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Thompson KM, Badizadegan K. Review of Poliovirus Transmission and Economic Modeling to Support Global Polio Eradication: 2020-2024. Pathogens 2024; 13:435. [PMID: 38921733 PMCID: PMC11206708 DOI: 10.3390/pathogens13060435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/27/2024] Open
Abstract
Continued investment in the development and application of mathematical models of poliovirus transmission, economics, and risks leads to their use in support of polio endgame strategy development and risk management policies. This study complements an earlier review covering the period 2000-2019 and discusses the evolution of studies published since 2020 by modeling groups supported by the Global Polio Eradication Initiative (GPEI) partners and others. We systematically review modeling papers published in English in peer-reviewed journals from 2020-2024.25 that focus on poliovirus transmission and health economic analyses. In spite of the long-anticipated end of poliovirus transmission and the GPEI sunset, which would lead to the end of its support for modeling, we find that the number of modeling groups supported by GPEI partners doubled and the rate of their publications increased. Modeling continued to play a role in supporting GPEI and national/regional policies, but changes in polio eradication governance, decentralized management and decision-making, and increased heterogeneity in modeling approaches and findings decreased the overall impact of modeling results. Meanwhile, the failure of the 2016 globally coordinated cessation of type 2 oral poliovirus vaccine use for preventive immunization and the introduction of new poliovirus vaccines and formulation, increased the complexity and uncertainty of poliovirus transmission and economic models and policy recommendations during this time.
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Bashorun AO, Kotei L, Jawla O, Jallow AF, Saidy AJ, Kinteh MA, Kujabi A, Jobarteh T, Kanu FJ, Donkor SA, Ezeani E, Fofana S, Njie M, Ceesay L, Jafri B, Williams A, Jeffries D, Kotanmi B, Mainou BA, Ooko M, Clarke E. Tolerability, safety, and immunogenicity of the novel oral polio vaccine type 2 in children aged 6 weeks to 59 months in an outbreak response campaign in The Gambia: an observational cohort study. THE LANCET. INFECTIOUS DISEASES 2024; 24:417-426. [PMID: 38237616 PMCID: PMC10954559 DOI: 10.1016/s1473-3099(23)00631-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 03/24/2024]
Abstract
BACKGROUND Novel oral polio vaccine type 2 (nOPV2) has been used to interrupt circulating vaccine-derived poliovirus type 2 outbreaks following its WHO emergency use listing. This study reports data on the safety and immunogenicity of nOPV2 over two rounds of a campaign in The Gambia. METHODS This observational cohort study collected baseline symptoms (vomiting, diarrhoea, irritability, reduced feeding, and reduced activity) and axillary temperature from children aged 6 weeks to 59 months in The Gambia before a series of two rounds of a nOPV2 campaign that took place on Nov 20-26, 2021, and March 19-22, 2022. Serum and stool samples were collected from a subset of the participants. The same symptoms were re-assessed during the week following each dose of nOPV2. Stool samples were collected on days 7 and 28, and serum was collected on day 28 following each dose. Adverse events, including adverse events of special interest, were documented for 28 days after each campaign round. Serum neutralising antibodies were measured by microneutralisation assay, and stool poliovirus excretion was measured by real-time RT-PCR. FINDINGS Of the 5635 children eligible for the study, 5504 (97·7%) received at least one dose of nOPV2. There was no increase in axillary temperature or in any of the baseline symptoms following either rounds of the campaigns. There were no adverse events of special interest and no other safety signals of concern. Poliovirus type 2 seroconversion rates were 70% (95% CI 62 to 78; 87 of 124 children) following one dose of nOPV2 and 91% (85 to 95; 113 of 124 children) following two doses. Poliovirus excretion on day 7 was lower after the second round (162 of 459 samples; 35·3%, 95% CI 31·1 to 39·8) than after the first round (292 of 658 samples; 44·4%, 40·6 to 48·2) of the campaign (difference -9·1%; 95% CI -14·8 to -3·3), showing the induction of mucosal immunity. INTERPRETATION In a campaign in west Africa, nOPV2 was well tolerated and safe. High rates of seroconversion and evidence of mucosal immunity support the licensure and WHO prequalification of this vaccine. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Adedapo O Bashorun
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Larry Kotei
