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Factors related to the mortality risk of severe hand, foot, and mouth diseases (HFMD): a 5-year hospital-based survey in Guangxi, Southern China. BMC Infect Dis 2023; 23:144. [PMID: 36890462 PMCID: PMC9993373 DOI: 10.1186/s12879-023-08109-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND To understand the factors influencing clinical outcomes of severe hand, foot, and mouth diseases (HFMD), and to provide scientific evidence for reducing the mortality risk of severe HFMD. METHODS From 2014 to 2018, children diagnosed with severe HFMD cases in Guangxi, China, were enrolled in this hospital-based study. The epidemiological data obtained through face-to-face interviews with the parents and guardians. Univariate and multivariate logistics regression models were used to analyze the factors influencing the clinical outcomes of severe HFMD. The impact of the EV-A71 vaccination on inpatient mortality was analyzed by a comparison approach. RESULTS A total of 1565 severe HFMD cases were enrolled in this survey, including 1474 (94.19%) survival cases and 91 (5.81%) death cases. The multivariate logistic analysis demonstrated that HFMD history of playmates in the last three months, first visit to the village hospital, time from the first visit to admission less than two days, no correct diagnosis for HFMD at the first visit, and having no rash symptoms were the independent risk factors for severe HFMD cases (all p < 0.05). While EV-A71 vaccination was a protective factor (p < 0.05). The EV-A71 vaccination group versus the non-vaccination group showed 2.23% of death in the vaccination group and 7.24% of death in the non-vaccination group. The EV-A71 vaccination protected 70.80% of the death of severe HFMD cases, with an effective index of 4.79. CONCLUSIONS The mortality risk of severe HFMD in Guangxi was related to playmates had HFMD history in last 3 months, hospital grade, EV-A71 vaccination, patients visit hospital previously, and rash symptom. EV-A71 vaccination can significantly reduce mortality among severe HFMD. The findings are of great significance for the effective prevention and control of HFMD in Guangxi, southern China.
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Immunogenicity and Safety of an Inactivated Enterovirus 71 Vaccine Administered Simultaneously with Hepatitis B Virus Vaccine, Group A Meningococcal Polysaccharide Vaccine, Measles-Rubella Combined Vaccine and Japanese Encephalitis Vaccine: A Multi-Center, Randomized, Controlled Clinical Trial in China. Vaccines (Basel) 2022; 10:vaccines10060895. [PMID: 35746502 PMCID: PMC9230521 DOI: 10.3390/vaccines10060895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The aim of this study was to investigate the immunogenicity and safety of the enterovirus 71 vaccine (EV71 vaccine) administered alone or simultaneously. Methods: A multi-center, open-label, randomized controlled trial was performed involving 1080 healthy infants aged 6 months or 8 months from Shandong, Shanxi, Shaanxi, and Hunan provinces. These infants were divided into four simultaneous administration groups and EV71 vaccine separate administration group. Blood samples were collected from the infants before the first vaccination and after the completion of the vaccination. This trial was registered in the Clinical Trials Registry (NCT03519568). Results: A total of 895 were included in the per-protocol analysis. The seroconversion rates of antibodies against EV71 in four simultaneous administration groups (98.44% (189/192), 94.57% (122/129), 99.47% (187/188) and 98.45% (190/193)) were non-inferior to EV71 vaccine separate administration group (97.93% [189/193]) respectively. Fever was the most common adverse event, the pairwise comparison tests showed no difference in the incidence rate of solicited, systemic or local adverse events. Three serious adverse events related to the vaccination were reported. Conclusions: The evidence of immunogenicity and safety supports that the EV71 vaccine administered simultaneously with vaccines need to be administered during the same period of time recommended in China.
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Peng H, Chen Z, Cai L, Liao J, Zheng K, Li S, Ren X, Duan X, Tang X, Wang X, Long L, Yang C. Relationship between meteorological factors, air pollutants and hand, foot and mouth disease from 2014 to 2020. BMC Public Health 2022; 22:998. [PMID: 35581574 PMCID: PMC9112249 DOI: 10.1186/s12889-022-13365-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Meteorological factors and air pollutants have been reported to be associated with hand, foot, and mouth disease (HFMD) epidemics before the introduction of vaccine. However, there is limited evidence for studies with long-term dimensions. Methods We collected the daily HFMD counts, weather and air pollution data from 2014 to 2020 in Chengdu. Distributed lag non-linear models (DLNM) were used to assess the associations of meteorological factors and air pollutants on HFMD cases. Results From 2014–2020, high relative humidity and precipitation and extremely high and low levels of PM10, O3, SO2 and CO increased the risk of HFMD. In pre-vaccination period, extreme high and low temperatures, PM10 and NO2, low precipitation and high concentrations of PM2.5 and O3 significantly increase the risk of HFMD; In post-vaccination period, high relative humidity and low level of CO can significantly increase the incidence of HFMD; During the period of COVID-19, only low temperature will significantly increase the risk of HFMD; Low concentration of air pollutants has the greatest impact on the 6–14 age group, while the high concentration of air pollutants has the greatest impact on the 0–1 age group. Conclusions Our study suggest that high relative humidity and precipitation and extremely high and low levels of PM10, O3, SO2 and CO increased the risk of HFMD from 2014 to 2020. The results of this study provide a reference for local authorities to formulate intervention measures and establish an environment-based disease early warning system. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13365-9.
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Affiliation(s)
- Hongxia Peng
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Zhenhua Chen
- Department of Microbiology Laboratory, Chengdu Municipal Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Lin Cai
- Department of Gastroenterology, West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, Sichuan, China.,Non-Communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China
| | - Juan Liao
- Department of Gastroenterology, West China School of Public Health and West China Forth Hospital, Sichuan University, Chengdu, Sichuan, China.,Non-Communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, Sichuan, China
| | - Ke Zheng
- Department of Immunization Planning, Chengdu Municipal Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Shuo Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Xueling Ren
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Xiaoxia Duan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Xueqin Tang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Xiao Wang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China
| | - Lu Long
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China.
| | - Chunxia Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16, Section 3, Renmin south road, Wuhou District, Chengdu, Sichuan, China.
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Liu X, Yang W, Zhang C, Wu H, Wang R, Ding Q, Hu Y, Xiong Y, Zhang S, Wang L. Immunogenicity and safety of an inactivated enterovirus 71 vaccine co-administered with measles-mumps-rubella vaccine and live-attenuated Japanese encephalitis vaccine: a phase 4, single-center, randomized controlled trial. Hum Vaccin Immunother 2021; 17:5348-5354. [PMID: 34905446 PMCID: PMC8903949 DOI: 10.1080/21645515.2021.2010428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Co-administration of vaccines could be an efficient strategy to increase vaccination uptake and reduce the number of clinic visits. This randomized controlled study aimed to evaluate the immunogenicity and safety of enterovirus 71 (EV71) vaccine co-administered with measles-mumps-rubella (MMR) vaccine and live-attenuated Japanese encephalitis vaccine (LA-JEV). A total of 372 healthy infants were randomly assigned in a 1:1:1 ratio to receive simultaneous administration of EV71 vaccine (dose 1) and MMR on d 0 and EV71 vaccine (dose 2) and LA-JEV on d 30 (Group 1); administration of MMR and LA-JEV on d 0 and 30, respectively (Group 2); or administration of doses 1 and 2 of EV71 vaccine on d 0 and 30, respectively (Group 3). The non-inferiority analysis of the seroconversion for EV71 neutralizing antibody after vaccination was the primary outcome. According to per protocol set, antibody response against EV71, measles, mumps, rubella, and Japanese encephalitis (JE) virus was similar regardless of administration schedule. After vaccination, the seroconversion rate of EV71 neutralizing antibody in Group 1 (107 [97.27%] of 110) was non-inferior to that in Group 3 (109 [97.32%] of 112; difference - 0.05% [95% CI - 5.38 to 5.21]). The incidences of adverse reactions were 62.60% (77/123) in Group 1, 54.84% (68/124) in Group 2, and 37.70% (46/122) in Group 3, and most of them were mild to moderate in severity. No vaccine-related serious adverse events were reported. In total, the co-administration of combined EV71 vaccine with MMR and LA-JEV showed no interference with antibody response and demonstrated good safety profiles.
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Affiliation(s)
- Xiaoyu Liu
- Center for Clinical Evaluation of Vaccines, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China,Lin Wang Sinovac Biotech Co. Ltd, Beijing 100089, China
| | - Wanqi Yang
- Sinovac Biotech Co. Ltd, Beijing, China,Lin Wang Sinovac Biotech Co. Ltd, Beijing 100089, China
| | - Chao Zhang
- Center for Clinical Evaluation of Vaccines, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China,Lin Wang Sinovac Biotech Co. Ltd, Beijing 100089, China
| | - Heng Wu
- Department of Immunology, Hanbin District Center for Disease Control and Prevention, Ankang, China,Lin Wang Sinovac Biotech Co. Ltd, Beijing 100089, China
| | - Ruize Wang
- Center for Clinical Evaluation of Vaccines, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China
| | - Qiang Ding
- Department of Immunology, Hanbin District Center for Disease Control and Prevention, Ankang, China
| | - Yan Hu
- Department of Immunology, Hanbin District Center for Disease Control and Prevention, Ankang, China
| | | | - Shaobai Zhang
- Center for Clinical Evaluation of Vaccines, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China,CONTACT Shaobai Zhang Shaanxi Provincial Center for Disease Control and Prevention, Xi’an710054, China
| | - Lin Wang
- Sinovac Biotech Co. Ltd, Beijing, China,Lin Wang Sinovac Biotech Co. Ltd, Beijing 100089, China
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Zhang L, Gao F, Zeng G, Yang H, Zhu T, Yang S, Meng X, Mao Q, Liu X. Immunogenicity and Safety of Inactivated Enterovirus 71 Vaccine in Children Aged 36-71 Months: A Double-Blind, Randomized, Controlled, Non-inferiority Phase III Trial. J Pediatric Infect Dis Soc 2021; 10:440-447. [PMID: 33269798 DOI: 10.1093/jpids/piaa129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/27/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Sinovac enterovirus 71 (EV71) vaccine has been given to children aged 6-35 months with good safety, immunogenicity, and efficacy. Further exploration is needed for the application of Sinovac EV71 vaccine in older children. METHODS A phase III, double-blind, single-center, randomized, controlled, non-inferiority, and bridging-designed trial enrolled 300 participants aged 6-35 months and 600 participants aged 36-71 months. Non-inferiority and superiority analyses were made to determine the immunogenicity of Sinovac EV71 vaccine in older children (Older-S group), comparing with that of control EV71 vaccine in the same age group (Older-C group), or comparing with that of Sinovac EV71 vaccine in younger children (Younger-S group). RESULTS The seroconversion rate of anti-EV71 in Older-S group (95.5%) was superior to that of Older-C group (86.0%), and non-inferior to that of Younger-S group (98.5%). For baseline seronegative participants, the geometric mean titer of Older-S group (370.0) was non-inferior to that of Older-C group (296.2) and superior to that of Younger-S group (176.5). Incidence of adverse reactions in Older-S group (47.0%) was similar to that of Older-C group (44.8%), or Younger-S group (49.8%). CONCLUSIONS This study showed good safety and immunogenicity of Sinovac EV71 vaccine in children aged 36-71 months. CLINICAL TRIALS REGISTRATION NCT03909074. URL https://clinicaltrials.gov/ct2/show/NCT03909074?term=NCT03909074&draw=2&rank=1.
