1
|
Berzosa A, Guillen S, Epalza C, Escosa L, Navarro ML, Prieto LM, Sainz T, de Ory SJ, Montes M, Abad R, Vázquez JA, García IS, Ramos-Amador JT. Immunogenicity of the Conjugate Meningococcal ACWY-TT Vaccine in Children and Adolescents Living with HIV. Microorganisms 2023; 12:30. [PMID: 38257857 PMCID: PMC10818554 DOI: 10.3390/microorganisms12010030] [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: 11/20/2023] [Revised: 12/08/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Children and adolescents living with HIV (CALHIV) are at high risk of meningococcal infections and may present lower immune responses to vaccines. The objectives of this study were to assess the immunogenicity of the quadrivalent Men ACWY-TT vaccine (Nimenrix®) in CALHIV after a two-dose schedule and to describe possible HIV-related factors that may affect the immunogenic response. METHODS A multicenter prospective study was designed, including CALHIV followed in five hospitals in Madrid, between 2019 and 2021. Two doses of the Men ACWY-TT vaccine were administered. Serum bactericidal antibody (SBA) assays using rabbit complement (rSBA) against serogroups C, W, and Y were used to determine seroprotection and vaccine response (the proportion achieving a putative protective titer of ≥eight or a ≥four-fold rise in titer from baseline). Serum was collected at baseline, and at 3 and 12 months after vaccination. RESULTS There were 29 CALHIV included, 76% of whom were perinatally infected. All were receiving TAR and presented a good immunovirological and clinical status overall. At baseline, 45% of CALHIV had seroprotective titers to at least one serogroup, with individual seroprotection rates of 24%, 28%, and 32% against C, W, and Y, respectively. After a two-dose schedule, vaccine response was 83% for each serogroup, eliciting a vaccine response to all serogroups in 69% of them. One year after vaccination, 75% of CALHIV maintained seroprotective titers against the C serogroup, and 96% against W and Y. None of the HIV-related characteristics analyzed could predict vaccine response or antibody duration. CONCLUSIONS CALHIV who received effective TAR and presented a good immuno-virological situation achieved an appropriate vaccine response after two doses of the Men ACWY-TT vaccine, and antibody-mediated protection against serogroups C, W, and Y was maintained in more than 70% of the patients one year after vaccination.
Collapse
Affiliation(s)
- Arantxa Berzosa
- Pediatric Infectious Diseases Unit, Department of Paediatrics, Clínico San Carlos Hospital, 28040 Madrid, Spain
- Health Research Institute of the Clínico San Carlos Hospital (IdISSC), 28040 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
| | - Sara Guillen
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital de Getafe, 28905 Madrid, Spain
| | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (C.E.); (L.M.P.)
| | - Luis Escosa
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Department of Pediatrics, Infectious and Tropical Diseases, Pediatrics, La Paz University Hospital, 28046 Madrid, Spain
- Hospital La Paz Institute for Health Research (Idipaz), 28029 Madrid, Spain
| | - Maria Luisa Navarro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Department of Pediatrics and IISGM, Gregorio Marañón Hospital, 28007 Madrid, Spain
- Department of Pediatrics, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Luis M. Prieto
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (C.E.); (L.M.P.)
| | - Talía Sainz
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Department of Pediatrics, Infectious and Tropical Diseases, Pediatrics, La Paz University Hospital, 28046 Madrid, Spain
- Hospital La Paz Institute for Health Research (Idipaz), 28029 Madrid, Spain
- Department of Pediatrics, Universidad Autonoma de Madrid (UAM), 28029 Madrid, Spain
| | | | - Marina Montes
- Neisseria, Listeria and Bordetella Unit, Reference and Research Laboratory for Vaccine Preventable Bacterial Diseases, National Centre for Microbiology, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (R.A.); (J.A.V.)
| | - Raquel Abad
- Neisseria, Listeria and Bordetella Unit, Reference and Research Laboratory for Vaccine Preventable Bacterial Diseases, National Centre for Microbiology, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (R.A.); (J.A.V.)
| | - Julio A. Vázquez
- Neisseria, Listeria and Bordetella Unit, Reference and Research Laboratory for Vaccine Preventable Bacterial Diseases, National Centre for Microbiology, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.M.); (R.A.); (J.A.V.)
| | - Irene Serrano García
- Health Research Institute of the Clínico San Carlos Hospital (IdISSC), 28040 Madrid, Spain;
| | - José Tomás Ramos-Amador
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; (S.G.); (L.E.); (M.L.N.); (J.T.R.-A.)
- Department of Pediatrics, Universidad Autonoma de Madrid (UAM), 28029 Madrid, Spain
- Pediatric Infectious Diseases Unit, Head of Department of Pediatrics, Clínico San Carlos Hospital, 28040 Madrid, Spain
| |
Collapse
|
2
|
Affiliation(s)
- Hugo Soudeyns
- Centre de recherche du CHU Sainte-Justine
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Caroline Quach
- Centre de recherche du CHU Sainte-Justine
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
3
|
Duarte G, Muresan P, Ward S, Laimon L, Pelton SI, Canniff J, Golner A, Bone F, Newton L, Fenton T, Coutinho CM, João EC, Santos BR, Pilotto JH, Oliveira RH, Pinto JA, Machado ES, Kreitchman R, Chakhtoura N, Mussi-Pinhata MM, Weinberg A. Immunogenicity of conjugated and polysaccharide pneumococcal vaccines administered during pregnancy or postpartum to women with HIV. J Infect Dis 2021; 225:1021-1031. [PMID: 34791324 DOI: 10.1093/infdis/jiab567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pneumococcal vaccination is recommended in people with HIV prioritizing PCV. We compared the immunogenicity of PCV-10 and PPV-23 administered antepartum or postpartum. METHODS This double-blind study randomized 346 pregnant women with HIV on antiretrovirals to PCV-10, PPV-23, or placebo at 14-34 weeks gestational age. Women who received placebo antepartum were randomized at 24 weeks postpartum to PCV-10 or PPV-23. Antibodies against seven serotypes common to both vaccines and one serotype only in PPV-23 were measured by ELISA/chemiluminescence; B- and T-cell responses to serotype-1 by FLUOROSPOT; and plasma cytokines/chemokines by chemiluminescence. RESULTS Antibody responses were higher after postpartum versus antepartum vaccination. PCV-10 generated lower antibody levels than PPV-23 against four and higher against one of seven common serotypes. Additional factors associated with high post-vaccination antibody concentrations were high pre-vaccination antibody concentrations and CD4+ cells; low CD8+ cells and plasma HIV RNA; and several plasma cytokines/chemokines. Serotype-1 B- and T-cell memory did not increase after vaccination. CONCLUSIONS Antepartum immunization generated suboptimal antibody responses, suggesting that postpartum booster doses may be beneficial and warrant further studies. Considering that PCV-10 and PPV-23 had similar immunogenicity, but PPV-23 covered more serotypes, the use of PPV-23 may be prioritized in women with HIV on ART.
Collapse
Affiliation(s)
- Geraldo Duarte
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | | | - Shawn Ward
- Frontier Science Foundation, Brookline, MA, USA
| | | | | | - Jennifer Canniff
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | | | - Conrado M Coutinho
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Esau C João
- Hospital dos Servidores Estaduais, Rio de Janeiro, RJ, Brazil
| | - Breno R Santos
- Hospital Nossa Senhora da Conceicao, Porto Alegre, RGS, Brazil
| | - Jose H Pilotto
- Hospital Geral de Nova Iguaçu & Laboratório de AIDS e Imunologia Molecular - Fiocruz, Rio de Janeiro, Brazil
| | - Ricardo H Oliveira
- Instituto de Puericultura e Pediatra Matagão Gesteira, Rio de Janeiro, RJ, Brazil
| | - Jorge A Pinto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Elizabeth S Machado
- Instituto de Puericultura e Pediatra Matagão Gesteira, Rio de Janeiro, RJ, Brazil
| | | | - Nahida Chakhtoura
- Eunice Kennedy Shriver National Institute of Child Health & Human Development, Bethesda, MD, USA
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Adriana Weinberg
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | |
Collapse
|
4
|
Makenga G, Mtove G, Yin JK, Mziray A, Bwana VM, Kisinza W, Mjema J, Amos B, Antony L, Shingadia D, Oftadeh S, Booy R. Immunogenicity and Efficacy of Pneumococcal Conjugate Vaccine (Prevenar13 ®) in Preventing Acquisition of Carriage of Pneumococcal Vaccine Serotypes in Tanzanian Children With HIV/AIDS. Front Immunol 2021; 12:673392. [PMID: 34220819 PMCID: PMC8248180 DOI: 10.3389/fimmu.2021.673392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
In every year, up to one million children die due to pneumococcal disease. Children infected with Human Immunodeficiency Virus (HIV) are mostly affected, as they appear to have higher rates of pneumococcal carriage and invasive disease. Successful immunity is dependent on mounting a sufficient immune response to the vaccine. We conducted a double blinded crossover randomised controlled trial to determine the serum antibody response (≥4-fold and geometric mean concentration) to pneumococcal vaccine (PCV13) serotypes at 3 months after second vaccination. We also determined the number and proportion of children carrying new (not present at baseline) vaccine serotypes of S. pneumoniae isolated from nasopharynx at 6 months post initial vaccination in recipients of Prevenar13® compared with those given Haemophilus influenzae-type b (Hib) vaccine (control). The study was conducted at St Augustine's also known as Teule Hospital in Muheza, Tanga Tanzania. 225 HIV infected children aged 1-14 years were enrolled from Jan 2013 to Nov 2013 and randomised to Prevenar13® or Hib vaccines each given at baseline and 2-3 months later. Nasopharyngeal and serum samples were collected at baseline and 4-6 months later. Serotyping was done by Quellung Reaction using Staten antisera. Serum antibodies were ELISA quantified. The study revealed a non-significant reduction in the acquisition of new vaccine serotypes of S. pneumoniae in the recipients of PCV13 by nearly a third compared to those who received Hib vaccine. The vaccine efficacy was 30.5% (95% confidence interval [CI] -6.4-54.6%, P = 0.100)]. The antibody response was not enough to induce a 4-fold rise in GMC in 7 of the 13 vaccine serotypes. When combining the effects of preventing new acquisition and clearing existing vaccine type carriage, the overall efficacy was 31.5% (95% CI 1.5-52.4%, P = 0.045). In the PCV13 group, the proportion of participants carrying vaccine serotype was significantly lower after 2 doses of PCV13 (30%; 32/107), compared with the baseline proportion (48%; 51/107). The introduction of PCV13 targeting HIV-positive children in a setting similar to Tanzania is likely to be associated with appreciable decrease in the acquisition and carriage of pneumococci, which is an important marker of the likely effect of the vaccine on pneumococcal disease. Clinical Trial Registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335579, identifier ACTRN12610000999033.