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ousubie Jawla
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Abdoulie F Jallow
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Aisha J Saidy
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ma-Ansu Kinteh
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Arafang Kujabi
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Tijan Jobarteh
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Francis John Kanu
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Simon A Donkor
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Esu Ezeani
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Sidat Fofana
- Expanded Programme on Immunization, Ministry of Health, Government of The Gambia, Kotu, The Gambia
| | - Mbye Njie
- Expanded Programme on Immunization, Ministry of Health, Government of The Gambia, Kotu, The Gambia
| | - Lamin Ceesay
- Expanded Programme on Immunization, Ministry of Health, Government of The Gambia, Kotu, The Gambia
| | - Basit Jafri
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Williams
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Jeffries
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Brezesky Kotanmi
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bernardo A Mainou
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Ooko
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ed Clarke
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
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Evaluating stability of attenuated Sabin and two novel type 2 oral poliovirus vaccines in children. NPJ Vaccines 2022; 7:19. [PMID: 35149714 PMCID: PMC8837630 DOI: 10.1038/s41541-022-00437-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Novel oral poliovirus vaccine type 2 (nOPV2) is being developed to reduce the rare occurrence of disease and outbreaks associated with the genetic instability of the Sabin vaccine strains. Children aged 1 to 5 years were enrolled in two related clinical studies to assess safety, immunogenicity, shedding rates and properties of the shed virus following vaccination with nOPV2 (two candidates) versus traditional Sabin OPV type 2 (mOPV2). The anticipated pattern of reversion and increased virulence was observed for shed Sabin-2 virus, as assessed using a mouse model of poliovirus neurovirulence. In contrast, there were significantly reduced odds of mouse paralysis for shed virus for both nOPV2 candidates when compared to shed Sabin-2 virus. Next-generation sequencing of shed viral genomes was consistent with and further supportive of the observed neurovirulence associated with shed Sabin-2 virus, as well as the reduced reversion to virulence of shed candidate viruses. While shed Sabin-2 showed anticipated A481G reversion in the primary attenuation site in domain V in the 5’ untranslated region to be associated with increased mouse paralysis, the stabilized domain V in the candidate viruses did not show polymorphisms consistent with reversion to neurovirulence. The available data from a key target age group for outbreak response confirm the superior genetic and phenotypic stability of shed nOPV2 strains compared to shed Sabin-2 and suggest that nOPV2 should be associated with less paralytic disease and potentially a lower risk of seeding new outbreaks.
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Connor RI, Brickley EB, Wieland-Alter WF, Ackerman ME, Weiner JA, Modlin JF, Bandyopadhyay AS, Wright PF. Mucosal immunity to poliovirus. Mucosal Immunol 2022; 15:1-9. [PMID: 34239028 PMCID: PMC8732262 DOI: 10.1038/s41385-021-00428-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 02/04/2023]
Abstract
A cornerstone of the global initiative to eradicate polio is the widespread use of live and inactivated poliovirus vaccines in extensive public health campaigns designed to prevent the development of paralytic disease and interrupt transmission of the virus. Central to these efforts is the goal of inducing mucosal immunity able to limit virus replication in the intestine. Recent clinical trials have evaluated new combined regimens of poliovirus vaccines, and demonstrated clear differences in their ability to restrict virus shedding in stool after oral challenge with live virus. Analyses of mucosal immunity accompanying these trials support a critical role for enteric neutralizing IgA in limiting the magnitude and duration of virus shedding. This review summarizes key findings in vaccine-induced intestinal immunity to poliovirus in infants, older children, and adults. The impact of immunization on development and maintenance of protective immunity to poliovirus and the implications for global eradication are discussed.