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Affiliation(s)
- Lifen Zhang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Fan Gao
- National Institutes for Food and Drug Control, Beijing, China
| | - Gang Zeng
- Sinovac Biotech Co., Ltd, Beijing, China
| | - Haitao Yang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Taotao Zhu
- Sinovac Biotech Co., Ltd, Beijing, China
| | - Shuangmin Yang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Xing Meng
- Sinovac Biotech Co., Ltd, Beijing, China
| | - Qunying Mao
- National Institutes for Food and Drug Control, Beijing, China
| | - Xiaoqiang Liu
- Yunnan Center for Disease Control and Prevention, Kunming, China
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Han Y, Chen Z, Zheng K, Li X, Kong J, Duan X, Xiao X, Guo B, Luan R, Long L. Epidemiology of Hand, Foot, and Mouth Disease Before and After the Introduction of Enterovirus 71 Vaccines in Chengdu, China, 2009-2018. Pediatr Infect Dis J 2020; 39:969-978. [PMID: 32433221 DOI: 10.1097/inf.0000000000002745] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) has posed a serious threat to children's health. Three inactivated monovalent enterovirus 71 (EV71) vaccines are proved to be highly efficacious in phase III clinical trials and are now available in China. METHODS We analyzed the citywide surveillance data on HFMD cases in Chengdu during 2009-2018, and estimated cumulative first-dose EV71 vaccination coverage among children eligible to EV71 vaccination after August 2016 in Chengdu. Time series susceptible-infected-recovered model was developed to analyze basic reproduction number and herd immunity threshold of HFMD. Overall and serotype-specific HFMD incidences and severity risks were compared before and after the EV71 vaccination. RESULTS Among 3 laboratory-identified serotype categories, i.e. EV71, coxsackievirus A16 (CV-A16), and other enteroviruses, the major serotype attributed to HFMD has been changing across years. The cumulative first-dose EV71 vaccination coverage rate was estimated as 60.8% during the study period in Chengdu. By contrast, herd immunity threshold for EV71-related HFMD was 94.0%. After introduction of EV71 vaccines, the overall incidence of HFMD increased 60.8%, mainly driven by 173.7% and 11.8% increased in HFMD caused by other enteroviruses and CV-A16, respectively, which offset a significant reduction in the incidence of HFMD caused by EV71. The overall case-severity risk decreased from 1.4% to 0.3%, with significantly declined presented in all serotype categories. CONCLUSIONS The incidence and severity of EV71-related HFMD decreased following implementation of EV71 vaccination. Developing multivalent vaccines and strengthening laboratory-based surveillance could further decline burden of HFMD.
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Affiliation(s)
- Yutong Han
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Zhenhua Chen
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Ke Zheng
- Department of Immunization Planning, Chengdu Municipal Center for Disease Control and Prevention, Sichuan, China
| | - Xianzhi Li
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Jinwang Kong
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Xiaoxia Duan
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Xiong Xiao
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Bing Guo
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Rongsheng Luan
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Lu Long
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
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Zhang Z, Liang Z, Zeng J, Zhang J, He P, Su J, Zeng Y, Fan R, Zhao D, Ma W, Zeng G, Zhang Q, Zheng H. Immunogenicity and Safety of an Inactivated Enterovirus 71 Vaccine Administered Simultaneously With Hepatitis B Vaccine and Group A Meningococcal Polysaccharide Vaccine: A Phase 4, Open-Label, Single-Center, Randomized, Noninferiority Trial. J Infect Dis 2020; 220:392-399. [PMID: 30891604 DOI: 10.1093/infdis/jiz129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/19/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This study tested the hypothesis that the immunogenicity and safety of the simultaneous administration of enterovirus 71 (EV71) vaccine (dose 1) with recombinant hepatitis B vaccine (HepB) on day 1 and EV71 vaccine (dose 2) with group A meningococcal polysaccharide vaccine (MenA) on day 30 is not inferior to separate administration of each vaccine. METHODS The study was designed as a randomized, open-label, noninferiority trial. A total of 775 healthy infants aged 6 months were randomly assigned in a ratio of 1:1:1 to receive simultaneous administration of EV71 vaccine (dose 1) and HepB on day 1 and EV71 vaccine (dose 2) and MenA on day 30 (the SI group); administration of doses 1 and 2 of EV71 vaccine on days 1 and 30, respectively (the SE1 group); or administration of HepB and MenA on days 1 and 30, respectively (the SE2 group). RESULTS According to the per protocol set, antibody responses against EV71, hepatitis B virus (HBV), and group A meningococcal polysaccharide were similar regardless of administration schedule. With the non-inferiority margin setting at 10%, the seroconversion rates of the three pathogens in the SI group (100% [98.25, 100], 44.84% [38.20, 51.63] and 27.83% [21.91, 34.38]) were not inferior to those in SE1 or SE2 group (100% [98.31, 100], 44.35% [37.82, 51.02] and 29.17% [23.20, 35.72], respectively). Frequencies of adverse reactions to each vaccination regimen were comparable (60.62% in the SI group vs 52.33% in the SE1 group and 56.98% in the SE2 group; P = .16). CONCLUSIONS Simultaneous administration of combined EV71 vaccine with HepB and MenA has noninferior immunogenicity and safety, compared with separate administration of these vaccines. CLINICAL TRIALS REGISTRATION NCT03274102.
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Affiliation(s)
- Zewu Zhang
- Center for Disease Control and Prevention of Dongguan City, Dongguan
| | | | | | - Jikai Zhang
- Guangdong Province Institute of Biological Products and Materia Medica
| | - Peng He
- National Institutes for Food and Drug Control
| | - Jiali Su
- Guangdong Province Institute of Biological Products and Materia Medica
| | - Yaoming Zeng
- Center for Disease Control and Prevention of Dongguan City, Dongguan
| | - Renfeng Fan
- Guangdong Province Institute of Biological Products and Materia Medica
| | - Dan Zhao
- National Institutes for Food and Drug Control
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health
| | | | - Qiaoli Zhang
- Center for Disease Control and Prevention of Dongguan City, Dongguan
| | - Huizhen Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
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Xu Q, Cao Q, Yang W, Liu X, Liu H, Tian X, Li J, Fang X, Jia N, Zeng G, Xu A. Interchangeability of two Enterovirus 71 inactivated vaccines in Chinese children: A phase IV, open-label, and randomized controlled trial. Vaccine 2020; 38:2671-2677. [PMID: 32067817 DOI: 10.1016/j.vaccine.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/11/2020] [Accepted: 02/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND In China, three inactivated Enterovirus 71 (EV71) vaccines have been approved. Although the vaccines in an immunization series should be from a single manufacture, children sometimes have to receive EV71 vaccines from more than one manufacturers. The aim of this study was to evaluate the interchangeability and safety of vaccination with EV71 vaccines from two manufacturers among Chinese children. METHODS We conducted an open label and randomized controlled study among children aged 6-35 months from November 2018 to January 2019. The participants were randomly assigned (1:1:1:1) to receive EV71 vaccines in one of the four different schedules (two using a single vaccine for all doses from one manufacture, and two mixed schedules using vaccines from two manufactures). Blood samples were collected pre-vaccination (Day 0) and one month after the second dose (Day 60) for neutralizing antibody assay. Immunogenicity was assessed in the per-protocol cohort and safety was assessed in the total vaccinated cohort. RESULTS A total of 300 children were enrolled and randomized, of whom 89.0% (267/300) were included in the per-protocol cohort for immunogenicity analysis. The seroconversion rates of the EV71 neutralizing antibody in four groups ranged from 98.4% to 100.0%, and were not significantly different among the groups. Compared with other groups, geometric mean titer was higher in group D, in which the participants received Institute of Medical Biology Chinese Academy of Medical Sciences (CAMS) vaccine in the first dose and the Sinovac vaccine in the second dose. Safety profiles were similar among the four groups and no serious adverse events related to the vaccination were reported. CONCLUSIONS Interchangeability of EV71 vaccines from two manufactures to complete an immunization series showed good immunogenicity and safety. The antibody response levels may vary by vaccination sequences of EV71 vaccines from the two manufacturers. TRIAL REGISTRATION ClinicalTrials.govNCT03873740.
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Affiliation(s)
- Qing Xu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China; Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Qingfan Cao
- Rushan City Center for Disease Control and Prevention, Rushan, Shandong, China
| | - Wanqi Yang
- Sinovac Biotech Co., Ltd., Beijing, China
| | - Xiaodong Liu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Haidong Liu
- Rushan City Center for Disease Control and Prevention, Rushan, Shandong, China
| | | | - Jing Li
- Sinovac Biotech Co., Ltd., Beijing, China
| | - Xueqiang Fang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | | | - Gang Zeng
- Sinovac Biotech Co., Ltd., Beijing, China.
| | - Aiqaing Xu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China; Academy of Preventive Medicine, Shandong University, Jinan, China.