Collapse
Affiliation(s)
- Geofrey Makenga
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - George Mtove
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - J. Kevin Yin
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance, University of Sydney, Sydney, NSW, Australia
| | - Abubakary Mziray
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - Veneranda M. Bwana
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - William Kisinza
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - Julius Mjema
- St Augustine’s, Hospitali Teule, Private Bag, Tanga, Tanzania
| | - Ben Amos
- St Augustine’s, Hospitali Teule, Private Bag, Tanga, Tanzania
| | - Laura Antony
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Delane Shingadia
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Shahin Oftadeh
- NSW and ACT Pneumococcal Reference Laboratory, Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Robert Booy
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
5
|
Jia S, Li J, Liu Y, Zhu F. Precision immunization: a new trend in human vaccination. Hum Vaccin Immunother 2020; 16:513-522. [PMID: 31545124 DOI: 10.1080/21645515.2019.1670123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vaccination has been one of the major revolutions in the history of human health. Vaccination programs have targeted entire populations such as infants or elderly subjects as a matter of being efficient with time and resources. These general populations are heterogeneous in terms of factors such as ethnicity, health status, and socio-economics. Thus, there have been variations in the safety and effectiveness profiles of certain vaccinations according to current population-wide strategies. As the concept of precision medicine has been raised in recent years, many researchers have suggested that vaccines could be administered more precisely in terms of particular target populations, vaccine formulations, regimens, and dosage levels. This review addresses the concept and framework of precision immunization, summarizes recent and representative clinical trials of among specific populations, mentions important factors to be addressed in customizing vaccinations, and provides suggestions on the establishment of precision immunization with the goal of maximizing the effectiveness of vaccines in general.
Collapse
Affiliation(s)
- Siyue Jia
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
| | - Jingxin Li
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
| | - Yuanbao Liu
- Expanded Program on Immunization Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China.,NHC Key laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
| | - Fengcai Zhu
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China.,NHC Key laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China
| |
Collapse
|
6
|
Nachman S. Influenza vaccine in pregnant women with HIV: are we there? Lancet HIV 2020; 7:e76-e77. [PMID: 31911144 DOI: 10.1016/s2352-3018(19)30328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Sharon Nachman
- Department of Pediatrics, Stony Brook University, New York, NY 11794-8111, USA.
| |
Collapse
|
7
|
Belmonti S, Rossetti B, Modica S, Paglicci L, Borghetti A, Ciccullo A, Picarelli C, Cauda R, De Luca A, Montagnani F, Lombardi F. Long-Term Serological Response to 13-Valent Pneumococcal Conjugate Vaccine Versus 23-Valent Polysaccharide Vaccine in HIV-Infected Adults. Infect Dis Ther 2019; 8:453-462. [PMID: 31364010 PMCID: PMC6702530 DOI: 10.1007/s40121-019-0256-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Long-term comparative immunologic response to 13-valent pneumococcal conjugate vaccine (PCV13) versus 23-valent polysaccharide vaccine (PPV23) among HIV-infected adults has not yet been investigated. METHODS In this prospective pilot study, we quantified in HIV-positive adults serotype-specific IgG concentrations of the 12 pneumococcal serotypes shared by both vaccines 5 years after vaccination with two doses of PCV13 8 weeks apart (group 1) or one dose of PPV23 (group 2) and compared them with those assessed prior to vaccination (BL) and after 1 year (T1). Comparison of immunogenicity was based on geometric mean concentration (GMC), proportion of individuals with ≥ twofold increase from BL in specific antibody concentration against ≥ 2 serotypes and percentage of individuals with serotype-specific IgG ≥ 0.35 μg/ml, ≥ 1 μg/ml and ≥ individual serotype-specific correlates of protection. RESULTS We included 91 subjects (median CD4+ 650 cells/µl, > 90% with HIV-RNA < 50 copies/ml); patients in groups 1 (n = 42) and 2 (n = 49) were homogeneous for the main characteristics. GMCs were significantly higher in the PCV13 group than in the PPV23 group for serotype 19F (p = 0.003). Both vaccines revealed higher significant GMCs to most serotypes compared with BL, i.e., eight in group 1 vs. seven in group 2. With respect to T1, GMCs decreased significantly in the PCV13 group for eight vs. ten serotypes in the PPV23 group. More participants in the PCV13 group had ≥ 2 increase from BL in antibody levels to ≥ 2 serotypes compared with the PPV23 group (78.6% vs. 59.2%, p = 0.042). Overall, the percentage of subjects with serotype-specific IgG ≥ 0.35 μg/ml, ≥ 1 μg/ml and ≥ individual serotype-specific correlates of protection was similar between groups. CONCLUSION In this study with HIV-positive adults with a favorable viro-immunologic profile, both vaccines were shown to achieve a long-term durable serologic response. We found minor differences in immunogenicity between the two vaccines, which favored PCV13 over PPV23 5 years after immunization. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02123433.
Collapse
Affiliation(s)
- Simone Belmonti
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Rossetti
- Hospital Department of Specialized and Internal Medicine, University Division of Infectious Diseases, Viale Bracci 16, 53100, Siena, Italy
| | - Sara Modica
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Lorenzo Paglicci
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Alberto Borghetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - Arturo Ciccullo
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Picarelli
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Cauda
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - Andrea De Luca
- Hospital Department of Specialized and Internal Medicine, University Division of Infectious Diseases, Viale Bracci 16, 53100, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Francesca Montagnani
- Hospital Department of Specialized and Internal Medicine, University Division of Infectious Diseases, Viale Bracci 16, 53100, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Francesca Lombardi
- Istituto di Clinica Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.
| |
Collapse
|
8
|
Hechter RC, Qian L, Tartof SY, Sy LS, Klein NP, Weintraub E, Mercado C, Naleway A, McLean HQ, Jacobsen SJ. Vaccine safety in HIV-infected adults within the Vaccine Safety Datalink Project. Vaccine 2019; 37:3296-3302. [PMID: 31064675 PMCID: PMC6538462 DOI: 10.1016/j.vaccine.2019.04.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We evaluate safety of routine vaccination among adults infected with human immunodeficiency virus (HIV) in five healthcare organizations in the United States. METHODS We conducted a retrospective cohort study of HIV-infected adults who received inactivated influenza vaccines, hepatitis B vaccines, pneumococcal vaccines, or tetanus, diphtheria, and acellular pertussis vaccines between 2002 and 2013. We conducted self-controlled case series analysis to estimate the relative risk (RR) for 11 pre-specified adverse events (AEs) requiring medical attention. RESULTS Among 20,417 HIV-infected adults (90.2% male), a total of 137,674 vaccine doses were administered. Based on ICD-9 codes, we detected an increased risk of cellulitis and infection (RR: 1.18, 95% CI: 1.03-1.35) among all patients, and an increased risk of stroke/cerebrovascular diseases among patients with an HIV viral load >10,000 copies/ml (adjusted RR: 3.94, 95% CI: 1.32-11.72). Further analyses on chart confirmed cases of stroke/cerebrovascular diseases indicated no statistically significant increased risk (adjusted RR: 1.72, 95% CI: 0.41-7.24). There was no evidence of increased risk for other AEs following routine vaccination in HIV-infected adults. CONCLUSIONS Routinely administered vaccines are generally safe for HIV-infected adults.