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Affiliation(s)
- Ruth I Connor
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Margaret E Ackerman
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Joshua A Weiner
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | | | | | - Peter F Wright
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Gast C, Bandyopadhyay AS, Sáez-Llorens X, De Leon T, DeAntonio R, Jimeno J, Aguirre G, McDuffie LM, Coffee E, Mathis DL, Oberste MS, Weldon WC, Konopka-Anstadt JL, Modlin J, Bachtiar NS, Fix A, Konz J, Clemens R, Clemens SAC, Rüttimann R. Fecal shedding of two novel live attenuated oral poliovirus type 2 vaccines candidates by healthy bOPV/IPV-vaccinated infants: two randomized clinical trials. J Infect Dis 2021; 226:852-861. [PMID: 34610135 PMCID: PMC9470102 DOI: 10.1093/infdis/jiab507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Primary intestinal immunity through viral replication of live oral vaccine is key to interrupt poliovirus transmission. We assessed viral fecal shedding from infants administered Sabin monovalent poliovirus type 2 vaccine (mOPV2) or low and high doses of 2 novel OPV2 (nOPV2) vaccine candidates. Methods In 2 randomized clinical trials in Panama, a control mOPV2 study (October 2015 to April 2016) and nOPV2 study (September 2018 to October 2019), 18-week-old infants vaccinated with bivalent oral poliovirus vaccine/inactivated poliovirus vaccine received 1 or 2 study vaccinations 28 days apart. Stools were assessed for poliovirus RNA by polymerase chain reaction (PCR) and live virus by culture for 28 days postvaccination. Results Shedding data were available from 621 initially reverse-transcription PCR–negative infants (91 mOPV2, 265 nOPV2-c1, 265 nOPV2-c2 recipients). Seven days after dose 1, 64.3% of mOPV2 recipients and 31.3%–48.5% of nOPV2 recipients across groups shed infectious type 2 virus. Respective rates 7 days after dose 2 decreased to 33.3% and 12.9%–22.7%, showing induction of intestinal immunity. Shedding of both nOPV2 candidates ceased at similar or faster rates than mOPV2. Conclusions Viral shedding of either nOPV candidate was similar or decreased relative to mOPV2, and all vaccines showed indications that the vaccine virus was replicating sufficiently to induce primary intestinal mucosal immunity.
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Affiliation(s)
| | | | - Xavier Sáez-Llorens
- Infectious Disease Department, Hospital del Niño "Dr. José Renán Esquivel", Panama City, Panama.,Sistema Nacional de Investigación, Senacyt, Panama
| | | | | | | | - Gabriela Aguirre
- Fighting Infectious Diseases in Emerging Countries (FIDEC), Miami, USA
| | - Larin M McDuffie
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Elizabeth Coffee
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Demetrius L Mathis
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | | | | | | | - John Modlin
- Bill & Melinda Gates Foundation, Seattle, USA
| | | | | | | | - Ralf Clemens
- Global Research in Infectious Diseases (GRID), Rio de Janeiro, Brazil
| | | | - Ricardo Rüttimann
- Fighting Infectious Diseases in Emerging Countries (FIDEC), Miami, USA
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Wahid R, Mercer L, Macadam A, Carlyle S, Stephens L, Martin J, Chumakov K, Laassri M, Petrovskaya S, Smits SL, Stittelaar KJ, Gast C, Weldon WC, Konopka-Anstadt JL, Steven Oberste M, Van Damme P, De Coster I, Rüttimann R, Bandyopadhyay A, Konz J. Assessment of genetic changes and neurovirulence of shed Sabin and novel type 2 oral polio vaccine viruses. NPJ Vaccines 2021; 6:94. [PMID: 34326330 PMCID: PMC8322168 DOI: 10.1038/s41541-021-00355-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/06/2021] [Indexed: 11/09/2022] Open
Abstract
Sabin-strain oral polio vaccines (OPV) can, in rare instances, cause disease in recipients and susceptible contacts or evolve to become circulating vaccine-derived strains with the potential to cause outbreaks. Two novel type 2 OPV (nOPV2) candidates were designed to stabilize the genome against the rapid reversion that is observed following vaccination with Sabin OPV type 2 (mOPV2). Next-generation sequencing and a modified transgenic mouse neurovirulence test were applied to shed nOPV2 viruses from phase 1 and 2 studies and shed mOPV2 from a phase 4 study. The shed mOPV2 rapidly reverted in the primary attenuation site (domain V) and increased in virulence. In contrast, the shed nOPV2 viruses showed no evidence of reversion in domain V and limited or no increase in neurovirulence in mice. Based on these results and prior published data on safety, immunogenicity, and shedding, the nOPV2 viruses are promising alternatives to mOPV2 for outbreak responses.