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Wang S, Zeng J, Zhang X, Gan Z, Fan J, Chen Y, Liang Z, Hu X, Zeng G, Lv H. Short-term dynamic changes in neutralizing antibodies against enterovirus 71 after vaccination. Hum Vaccin Immunother 2020; 16:1595-1601. [PMID: 31977278 DOI: 10.1080/21645515.2020.1711678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Short-term dynamic changes in neutralizing antibodies against EV71 and EV71-IgM after inactivated EV71 vaccine injection are unknown. METHODS This study was designed as a randomized, open-label study and was registered at ClinicalTrials.gov (NCT03278132). In total, 120 healthy infants aged 6-35 months were randomized 1:1:1 to provide a second blood sample on day 10, day 20, or day 30 after the first vaccine dose, respectively. RESULTS According to the per-protocol set, a rapid immune response against EV71 was observed 10 days after the first EV71 vaccine dose, with antibody titers ≥1:8 in 89.19% of participants (95% CI: 74.58-96.97%) on day 10, in 80.65% (95% CI: 62.53-92.55%) on day 20, in 66.67% (95% CI: 49.03-81.44%) on day 30, and in 100% (95% CI: 96.52%-.) on day 60. Based on an ELISA, the percentages of participants positive for EV71-IgM on day 0 and day 60 were 1.71% (2 out of 117) and 82.86% (87 out of 105), respectively. CONCLUSIONS The EV71 vaccine could be used for contingency vaccination to further control EV71-associated disease outbreaks. Caution should be taken in using the EV71-IgM test for rapid EV71 infection diagnosis after EV71 vaccine administration. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT03278132.
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Affiliation(s)
- Shenyu Wang
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Ji Zeng
- Clinical Research Department, Sinovac Biotech Co., Ltd , Beijing, China
| | - Xinpei Zhang
- Shangyu District Center for Disease Control and Prevention , Shaoxing, China
| | - Zhengkai Gan
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China.,Department of Immunization Programme, Xiuzhou District Center for Disease Control and Prevention , Jiaxing, China
| | - Jianqiang Fan
- Shangyu District Center for Disease Control and Prevention , Shaoxing, China
| | - Yingping Chen
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Zhenzhen Liang
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Xiaosong Hu
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
| | - Gang Zeng
- Clinical Research Department, Sinovac Biotech Co., Ltd , Beijing, China
| | - Huakun Lv
- Department of Immunization Programme, Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou, China
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Luo S, Wu F, Ye X, Fu T, Tao J, Luo W, Wang Y, Jia J, Lou L. Safety Comparison of Two Enterovirus 71 (EV71) Inactivated Vaccines in Yiwu, China. J Trop Pediatr 2019; 65:547-551. [PMID: 31079146 DOI: 10.1093/tropej/fmz004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The safety of two kinds of post-marketing enterovirus 71 (EV71) vaccine in China was evaluated in this study. Fourteen vaccination clinics were randomly assigned in a 1:1 ratio, and both children in two groups were administered according to a two-dose schedule (on a 0 and 28 day schedule). Written informed consent was obtained, and recipients in this study were observed for 30 min after inoculation in the clinic, and then followed via phone or on-site follow-up at day 3 and 30. No severe EV71-associated adverse event was reported. No significant difference was noticed between Group Sinovac and Group CAMS (χz = 0.346, p = 0.556). There was no significant difference in the occurrence of adverse events among recipients aged less than 24 months; however, the proportion of adverse events was higher in Group CAMS than in Group Sinovac among the subjects aged 24-35 months (5.3% vs. 2.5%, p < 0.001). The two kinds of EV71 vaccines showed satisfactory safety. Adverse events after vaccination were normal and acceptable.
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Affiliation(s)
- Shuying Luo
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
| | - Fei Wu
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
| | - Xiaojun Ye
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
| | - Tao Fu
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
| | - Jingbo Tao
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
| | - Weibiao Luo
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
| | - Ying Wang
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
| | - Jianwei Jia
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
| | - Lingqiao Lou
- Division of Planned Immunization, Yiwu Center for Disease Prevention and Control, Zhejiang Province, China
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11
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Li Y, Zhou Y, Cheng Y, Wu P, Zhou C, Cui P, Song C, Liang L, Wang F, Qiu Q, Guo C, Zeng M, Long L, Cowling BJ, Yu H. Effectiveness of EV-A71 vaccination in prevention of paediatric hand, foot, and mouth disease associated with EV-A71 virus infection requiring hospitalisation in Henan, China, 2017-18: a test-negative case-control study. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:697-704. [PMID: 31375313 PMCID: PMC8713082 DOI: 10.1016/s2352-4642(19)30185-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inactivated monovalent enterovirus A71 (EV-A71) vaccines are now available in China to reduce the substantial public health burden of hand, foot, and mouth disease. However, post-licensure monitoring of vaccine effectiveness is important. We did an observational test-negative study of EV-A71 vaccine effectiveness. METHODS Children with hand, foot, and mouth disease who were admitted to Henan Children's Hospital (Zhengzhou, China) within 7 days of illness onset were invited to participate in this test-negative case-control study. Participant vaccination history with EV-A71, including the number of doses received and the date of each dose of vaccination, was elicited from parents or legal guardians of participants with a standardised questionnaire. Children must have received two doses before hospitalisation to be counted as fully vaccinated. Patients who had received a single dose before hospitalisation were classified as partly vaccinated. Children who had received no EV-A71 vaccine before hospitalisation were classified as unvaccinated. Throat swabs and stool samples collected from patients were tested by RT-PCR to identify EV-A71 and other enteroviruses. The primary outcome of the study was paediatric hand, foot, and mouth disease associated with EV-A71 requiring hospitalisation. We estimated vaccine effectiveness with conditional logistic regression models adjusted for potential confounders. FINDINGS Between Feb 15, 2017, and Feb 15, 2018, we enrolled 1803 children aged 6-71 months with hand, foot, and mouth disease. 234 (13%) children tested positive for EV-A71, 1529 (85%) tested positive for other enteroviruses-528 (29%) were positive for Coxsackievirus (CV)-A6 and 342 (19%) were positive for CV-A16-and 29 (2%) tested negative for all enteroviruses. 11 (1%) children with neither throat swab nor stool testing results were excluded from further analyses. Overall vaccine effectiveness was estimated to be 85·4% (95% CI 53·2 to 95·4) for fully vaccinated children and 63·1% (13·1 to 84·3) for partly vaccinated children. The vaccine effectiveness for full vaccination was estimated to be 91·1% (35·1 to 98·8) among non-severe cases compared with 73·3% (-32·6 to 94·6) in severe cases. The vaccine effectiveness for partial vaccination was 77·9% (4·3 to 94·9) in children aged 24-71 months and 40·8% (-71·1 to 79·5) in children aged 6-23 months. We found no significant association between full or partial vaccination and CV-A6 or CV-A16-related hand, foot, and mouth disease. INTERPRETATION EV-A71 vaccination was effective in preventing non-severe hand, foot, and mouth disease associated with EV-A71 virus infection in children aged 6-71 months, and we found evidence that one dose of vaccination provided partial protection for children aged 24-71 months. Introduction of multivalent vaccines could further reduce the burden of hand, foot, and mouth disease. FUNDING The National Science Fund for Distinguished Young Scholars.
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Affiliation(s)
- Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yonghong Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yibing Cheng
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Chongchen Zhou
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Peng Cui
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Chunlan Song
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Lu Liang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fang Wang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Chun Guo
- School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Mengyao Zeng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China; NHC Key Lab of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research, Medical School, Fudan University, Shanghai, China
| | - Lu Long
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
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12
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Zhou B, Xu L, Zhu R, Tang J, Wu Y, Su R, Yin Z, Liu D, Jiang Y, Wen C, You M, Dai L, Lin Y, Chen Y, Yang H, An Z, Fan C, Cheng T, Luo W, Xia N. A bispecific broadly neutralizing antibody against enterovirus 71 and coxsackievirus A16 with therapeutic potential. Antiviral Res 2018; 161:28-35. [PMID: 30419253 DOI: 10.1016/j.antiviral.2018.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/27/2018] [Accepted: 11/06/2018] [Indexed: 01/03/2023]
Abstract
Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) are the major pathogens of hand, foot and mouth disease (HFMD), which affects children worldwide and is often associated with neurological complications. At present, there is no vaccine or cure available for simultaneous EV71 and CA16 infection, posing a great need to develop novel strategies for the treatment of this disease. Here, we engineered four bispecific antibodies using variable fragments of monoclonal antibodies (mAbs) from EV71- and CA16-specific neutralizing antibodies. The engineered bispecific antibody Bs(scFv)4-IgG-1 exhibits remarkable cross-reactivity against EV71 and CA16 and has a more potent cross-neutralization than its parental antibodies. Furthermore, we showed that Bs(scFv)4-IgG-1 conferred 100% therapeutic efficacy against single or mixed EV71 and CA16 infections in mice. Our study provides important insights into bispecific antibody engineering against enterovirus and will inform new curative treatment options for HFMD.
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Affiliation(s)
- Bing Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Longfa Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Rui Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Jixian Tang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Yangtao Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Ruopeng Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Zhichao Yin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Dongxiao Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Yichao Jiang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Can Wen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Min You
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Linlin Dai
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Yu Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Yuanzhi Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
| | - Haijie Yang
- School of Life Sciences and Technology, Xinxiang Medical University, Xinxiang, 453003, PR China
| | - Zhiqiang An
- The Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Changfa Fan
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control, Beijing, 100050, PR China.
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China.
| | - Wenxin Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China.