Collapse
Affiliation(s)
| | - Lei Qian
- Kaiser Permanente Southern California, USA.
| | | | - Lina S Sy
- Kaiser Permanente Southern California, USA.
| | | | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, USA.
| | | | | | | | | |
Collapse
|
9
|
Warshaw MG, Siberry GK, Williams P, Decker MD, Jean-Philippe P, Lujan-Zilbermann J. Immunogenicity of a Booster Dose of Quadrivalent Meningococcal Conjugate Vaccine in Previously Immunized HIV-Infected Children and Youth. J Pediatric Infect Dis Soc 2017; 6:e69-e74. [PMID: 28339668 PMCID: PMC5907864 DOI: 10.1093/jpids/piw094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/04/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The US Advisory Committee on Immunization Practices recommends a booster dose of quadrivalent meningococcal conjugate vaccine (MCV4) after initial immunization for patients at high risk for meningococcal infection. METHODS The International Maternal Pediatric Adolescents AIDS Clinical Trials (IMPAACT) P1065 trial evaluated the use of MCV4 in human immunodeficiency virus (HIV)-infected children and youth. The final step of this trial was an open-label study of an MCV4 booster dose 3.5 years after primary MCV4 immunization. Antibody titers were evaluated at the time of the booster vaccine and 1, 4, and 24 weeks after the booster. Immunogenicity was measured by rabbit serum bactericidal antibody (rSBA) against each meningococcal serogroup. Immunologic memory was defined as either seroprotection (rSBA titer ≥1:128) or a ≥4-fold increase 1 week after the booster dose. Primary response was defined as either a ≥4-fold response or seropositivity 4 weeks after the booster in the absence of immunologic memory. Adverse events were assessed for 4 weeks after the booster dose. RESULTS Of 174 participants with serology results at entry and 1 and 4 weeks later, the percentage with protective antibody levels at entry varied according to serogroup, ranging from a low of 26% for serogroup C to a high of 68% for serogroup A. A memory response to at least 1 serogroup occurred in 98% of the participants: 93% each for serogroups A and Y, 88% for serogroup C, and 94% for serogroup W-135; 83% had a memory response to all 4 serogroups. Overall, rates of any memory or primary response were ≥90% for all serogroups. No serious adverse events were encountered. CONCLUSIONS A booster dose of MCV4 elicited a memory response in 88% to 94% of previously immunized HIV-infected participants depending on serogroup, including those who lacked a protective titer level for that serogroup before booster vaccination.
Collapse
Affiliation(s)
- Meredith G Warshaw
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts;,Correspondence: M. G. Warshaw, Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB-547 Boston, MA 02115 ()
| | - George K Siberry
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Paige Williams
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Michael D Decker
- SanofiPasteur, Swiftwater, Pennsylvania;,Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Patrick Jean-Philippe
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jorge Lujan-Zilbermann
- Hill-Top Research, Inc., St. Petersburg, Florida; and,University of South Florida College of Medicine, Tampa, Florida
| |
Collapse
|
10
|
Jallow S, Madhi SA. Pneumococcal conjugate vaccine in HIV-infected and HIV-exposed, uninfected children. Expert Rev Vaccines 2017; 16:453-465. [PMID: 28351187 DOI: 10.1080/14760584.2017.1307740] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Incidence of invasive pneumococcal disease (IPD) among HIV-infected children is 20-40 fold greater compared to HIV-uninfected children, including among HIV-infected children on antiretroviral therapy (ART). Also, HIV-exposed, uninfected children have 2.7-fold greater risk of IPD compared to HIV-unexposed children. Areas covered: We reviewed studies identified on Pubmed database with the terms 'PCV' and 'HIV'; studies involving adults only were excluded. Expert commentary: While ART and pneumococcal conjugate vaccines (PCV) have reduced IPD morbidity and mortality in HIV-infected children, ART-naïve and immunosuppressed children have inferior immunogenicity to most PCV serotypes; highlighting the need for concomitant use of ART with PCV. Furthermore, studies to determine optimal PCV dosing schedules, timing and number of doses, are urgently required to ensure sustained vaccine efficacy in HIV-infected children.
Collapse
Affiliation(s)
- Sabelle Jallow
- a Respiratory and Meningeal Pathogens Unit, Faculty of Health Sciences , University of Witwatersrand , Johannesburg , South Africa.,b Centre for Vaccines and Immunology , National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg , South Africa
| | - Shabir A Madhi
- a Respiratory and Meningeal Pathogens Unit, Faculty of Health Sciences , University of Witwatersrand , Johannesburg , South Africa.,b Centre for Vaccines and Immunology , National Institute for Communicable Diseases of the National Health Laboratory Service , Johannesburg , South Africa
| |
Collapse
|
11
|
Rurangwa J, Rujeni N. Decline in Child Hospitalization and Mortality After the Introduction of the 7-Valent Pneumococcal Conjugative Vaccine in Rwanda. Am J Trop Med Hyg 2016; 95:680-2. [PMID: 27430538 PMCID: PMC5014278 DOI: 10.4269/ajtmh.15-0923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 05/19/2016] [Indexed: 01/12/2023] Open
Abstract
Pneumonia is a public health problem in the tropics, and the 7-valent pneumococcal conjugative vaccine (PCV-7) has been introduced in an effort to prevent the disease and therefore reduce childhood mortality. In Rwanda, PCV-7 was introduced in 2009, and we aimed to determine its impact on the rate of child hospitalization/mortality due to pneumonia. A retrospective survey was conducted on hospitalization rates and pediatric deaths between two periods, that is, before the introduction of PCV-7 (2007-2009) and after the introduction of PCV-7 (2010-2013) in Kabutare District Hospital. There was a 53% reduction in hospitalization, with a significant decline in in-hospital deaths between the two periods. There was also a significant correlation between vaccination coverage and decline in hospitalization rates between 2009 and 2013. We conclude that PCV-7 vaccine is associated with significant reduction in the rate of child hospitalization and mortality but more mechanistic studies are warranted to determine the immunological impact, especially in the context of coinfections and malnutrition.
Collapse
Affiliation(s)
- Janvier Rurangwa
- Department of Biology, College of Science and Technology, University of Rwanda, Kigali, Rwanda
| | - Nadine Rujeni
- Department of Biomedical Laboratory Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| |
Collapse
|
12
|
CD4/CD8 Ratio Predicts Yellow Fever Vaccine-Induced Antibody Titers in Virologically Suppressed HIV-Infected Patients. J Acquir Immune Defic Syndr 2016; 71:189-95. [PMID: 26361176 DOI: 10.1097/qai.0000000000000845] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Yellow fever vaccine (YFV) induces weaker immune responses in HIV-infected individuals. However, little is known about YFV responses among antiretroviral-treated patients and potential immunological predictors of YFV response in this population. METHODS We enrolled 34 antiretroviral therapy (ART)-treated HIV-infected and 58 HIV-uninfected adults who received a single YFV dose to evaluate antibody levels and predictors of immunity, focusing on CD4(+) T-cell count, CD4(+)/CD8(+) ratio, and Human Pegivirus (GBV-C) viremia. Participants with other immunosuppressive conditions were excluded. RESULTS Median time since YFV was nonsignificantly shorter in HIV-infected participants than in HIV-uninfected participants (42 and 69 months, respectively, P = 0.16). Mean neutralizing antibody (NAb) titers was lower in HIV-infected participants than HIV-uninfected participants (3.3 vs. 3.6 log10mIU/mL, P = 0.044), a difference that remained significant after adjustment for age, sex, and time since vaccination (P = 0.024). In HIV-infected participants, lower NAb titers were associated with longer time since YFV (rho: -0.38, P = 0.027) and lower CD4(+)/CD8(+) ratio (rho: 0.42, P = 0.014), but not CD4(+) T-cell count (P = 0.52). None of these factors were associated with NAb titers in HIV-uninfected participant. GBV-C viremia was not associated with difference in NAb titers overall or among HIV-infected participants. CONCLUSIONS ART-treated HIV-infected individuals seem to have impaired and/or less durable responses to YFV than HIV-uninfected individuals, which were associated with lower CD4(+)/CD8(+) ratio, but not with CD4(+) T-cell count. These results supports the notion that low CD4(+)/CD8(+) ratio, a marker linked to persistent immune activation, is a better indicator of functional immune disturbance than CD4(+) T-cell count in patients with successful ART.