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Affiliation(s)
- Rahnuma Wahid
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA.
| | - Laina Mercer
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Andrew Macadam
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Sarah Carlyle
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Laura Stephens
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Javier Martin
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Konstantin Chumakov
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
- Global Virus Network Center of Excellence, Baltimore, MD, USA
| | - Majid Laassri
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Svetlana Petrovskaya
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Saskia L Smits
- Viroclinics Biosciences B.V., Rotterdam, the Netherlands
| | - Koert J Stittelaar
- Viroclinics Xplore, Viroclinics Biosciences B.V., Rotterdam, the Netherlands
| | - Chris Gast
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - William C Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ilse De Coster
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ricardo Rüttimann
- Fighting Infectious Diseases in Emerging Countries (FIDEC), Miami, FL, USA
| | | | - John Konz
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
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Cochi SL, Pallansch MA. The Long and Winding Road to Eradicate Vaccine-Related Polioviruses. J Infect Dis 2021; 223:7-9. [PMID: 32621744 PMCID: PMC10546420 DOI: 10.1093/infdis/jiaa393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen L. Cochi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark A. Pallansch
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Sáez-Llorens X, Bandyopadhyay AS, Gast C, Leon TD, DeAntonio R, Jimeno J, Caballero MI, Aguirre G, Oberste MS, Weldon WC, Konopka-Anstadt JL, Modlin J, Bachtiar NS, Fix A, Konz J, Clemens R, Costa Clemens SA, Rüttimann R. Safety and immunogenicity of two novel type 2 oral poliovirus vaccine candidates compared with a monovalent type 2 oral poliovirus vaccine in children and infants: two clinical trials. Lancet 2021; 397:27-38. [PMID: 33308427 PMCID: PMC7811205 DOI: 10.1016/s0140-6736(20)32540-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Continued emergence and spread of circulating vaccine-derived type 2 polioviruses and vaccine-associated paralytic poliomyelitis from Sabin oral poliovirus vaccines (OPVs) has stimulated development of two novel type 2 OPV candidates (OPV2-c1 and OPV2-c2) designed to have similar immunogenicity, improved genetic stability, and less potential to reacquire neurovirulence. We aimed to assess safety and immunogenicity of the two novel OPV candidates compared with a monovalent Sabin OPV in children and infants. METHODS We did two single-centre, multi-site, partly-masked, randomised trials in healthy cohorts of children (aged 1-4 years) and infants (aged 18-22 weeks) in Panama: a control phase 4 study with monovalent Sabin OPV2 before global cessation of monovalent OPV2 use, and a phase 2 study with low and high doses of two novel OPV2 candidates. All participants received one OPV2 vaccination and subsets received two doses 28 days apart. Parents reported solicited and unsolicited adverse events. Type 2 poliovirus neutralising antibodies were measured at days 0, 7, 28, and 56, and stool viral shedding was assessed up to 28 days post-vaccination. Primary objectives were to assess safety in all participants and non-inferiority of novel OPV2 day 28 seroprotection versus monovalent OPV2 in infants (non-inferiority margin 10%). These studies were registered with ClinicalTrials.gov, NCT02521974 and NCT03554798. FINDINGS The control study took place between Oct 23, 2015, and April 29, 2016, and the subsequent phase 2 study between Sept 19, 2018, and Sept 30, 2019. 