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, PR China
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13
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Hu Y, Zeng G, Chu K, Zhang J, Han W, Zhang Y, Li J, Zhu F. Five-year immunity persistence following immunization with inactivated enterovirus 71 type (EV71) vaccine in healthy children: A further observation. Hum Vaccin Immunother 2018; 14:1517-1523. [PMID: 29482422 PMCID: PMC6037439 DOI: 10.1080/21645515.2018.1442997] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/30/2018] [Accepted: 02/15/2018] [Indexed: 12/21/2022] Open
Abstract
The longevity of antibodies induced by inactivated enterovirus 71 type (EV71) vaccine is not well studied. To estimate the immunity persistence following two-dose vaccination of EV71 vaccine, a five-year follow-up study was conducted as an extension of a Phase III clinical trial. In this study, a sub-cohort of volunteers who was eligible for enrollment and randomly administrated either 2 dose EV71 vaccine or placebo in the phase III clinical trial was selected, and then further observed 64 months post the 1st vaccination. 211 Subjects (106 vaccine subjects and 105 placebo subjects) who provided a full series of blood samples (at all the sampling points) were included in the final analyzed population. Seropositive rate (SR) and geometric mean titer (GMT) of the neutralizing antibodies (NAb) was calculated to detect the dynamic profiles of EV71 vaccine-induced immunogenicity. SR at the 5th year remained 94.34% in the vaccine subjects, with a GMT of 141.42. The SR was 71.43% in the placebo subjects, with a GMT of 71.83. Despite natural infection consistently promoted the NAb increase in the placebo subjects, the SR and GMT in vaccine subjects remained significantly higher than that in the placebo subjects at all the sampling points. The inactivated EV71 vaccine-induced immunity had a good persistence, within 5 years following the primary vaccination.
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Affiliation(s)
- Yuemei Hu
- Jiangsu Province Center for Disease Control and Prevention, Nanjing, China
| | - Gang Zeng
- Sinovac Biotech Co., LTD., Beijing, China
- Beijing Engineering Research Center, Beijing, China
| | - Kai Chu
- Jiangsu Province Center for Disease Control and Prevention, Nanjing, China
| | - Jing Zhang
- Sheyang County Center for Disease Control and Prevention, China
| | | | - Ying Zhang
- Sinovac Biotech Co., LTD., Beijing, China
| | - Jing Li
- Sinovac Biotech Co., LTD., Beijing, China
| | - Fengcai Zhu
- Jiangsu Province Center for Disease Control and Prevention, Nanjing, China
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14
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Wang M, Dong Q, Wang H, He Y, Chen Y, Zhang H, Wu R, Chen X, Zhou B, He J, Kung HF, Huang C, Wei Y, Huang JD, Xu H, He ML. Oblongifolin M, an active compound isolated from a Chinese medical herb Garcinia oblongifolia, potently inhibits enterovirus 71 reproduction through downregulation of ERp57. Oncotarget 2017; 7:8797-808. [PMID: 26848777 PMCID: PMC4891005 DOI: 10.18632/oncotarget.7122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
There is no effective drug to treat EV71 infection yet. Traditional Chinese herbs are great resources for novel antiviral compounds. Here we showed that Oblongifolin M (OM), an active compound isolated from Garcinia oblongifolia, potently inhibited EV71 infection in a dose dependent manner. To identify its potential effectors in the host cells, we successfully identified 18 proteins from 52 differentially expressed spots by comparative proteomics studies. Further studies showed that knockdown of ERp57 inhibited viral replication through downregulating viral IRES (internal ribosome entry site) activities, whereas ectopic expression of ERp57 increased IRES activity and partly rescued the inhibitory effects of OM on viral replication. We demonstrated that OM is an effective antiviral agent; and that ERp57 is one of its cellular effectors against EV71 infection.
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Affiliation(s)
- Mengjie Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Qi Dong
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.,Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.,Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
| | - Hua Wang
- Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Yaqing He
- Shenzhen Center for Disease Control and Prevention (Shenzhen CDC), Shenzhen, China
| | - Ying Chen
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
| | - Hong Zhang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rong Wu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinchun Chen
- Institute of Infectious Diseases, The 3rd Peoples' Hospital of Shenzhen, Shenzhen, China
| | - Boping Zhou
- Institute of Infectious Diseases, The 3rd Peoples' Hospital of Shenzhen, Shenzhen, China
| | - Jason He
- College of Letter and Sciences, University of California at Berkeley, Berkeley, CA, USA
| | - Hsiang-Fu Kung
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.,Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Canhua Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuquan Wei
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jian-dong Huang
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, China
| | - Hongxi Xu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming-Liang He
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
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15
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Li Y, Lin Z, Xu T, Wang C, Zhao M, Xiao M, Wang H, Deng N, Zhu B. Delivery of VP1 siRNA to inhibit the EV71 virus using functionalized silver nanoparticles through ROS-mediated signaling pathways. RSC Adv 2017. [DOI: 10.1039/c6ra26472g] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Enterovirus 71 (EV71) is the primary causative agent of hand, foot, and mouth disease (HFMD).
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Affiliation(s)
- Yinghua Li
- Center Laboratory
- Guangzhou Women and Children's Medical Center
- Guangzhou Medical University
- Guangzhou
- China
| | - Zhengfang Lin
- Center Laboratory
- Guangzhou Women and Children's Medical Center
- Guangzhou Medical University
- Guangzhou
- China
| | - Tiantian Xu
- Center Laboratory
- Guangzhou Women and Children's Medical Center
- Guangzhou Medical University
- Guangzhou
- China
| | - Changbing Wang
- Center Laboratory
- Guangzhou Women and Children's Medical Center
- Guangzhou Medical University
- Guangzhou
- China
| | - Mingqi Zhao
- Center Laboratory
- Guangzhou Women and Children's Medical Center
- Guangzhou Medical University
- Guangzhou
- China
| | - Misi Xiao
- Center Laboratory
- Guangzhou Women and Children's Medical Center
- Guangzhou Medical University
- Guangzhou
- China
| | - Hanzhong Wang
- State Key Laboratory of Virology
- Wuhan Institute of Virology
- Chinese Academy of Sciences
- China
| | - Ning Deng
- Guangdong Province
- Key Laboratory of Molecular Immunology and Antibody Engineering
- Jinan University
- Guangzhou
- China
| | - Bing Zhu
- Center Laboratory
- Guangzhou Women and Children's Medical Center
- Guangzhou Medical University
- Guangzhou
- China
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16
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Zhou Y, Li JX, Jin PF, Wang YX, Zhu FC. Enterovirus 71: a whole virion inactivated enterovirus 71 vaccine. Expert Rev Vaccines 2016; 15:803-13. [PMID: 27206811 DOI: 10.1080/14760584.2016.1191357] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Enterovirus A71 (EV71) is the predominant causative agent of hand, foot, and mouth disease (HFMD), which is often associated with severe cases and even deaths. EV71-associated epidemics have emerged as a serious threat to public health, particularly in the Asia-Pacific region. AREAS COVERED We searched PubMed using the terms 'enterovirus 71', 'hand, foot, and mouth disease', and 'vaccine', with no date or language restrictions for all publications before April 27, 2016. Among various vaccine candidates, the alum-adjuvant inactivated EV71 vaccines are most promising. Three alum-adjuvant inactivated EV71 vaccines developed by mainland China showed high efficacy, good immunogenicity persistence and acceptable safety profiles in clinical trials. Recently, two of these EV71 vaccines have been approved for marketing in China and the other one is undergoing the review process of licensure. In this manuscript, we summarized previous study results as well as discussed the regulatory affairs and post-market surveillances issues. Expert commentary: The marketing of EV71 vaccines is a milestone in the controlling of HFMD. International clinical trials are needed to further assess the efficacy and cross-immunogenicity. Establishing a sensitive pathogen monitoring system would be essential to monitor the variation of genotypes and control HFMD epidemics.
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Affiliation(s)
- Yang Zhou
- a School of Public Health , Southeast University , Nanjing , PR China
| | - Jing-Xin Li
- b Department of Vaccine Clinical Evaluation , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China.,c College of Pharmacy , Third Military Medical University & National Engineering Research Center for Immunological Products , Chongqing , PR China
| | - Peng-Fei Jin
- d School of Public Health , Nanjing Medical University , Nanjing , PR China
| | - Yu-Xiao Wang
- a School of Public Health , Southeast University , Nanjing , PR China
| | - Feng-Cai Zhu
- b Department of Vaccine Clinical Evaluation , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
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17
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Zhang W, Kong Y, Jiang Z, Li C, Wang L, Xia J. Comprehensive safety assessment of a human inactivated diploid enterovirus 71 vaccine based on a phase III clinical trial. Hum Vaccin Immunother 2016; 12:922-30. [PMID: 26837471 DOI: 10.1080/21645515.2015.1115934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Human enterovirus 71 (EV71) is a causative agent of hand, foot, and mouth disease (HFMD). In a previous phase III trial in children, a human diploid cell-based inactivated EV71 vaccine elicited EV71 specific immune responses and protection against EV71 associated HFMD. This study aimed to assess the factors influencing the severity of adverse events observed in this previous trial. This was a randomized, double-blinded, placebo-controlled, phase III clinical trial of a human diploid vaccine carried out in 12,000 children in Guangxi Zhuang Autonomous Region, China (ClinicalTrials.gov: NCT01569581). Solicited events were recorded for 7 days and unsolicited events were reported for 28 days after each injection. Age trend analysis of adverse reaction was conducted in each treatment group. Multiple logistic regression models were built to identify factors influencing the severity of adverse reactions. Fewer solicited adverse reactions were observed in older participants within the first 7 days after vaccination (P < 0.0001), except local pain and pruritus. More severe adverse reactions were observed after the initial injection than after the booster injection. Serious cold or respiratory tract infections (RTI) were observed more often in children aged 6-36 months than in older children. Only the severity of local swelling was associated with body mass index. Children with throat discomfort before injection had a higher risk of serious cold or RTI. These results indicated that the human diploid cell-based vaccine achieved a satisfactory safety profile.