Collapse
|
13
|
Lombardi F, Belmonti S, Fabbiani M, Morandi M, Rossetti B, Tordini G, Cauda R, De Luca A, Di Giambenedetto S, Montagnani F. Immunogenicity and Safety of the 13-Valent Pneumococcal Conjugate Vaccine versus the 23-Valent Polysaccharide Vaccine in Unvaccinated HIV-Infected Adults: A Pilot, Prospective Controlled Study. PLoS One 2016; 11:e0156523. [PMID: 27258647 PMCID: PMC4892598 DOI: 10.1371/journal.pone.0156523] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/16/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives Definition of the optimal pneumococcal vaccine strategy in HIV-infected adults is still under evaluation. We aimed to compare immunogenicity and safety of the 13-valent pneumococcal conjugate vaccine (PCV13) versus the 23-valent polysaccharide vaccine (PPSV23) in HIV-infected adults. Methods We performed a pilot, prospective controlled study enrolling HIV-infected pneumococcal vaccine-naïve outpatients, aged 18–65 years with CD4 counts ≥200 cells/μL. Eligible subjects were recruited into two parallel groups: group 1 (n = 50) received two doses of PCV13 eight weeks apart, and group 2 (n = 50) received one dose of PPSV23, as part of their standard of care. Anti-pneumococcal capsular polysaccharide immunoglobulin G concentrations were quantified by ELISA at baseline, 8, 24 and 48 weeks. Clinical and viro-immunological follow-up was performed at the same time points. Unvaccinated, age-matched HIV-negative adults (n = 100) were also enrolled as baseline controls. Results Pre-vaccination specific IgG titers for each pneumococcal antigen did not differ between study groups but they were constantly lower than those from the HIV-negative controls. After immunization, significant increases in IgG titers were observed in both study groups at each time point compared to baseline, but response to serotype 3 was blunted in group 1. Antibody titers for each antigen did not differ between study groups at week 48. Overall, the proportion of subjects achieving seroprotection and seroconversion to all serotypes was comparable between groups. A marked decrease in IgG levels over time was observed with both vaccines. No relevant adverse reactions were reported in either group. Conclusions In this population with favorable immune profile, no relevant differences were observed in immunogenicity between PCV13 and PPSV23. Both vaccines were safe and well tolerated. Trial Registration ClinicalTrials.gov NCT02123433
Collapse
Affiliation(s)
- Francesca Lombardi
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy
| | - Simone Belmonti
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy
| | - Massimiliano Fabbiani
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy
- Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Matteo Morandi
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, Siena, Italy
| | - Barbara Rossetti
- University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Viale Bracci 16, Siena, Italy
| | - Giacinta Tordini
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, Siena, Italy
| | - Roberto Cauda
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy
| | - Andrea De Luca
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, Siena, Italy
- University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Viale Bracci 16, Siena, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, Rome, Italy
| | - Francesca Montagnani
- Department of Medical Biotechnologies, University of Siena, Viale Bracci 16, Siena, Italy
- University Division of Infectious Diseases, Hospital Department of Specialized and Internal Medicine, Viale Bracci 16, Siena, Italy
- * E-mail:
| |
Collapse
|
14
|
Miller ER, Moro PL, Cano M, Lewis P, Bryant-Genevier M, Shimabukuro TT. Post-licensure safety surveillance of 23-valent pneumococcal polysaccharide vaccine in the Vaccine Adverse Event Reporting System (VAERS), 1990-2013. Vaccine 2016; 34:2841-6. [PMID: 27087150 PMCID: PMC6546117 DOI: 10.1016/j.vaccine.2016.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND 23-Valent pneumococcal polysaccharide vaccine, trade name Pneumovax(®)23 (PPSV23), has been used for decades in the Unites States and has an extensive clinical record. However, limited post-licensure safety assessment has been conducted. OBJECTIVE To analyze reports submitted to the Vaccine Adverse Event Reporting System (VAERS) following PPSV23 from 1990 to 2013 in order to characterize its safety profile. METHODS We searched the VAERS database for US reports following PPSV23 for persons vaccinated from 1990 to 2013. We assessed safety through: automated analysis of VAERS data, crude adverse event (AE) reporting rates based on PPSV23 doses distributed in the US market, clinical review of death reports and reports involving vaccine administered to pregnant women, and empirical Bayesian data mining to assess for disproportional reporting. RESULTS During the study period, VAERS received 25,168 PPSV23 reports; 92% were non-serious, 67% were in females and 86% were in adults aged ≥19 years. When PPSV23 was administered alone, fever (43%), injection site erythema (28%) and injection site pain (25%) were the most commonly reported non-serious AEs in children. Injection site erythema (32%), injection site pain (27%) and injection site swelling (23%) were the most commonly reported non-serious AEs in adults. Of serious reports (2129, 8% of total), fever was most commonly reported in both children (69%) and adults (39%). There were 66 reports of death, four in children and 62 in adults. Clinical review of death reports did not reveal any concerning patterns that would suggest a causal association with PPSV23. No disproportional reporting of unexpected AEs was observed in empirical Bayesian data mining. CONCLUSIONS We did not identify any new or unexpected safety concerns for PPSV23. The VAERS data are consistent with safety data from pre-licensure clinical trials and other post-licensure studies.
Collapse
Affiliation(s)
- Elaine R Miller
- Immunization Safety Office, Centers for Disease Control and Prevention, United States.
| | - Pedro L Moro
- Immunization Safety Office, Centers for Disease Control and Prevention, United States
| | - Maria Cano
- Immunization Safety Office, Centers for Disease Control and Prevention, United States
| | - Paige Lewis
- Immunization Safety Office, Centers for Disease Control and Prevention, United States
| | - Marthe Bryant-Genevier
- Center for Biologics Evaluation and Research, US Food and Drug Administration, United States
| | - Tom T Shimabukuro
- Immunization Safety Office, Centers for Disease Control and Prevention, United States
| |
Collapse
|
15
|
Abstract
INTRODUCTION A number of pneumococcal vaccines have long been available and have been used to reduce the medical, social, and economic problems associated with Streptococcus pneumoniae-related diseases. AREAS COVERED The main purpose of this review was to analyze what has been, until recently, the established doctrine regarding the safety and tolerability of pneumococcal vaccines that have been used in the past and are currently being used in children. EXPERT OPINION Pneumococcal vaccines available on the market are all safe and are highly recommended in clinical practice. In children, pneumococcal conjugate vaccines (PCVs) are considered the preparations of choice because of their enhanced immunogenicity and superior ability to impact nasopharyngeal carriage. All PCVs are considered safe because the incidence of severe adverse events (AEs) is marginal. Nonetheless, evidence has emerged from post-marketing surveillance regarding the occurrence of very rare but significant potential AEs following PCV administration. Therefore, post-marketing surveillance should be maintained to confirm the existence of these AEs. Over the next few years, other pneumococcal vaccines will be developed. When these new products are licensed and reach the market, new technologies and innovative epidemiological methods will permit a more rapid and more effective evaluation of AEs.
Collapse
Affiliation(s)
- Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| |
Collapse
|
16
|
Daniels CC, Rogers PD, Shelton CM. A Review of Pneumococcal Vaccines: Current Polysaccharide Vaccine Recommendations and Future Protein Antigens. J Pediatr Pharmacol Ther 2016; 21:27-35. [PMID: 26997927 PMCID: PMC4778694 DOI: 10.5863/1551-6776-21.1.27] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This review describes development of currently available pneumococcal vaccines, provides summary tables of current pneumococcal vaccine recommendations in children and adults, and describes new potential vaccine antigens in the pipeline. Streptococcus pneumoniae, the bacteria responsible for pneumonia, otitis media, meningitis and bacteremia, remains a cause of morbidity and mortality in both children and adults. Introductions of unconjugated and conjugated pneumococcal polysaccharide vaccines have each reduced the rate of pneumococcal infections caused by the organism S. pneumoniae. The first vaccine developed, the 23-valent pneumococcal polysaccharide vaccine (PPSV23), protected adults and children older than 2 years of age against invasive disease caused by the 23 capsular serotypes contained in the vaccine. Because PPSV23 did not elicit a protective immune response in children younger than 2 years of age, the 7-valent pneumococcal conjugate vaccine (PCV7) containing seven of the most common serotypes from PPSV23 in pediatric invasive disease was developed for use in children younger than 2 years of age. The last vaccine to be developed, the 13-valent pneumococcal conjugate vaccine (PCV13), contains the seven serotypes in PCV7, five additional serotypes from PPSV23, and a new serotype not contained in PPSV23 or PCV7. Serotype replacement with virulent strains that are not contained in the polysaccharide vaccines has been observed after vaccine implementation and stresses the need for continued research into novel vaccine antigens. We describe eight potential protein antigens that are in the pipeline for new pneumococcal vaccines.
Collapse
Affiliation(s)
- Calvin C. Daniels
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| | - P. David Rogers
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
- Center for Pediatric Pharmacokinetics and Therapeutics, Memphis, Tennessee
| | - Chasity M. Shelton
- Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
| |
Collapse
|
17
|
Eibl MM, Wolf HM. Vaccination in patients with primary immune deficiency, secondary immune deficiency and autoimmunity with immune regulatory abnormalities. Immunotherapy 2015; 7:1273-92. [PMID: 26289364 DOI: 10.2217/imt.15.74] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Vaccination has been an important healthcare measure in preventing infectious diseases. The response to vaccination is reduced in immunocompromised patients, primary immune deficiency (PID) and secondary immune deficiency (SID), but vaccination studies still demonstrated a protective effect resulting in reducing complications, hospitalization, treatment costs and even mortality. The primary physician and the specialist directing patient care are responsible for vaccination. Live vaccines are contraindicated in patients with severe immune impairment, killed vaccines are highly recommended in PID and SID. Criteria have been defined to distinguish high- or low-level immune impairment in the different disease entities among PID and SID patients. For patients who do not respond to diagnostic vaccination as characterized by antibody failure immunoglobulin replacement is the mainstay of therapy.
Collapse
Affiliation(s)
- Martha M Eibl
- Immunology Outpatient Clinic, Schwarzspanierstrasse 15,1090 Vienna, Austria
| | - Hermann M Wolf
- Immunology Outpatient Clinic, Schwarzspanierstrasse 15,1090 Vienna, Austria
| |
Collapse
|
18
|
Hofstetter AM, LaRussa P, Rosenthal SL. Vaccination of adolescents with chronic medical conditions: Special considerations and strategies for enhancing uptake. Hum Vaccin Immunother 2015; 11:2571-81. [PMID: 26212313 PMCID: PMC4685675 DOI: 10.1080/21645515.2015.1067350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/04/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022] Open
Abstract
Adolescents with chronic medical conditions (CMCs), a growing population worldwide, possess a wide array of preventive health care needs. Vaccination is strongly recommended for the vast majority of these adolescents given their increased risk of vaccine preventable infection and associated complications. Not only should they receive routine vaccines, but some also require additional vaccines. Despite these guidelines, evidence suggests that adolescents with CMCs often fail to receive needed vaccines. Many factors contribute to this under-immunization, including lack of knowledge among parents and providers and suboptimal coordination of primary and subspecialty care. This review describes current vaccination recommendations for these adolescents as well as recent data related to infection risk, vaccine efficacy and safety, vaccination coverage, and the unique multilevel factors impacting uptake in this population. It also discusses strategies for improving coverage levels and reducing missed vaccination opportunities, with a particular focus on technology-based interventions.
