biology, epidemiology, bioinformatics, public health and regulatory science to address fundamental questions of immunological mechanisms, as well as translational questions about vaccines NSEs. NSE observations were examined using case-studies on live attenuated vaccines and non-live vaccines followed by discussion of studies of possible biological mechanisms. Some possible pathways forward in the study of vaccines NSE were identified and discussed by the expert group.
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Affiliation(s)
- Mitra Saadatian-Elahi
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, 5 Place d'Arsonval, 69437 Lyon cedex 03, France.
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, CP861 Bissau, Guinea-Bissau
| | - Frank Shann
- Department of Pediatrics, University of Melbourne, Victoria 3052, Australia
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ofer Levy
- Precision Vaccines Program, Boston Children's Hospital & Havard Medical School, Boston, MA 02115, USA
| | - Jacques Louis
- Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France
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32
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Goodridge HS, Ahmed SS, Curtis N, Kollmann TR, Levy O, Netea MG, Pollard AJ, van Crevel R, Wilson CB. Harnessing the beneficial heterologous effects of vaccination. Nat Rev Immunol 2016; 16:392-400. [PMID: 27157064 PMCID: PMC4931283 DOI: 10.1038/nri.2016.43] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Clinical evidence strongly suggests that certain live vaccines, in particular bacille Calmette-Guérin (BCG) and measles vaccines, can reduce all-cause mortality, most probably through protection against non-targeted pathogens in addition to the targeted pathogen. The underlying mechanisms are currently unknown. We discuss how heterologous lymphocyte activation and innate immune memory could promote protection beyond the intended target pathogen and consider how vaccinologists could leverage heterologous immunity to improve outcomes in vulnerable populations, in particular the very young and the elderly.
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Affiliation(s)
- Helen S. Goodridge
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
| | | | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne and Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, Australia.
| | - Tobias R. Kollmann
- Division of Infectious Disease, Department of Paediatrics, University of British Columbia, CFRI A5-175, 950 W 28th Ave, Vancouver, BC V5Z4H4, Canada.
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA.
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Christopher B. Wilson
- Global Health Program, Bill and Melinda Gates Foundation, 500 5 Ave N, Seattle, WA 98105, USA.
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Brand JS, Colzani E, Johansson ALV, Giesecke J, Clements M, Bergh J, Hall P, Czene K. Infection-related hospitalizations in breast cancer patients: Risk and impact on prognosis. J Infect 2016; 72:650-658. [PMID: 27063280 DOI: 10.1016/j.jinf.2016.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/04/2016] [Accepted: 04/03/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Infections are a common cause of hospitalization in breast cancer patients. We studied the risk, clinical characteristics and outcomes of infection-related hospitalizations in this patient population. METHODS A Swedish registry-based study including 8338 breast cancer patients diagnosed between 2001 and 2008, followed prospectively for infection-related hospitalizations until 2010. Standardized incidence ratios (SIRs) were calculated using background rates from the general female population. Associations with clinical characteristics and mortality were analyzed using flexible parametric survival models. RESULTS In total, 720 patients experienced an infection-related hospitalization during a median follow-up of 4.9 years. Infection rates were highest within the first year of diagnosis (SIR = 5.61, 95% CI; 4.98-6.32), and site-specific risks were most pronounced for sepsis (SIR = 3.14, 95% CI; 2.66-3.71) and skin infections (SIR = 2.80, 95% CI; 2.24-3.50). Older age at diagnosis, comorbidities, markers of tumor aggressiveness, chemotherapy and axillary node dissection were independent predictors of infectious disease risk. Infection-related hospitalizations were also independently associated with overall and breast cancer-specific death. CONCLUSIONS A significant number of breast cancer patients are hospitalized with an infection following diagnosis, which in turn predicts poor prognosis. The risk profile of infection-related hospitalizations is multifactorial, including patient, tumor and treatment-related factors.