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Affiliation(s)
- Wei Zhang
- a Department of Health Statistics , Faculty of Preventative Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Yujia Kong
- a Department of Health Statistics , Faculty of Preventative Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China.,b Department of Public Health , Weifang Medical College , Weifang , Shandong , China
| | - Zhiwei Jiang
- a Department of Health Statistics , Faculty of Preventative Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Chanjuan Li
- a Department of Health Statistics , Faculty of Preventative Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Ling Wang
- a Department of Health Statistics , Faculty of Preventative Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Jielai Xia
- a Department of Health Statistics , Faculty of Preventative Medicine, Fourth Military Medical University , Xi'an , Shaanxi , China
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18
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Lin SY, Chiu HY, Chiang BL, Hu YC. Development of EV71 virus-like particle purification processes. Vaccine 2015; 33:5966-73. [DOI: 10.1016/j.vaccine.2015.04.077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/11/2015] [Accepted: 04/16/2015] [Indexed: 12/20/2022]
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19
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Li JX, Song YF, Wang L, Zhang XF, Hu YS, Hu YM, Xia JL, Li J, Zhu FC. Two-year efficacy and immunogenicity of Sinovac Enterovirus 71 vaccine against hand, foot and mouth disease in children. Expert Rev Vaccines 2015; 15:129-37. [PMID: 26460695 DOI: 10.1586/14760584.2016.1096782] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To evaluate the efficacy and immunogenicity of the Sinovac Enterovirus 71 (EV71) vaccine for up to two years. METHODS We did a follow-up study of our initial randomized trial in 10,077 participants, who were randomized to receive EV71 vaccine or placebo in a 1:1 ratio and followed for 14 months. The extended follow-up study lasted for another 12 months and EV71-associated hand, foot, and mouth disease (HFMD) was the primary endpoint. RESULTS The EV71 vaccine showed an efficacy of 95.1% (95%CI 63.6, 99.3) against EV71-associated HFMD during the extended follow-up and an overall efficacy of 94.7% (95%CI 87.8, 97.6) for two years. The EV71 vaccine elicited a sustained high level of neutralizing antibodies in participants, and no serious adverse event was judged to be related to the vaccination. CONCLUSION The Sinovac EV71 vaccine could provide a sustained high protection against EV71-associated HFMDs for up to 2 years.
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Affiliation(s)
- Jing-Xin Li
- a College of Pharmacy , Third Military Medical University & National Engineering Research Center for Immunological Products , Chongqing , PR China.,b Vaccine Clinical Evaluation Department , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
| | | | - Ling Wang
- d Statistics Department , Fourth Military Medical University , Xi'an , PR China
| | - Xue-Feng Zhang
- b Vaccine Clinical Evaluation Department , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
| | | | - Yue-Mei Hu
- b Vaccine Clinical Evaluation Department , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
| | - Jie-Lai Xia
- d Statistics Department , Fourth Military Medical University , Xi'an , PR China
| | - Jing Li
- c Sinovac Biotech , Beijing , PR China
| | - Feng-Cai Zhu
- b Vaccine Clinical Evaluation Department , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
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Development of a Specific Latex Agglutination Test to Detect Antibodies of Enterovirus 71. Arch Med Res 2015; 46:580-7. [DOI: 10.1016/j.arcmed.2015.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
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A Broadly Cross-protective Vaccine Presenting the Neighboring Epitopes within the VP1 GH Loop and VP2 EF Loop of Enterovirus 71. Sci Rep 2015; 5:12973. [PMID: 26243660 PMCID: PMC4525384 DOI: 10.1038/srep12973] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 07/14/2015] [Indexed: 02/01/2023] Open
Abstract
Human enterovirus 71 (EV71) and coxsackievirus A16 (CA16) are the major etiological agents of hand, foot and mouth disease (HFMD) and are often associated with neurological complications. Currently, several vaccine types are being developed for EV71 and CA16. In this study, we constructed a bivalent chimeric virus-like particle (VLP) presenting the VP1 (aa208-222) and VP2 (aa141-155) epitopes of EV71 using hepatitis B virus core protein (HBc) as a carrier, designated HBc-E1/2. Immunization with the chimeric VLPs HBc-E1/2 induced higher IgG titers and neutralization titers against EV71 and CA16 in vitro than immunization with only one epitope incorporated into HBc. Importantly, passive immunization with the recombinant HBc-E2 particles protected neonatal mice against lethal EV71 and CA16 infections. We demonstrate that anti-VP2 (aa141-155) sera bound authentic CA16 viral particles, whereas anti-VP1 (aa208-222) sera could not. Moreover, the anti-VP2 (aa141-155) antibodies inhibited the binding of human serum to virions, which demonstrated that the VP2 epitope is immunodominant between EV71 and CA16. These results illustrated that the chimeric VLP HBc-E1/2 is a promising candidate for a broad-spectrum HFMD vaccine, and also reveals mechanisms of protection by the neighboring linear epitopes of the VP1 GH and VP2 EF loops.
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22
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Lin SY, Yeh CT, Li WH, Yu CP, Lin WC, Yang JY, Wu HL, Hu YC. Enhanced enterovirus 71 virus-like particle yield from a new baculovirus design. Biotechnol Bioeng 2015; 112:2005-15. [PMID: 25997678 PMCID: PMC7161748 DOI: 10.1002/bit.25625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/17/2015] [Accepted: 04/23/2015] [Indexed: 01/22/2023]
Abstract
Enterovirus 71 (EV71) is responsible for the outbreaks of hand‐foot‐and‐mouth disease in the Asia‐Pacific region. To produce the virus‐like particle (VLP) vaccine, we previously constructed recombinant baculoviruses to co‐express EV71 P1 polypeptide and 3CD protease using the Bac‐to‐Bac® vector system. The recombinant baculoviruses resulted in P1 cleavage by 3CD and subsequent VLP assembly in infected insect cells, but caused either low VLP yield or excessive VLP degradation. To tackle the problems, here we explored various expression cassette designs and flashBAC GOLD™ vector system which was deficient in v‐cath and chiA genes. We found that the recombinant baculovirus constructed using the flashBAC GOLD™ system was insufficient to improve the EV71 VLP yield. Nonetheless, BacF‐P1‐C3CD, a recombinant baculovirus constructed using the flashBAC GOLDTM system to express P1 under the polh promoter and 3CD under the CMV promoter, dramatically improved the VLP yield while alleviating the VLP degradation. Infection of High FiveTM cells with BacF‐P1‐C3CD enhanced the total and extracellular VLP yield to ≈268 and ≈171 mg/L, respectively, which enabled the release of abundant VLP into the supernatant and simplified the downstream purification. Intramuscular immunization of mice with 5 μg purified VLP induced cross‐protective humoral responses and conferred protection against lethal virus challenge. Given the significantly improved extracellular VLP yield (≈171 mg/L) and the potent immunogenicity conferred by 5 μg VLP, one liter High FiveTM culture produced ≈12,000 doses of purified vaccine, thus rendering the EV71 VLP vaccine economically viable and able to compete with inactivated virus vaccines. Biotechnol. Bioeng. 2015;112: 2005–2015. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Shih-Yeh Lin
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Chia-Tsui Yeh
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Wan-Hua Li
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Cheng-Ping Yu
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Chin Lin
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Jyh-Yuan Yang
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Taipei, Taiwan
| | - Hsueh-Ling Wu
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Hu
- Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan.
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23
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Bian L, Wang Y, Yao X, Mao Q, Xu M, Liang Z. Coxsackievirus A6: a new emerging pathogen causing hand, foot and mouth disease outbreaks worldwide. Expert Rev Anti Infect Ther 2015; 13:1061-71. [DOI: 10.1586/14787210.2015.1058156] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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24
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Mao Q, Wang Y, Shao J, Ying Z, Gao F, Yao X, Li C, Ye Q, Xu M, Li R, Zhu F, Liang Z. The compatibility of inactivated-Enterovirus 71 vaccination with Coxsackievirus A16 and Poliovirus immunizations in humans and animals. Hum Vaccin Immunother 2015; 11:2723-33. [PMID: 25715318 DOI: 10.1080/21645515.2015.1011975] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Enterovirus 71 (EV71) is the key pathogen for Hand, Foot, and Mouth Disease (HFMD) and can result in severe neurological complications and death among young children. Three inactivated-EV71 vaccines have gone through phase III clinical trials and have demonstrated good safety and efficacy. These vaccines will benefit young children under the threat of severe HFMD. However, the potential immunization-related compatibility for different enterovirus vaccines remains unclear, making it hard to include the EV71 vaccine in Expanded Program on Immunization (EPI). Here, we measured the neutralizing antibodies (NTAbs) against EV71, Coxsackievirus A16 (CA16) and Poliovirus from infants enrolled in those EV71 vaccine clinical trials. The results indicated that the levels of NTAb GMTs for EV71 increased significantly in all 3 vaccine groups (high, middle and low dosages, respectively) post-vaccination. Seroconversion ratios and Geometric mean fold increase were significantly higher in the vaccine groups (≥ 7/9 and 8.9 ~ 228.1) than in the placebo group (≤ 1/10 and 0.8 ~ 1.7, P < 0.05). But no similar NTAb response trends were found in CA16 and 3 types of Poliovirus. The decrease of 3 types of Poliovirus NTAb GMTs and an increase of CA16 GMTs post-EV71-vaccination were found in vaccine and placebo groups. Further animal study on CA16 and poliovirus vaccine co-immunization or pre-immunization with EV71 vaccine in mice indicated that there was no NTAb cross-activity between EV71 and CA16/Poliovirus. Our research showed that inactivated-EV71 vaccine has good specific-neutralizing capacity and can be included in EPI.
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Affiliation(s)
- Qunying Mao
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Yiping Wang
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Jie Shao
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Zhifang Ying
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Fan Gao
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Xin Yao
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Changgui Li
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Qiang Ye
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Miao Xu
- a National Institutes for Food and Drug Control ; Beijing , China
| | - Rongcheng Li
- b The Center for Disease Control and Prevention of the Guangxi Zhuang Autonomous Region ; Nanning , China
| | - Fengcai Zhu
- c Jiangsu Provincial Center for Disease Control and Prevention ; Nanjing , China
| | - Zhenglun Liang
- a National Institutes for Food and Drug Control ; Beijing , China
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25
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Hou W, Yang L, He D, Zheng J, Xu L, Liu J, Liu Y, Zhao H, Ye X, Cheng T, Xia N. Development of a coxsackievirus A16 neutralization test based on the enzyme-linked immunospot assay. J Virol Methods 2015; 215-216:56-60. [PMID: 25704596 DOI: 10.1016/j.jviromet.2015.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 12/17/2014] [Accepted: 02/11/2015] [Indexed: 01/16/2023]
Abstract
Coxsackievirus A16 (CA16) is one of the major pathogens responsible for hand, foot and mouth disease (HFMD). The assessment of the humoral immunity response is indispensable in the development of vaccines against enteroviruses. The neutralization test based on the inhibition of cytopathic effects (Nt-CPE) is a common method for measuring neutralizing antibodies against CA16. However, an efficient neutralization test needs to be developed for seroepidemiological surveys and clinical trials of CA16 vaccines because Nt-CPE is time-consuming and labor-intensive. In this study, a high-throughput neutralization test for CA16 based on the enzyme-linked immunospot assay (Nt-ELISPOT) was developed. The monoclonal antibody 7D10, which reacted with the viral protein VP1, was used to detect the cells infected with CA16. The neutralizing titers of sera were proven to be unchanged over an infectious dose range from 10 to 10,000TCID50 per well. The Nt-ELISPOT results correlated well with the Nt-CPE results (R(2) = 0.9250), and the detection period was shortened from five days to approximately 30h. Overall, the Nt-ELISPOT is a reliable and efficient method for measuring neutralizing antibodies against CA16.