Collapse
Affiliation(s)
- Annika M Hofstetter
- Department of Pediatrics; University of Washington; Seattle, WA USA
- Center for Clinical and Translational Research; Seattle Children's Research Institute; Seattle, WA USA
| | - Philip LaRussa
- Department of Pediatrics; Columbia University Medical Center; New York, NY USA
- NewYork-Presbyterian Hospital; New York, NY USA
| | - Susan L Rosenthal
- Department of Pediatrics; Columbia University Medical Center; New York, NY USA
- NewYork-Presbyterian Hospital; New York, NY USA
- Department of Psychiatry; Columbia University Medical Center; New York, NY USA
| |
Collapse
|
19
|
Esposito S, Prada E, Lelii M, Castellazzi L. Immunization of children with secondary immunodeficiency. Hum Vaccin Immunother 2015; 11:2564-70. [PMID: 26176360 DOI: 10.1080/21645515.2015.1039208] [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] [Indexed: 01/04/2023] Open
Abstract
The main causes of secondary immunodeficiency at a pediatric age include infectious diseases (mainly HIV infection), malignancies, haematopoietic stem cell or solid organ transplantation and autoimmune diseases. Children with secondary immunodeficiency have an increased risk of severe infectious diseases that could be prevented by adequate vaccination coverage, but vaccines administration can be associated with reduced immune response and an increased risk of adverse reactions. The immunogenicity of inactivated and recombinant vaccines is comparable to that of healthy children at the moment of vaccination, but it undergoes a progressive decline over time, and in the absence of a booster, the patients remain at risk of developing vaccine-preventable infections. However, the administration of live attenuated viral vaccines is controversial because of the risk of the activation of vaccine viruses. A specific immunization program should be administered according to the clinical and immunological status of each of these conditions to ensure a sustained immune response without any risks to the patients' health.
Collapse
Affiliation(s)
- Susanna Esposito
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation ; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
| | - Elisabetta Prada
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation ; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
| | - Mara Lelii
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation ; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
| | - Luca Castellazzi
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation ; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
| |
Collapse
|
20
|
Zhang L, Li Z, Wan Z, Kilby A, Kilby JM, Jiang W. Humoral immune responses to Streptococcus pneumoniae in the setting of HIV-1 infection. Vaccine 2015; 33:4430-6. [PMID: 26141012 DOI: 10.1016/j.vaccine.2015.06.077] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/07/2015] [Accepted: 06/19/2015] [Indexed: 02/06/2023]
Abstract
Streptococcus pneumoniae (pneumococcus) remains one of the most commonly identified causes of bacterial infection in the general population, and the risk is 30-100 fold higher in HIV-infected individuals. Both innate and adaptive host immune responses to pneumococcal infection are important against pathogen invasion. Pneumococcal-specific IgA antibody (Ab) is key to control infection at the mucosal sites. Ab responses against pneumococcal infection by B cells can be generated through T cell-dependent or T cell-independent pathways. Depletion of CD4+ T cells is a hallmark of immunodeficiency in HIV infection and this defect also contributes to B cell dysfunction, which predisposes to infections such as the pneumococcus. Two pneumococcal vaccines have been demonstrated to have potential benefits for HIV-infected patients. One is a T cell dependent 13-valent pneumococcal conjugate vaccine (PCV13); the other is a T cell independent 23-valent pneumococcal polysaccharide vaccine (PPV23). However, many questions remain unknown regarding these two vaccines in the clinical setting in HIV disease. Here we review the latest research regarding B cell immune responses against pneumococcal antigens, whether derived from potentially invading pathogens or vaccinations, in the setting of HIV-1 infection.
Collapse
Affiliation(s)
- Lumin Zhang
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Zihai Li
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Zhuang Wan
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Andrew Kilby
- Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - J Michael Kilby
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, United States; Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Wei Jiang
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC 29425, United States; Division of Infectious Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
| |
Collapse
|
21
|
Fletcher MA, Balmer P, Bonnet E, Dartois N. PCVs in individuals at increased risk of pneumococcal disease: a literature review. Expert Rev Vaccines 2015; 14:975-1030. [DOI: 10.1586/14760584.2015.1037743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
22
|
Immunogenicity and safety of meningococcal C conjugate vaccine in children and adolescents infected and uninfected with HIV in Rio de Janeiro, Brazil. Pediatr Infect Dis J 2015; 34:e113-8. [PMID: 25876102 PMCID: PMC4454630 DOI: 10.1097/inf.0000000000000630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to evaluate the Meningococcal (Neisseria meningitidis) C conjugated (MCC) vaccine seroconversion and adverse events (AEs) in HIV-infected and HIV-uninfected children and adolescents in Rio de Janeiro, Brazil. METHODS HIV-infected or HIV-uninfected subjects, 2-18 years old, with CD4+ T-lymphocyte cell (CD4) percentage >15%, without active infection or antibiotic use, were enrolled. All patients were evaluated before and 1-2 months after immunization for seroconversion (defined as ≥4-fold titer increase in human serum bactericidal activity) and at 20 minutes, 3 and 7 days after immunization for AEs. Factors associated with seroconversion among HIV-infected group were studied. RESULTS Two hundred four subjects were enrolled: 154 HIV-infected and 50 HIV-uninfected. Median age was 12 years, and 53% were female. Among the HIV-infected group, 82 (53%) had a history of at least 1 C clinical category of Centers for Diseases Control and Prevention event, and 134 (87%) were using combination antiretroviral therapy. The median nadir CD4 percentage was 13% (0-47%). Seventy-six (37.3%) experienced mild AEs. Seroconversion occurred in 46 of 154 (30%) in the HIV-infected group and in 38 of 50 (76%) in the uninfected group (P < 0.01). Factors associated with seroconversion in the HIV-infected group were as follows: never had a C clinical category event [odds ratio (OR) = 2.1, 95% confidence interval (CI): 1.0-4.4]; undetectable viral load at immunization (OR: 2.4, 95% CI: 1.1-5.2) and higher CD4 nadir/100 cells (OR: 1.1, 95% CI: 1.0-1.2). CONCLUSION MCC vaccine should be administered to HIV-infected children and adolescents after maximum immunologic and virologic benefits have been achieved with combination antiretroviral therapy. Our data suggest that a single dose of MCC vaccine is insufficient for HIV-infected individuals 2-18 years of age.
Collapse
|
23
|
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) has transformed human immunodeficiency virus infection (HIV) into a chronic condition. The effects of long-term HAART on the immune system activity of early infected children are not fully understood. Hence, the aim of this review is to investigate immune system recovery and residual alteration in HIV-infected children receiving HAART in high-income countries. METHODS A systematic review was performed by searches of PubMed and references of the relevant articles. Studies published between January 1, 2000 and April 1, 2014 and conducted in high-income countries reporting data on immunological features in HIV-infected children receiving HAART were included in this review. RESULTS Fifty-three articles were included in this review. Present knowledge on B-cell and T-cell function, immunoglobulin production, response to vaccine and innate immune system activity in HIV-infected children receiving HAART is discussed. CONCLUSION Starting therapy as soon as diagnosis is ascertained and monitoring vaccine response in children under HAART are the most important tools to safeguard immunological function in HIV-infected children.
Collapse
|
24
|
Incidence of pneumococcal and varicella disease in HIV-infected children and adolescents in the United Kingdom and Ireland, 1996-2011. Pediatr Infect Dis J 2015; 34:149-54. [PMID: 25036047 DOI: 10.1097/inf.0000000000000476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To define the burden of hospitalization due to 2 vaccine-preventable infections, invasive pneumococcal disease (IPD) and varicella zoster (VZ), among HIV-infected children in the UK and Ireland. METHODS Analysis of hospitalizations of HIV-infected children <18 years receiving pediatric care and reported to the Collaborative HIV Paediatric Study (CHIPS) between 1996 and 2011. RESULTS Admissions for IPD and VZ combined accounted for ~5% of all hospital admissions for HIV-infected children each year. When compared with background rates for healthy children, the admission rate ratio for HIV-infected children on combination antiretroviral therapy (cART) was 16.7, 14.8 and 126.7 for IPD, varicella and herpes zoster, respectively, and 156.7, 86.1 and 470, respectively, for HIV-infected children not on cART. Those admitted with IPD or VZ were more likely to have Centers for Disease Control stage B/C at presentation with HIV than those without such admissions (36.8% for IPD, 29.7% for VZ and 22.1% for no IPD or VZ, P = 0.006), and were more likely to subsequently commence cART (94.7%, 91.3% and 80.2% respectively, P = 0.004). CONCLUSIONS There is a clear increased risk of admission with IPD or VZ in HIV-infected compared with uninfected children, magnified in those who have not yet commenced cART. It is anticipated that the introduction of new guidelines will result in improved vaccine uptake and thereby reduce the burden of IPD and VZ disease. Subsequent evaluation will assess the impact of these guidelines.