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Affiliation(s)
- Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Edoardo Colzani
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Giesecke
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark Clements
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Radiumhemmet, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Muraille E. The Unspecific Side of Acquired Immunity Against Infectious Disease: Causes and Consequences. Front Microbiol 2016; 6:1525. [PMID: 26793171 PMCID: PMC4707229 DOI: 10.3389/fmicb.2015.01525] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
Acquired immunity against infectious disease (AIID) has long been considered as strictly dependent on the B and T lymphocytes of the adaptive immune system. Consequently, AIID has been viewed as highly specific to the antigens expressed by pathogens. However, a growing body of data motivates revision of this central paradigm of immunology. Unrelated past infection, vaccination, and chronic infection have been found to induce cross-protection against numerous pathogens. These observations can be partially explained by the poly-specificity of antigenic T and B receptors, the Mackaness effect and trained immunity. In addition, numerous studies highlight the importance of microbiota composition on resistance to infectious disease via direct competition or modulation of the immune response. All of these data support the idea that a non-negligible part of AIID in nature can be nonspecific to the pathogens encountered and even of the antigens expressed by pathogens. As this protection may be dependent on the private T and B repertoires produced by the random rearrangement of genes, past immune history, chronic infection, and microbiota composition, it is largely unpredictable at the individual level. However, we can reasonably expect that a better understanding of the underlying mechanisms will allow us to statistically predict cross-protection at the population level. From an evolutionary perspective, selection of immune mechanisms allowing for partially nonspecific AIID would appear to be advantageous against highly polymorphic and rapidly evolving pathogens. This new emerging paradigm may have several important consequences on our understanding of individual infectious disease susceptibility and our conception of tolerance, vaccination and therapeutic strategies against infection and cancer. It also underscores the importance of viewing the microbiota and persisting infectious agents as integral parts of the immune system.
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Affiliation(s)
- Eric Muraille
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de BruxellesBruxelles, Belgium
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Innate Immune Memory: The Latest Frontier of Adjuvanticity. J Immunol Res 2015; 2015:478408. [PMID: 26380322 PMCID: PMC4561982 DOI: 10.1155/2015/478408] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022] Open
Abstract
Recent findings in the field of immune memory have demonstrated that B and T cell mediated immunity following infections are enhanced by the so-called trained immunity. This effect has been most extensively investigated for the tuberculosis vaccine strain Bacillus Calmette-Guérin (BCG). Epidemiological studies suggest that this vaccine is associated with a substantial reduction in overall child mortality that cannot be solely explained by prevention of the target disease but that it seems to rely on inducing resistance to other infections. Upon infection or vaccination, monocytes/macrophages can be functionally reprogrammed so as to display an enhanced defensive response against unrelated infections. Epigenetic modifications seem to play a key role in the induction of this “innate memory.” These findings are revolutionising our knowledge of the immune system, introducing the concept of memory also for mammalian innate immunity. Thus, vaccines are likely to nonspecifically affect the overall immunological status of individuals in a clinically relevant manner. As a consequence, future vaccine strategies ought to take into account the contribution of innate memory through appropriate design of formulations and administration scheduling.
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Measles-mumps-rubella vaccination and respiratory syncytial virus-associated hospital contact. Vaccine 2014; 33:237-45. [PMID: 25446818 PMCID: PMC4270443 DOI: 10.1016/j.vaccine.2014.07.110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/01/2014] [Accepted: 07/21/2014] [Indexed: 11/22/2022]
Abstract
MMR vaccination is given to protect against measles, mumps and rubella. RSV is an important cause of acute lower respiratory infections in young children. MMR vaccination was associated with 22% lower rate of RSV hospital contacts. MMR vaccination may reduce the rate or severity of RSV infection.