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Affiliation(s)
- Wangheng Hou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, 361102, China
| | - Lisheng Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, 361102, China
| | - Delei He
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, 361102, China
| | - Jun Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, 361102, China
| | - Longfa Xu
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Jian Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, 361102, China
| | - Yajing Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, 361102, China
| | - Huan Zhao
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Xiangzhong Ye
- Beijing Wantai Biological Pharmacy Enterprise Co., Ltd., Beijing, 102206, China
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, 361102, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen 361102, China.
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, Xiamen University, Xiamen, 361102, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen 361102, China
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Abstract
Enterovirus 71 (EV-71) is the main causative agent of hand, foot, and mouth disease (HFMD) which is generally regarded as a mild childhood disease. In recent years, EV71 has emerged as a significant pathogen capable of causing high mortalities and severe neurological complications in large outbreaks in Asia. A formalin-inactivated EV71 whole virus vaccine has completed phase III trial in China but is currently unavailable clinically. The high cost of manufacturing and supply problems may limit practical implementations in developing countries. Synthetic peptides representing the native primary structure of the viral immunogen which is able to elicit neutralizing antibodies can be made readily and is cost effective. However, it is necessary to conjugate short synthetic peptides to carrier proteins to enhance their immunogenicity. This review describes the production of cross-neutralizing anti-peptide antibodies in response to immunization with synthetic peptides selected from in silico analysis, generation of B-cell epitopes of EV71 conjugated to a promiscuous T-cell epitope from Poliovirus, and evaluation of the neutralizing activities of the anti-peptide antibodies. Besides neutralizing EV71 in vitro, the neutralizing antibodies were cross-reactive against several Enteroviruses including CVA16, CVB4, CVB6, and ECHO13.
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Affiliation(s)
- Chit Laa Poh
- Sunway University, No. 5, Jalan Universiti, Bandar Sunway, Kuala Lumpur, Selangor Darul Ehsan, 47500, Malaysia.
| | | | - Hui Na Chua
- Sunway University, No. 5, Jalan Universiti, Bandar Sunway, Kuala Lumpur, Selangor Darul Ehsan, 47500, Malaysia
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Li L, Yin H, An Z, Feng Z. Considerations for developing an immunization strategy with enterovirus 71 vaccine. Vaccine 2014; 33:1107-12. [PMID: 25444807 DOI: 10.1016/j.vaccine.2014.10.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/21/2014] [Accepted: 10/30/2014] [Indexed: 12/16/2022]
Abstract
Enterovirus 71 (EV71) is a common pathogen for hand, foot, and mouth disease (HFMD), which has significant morbidity and mortality, and for which children aged 6-59 months age are at highest risk. Due to lack of effective treatment options, control of EV71 epidemics has mainly focused on development of EV71 vaccines. Clinical trials have been completed on 3 EV71 vaccines, with trial results demonstrating good vaccine efficacy and safety. When EV71 vaccine is approved by China's national regulatory authority, an evidence-based strategy should be developed to optimize impact and safety. An immunization strategy for EV71 vaccine should consider several factors, including the target population age group, the number of doses for primary immunization, the need for a booster dose, concomitant administration of other vaccines, economic value, program capacity and logistics, and public acceptance. Once EV71 vaccines are in use, vaccine effectiveness and safety must be monitored in large populations, and the epidemiology of HFMD must be evaluated to assure a match between vaccination strategy and epidemiology. Evaluation in China is especially important because there are no other EV71 vaccines globally.
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Affiliation(s)
- Li Li
- Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Hongzhang Yin
- The Center for Drug Evaluation, China Food and Drug Administration, Beijing 100050, China
| | - Zhijie An
- Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, Beijing 100050, China.
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28
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EV71 vaccine, an invaluable gift for children. Clin Transl Immunology 2014; 3:e28. [PMID: 25505956 PMCID: PMC4237031 DOI: 10.1038/cti.2014.24] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/09/2014] [Accepted: 09/09/2014] [Indexed: 12/26/2022] Open
Abstract
Enterovirus 71 (EV71) is a major pathogen for severe hand, foot and mouth disease (HFMD). Development of vaccines against EV71 would be the most effective approach to prevent the EV71 outbreak. Research and development (R&D) of EV71 vaccine was carried out in several Asian countries. Currently three companies in mainland China have completed Phase III clinical trials of inactivated EV71 whole-virus vaccines, whereas the other two companies have completed Phase I clinical trials separately in Taiwan and in Singapore. Results from those clinical trials have indicated high safety and immunogenicity of EV71 vaccine. Protective efficacies were over 90% on EV71-associated HFMD and over 80% on other EV71-associated diseases. In this paper, we summarize the results from three EV71 vaccine Phase III clinical trials and discuss the challenges of incorporating EV71 vaccine into Expanded Program on Immunization (EPI) in countries with EV71 epidemics.
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Abstract
INTRODUCTION Enterovirus 71 (EV71) is an etiological agent that causes severe neurological complications in children. EV71 outbreaks have occurred throughout the Asia-Pacific region, posing a severe global public health threat; however, no specific therapeutic strategy exists for treating EV71-infected children. AREAS COVERED Five manufacturers have produced inactivated EV71 whole virus vaccines in mainland China, Taiwan, and Singapore, which have completed Phase III (mainland China) and Phase I (Taiwan and Singapore) clinical trials. Various EV71 vaccine candidates are being researched in animal models, including live-attenuated virus vaccine, recombinant VP1 vaccine, VP1-based DNA vaccine, synthetic peptide vaccine and virus-like particle vaccine. In this review, the present situation is summarized, and feasible improvements to the EV71 vaccine are explored. EXPERT OPINION Although inactivated EV71 vaccines are safe, efficient and elicit strong immune responses to protect adults, children and infants against infection, the quality control of production is critical.
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Affiliation(s)
- Yu-An Kung
- Chang Gung University, Research Center for Emerging Viral Infections , 259 Wen-Hua 1st Road, Kwei-Shan, Taoyuan, 333 (Zip code) , Taiwan +886 3 2118800 ext. 5497 ; +886 3 2118174 ;
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30
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Cryo-electron microscopy study of insect cell-expressed enterovirus 71 and coxsackievirus a16 virus-like particles provides a structural basis for vaccine development. J Virol 2014; 88:6444-52. [PMID: 24672036 DOI: 10.1128/jvi.00200-14] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) are the two most common etiological agents responsible for the epidemics of hand, foot, and mouth disease (HFMD), a childhood illness with occasional severe neurological complications. A number of vaccine candidates against EV71 or CA16 have been reported; however, no vaccine is currently available for clinical use. Here, we generated a secreted version of EV71 and CA16 virus-like particles (VLPs) using a baculovirus-insect cell expression system and reconstructed the three-dimensional (3D) structures of both VLPs by cryo-electron microscopy (cryo-EM) single-particle analysis at 5.2-Å and 5.5-Å resolutions, respectively. The reconstruction results showed that the cryo-EM structures of EV71 and CA16 VLPs highly resemble the recently published crystal structures for EV71 natural empty particles and CA16 135S-like expanded particles, respectively. Our cryo-EM analysis also revealed that the majority of previously identified linear neutralizing epitopes are well preserved on the surface of EV71 and CA16 VLPs. In addition, both VLPs were able to induce efficiently neutralizing antibodies against various strains of EV71 and CA16 viruses in mouse immunization. These studies provide a structural basis for the development of insect cell-expressed VLP vaccines and for a potential bivalent VLP vaccine against both EV71- and CA16-associated HFMD. IMPORTANCE The recent outbreaks of hand, foot, and mouth disease (HFMD) in the Asia Pacific region spurred the search for effective vaccines against EV71 and CA16 viruses, the two most common etiological agents responsible for HFMD. In this paper, we show that secreted versions of EV71 and CA16 VLPs generated in the baculovirus-insect cell expression system highly resemble the crystal structures of their viral conterparts and that the majority of previously identified linear neutralizing epitopes are well preserved on the VLP surfaces. In addition, the generated VLPs can efficiently induce neutralizing antibodies against various strains of EV71 and CA16 viruses in mouse immunization. These studies provide a structural basis for the development of insect cell-expressed VLP vaccines and for a potential bivalent VLP vaccine against both EV71- and CA16-associated HFMD.
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31
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Chen YJ, Meng FY, Mao Q, Li JX, Wang H, Liang ZL, Zhang YT, Gao F, Chen QH, Hu Y, Ge ZJ, Yao X, Guo HJ, Zhu FC, Li XL. Clinical evaluation for batch consistency of an inactivated enterovirus 71 vaccine in a large-scale phase 3 clinical trial. Hum Vaccin Immunother 2014; 10:1366-72. [PMID: 24633366 DOI: 10.4161/hv.28397] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The demonstration of batch-to-batch consistency to confirm the reliability of the manufacturing process has become a mandatory step in vaccine development. This is a post-hoc analysis aimed to provide more solid evidence on the immunogenicity and consistency of 3 consecutive batches of a novel inactivated enterovirus 71 (EV71) vaccine. In total 10 245 healthy Chinese children aged 6-35 months had been recruited and randomized to receive one of 3 batches of EV71 vaccine or placebo according to a two-dose immunization schedule in a phase 3 clinical trial. Blood samples were taken just before and 28 days after vaccinations for serological tests of EV71 neutralizing antibody (NTAb) titer from the subjects. Among them, 7263 (70.9%) subjects with seronegative EV71 NTAb at baseline and the data of serological tests post-vaccination available were included for the analysis. The results showed that EV71 vaccine elicited high geometric mean titers (GMTs) of 407.0 U/mL (95% CI, 373.5-443.6) for batch 1, 468.1 U/mL (95% CI, 432.2-507.0) for batch 2, and 520.6 U/mL (95% CI, 481.2-563.3) for batch 3. The two-sided 95% confidence intervals (CIs) for the GMT ratios between each pair of vaccine batches were all within an interval of [0.67, 1.5]. Subjects who received EV71 vaccines demonstrated significant higher GMTs than those received placebos did (P<0.001). In terms of incidence of both local and general adverse reactions, no differences were found among 3 vaccine batches and placebos. EV71 vaccine was highly immunogenic in children, and the 3 consecutive batches were well consistent.