Collapse
|
25
|
Serological response to 13-valent pneumococcal conjugate vaccine in children and adolescents with perinatally acquired HIV infection. AIDS 2014; 28:2033-43. [PMID: 25222526 PMCID: PMC4166014 DOI: 10.1097/qad.0000000000000385] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Children with perinatally acquired HIV (paHIV) remain at an increased risk of pneumococcal infection despite highly active antiretroviral therapy (HAART). Beyond infancy, responses to pneumococcal conjugate vaccine (PCV) remain under-investigated. There are currently no published data on serological response to 13-valent PCV (PCV13) in the HIV-infected populations. Methods: We measured pneumococcal serotype-specific IgG in 48 paHIV-infected child patients (CP), 27 young adult healthy controls (AHC) and 30 child healthy controls (CHC). Opsonophagocytic assay (OPA) titres for three PCV13-exclusive serotypes were measured in a subset of children. Serotype-specific IgG was repeated 1 and 6 months following PCV13 vaccination of CP and AHC groups. OPA titres for four serotypes were measured at the 1-month time-point. Results: The majority of CP, CHC and AHC had serotype-specific IgG above 0.35 μg/ml at baseline, although OPA activity was undetectable for two of the three serotypes studied. Baseline IgG concentrations were significantly lower in CP than AHC for a proportion of serotypes and were strongly predictive of responses to vaccine. After adjusting for baseline, postvaccination IgG concentrations were comparable, although responses to some serotypes were impaired for CP. OPA correlated well with IgG after vaccination. Detectable HIV viral load was associated with significantly lower IgG concentration and OPA titre. Conclusion: Children with paHIV mount a robust serological response to PCV13 for most but not all vaccine serotypes. Viral load suppression with HAART and higher baseline IgG concentration are associated with higher postvaccination antibody levels. This has implications for HAART treatment and vaccination practices.
Collapse
|
26
|
Kernéis S, Launay O, Turbelin C, Batteux F, Hanslik T, Boëlle PY. Long-term immune responses to vaccination in HIV-infected patients: a systematic review and meta-analysis. Clin Infect Dis 2014; 58:1130-9. [PMID: 24415637 DOI: 10.1093/cid/cit937] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Vaccine-induced antibodies may wane more quickly in persons living with human immunodeficiency virus (HIV) than in healthy individuals. We reviewed the literature on vaccines routinely recommended in HIV-infected patients to estimate how seroprotection decreases over time in those who initially responded to immunization. For each study retrieved from the literature, the decrease of seroprotection was modeled with a log binomial generalized linear model, and data were pooled in a meta-analysis to provide estimates of seroprotection 2 and 5 years after the last vaccine administration. Our analyses confirmed that the duration of seroprotection was shorter in HIV-infected patients and that with current guidelines, a substantial proportion of patients would have lost protective antibodies before a booster was proposed. We therefore discuss the implications for the monitoring of antibody levels and timing of revaccination in these patients.
Collapse
|
27
|
Cordonnier C, Averbuch D, Maury S, Engelhard D. Pneumococcal immunization in immunocompromised hosts: where do we stand? Expert Rev Vaccines 2013; 13:59-74. [PMID: 24308578 DOI: 10.1586/14760584.2014.859990] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Immunocompromised patients are all at risk of invasive pneumococcal disease, of different degrees and timings. However, considerable progress in pneumococcal immunization over the last 30 years should benefit these patients. The 23-valent polysaccharide vaccine has been widely evaluated in these populations, but due to its low immunogenicity, its efficacy is sub-optimal, or even low. The principle of the conjugate vaccine is that, through the protein conjugation with the polysaccharide, the vaccine becomes more immunogenic, T-cell dependent, and thus providing a better early response and a boost effect. The 7-valent conjugate vaccine has been the first one to be evaluated in different immunocompromised populations. We review here the efficacy and safety of the different antipneumococcal vaccines in cancer, transplant and HIV-positive patients and propose a critical appraisal of the current guidelines.
Collapse
Affiliation(s)
- Catherine Cordonnier
- Hematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and Université Paris-Est-Créteil, Créteil 94000, France
| | | | | | | |
Collapse
|
28
|
Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2013; 58:e44-100. [PMID: 24311479 DOI: 10.1093/cid/cit684] [Citation(s) in RCA: 543] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
An international panel of experts prepared an evidenced-based guideline for vaccination of immunocompromised adults and children. These guidelines are intended for use by primary care and subspecialty providers who care for immunocompromised patients. Evidence was often limited. Areas that warrant future investigation are highlighted.
Collapse
Affiliation(s)
- Lorry G Rubin
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York of the North Shore-LIJ Health System, New Hyde Park
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
CD4+ T-cell activation impairs serogroup C Neisseria meningitis vaccine response in HIV-infected children. AIDS 2013; 27:2697-705. [PMID: 24149087 DOI: 10.1097/qad.0000000000000007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the influence of CD4 T-cell activation and regulatory populations in HIV-infected children antibody response to vaccination with a conjugate C polysaccharide vaccine. DESIGN CD4 T-cell activation was evaluated by expression of CD38, HLA-DR and CCR5 molecules. Regulatory CD4 T cells (TReg) were characterized as FoxP3CD127CD25 and inducer T cells (TInd) as CD4FoxP3CD25CD39. METHODS All patients (n = 36) were HIV-vertically infected, aged 2-17 years-old and were vaccinated with one vaccine injection. Blood samples were obtained before and after immunization to determine bactericidal antibody titers (SBA), CD4 T-cell activation and frequency of TReg and TInd subsets (multiparametric flow cytometry). RESULTS Children not-responding (n = 18) to MenC vaccine expressed higher frequency of activated CD4 T cells (HLA-DRCD38CCR5) than responders (n = 18), both before and after vaccination (P < 0.05). A significant higher frequency of TReg was detected in responders compared with nonresponders (P = 0.0001). We also detected an inverse correlation between CD4DRCD38CCR5 (P = 0.01) or CD4DRCD38 (P = 0.02) T cells and TReg cell frequency after vaccination. CD4 T-cell activation negatively correlated (P = 0.006) with postvaccination SBA titers but a positive correlation (P = 0.0001) was detected between TReg cells and SBA. TReg and TInd subsets were inversely correlated (P = 0.04). CONCLUSION Our findings suggest that higher CD4 T-cell activation leads to poor vaccine response in children living with HIV, which may be associated with a TReg/TInd disequilibrium.
Collapse
|
30
|
Antibody persistence and immunologic memory after sequential pneumococcal conjugate and polysaccharide vaccination in HIV-infected children on highly active antiretroviral therapy. Vaccine 2013; 31:4782-90. [PMID: 23954381 DOI: 10.1016/j.vaccine.2013.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/02/2013] [Accepted: 08/01/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The capacity of pneumococcal vaccination to confer memory in HIV-infected children is critical for durable protection. METHODS HIV-infected children 2-<19 years administered two doses of pneumococcal conjugate vaccine (PCV7) and one dose of polysaccharide vaccine (PPV) on HAART were randomized 4-5 years later to receive a PCV7 or PPV booster. Total and high avidity antibodies to serotypes 1 (PPV) and 6B and 14 (PCV7 and PPV) were determined by ELISA. Memory was defined as persistence of ≥ 0.5 mcg/mL of serotype-specific antibody on day 0 or change from <0.5 mcg/mL to ≥ 0.5 mcg/mL between day 0 and week 1, or, ≥ 4-fold antibody rise between day 0 and week 1. RESULTS Prior to boosting, 4-5 years after the previous PCV7-PCV7-PPV series, geometric mean concentrations (GMCs) were 0.46 mcg/mL (serotype 1), 1.31 mcg/mL (serotype 6B), and 1.47 mcg/mL (serotype 14), with concentrations ≥ 0.5 mcg/mL in 41% (serotype 1) to 82% (serotypes 6B and 14). Memory based on antibody concentration ≥ 0.5 mcg/mL before or 1 week after boosting with PCV7 or PPV was demonstrated in 42-61% for serotype 1 and 87-94% for serotypes 6B and 14, with lower rates based on day 0 to week 1 ≥ 4-fold antibody rise (serotype 1, 3-13%; serotype 6B, 13-31%; serotype 14, 29-53%). Antibody concentrations post-boosting were greater following PCV7 than PPV for serotypes 6B and 14. Ratios of highly avid to total antibody pre- and post-boosting were 0.5-0.8. Predictors of memory included higher CD4% (nadir before HAART and at P1024 and P1061s entry), CD19% (at P1024 and P1061s entry), and antibody response after the PCV7-PCV7-PPV primary series and lower viral load (at P1024 and P1061s entry) and age. CONCLUSIONS Protective antibody concentrations, high avidity, and booster responses to PCV7 or PPV indicative of memory were present 4-5 years after PCV7-PCV7-PPV in HIV-infected children on HAART.
Collapse
|
31
|
Mitchell R, Trück J, Pollard AJ. Use of the 13-valent pneumococcal conjugate vaccine in children and adolescents aged 6 - 17 years. Expert Opin Biol Ther 2013; 13:1451-65. [PMID: 23889554 DOI: 10.1517/14712598.2013.824419] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The introduction of pneumococcal conjugate vaccines into infant immunization schedules has successfully reduced the incidence of pneumococcal disease caused by vaccine serotypes. Disease incidence is low in healthy 6 - 17-year-old children and young people; however, there are a number of clinical conditions that put individuals in this age group at increased risk. Expansion of the license of a 13-valent pneumococcal conjugate vaccine , PCV-13, to include the 6 - 17 age group has recently been approved by European and American regulatory bodies. AREAS COVERED Studies assessing the safety, immunogenicity, and efficacy of pneumococcal conjugate vaccines in both healthy and high-risk 6 - 17-year-old children and adolescents are covered and the potential impact of PCV-13 in these populations is discussed. The use of the 23-valent pneumococcal polysaccharide vaccine, PPV-23, in high-risk children and adolescents is also considered. EXPERT OPINION Expanding the use of PCV-13 to include high-risk children and adolescents aged 6 - 17 has the potential to prevent additional cases of disease; however, vaccination of this population may no longer be necessary when herd immunity to PCV-13 serotypes becomes fully established. Despite the broader serotype coverage of PPV-23, the benefits of this vaccine in high-risk populations are uncertain.