150 children (50 in the control study and 100 of 129 assessed for eligibility in the novel OPV2 study) and 684 infants (110 of 114 assessed for eligibility in the control study and 574 of 684 assessed for eligibility in the novel OPV2 study) were enrolled and received at least one study vaccination. Vaccinations were safe and well tolerated with no causally associated serious adverse events or important medical events in any group. Solicited and unsolicited adverse events were overwhelmingly mild or moderate irrespective of vaccine or dose. Nearly all children were seroprotected at baseline, indicating high baseline immunity. In children, the seroprotection rate 28 days after one dose was 100% for monovalent OPV2 and both novel OPV2 candidates. In infants at day 28, 91 (94% [95% CI 87-98]) of 97 were seroprotected after receiving monovalent OPV2, 134 (94% [88-97]) of 143 after high-dose novel OPV2-c1, 122 (93% [87-97]) of 131 after low-dose novel OPV2-c1, 138 (95% [90-98]) of 146 after high-dose novel OPV2-c2, and 115 (91% [84-95]) of 127 after low-dose novel OPV2-c2. Non-inferiority was shown for low-dose and high-dose novel OPV2-c1 and high-dose novel OPV2-c2 despite monovalent OPV2 recipients having higher baseline immunity. INTERPRETATION Both novel OPV2 candidates were safe, well tolerated, and immunogenic in children and infants. Novel OPV2 could be an important addition to our resources against poliovirus given the current epidemiological situation. FUNDING Fighting Infectious Diseases in Emerging Countries and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Xavier Sáez-Llorens
- Infectious Disease Department, Hospital del Niño Dr José Renán Esquivel, Panama City, Panama; Sistema Nacional de Investigación, Senacyt, Panama
| | | | | | | | - Rodrigo DeAntonio
- Sistema Nacional de Investigación, Senacyt, Panama; Cevaxin, Panama City, Panama
| | | | | | - Gabriela Aguirre
- Fighting Infectious Diseases in Emerging Countries, Miami, FL, USA
| | - M Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William C Weldon
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L Konopka-Anstadt
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Modlin
- Bill & Melinda Gates Foundation, Seattle, WA, USA; PATH, Washington DC, USA; Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | | | | | | | - Ralf Clemens
- Global Research in Infectious Diseases, Rio de Janeiro, Brazil
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De Coster I, Leroux-Roels I, Bandyopadhyay AS, Gast C, Withanage K, Steenackers K, De Smedt P, Aerssens A, Leroux-Roels G, Oberste MS, Konopka-Anstadt JL, Weldon WC, Fix A, Konz J, Wahid R, Modlin J, Clemens R, Costa Clemens SA, Bachtiar NS, Van Damme P. Safety and immunogenicity of two novel type 2 oral poliovirus vaccine candidates compared with a monovalent type 2 oral poliovirus vaccine in healthy adults: two clinical trials. Lancet 2021; 397:39-50. [PMID: 33308429 PMCID: PMC7811203 DOI: 10.1016/s0140-6736(20)32541-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Two novel type 2 oral poliovirus vaccine (OPV2) candidates, novel OPV2-c1 and novel OPV2-c2, designed to be more genetically stable than the licensed Sabin monovalent OPV2, have been developed to respond to ongoing polio outbreaks due to circulating vaccine-derived type 2 polioviruses. METHODS We did two randomised studies at two centres in Belgium. The first was a phase 4 historical control study of monovalent OPV2 in Antwerp, done before global withdrawal of OPV2, and the second was a phase 2 study in Antwerp and Ghent with novel OPV2-c1 and novel OPV2-c2. Eligible participants were healthy adults aged 18-50 years with documented history of at least three polio vaccinations, including OPV in the phase 4 study and either OPV or inactivated poliovirus vaccine (IPV) in the novel OPV2 phase 2 study, with no dose within 12 months of study start. In the historical control trial, participants were randomly assigned to either one dose or two doses of monovalent OPV2. In the novel OPV2 trial, participants with previous OPV vaccinations were randomly assigned to either one or two doses of novel OPV2-c1 or to one or two doses of novel OPV2-c2. IPV-vaccinated participants were randomly assigned to receive two