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Affiliation(s)
- Yi-Juan Chen
- School of Public Health; Southeast University; Nanjing, Jiangsu Province, PR China
| | - Fan-Yue Meng
- Jiangsu Provincial Center for Disease Control and Prevention; Nanjing, Jiangsu Province, PR China
| | - Qunying Mao
- National Institute for Food and Drug Control; Beijing, PR China
| | - Jing-Xin Li
- Jiangsu Provincial Center for Disease Control and Prevention; Nanjing, Jiangsu Province, PR China; College of Pharmacy; Third Military Medical University & National Engineering Research Center for Immunological Products; Chongqing, PR China
| | - Hua Wang
- Jiangsu Provincial Center for Disease Control and Prevention; Nanjing, Jiangsu Province, PR China
| | - Zheng-Lun Liang
- National Institute for Food and Drug Control; Beijing, PR China
| | - Yun-Tao Zhang
- Beijing Vigoo Biological Co., Ltd; Beijing, PR China
| | - Fan Gao
- National Institute for Food and Drug Control; Beijing, PR China
| | - Qing-Hua Chen
- Beijing Vigoo Biological Co., Ltd; Beijing, PR China
| | - Yuemei Hu
- Jiangsu Provincial Center for Disease Control and Prevention; Nanjing, Jiangsu Province, PR China
| | - Zi-Jun Ge
- School of Public Health; Nantong University; Nantong, Jiangsu Province, PR China
| | - Xin Yao
- National Institute for Food and Drug Control; Beijing, PR China
| | - Hui-Jie Guo
- Beijing Vigoo Biological Co., Ltd; Beijing, PR China
| | - Feng-Cai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention; Nanjing, Jiangsu Province, PR China
| | - Xiu-Ling Li
- Beijing Vigoo Biological Co., Ltd; Beijing, PR China
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32
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Li JX, Mao QY, Liang ZL, Ji H, Zhu FC. Development of enterovirus 71 vaccines: from the lab bench to Phase III clinical trials. Expert Rev Vaccines 2014; 13:609-18. [PMID: 24621093 DOI: 10.1586/14760584.2014.897617] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The widespread epidemics of enterovirus 71 (EV71) seriously affected the Western Pacific Region. Young children, especially those younger than 3 years are the most susceptible population to the EV71-associated diseases. Several Asian countries have begun to focus on the research and development of EV71 vaccines. Five inactivated whole-virus EV71 candidate vaccines (three were manufactured in mainland China based on a C4 genotype strain, one in Taiwan based on a B4 genotype strain and one in Singapore based on a B2 genotype strain) have been assessed in clinical trials. Three candidate vaccines developed in mainland China have already completed Phase III clinical trials recently. The tested EV71 vaccine could provide good efficacy, satisfactory safety, and high immunogenicity. Thus, inactivated EV71 vaccines are expected to become the first available vaccines against EV71 in the near future.
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Affiliation(s)
- Jing-Xin Li
- College of Pharmacy, Third Military Medical University and National Engineering Research Center for Immunological Products, Chongqing, PR China
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33
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Shenyu W, Jingxin L, Zhenglun L, Xiuling L, Qunying M, Fanyue M, Hua W, Yuntao Z, Fan G, Qinghua C, Yuemei H, Xin Y, Huijie G, Fengcai Z. A Booster Dose of an Inactivated Enterovirus 71 Vaccine in Chinese Young Children: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Infect Dis 2014; 210:1073-82. [DOI: 10.1093/infdis/jiu113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Attenuation of human enterovirus 71 high-replication-fidelity variants in AG129 mice. J Virol 2014; 88:5803-15. [PMID: 24623423 DOI: 10.1128/jvi.00289-14] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
UNLABELLED In a screen for ribavirin resistance, a novel high-fidelity variant of human enterovirus 71 (EV71) with the single amino acid change L123F in its RNA-dependent RNA polymerase (RdRp or 3D) was identified. Based on the crystal structure of EV71 RdRp, L123 locates at the entrance of the RNA template binding channel, which might form a fidelity checkpoint. EV71 RdRp-L123F variants generated less progeny in a guanidine resistance assay and virus populations with lower mutation frequencies in cell culture passage due to their higher replication fidelity. However, compared with wild-type viruses, they did not show growth defects. In vivo infections further revealed that high-fidelity mutations L123F and G64R (previously reported) negatively impacted EV71 fitness and greatly reduced viral pathogenicity alone or together in AG129 mice. Interestingly, a variant with double mutations, RG/B4-G64R/L123F (where RG/B4 is an EV71 genotype B4 virus constructed by reverse genetics [RG])showed higher fidelity in vitro and less virulence in vivo than any one of the above two single mutants. The 50% lethal dose (LD50) of the double mutant increased more than 500 times compared with the LD50 of wild-type RG/B4 in mice. The results indicated that these high-fidelity variants exhibited an attenuated pathogenic phenotype in vivo and offer promise as a live attenuated EV71 vaccine. IMPORTANCE The error-prone nature of the RNA-dependent RNA polymerase (RdRp) of RNA viruses during replication results in quasispecies and aids survival of virus populations under a wide range of selective pressures. Virus variants with higher replication fidelity exhibit lower genetic diversity and attenuated pathogenicity in vivo. Here, we identified a novel high-fidelity mutation L123F in the RdRp of human enterovirus 71 (EV71). We further elucidated that EV71 variants with the RdRp-L123F mutation and/or the previously identified high-fidelity mutation RdRp-G64R were attenuated in an AG129 mouse model. As EV71 has emerged as a serious worldwide health threat, especially in developing countries in the Asia-Pacific region, we urgently need EV71 vaccines. Learning from the poliovirus vaccination, we prefer live attenuated EV71 vaccines to inactivated EV71 vaccines in order to effectively control EV71 outbreaks at low cost. Our results imply a new means of attenuating EV71 and reducing its mutation rate at the same time.
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Bessaud M, Razafindratsimandresy R, Nougairède A, Joffret ML, Deshpande JM, Dubot-Pérès A, Héraud JM, de Lamballerie X, Delpeyroux F, Bailly JL. Molecular comparison and evolutionary analyses of VP1 nucleotide sequences of new African human enterovirus 71 isolates reveal a wide genetic diversity. PLoS One 2014; 9:e90624. [PMID: 24598878 PMCID: PMC3944068 DOI: 10.1371/journal.pone.0090624] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/01/2014] [Indexed: 01/11/2023] Open
Abstract
Most circulating strains of Human enterovirus 71 (EV-A71) have been classified primarily into three genogroups (A to C) on the basis of genetic divergence between the 1D gene, which encodes the VP1 capsid protein. The aim of the present study was to provide further insights into the diversity of the EV-A71 genogroups following the recent description of highly divergent isolates, in particular those from African countries, including Madagascar. We classified recent EV-A71 isolates by a large comparison of 3,346 VP1 nucleotidic sequences collected from GenBank. Analysis of genetic distances and phylogenetic investigations indicated that some recently-reported isolates did not fall into the genogroups A-C and clustered into three additional genogroups, including one Indian genogroup (genogroup D) and 2 African ones (E and F). Our Bayesian phylogenetic analysis provided consistent data showing that the genogroup D isolates share a recent common ancestor with the members of genogroup E, while the isolates of genogroup F evolved from a recent common ancestor shared with the members of the genogroup B. Our results reveal the wide diversity that exists among EV-A71 isolates and suggest that the number of circulating genogroups is probably underestimated, particularly in developing countries where EV-A71 epidemiology has been poorly studied.
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Affiliation(s)
- Maël Bessaud
- Aix Marseille Univ, IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 “Emergence des Pathologies Virales”, Marseille, France
- * E-mail:
| | | | - Antoine Nougairède
- Aix Marseille Univ, IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 “Emergence des Pathologies Virales”, Marseille, France
| | - Marie-Line Joffret
- Institut Pasteur, Unité de biologie des virus entériques, Paris, France
- INSERM U994, Paris, France
| | | | - Audrey Dubot-Pérès
- Aix Marseille Univ, IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 “Emergence des Pathologies Virales”, Marseille, France
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom
| | - Jean-Michel Héraud
- Institut Pasteur de Madagascar, Unité de Virologie, Antananarivo, Madagascar
| | - Xavier de Lamballerie
- Aix Marseille Univ, IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 “Emergence des Pathologies Virales”, Marseille, France
| | | | - Jean-Luc Bailly
- Clermont Université, Université d'Auvergne, EPIE EA4843, Clermont-Ferrand, France
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Wang SM, Liu CC. Update of enterovirus 71 infection: epidemiology, pathogenesis and vaccine. Expert Rev Anti Infect Ther 2014; 12:447-56. [PMID: 24579906 DOI: 10.1586/14787210.2014.895666] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Enterovirus 71 (EV71) is a neurotropic human pathogen that is the causative agent of hand foot and mouth disease (HFMD), herpangina and brain stem encephalitis. Recurrent EV71 epidemics of various scales have occurred in the Asia-Pacific region. Several specific cell surface molecules serve as the receptors for EV71. Identification of the receptors is an important step to understand EV71 disease. Cytokines, lymphocytes and monocytes contribute significantly to EV71 pathogenesis. The interaction of EV71 and receptors may be associated with the cytokines immunopathogenesis. Some animal models have been established and aim to explore the pathogenesis of EV71 infections. EV71 antibodies can neutralize or enhance infection at subneutralizing levels. These results are important for EV71 vaccine and therapeutics design. Several clinical trials of human inactivated EV71 vaccine have recently been completed. The purpose of this review is to summarize recent discoveries about the epidemiology and pathogenesis of EV71 and provide insights into human vaccine development.