Collapse
Affiliation(s)
- Ruth Mitchell
- University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine (CCVTM), Churchill Hospital, Department of Paediatrics, Oxford Vaccine Group , Old Road, Headington, Oxford, OX3 7LE , UK +44 0 1865 857420 ; +44 0 1865 857420 ;
| | | | | |
Collapse
|
32
|
Watanabe D, Otani N, Suzuki S, Dohi H, Hirota K, Yonemoto H, Koizumi Y, Otera H, Yajima K, Nishida Y, Uehira T, Shima M, Shirasaka T, Okuno T. Evaluation of VZV-specific cell-mediated immunity in adults infected with HIV-1 by using a simple IFN-γ release assay. J Med Virol 2013; 85:1313-20. [DOI: 10.1002/jmv.23611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Dai Watanabe
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Naruhito Otani
- Department of Public Health; Hyogo College of Medicine; Osaka Japan
| | - Sachiko Suzuki
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Hiromi Dohi
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Kazuyuki Hirota
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Hitoshi Yonemoto
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Yusuke Koizumi
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Hiroshi Otera
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Keishiro Yajima
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Yasuharu Nishida
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Tomoko Uehira
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Masayuki Shima
- Department of Public Health; Hyogo College of Medicine; Osaka Japan
| | - Takuma Shirasaka
- AIDS Medical Center; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Toshiomi Okuno
- Department of Microbiology; Hyogo College of Medicine; Osaka Japan
| |
Collapse
|
33
|
Lu CL, Hung CC, Chuang YC, Liu WC, Su CT, Su YC, Chang SF, Chang SY, Chang SC. Serologic response to primary vaccination with 7-valent pneumococcal conjugate vaccine is better than with 23-valent pneumococcal polysaccharide vaccine in HIV-infected patients in the era of combination antiretroviral therapy. Hum Vaccin Immunother 2013; 9:398-404. [PMID: 23291936 DOI: 10.4161/hv.22836] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The objectives of this study were to compare the serologic responses at week 48 to primary vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV) vs. 7-valent pneumococcal conjugate vaccine (PCV); and to identify factors associated with serologic response in HIV-infected adult patients with access to combination antiretroviral therapy (cART). METHODS One hundred and four CD4-matched pairs of HIV-infected patients who underwent primary pneumococcal vaccination with 23-valent PPV or 7-valent PCV were enrolled for determinations of anti-capsular antibody responses against four serotypes (6B, 14, 19F and 23F) at baseline, 24 weeks and 48 weeks following vaccination. Significant antibody responses were defined as 2-fold or greater increase of antibody levels at week 48 compared with baseline. The logistic regression model was used to determine the factors associated with serologic response to at least one and two serotypes. RESULTS At week 48, patients who received PCV demonstrated a statistically significantly higher response rate to at least 2 serotypes than those who received PPV (37.5% vs. 20.2%, p = 0.006). In multivariate analysis, factors associated with significant antibody responses to at least one or two serotypes included receipt of PCV (adjusted odds ratio [AOR], 2.42 [95% CI, 1.23-4.78] and 3.58 [95% CI. 1.76-7.28], respectively), and undetectable plasma HIV RNA load (< 400 copies/ml) at vaccination (AOR, 1.47 [95% CI, 0.60-3.64] and 3.62 [95% CI, 1.11-11.81], respectively). CONCLUSIONS Primary vaccination with 7-valent PCV achieved a significantly better serologic responses to one or two out of the four serotypes studied at week 48 than with 23-valent PPV in HIV-infected patients in the cART era. Suppression of HIV replication when primary vaccination was administered was associated with better serologic responses.
Collapse
Affiliation(s)
- Ching-Lan Lu
- Department of Internal Medicine; National Taiwan University Hospital Hsin-Chu Branch; Hsin-Chu, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Moss WJ, Sutcliffe CG, Halsey NA. Vaccination of human immunodeficiency virus–infected persons. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
35
|
Cagigi A, Cotugno N, Giaquinto C, Nicolosi L, Bernardi S, Rossi P, Douagi I, Palma P. Immune reconstitution and vaccination outcome in HIV-1 infected children: present knowledge and future directions. Hum Vaccin Immunother 2012; 8:1784-94. [PMID: 22906931 PMCID: PMC3656066 DOI: 10.4161/hv.21827] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/07/2012] [Accepted: 08/14/2012] [Indexed: 01/09/2023] Open
Abstract
Current evidence on routine immunization of HIV-1 infected children point out the need for a special vaccine schedule in this population. However, optimal strategies for identifying individuals susceptible to infections, and then offering them sustained protection through appropriate immunization schedule, both in terms of timing and number of vaccine doses, still remain to be elucidated. Understanding the degree of immune recovery after HAART initiation is important in guiding administration of routine vaccination in HIV-1 infected children. Although quantitative measures (e.g., CD4+ T-cell counts and immunoglobulin levels) are frequently performed to evaluate immune parameters, these measures do not fully mirror functional immune recovery. Here, we will review the status of single mandatory and recommended vaccines for HIV-1 infected children in relation to immune recovery after HAART initiation with the aim of identifying new means to help design personalized vaccine schedules for this population.
Collapse
Affiliation(s)
- Alberto Cagigi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
| | - Nicola Cotugno
- Chair of Pediatrics; University of Rome “Tor Vergata”; Rome, Italy
| | | | - Luciana Nicolosi
- Department of Pediatric Medicine; Bambino Gesù Children’s Hospital; Rome, Italy
| | - Stefania Bernardi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
| | - Paolo Rossi
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
- Chair of Pediatrics; University of Rome “Tor Vergata”; Rome, Italy
| | - Iyadh Douagi
- Center for Hematology and Regenerative Medicine; Karolinska Institutet; Huddinge, Sweden
| | - Paolo Palma
- University Department of Pediatrics; DPUO; Unit of Immunology and Infectious Diseases; Children's Hospital Bambino Gesù; Rome, Italy
| |
Collapse
|
36
|
Lujan-Zilbermann J, Warshaw MG, Williams PL, Spector SA, Decker MD, Abzug MJ, Heckman B, Manzella A, Kabat B, Jean-Philippe P, Nachman S, Siberry GK. Immunogenicity and safety of 1 vs 2 doses of quadrivalent meningococcal conjugate vaccine in youth infected with human immunodeficiency virus. J Pediatr 2012; 161:676-81.e2. [PMID: 22622049 PMCID: PMC3434315 DOI: 10.1016/j.jpeds.2012.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 02/13/2012] [Accepted: 04/11/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the immunogenicity of 1 vs 2 doses of meningococcal polysaccharide conjugate vaccine (MCV4) in youth infected with human immunodeficiency virus (HIV). STUDY DESIGN P1065 was a phase I/II immunogenicity and safety trial of MCV4 in 324 youth infected with HIV performed at 27 sites of the International Maternal Pediatric Adolescent AIDS Clinical Trials Group network in the US. At entry subjects received 1 dose of MCV4. At 24 weeks, those with screening cluster of differentiation 4 (CD4)% ≥ 15 were randomized to receive a second dose or not, and all with screening CD4% <15 received a second dose. Immunogenicity was evaluated as the proportion of subjects with a ≥ 4-fold rise from entry in serum bactericidal antibody against each meningococcal serogroup (SG) at weeks 28 and 72. Logistic regression models adjusting for HIV disease severity were used to evaluate the effect of 1 vs 2 MCV4 doses among those with screening CD4% ≥ 15. RESULTS Subjects randomized to receive 2 vs 1 MCV4 dose had significantly higher response rates to all SGs at week 28 and to all except Neisseria meningitidis SG Y at week 72, with adjusted ORs of 2.5-5.6. In 31 subjects with screening CD4% <15 who received 2 MCV4 doses, response rates ranged from 22%-55% at week 28 and 6%-28% at week 72. CONCLUSION In youth infected with HIV with a CD4% ≥ 15, a second dose of MCV4 given 6 months after the initial dose significantly improves response rates at 28 and 72 weeks. Subjects with CD4% <15 at entry had lower response rates despite 2 doses of MCV4.