Background The live measles vaccine has been associated with lower non-measles mortality and admissions in low-income countries. The live measles–mumps–rubella vaccine has also been associated with lower rate of admissions with any type of infection in Danish children; the association was strongest for admissions with lower respiratory infections. Objective To examine whether measles, mumps, and rubella (MMR) vaccination was associated with reduced rate of hospital contact related to respiratory syncytial virus (RSV) in a high-income country. Methods Nationwide cohort study of laboratory-confirmed RSV hospital contacts at age 14–23 months in all children born in Denmark 1997–2002 who had already received the vaccine against diphtheria, tetanus, pertussis (acellular), polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) at the recommended ages of 3, 5, and 12 months. Results The study included 888 RSV hospital contacts in 128,588 person years of follow up (rate 6.8/1000 person years). Having MMR as the most recent vaccine was associated with a reduced rate of RSV hospital contacts compared with having DTaP-IPV-Hib as the most recent vaccine (Incidence rate ratio (IRR), 0.75; 95% confidence interval (CI), 0.63–0.89). After adjustment for potential confounders including exact age in days the IRR was 0.78 (95% CI, 0.66–0.93). The adjusted IRR was 0.74 (95% CI, 0.60–0.92) in males and 0.84 (95% CI, 0.66–1.06) in females (P Interaction, 0.42). There was no association in the first month after MMR vaccination (adjusted IRR, 0.97; 95% CI, 0.76–1.24) but the adjusted IRR was 0.70 (95% CI, 0.58–0.85) from one month after MMR vaccination. Conclusions MMR vaccination was associated with reduced rate of hospital contacts related to laboratory-confirmed RSV infection. Further research on the association between MMR vaccination and other unrelated pathogens are warranted.
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Sankoh O, Welaga P, Debpuur C, Zandoh C, Gyaase S, Poma MA, Mutua MK, Hanifi SMMA, Martins C, Nebie E, Kagoné M, Emina JBO, Aaby P. The non-specific effects of vaccines and other childhood interventions: the contribution of INDEPTH Health and Demographic Surveillance Systems. Int J Epidemiol 2014; 43:645-53. [PMID: 24920644 PMCID: PMC4052142 DOI: 10.1093/ije/dyu101] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Most childhood interventions (vaccines, micronutrients) in low-income countries are justified by their assumed effect on child survival. However, usually the interventions have only been studied with respect to their disease/deficiency-specific effects and not for their overall effects on morbidity and mortality. In many situations, the population-based effects have been very different from the anticipated effects; for example, the measles-preventive high-titre measles vaccine was associated with 2-fold increased female mortality; BCG reduces neonatal mortality although children do not die of tuberculosis in the neonatal period; vitamin A may be associated with increased or reduced child mortality in different situations; effects of interventions may differ for boys and girls. The reasons for these and other contrasts between expectations and observations are likely to be that the immune system learns more than specific prevention from an intervention; such training may enhance or reduce susceptibility to unrelated infections. INDEPTH member centres have been in an ideal position to document such additional non-specific effects of interventions because they follow the total population long term. It is proposed that more INDEPTH member centres extend their routine data collection platform to better measure the use and effects of childhood interventions. In a longer perspective, INDEPTH may come to play a stronger role in defining health research issues of relevance to low-income countries.