doses of either novel OPV2-c1, novel OPV2-c2, or placebo. Vaccine administrators were unmasked to treatment; medical staff performing safety and reactogenicity assessments or blood draws for immunogenicity assessments were masked. Participants received the first vaccine dose on day 0, and a second dose on day 28 if assigned to receive a second dose. Primary objectives were assessments and comparisons of safety up to 28 days after each dose, including solicited adverse events and serious adverse events, and immunogenicity (seroprotection rates on day 28 after the first vaccine dose) between monovalent OPV2 and the two novel OPV2 candidates. Primary immunogenicity analyses were done in the per-protocol population. Safety was assessed in the total vaccinated population-ie, all participants who received at least one dose of their assigned vaccine. The phase 4 control study is registered with EudraCT (2015-003325-33) and the phase 2 novel OPV2 study is registered with EudraCT (2018-001684-22) and ClinicalTrials.gov (NCT04544787). FINDINGS In the historical control study, between Jan 25 and March 18, 2016, 100 volunteers were enrolled and randomly assigned to receive one or two doses of monovalent OPV2 (n=50 in each group). In the novel OPV2 study, between Oct 15, 2018, and Feb 27, 2019, 200 previously OPV-vaccinated volunteers were assigned to the four groups to receive one or two doses of novel OPV2-c1 or novel OPV2-c2 (n=50 per group); a further 50 participants, previously vaccinated with IPV, were assigned to novel OPV2-c1 (n=17), novel OPV2-c2 (n=16), or placebo (n=17). All participants received the first dose of assigned vaccine or placebo and were included in the total vaccinated population. All vaccines appeared safe; no definitely vaccine-related withdrawals or serious adverse events were reported. After first doses in previously OPV-vaccinated participants, 62 (62%) of 100 monovalent OPV2 recipients, 71 (71%) of 100 recipients of novel OPV2-c1, and 74 (74%) of 100 recipients of novel OPV2-c2 reported solicited systemic adverse events, four (monovalent OPV2), three (novel OPV2-c1), and two (novel OPV2-c2) of which were considered severe. In IPV-vaccinated participants, solicited adverse events occurred in 16 (94%) of 17 who received novel OPV2-c1 (including one severe) and 13 (81%) of 16 who received novel OPV2-c2 (including one severe), compared with 15 (88%) of 17 placebo recipients (including two severe). In previously OPV-vaccinated participants, 286 (97%) of 296 were seropositive at baseline; after one dose, 100% of novel OPV2 vaccinees and 97 (97%) of monovalent OPV2 vaccinees were seropositive. INTERPRETATION Novel OPV2 candidates were as safe, well tolerated, and immunogenic as monovalent OPV2 in previously OPV-vaccinated and IPV-vaccinated adults. These data supported the further assessment of the vaccine candidates in children and infants. FUNDING University of Antwerp and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ilse De Coster
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Isabel Leroux-Roels
- Center for Vaccinology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | | | | | - Kanchanamala Withanage
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Katie Steenackers
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Philippe De Smedt
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Annelies Aerssens
- Center for Vaccinology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Geert Leroux-Roels
- Center for Vaccinology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - M Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L Konopka-Anstadt
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William C Weldon
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - John Modlin
- Bill & Melinda Gates Foundation, Seattle, WA, USA; PATH, Washington DC, USA; Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Ralf Clemens
- Global Research in Infectious Diseases, Rio de Janeiro, Brazil
| | | | | | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium.