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Affiliation(s)
- Shih-Min Wang
- Department of Emergency Medicine, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
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Zhu F, Xu W, Xia J, Liang Z, Liu Y, Zhang X, Tan X, Wang L, Mao Q, Wu J, Hu Y, Ji T, Song L, Liang Q, Zhang B, Gao Q, Li J, Wang S, Hu Y, Gu S, Zhang J, Yao G, Gu J, Wang X, Zhou Y, Chen C, Zhang M, Cao M, Wang J, Wang H, Wang N. Efficacy, safety, and immunogenicity of an enterovirus 71 vaccine in China. N Engl J Med 2014; 370:818-28. [PMID: 24571754 DOI: 10.1056/nejmoa1304923] [Citation(s) in RCA: 338] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enterovirus 71 (EV71) is one of the major causative agents of outbreaks of hand, foot, and mouth disease or herpangina worldwide. This phase 3 trial was designed to evaluate the efficacy, safety, and immunogenicity of an EV71 vaccine. METHODS We conducted a randomized, double-blind, placebo-controlled, multicenter trial in which 10,007 healthy infants and young children (6 to 35 months of age) were randomly assigned in a 1:1 ratio to receive two intramuscular doses of either EV71 vaccine or placebo, 28 days apart. The surveillance period was 12 months. The primary end point was the occurrence of EV71-associated hand, foot, and mouth disease or herpangina. RESULTS During the 12-month surveillance period, EV71-associated disease was identified in 0.3% of vaccine recipients (13 of 5041 children) and 2.1% of placebo recipients (106 of 5028 children) in the intention-to-treat cohort. The vaccine efficacy against EV71-associated hand, foot, and mouth disease or herpangina was 94.8% (95% confidence interval [CI], 87.2 to 97.9; P<0.001) in this cohort. Vaccine efficacies against EV71-associated hospitalization (0 cases vs. 24 cases) and hand, foot, and mouth disease with neurologic complications (0 cases vs. 8 cases) were both 100% (95% CI, 83.7 to 100 and 42.6 to 100, respectively). Serious adverse events occurred in 111 of 5044 children in the vaccine group (2.2%) and 131 of 5033 children in the placebo group (2.6%). In the immunogenicity subgroup (1291 children), an anti-EV71 immune response was elicited by the two-dose vaccine series in 98.8% of participants at day 56. An anti-EV71 neutralizing antibody titer of 1:16 was associated with protection against EV71-associated hand, foot, and mouth disease or herpangina. CONCLUSIONS The EV71 vaccine provided protection against EV71-associated hand, foot, and mouth disease or herpangina in infants and young children. (Funded by Sinovac Biotech; ClinicalTrials.gov number, NCT01507857.).
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Affiliation(s)
- Fengcai Zhu
- From the Jiangsu Provincial Center for Disease Control and Prevention, Nanjing (F.Z., X.Z., Yuemei Hu, Q.L., J.L., S.W., H.W.); National Institutes for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention (W.X., X.T., T.J., B.Z.), National Institutes for Food and Drug Control (Z.L., Q.M., J. Wang), and Sinovac Biotech (Y.L., J. Wu, L.S., Q.G., Yuansheng Hu, N.W.), Beijing; the Fourth Military Medical University, Xi'an (J.X., L.W.); Sheyang County Center for Disease Control and Prevention, Yancheng City (S.G., J.G., C.C.); Ganyu County Center for Disease Control and Prevention, No. 98, Lianyungang City (J.Z., X.W., M.Z.); and Taixing County Center for Disease Control and Prevention, No. 224, Taizhou City (G.Y., Y.Z., M.C.) - all in China
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Liu Y, Zhang F, Liu J, Xiao X, Zhang S, Qin C, Xiang Y, Wang P, Cheng G. Transmission-blocking antibodies against mosquito C-type lectins for dengue prevention. PLoS Pathog 2014; 10:e1003931. [PMID: 24550728 PMCID: PMC3923773 DOI: 10.1371/journal.ppat.1003931] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/31/2013] [Indexed: 12/29/2022] Open
Abstract
C-type lectins are a family of proteins with carbohydrate-binding activity. Several C-type lectins in mammals or arthropods are employed as receptors or attachment factors to facilitate flavivirus invasion. We previously identified a C-type lectin in Aedes aegypti, designated as mosquito galactose specific C-type lectin-1 (mosGCTL-1), facilitating the attachment of West Nile virus (WNV) on the cell membrane. Here, we first identified that 9 A. aegypti mosGCTL genes were key susceptibility factors facilitating DENV-2 infection, of which mosGCTL-3 exhibited the most significant effect. We found that mosGCTL-3 was induced in mosquito tissues with DENV-2 infection, and that the protein interacted with DENV-2 surface envelop (E) protein and virions in vitro and in vivo. In addition, the other identified mosGCTLs interacted with the DENV-2 E protein, indicating that DENV may employ multiple mosGCTLs as ligands to promote the infection of vectors. The vectorial susceptibility factors that facilitate pathogen invasion may potentially be explored as a target to disrupt the acquisition of microbes from the vertebrate host. Indeed, membrane blood feeding of antisera against mosGCTLs dramatically reduced mosquito infective ratio. Hence, the immunization against mosGCTLs is a feasible approach for preventing dengue infection. Our study provides a future avenue for developing a transmission-blocking vaccine that interrupts the life cycle of dengue virus and reduces disease burden. Dengue virus (DENV), a mosquito-borne flavivirus, is currently the most significant arbovirus afflicting tropical and sub-tropical countries worldwide. No vaccine or therapeutics are available, and dengue has rapidly spread over the last decade. Therefore, additional strategies to combat dengue are urgently needed. In this study, we characterized multiple C-type lectins as susceptibility factors for dengue infection in A. aegypti. These mosGCTLs directly interacted with dengue virus in vitro and in vivo. The combination of antisera against multiple mosGCTLs efficiently reduced DENV-2 infection after a blood meal, suggesting that it is feasible to develop a mosGCTL-based transmission-blocking vaccine to interrupt the life cycle of dengue virus and control disease burden in nature. This study substantially extends our understanding of dengue replication in vectors and provides a research avenue by which the development of therapeutics for preventing the dissemination of mosquito-borne viral diseases can be pursued in the future.
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Affiliation(s)
- Yang Liu
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Fuchun Zhang
- Guangzhou 8th People's Hospital, Guangzhou, People's Republic of China
| | - Jianying Liu
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Xiaoping Xiao
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Siyin Zhang
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Chengfeng Qin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China
| | - Ye Xiang
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Penghua Wang
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Gong Cheng
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, People's Republic of China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
- * E-mail:
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Li W, Yi L, Su J, Lu J, Ke C, Zeng H, Guan D, Ma C, Zhang W, Xiao H, Li H, Lin J, Zhang Y. Seroprevalence of human enterovirus 71 and coxsackievirus A16 in Guangdong, China, in pre- and post-2010 HFMD epidemic period. PLoS One 2013; 8:e80515. [PMID: 24324604 PMCID: PMC3850913 DOI: 10.1371/journal.pone.0080515] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/04/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human Enterovirus 71 and Coxsackie A16 have caused many outbreaks in the last decade in mainland China, resulting in thousands of fatal cases. Seroepidemiology which provides important information to document population immunity is rare in China. METHODOLOGY/PRINCIPAL FINDINGS A cross sectional study of Enterovirus 71 (EV71) and Coxsackie A16 (CA16) seroprevalence was carried out in Guangdong, China, pre- and post- the 2010 hand, foot and mouth disease (HFMD) epidemic period. The levels of EV71 and CA16 specific antibodies were evaluated by a microneutralization test and the geometric mean titer (GMT) was calculated and compared. Our results indicated frequent infection by EV71 and CA16 in Guangdong before the 2010 epidemic. Only EV71 neutralizing antibody but not CA16 seroprevalence was significantly increased after the 2010 HFMD epidemic. Children less than 3 years old especially those aged 2 years showed the lowest positive rates for EV71 and CA16 NA before epidemic and the most significantly increased EV71 seroprevalence after epidemic. CA16 GMT values declined after the 2010 epidemic. CONCLUSIONS These results indicate EV71 was the major pathogen of HFMD in Guangdong during the 2010 epidemic. The infection occurs largely in children less than 3 years, who should have first priority to receive an EV71 vaccine.
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Affiliation(s)
- Wei Li
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Lina Yi
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Juan Su
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Jing Lu
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Changwen Ke
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hanri Zeng
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Dawei Guan
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Cong Ma
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Wanly Zhang
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hong Xiao
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hui Li
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Jinyan Lin
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Yonghui Zhang
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
- * E-mail:
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Immunogenicity, safety, and lot consistency of a novel inactivated enterovirus 71 vaccine in Chinese children aged 6 to 59 months. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 20:1805-11. [PMID: 24108780 DOI: 10.1128/cvi.00491-13] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The determination of lot-to-lot consistency in the manufacturing process is a mandatory step in the clinical development of the novel enterovirus 71 (EV71) vaccine. A phase III, randomized, placebo-controlled, double-blind trial assessed the lot consistency, immunogenicity, and safety of the EV71 vaccine in children aged 6 to 59 months. Healthy children (n = 1,400) received one of three lots of the EV71 vaccine containing 400 U of EV71 antigen or a placebo at days 0 and 28. Blood samples were collected before dose 1 and at 28 days after dose 2 (day 56) for an anti-EV71 neutralizing antibody (NTAb) assay. The geometric mean titer (GMT) and the seropositivity rates (with titers of ≥1:8) were compared at day 56. After each dose, the solicited injection site and general adverse events (AEs) were recorded for 7 days, and unsolicited AEs were recorded for 28 days. At day 56, the seropositivity rates ranged from 99.7% to 100% for the vaccine groups. The NTAb GMTs for the vaccine were 140.3 (95% confidence interval [CI], 117.8 to 167.1), 141.5 (95% CI, 118.0 to 169.6), and 146.6 (95% CI, 122.5 to 175.3). The two-sided 95% CI of the log difference in GMTs between the pairs of lots were between -0.176 and 0.176, therefore meeting the predefined equivalence criteria. The percentages of subjects reporting any injection site AEs, general AEs, or serious AEs were similar across the four vaccination groups. In conclusion, the demonstration of consistency between the manufacturing lots confirms for the purposes of clinical development the reliability of the EV71 vaccine production process. (This study has been registered at ClinicalTrials.gov under registration no. NCT01636245.).
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