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Affiliation(s)
- Osman Sankoh
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (C
| | - Paul Welaga
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Cornelius Debpuur
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Charles Zandoh
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Stephney Gyaase
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Mary Atta Poma
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Martin Kavao Mutua
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - S M Manzoor Ahmed Hanifi
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Cesario Martins
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Eric Nebie
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Moubassira Kagoné
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Jacques B O Emina
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Peter Aaby
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
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Abstract
αβ T cells are an integral part of protective immunity against pathogens. After precursor cells arise in the adult bone marrow or fetal liver, they migrate to the thymus where they rearrange their T-cell receptor genes (TCR) and undergo selection on the basis of their interactions with ligands expressed by thymic stroma and other cells. Those that survive then exit the thymus to populate the peripheral immune compartment, where they patrol the blood and lymphoid systems. The composition of this pre-immune peripheral repertoire is critically important in determining the robustness of an immune response. In both mice and humans, the magnitude and diversity of a response are directly correlated with the frequency of precursor T cells. Equally relevant are the functional characteristics of these lymphocytes. Engagement of a specific antigen to the TCR activates signaling pathways in the naive T cell that result in cellular proliferation and the acquisition of particular effector functions. A portion of these persist following the resolution of infection and become memory cells. These memory cells can mount a faster and stronger response when they encounter the same antigen at a later time. As the molecular basis for TCR ligand interaction has become better defined, it is clear that some T cells can recognize multiple distinct ligands and therefore T-cell memory developed by exposure to one ligand may play a significant role in the response to a different antigen. Thus, there is an increasing focus on understanding how exposure to related or unrelated antigens influences the T-cell repertoire and impacts subsequent immunity. In this review, we discuss the issue of TCR cross-reactivity in the development of memory phenotype CD4(+) T cells and the implications for pathogen-specific responses. We review both the human and mouse data and discuss the therapeutic implications of these findings in the contexts of infection and vaccination.
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Affiliation(s)
- Laura F Su
- The Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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The promised land of human immunology. COLD SPRING HARBOR SYMPOSIA ON QUANTITATIVE BIOLOGY 2014; 78:203-13. [PMID: 24638855 DOI: 10.1101/sqb.2013.78.022905] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Advances in technology and data analysis have made it possible to take a new look at human immunology. These advances run the gamut from systems biology approaches, which are likely in the vanguard of how we can start "to put the pieces together" of immune function, to a deeper understanding of specific diseases and vaccines and the immune repertoire. In our own experience, we have also found that asking simple questions about human immunity has often given us very surprising answers, causing a rethink of established dogma. Thus, we have developed a new perspective on the nature of the αβ TCR repertoire and also the likely role of T-cell repertoire (TCR) cross-reactivity in generating T memory independent of specific antigen interactions. These findings show that human immunology is not just a necessary step for "translating" basic immunology to treat diseases or develop better vaccines, but is also an important complement to the inbred mouse model.
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Sattenspiel L, Mamelund SE. COCIRCULATING EPIDEMICS, CHRONIC HEALTH PROBLEMS, AND SOCIAL CONDITIONS IN EARLY 20TH CENTURY LABRADOR AND ALASKA. ANNALS OF ANTHROPOLOGICAL PRACTICE 2013. [DOI: 10.1111/napa.12011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Benn CS, Netea MG, Selin LK, Aaby P. A small jab - a big effect: nonspecific immunomodulation by vaccines. Trends Immunol 2013; 34:431-9. [PMID: 23680130 DOI: 10.1016/j.it.2013.04.004] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 03/18/2013] [Accepted: 04/07/2013] [Indexed: 02/07/2023]
Abstract
Recent epidemiological studies have shown that, in addition to disease-specific effects, vaccines against infectious diseases have nonspecific effects on the ability of the immune system to handle other pathogens. For instance, in randomized trials tuberculosis and measles vaccines are associated with a substantial reduction in overall child mortality, which cannot be explained by prevention of the target disease. New research suggests that the nonspecific effects of vaccines are related to cross-reactivity of the adaptive immune system with unrelated pathogens, and to training of the innate immune system through epigenetic reprogramming. Hence, epidemiological findings are backed by immunological data. This generates a new understanding of the immune system and about how it can be modulated by vaccines to impact the general resistance to disease.
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Affiliation(s)
- Christine S Benn
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Institute of Clinical Research, University of Southern Denmark, and Odense University Hospital, Denmark.
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Aaby P, Benn CS. Saving lives by training innate immunity with bacille Calmette-Guerin vaccine. Proc Natl Acad Sci U S A 2012; 109:17317-8. [PMID: 23071307 PMCID: PMC3491466 DOI: 10.1073/pnas.1215761109] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Peter Aaby
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, 2300 Copenhagen S, Denmark.
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