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Brickley EB, Connor RI, Wieland-Alter W, Weiner JA, Ackerman ME, Arita M, Gast C, De Coster I, Van Damme P, Bandyopadhyay AS, Wright PF. Intestinal antibody responses to two novel live attenuated type 2 oral poliovirus vaccines in healthy adults in Belgium. J Infect Dis 2020; 226:287-291. [PMID: 33367918 PMCID: PMC9400418 DOI: 10.1093/infdis/jiaa783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/18/2020] [Indexed: 12/03/2022] Open
Abstract
In a blinded phase 1 trial (EudraCT 2017-0000908-21; NCT03430349) in Belgium, healthy adults (aged 18–50 years) previously immunized exclusively with inactivated poliovirus vaccine were administered a single dose of 1 of 2 novel type 2 oral poliovirus vaccines (nOPV2-c1: S2/cre5/S15domV/rec1/hifi3 (n = 15); nOPV2-c2: S2/S15domV/CpG40 (n = 15)) and isolated for 28 days in a purpose-built containment facility. Using stool samples collected near days 0, 14, 21, and 28, we evaluated intestinal neutralization and immunoglobulin A responses to the nOPV2s and found that nOPV2-c1 and nOPV2-c2 induced detectable poliovirus type 2–specific intestinal neutralizing responses in 40.0% and 46.7% of participants, respectively.
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Affiliation(s)
- Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ruth I Connor
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States of America
| | - Wendy Wieland-Alter
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States of America
| | - Joshua A Weiner
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Margaret E Ackerman
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Minetaro Arita
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chris Gast
- PATH, Seattle, Washington, United States of America
| | - Ilse De Coster
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | | | - Peter F Wright
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States of America
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11
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de Deus N, Capitine IPU, Bauhofer AFL, Marques S, Cassocera M, Chissaque A, Bero DM, Langa JP, Padama FM, Jeyaseelan V, Oberste MS, Estivariz CF, Verma H, Jani I, Mach O, Sutter RW. Immunogenicity of reduced-dose monovalent type 2 oral poliovirus vaccine in Mocuba, Mozambique. J Infect Dis 2020; 226:292-298. [PMID: 33180924 PMCID: PMC9400415 DOI: 10.1093/infdis/jiaa704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Monovalent type 2 oral poliovirus vaccine (mOPV2) stockpile is low. One potential strategy to stretch the existing mOPV2 supply is to administer a reduced dose: one-drop instead of two-drops. METHODS We conducted a randomized, controlled, open-label, non-inferiority trial (10% margin) to compared immunogenicity following administration of one versus two-drops of mOPV2. We enrolled 9-22-months old infants from Mocuba district of Mozambique. Poliovirus neutralizing antibodies were measured in sera collected before and one month after mOPV2 administration. Immune response was defined as seroconversion from seronegative (<1:8) at baseline to seropositive (>1:8) after vaccination or boosting titers by >4-fold for those with titers between 1:8 and 1:362 at baseline. The trial was registered at anzctr.org.au (number ACTRN12619000184178p). RESULTS We enrolled 378 children and 262 (69%) completed per-protocol requirements. Immune response of mOPV2 was 53.6% (95% confidence interval [CI]: 44.9%-62.1%) and 60.6% (95% CI: 52.2%-68.4%) in 1-drop and 2-drops recipients, respectively. The non-inferiority margin of the 10% was not reached (difference=7.0%; 95%CI= -5.0-19.0). CONCLUSION A small loss of immunogenicity of reduced mOPV2 was observed. Although the non-inferiority target was not achieved, the Strategic Advisory Group of Experts on Immunization, recommended the 1-drop strategy as a dose-sparing measure if mOPV2 supplies deteriorate further.
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Affiliation(s)
- Nilsa de Deus
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique
| | | | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique.,Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, Lisboa, Portugal
| | - Selma Marques
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique
| | - Marta Cassocera
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique.,Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, Lisboa, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique.,Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - José Paulo Langa
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique
| | | | | | | | | | - Harish Verma
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Ilesh Jani
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique
| | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Roland W Sutter
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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