Collapse
Affiliation(s)
| | - Meredith G. Warshaw
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA
| | - Paige L. Williams
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA
| | - Stephen A. Spector
- University of California, San Diego, La Jolla, CA and Rady Children’s Hospital San Diego, CA
| | | | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - Barb Heckman
- Frontier Science and Technology Research Foundation, Amherst, NY
| | - Adam Manzella
- Frontier Science and Technology Research Foundation, Amherst, NY
| | - Bill Kabat
- Special Infectious Diseases Laboratory, Divisions of Infectious Disease and Pathology, The Children’s Memorial Hospital, Chicago, IL
| | - Patrick Jean-Philippe
- Contractor, Henry Jackson Foundation for the Advancement of Military Medicine-Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Sharon Nachman
- Department of Pediatrics, SUNY Stony Brook, Stony Brook, NY
| | - George K Siberry
- Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | |
Collapse
|
37
|
Abzug MJ, Qin M, Levin MJ, Fenton T, Beeler JA, Bellini WJ, Audet S, Sowers SB, Borkowsky W, Nachman SA, Pelton SI, Rosenblatt HM. Immunogenicity, immunologic memory, and safety following measles revaccination in HIV-infected children receiving highly active antiretroviral therapy. J Infect Dis 2012; 206:512-22. [PMID: 22693229 DOI: 10.1093/infdis/jis386] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Response rates and immunologic memory following measles vaccination are reduced in human immunodeficiency virus (HIV)-infected children in the absence of highly active antiretroviral therapy (HAART). METHODS HIV-infected children 2 to <19 years old receiving HAART and with HIV loads <30,000 copies/mL, CD4% ≥15, and ≥1 prior measles-mumps-rubella vaccination (MMR) were given another MMR. Measles antibody concentrations before and 8, 32, and 80 weeks postvaccination were determined by plaque reduction neutralization (PRN). A subset was given another MMR 4-5 years later, and PRN antibody was measured before and 7 and 28 days later. RESULTS At entry, 52% of 193 subjects were seroprotected (PRN ≥120 mIU/mL). Seroprotection increased to 89% 8 weeks postvaccination, and remained at 80% 80 weeks postvaccination. Of 65 subjects revaccinated 4-5 years later, 85% demonstrated memory based on seroprotection before or 7 days after vaccination. HIV load ≤400 copies/mL at initial study vaccination was associated with higher seroprotection rates, greater antibody concentrations, and memory. Grade 3 fever or fatigue occurred in 2% of subjects. CONCLUSIONS Measles revaccination induced high rates of seroprotection and memory in children receiving HAART. Both endpoints were associated with HIV viral load suppression. CLINICAL TRIALS REGISTRATION NCT00013871 (www.clinicaltrials.gov).
Collapse
Affiliation(s)
- Mark J Abzug
- Pediatric Infectious Diseases, Box B055, Children’s Hospital Colorado, 13123 East 16th Ave, Aurora, CO 80045, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Setzer B, Walker UA. Antiretroviral nucleoside analogues suppress antibody synthesis in human B-lymphocytes. Antivir Ther 2012; 17:729-35. [PMID: 22414568 DOI: 10.3851/imp2086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Some antiretroviral nucleoside reverse transcriptase inhibitors (NRTI) impair mitochondrial polymerase-γ and T-cell proliferation, possibly by pyrimidine depletion. We aimed to analyse NRTI effects on the content of mitochondrial DNA (mtDNA) and B-cells, and on their proliferation and antibody synthesis. METHODS Peripheral blood B-lymphocytes from six healthy individuals were stimulated in vitro with interleukin-4 and Staphylococcus aureus superantigen in the presence or absence of NRTI in concentrations equivalent to, or fivefold exceeding, human peak plasma levels. We also tested the effects of uridine, a pyrimidine precursor, which has antagonized NRTI toxicities in other models. RESULTS During 9 days of culture, B-lymphocyte proliferation and vitality were not affected by NRTI. Didanosine and stavudine, but not zidovudine, dose-dependently induced mtDNA depletion. All three NRTI significantly and dose-dependently impaired the synthesis of all immunoglobulin classes. The lymphocytotoxic effects of the thymidine analogues zidovudine and stavudine on B-lymphocytes were antagonized by the addition of uridine. CONCLUSIONS Didanosine, stavudine and zidovudine induce mitochondrial toxicity in human B-lymphocytes and impair the immunoglobulin synthesis in vitro, warranting further studies on their in vivo effects.
Collapse
Affiliation(s)
- Bernhard Setzer
- Department of Rheumatology and Clinical Immunology, Medizinische Universitätsklinik, Freiburg, Germany
| | | |
Collapse
|
40
|
Safety reporting in developing country vaccine clinical trials-a systematic review. Vaccine 2012; 30:3255-65. [PMID: 22406279 DOI: 10.1016/j.vaccine.2012.02.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/17/2012] [Accepted: 02/23/2012] [Indexed: 12/30/2022]
Abstract
With more vaccines becoming available worldwide, vaccine research is on the rise in developing countries. To gain a better understanding of safety reporting from vaccine clinical research in developing countries, we conducted a systematic review in Medline and Embase (1989-2011) of published randomized clinical trials (RCTs) reporting safety outcomes with ≥50% developing country participation (PROSPERO systematic review registration number: CRD42012002025). Developing country vaccine RCTs were analyzed with respect to the number of participants, age groups studied, inclusion of safety information, number of reported adverse events following immunization (AEFI), type and duration of safety follow-up, use of standardized AEFI case definitions, grading of AEFI severity, and the reporting of levels of diagnostic certainty for AEFI. The systematic search yielded a total number of 50 randomized vaccine clinical trials investigating 12 different vaccines, most commonly rotavirus and malaria vaccines. In these trials, 94,459 AEFI were reported from 446,908 participants receiving 735,920 vaccine doses. All 50 RCTs mentioned safety outcomes with 70% using definitions for at least one AEFI. The most commonly defined AEFI was fever (27), followed by local (16) and systemic reactions (14). Logistic regression analysis revealed a positive correlation between the implementation of a fever case definition and the reporting rate for fever as an AEFI (p=0.027). Overall, 16 different definitions for fever and 7 different definitions for erythema were applied. Predefined AEFI case definitions by the Brighton Collaboration were used in only two out of 50 RCTs. The search was limited to RCTs published in English or German and may be missing studies published locally. The reported systematic review suggests room for improvement with respect to the harmonization of safety reporting from developing country vaccine clinical trials and the implementation of standardized case definitions.
Collapse
|
41
|
Nunes MC, Madhi SA. Safety, immunogenicity and efficacy of pneumococcal conjugate vaccine in HIV-infected individuals. Hum Vaccin Immunother 2012; 8:161-73. [PMID: 22426374 PMCID: PMC3367711 DOI: 10.4161/hv.18432] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Streptococcus pneumoniae is the leading bacterial opportunistic infection in HIV-infected individuals. Anti-retroviral treatment (ART) of HIV-infected individuals reduces their risk of invasive pneumococcal disease (IPD), however, it remains 20- to 40-fold greater compared with age-matched general population. This review summarizes the available published data on the immunogenicity, safety and efficacy of pneumococcal polysaccharide-protein conjugate vaccines (PCV) in HIV-infected children and adults. Several studies have demonstrated that PCV are safe in the HIV-infected persons. Although PCV are immunogenic in HIV-infected infants, the antibodies produced are functionally impaired, there is possibly a lack or loss of anamnestic responses and immunity declines in later life However, quantitative and qualitative antibody responses to PCV in HIV-infected infants are enhanced when vaccination occurs whilst on ART, as well as if vaccination occurs when the CD4+ cell percentage is ≥ 25% and if the nadir CD4+ is > 15%. Although the efficacy of PCV was lower, the vaccine preventable burden of hospitalization for IPD and clinical pneumonia were 18-fold and 9-fold greater, respectively, in HIV-infected children compared with -uninfected children. In HIV-infected adults, PCV vaccination induces more durable and functional antibody responses in individuals on ART at the time of vaccination than in ART-naive adults, independently of baseline CD4+ cell count, although there does not appear to be much benefit from a second-dose of PCV. PCV has also been shown to reduce the risk of recurrent IPD by 74% in HIV-infected adults not on ART, albeit, also with subsequent decline in immunity and protection.
Collapse
Affiliation(s)
- Marta C Nunes
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases & Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | |
Collapse
|
42
|
Siberry GK, Warshaw MG, Williams PL, Spector SA, Decker MD, Jean-Philippe P, Yogev R, Heckman BE, Manzella A, Roa J, Nachman S, Lujan-Zilbermann J. Safety and immunogenicity of quadrivalent meningococcal conjugate vaccine in 2- to 10-year-old human immunodeficiency virus-infected children. Pediatr Infect Dis J 2012; 31:47-52. [PMID: 21987006 PMCID: PMC3252429 DOI: 10.1097/inf.0b013e318236c67b] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected children are at increased risk of meningococcal infection and poor response to quadrivalent meningococcal conjugate vaccine (MCV4), but MCV4 has not been studied in preadolescent HIV-infected children. METHODS The P1065 trial enrolled 2- to 10-year-old HIV-infected children with CD4 ≥ 25% to receive MCV4 at entry and at week 24. Rates of response (≥ 4-fold increase in rabbit serum bactericidal antibody) against each meningococcal serogroup (A, C, Y, W-135), geometric mean titers, and rates of seroprotection (rabbit serum bactericidal antibody titer ≥ 1:128) were determined from sera obtained at entry and weeks 4, 24, 28, and 72. Adverse events were assessed for 6 weeks after each MCV4 dose. RESULTS At entry, 47% of the 59 participants were male, 56% black, 31% Latino, median age was 6 years, 88% were receiving antiretroviral therapy, and 75% had viral load <400 copies/mL. There were no serious adverse events within 6 weeks after MCV4 doses; all vaccination reactions were mild. Response after a single MCV4 dose was high to serogroup A (92%) and W-135 (98%); responses improved after a second dose for serogroup C (43%-80%) (P < 0.0001) and Y (76%-84%) (P = 0.38). By week 72, seroprotection rates were 93%, 91%, 78%, and 46% for serogroups W-135, Y, A, and C, respectively. CONCLUSIONS Two doses of MCV4 were safe and immunogenic in 2- to 10-year-old HIV-infected children. The second dose increased the proportion of children who made a response to serogroup C. Seroprotection waned substantially for serogroups A and C within 1 year of last MCV4 dose.
Collapse
MESH Headings
- Antibodies, Bacterial/blood
- Antibodies, Bacterial/immunology
- Child
- Child, Preschool
- Diphtheria Toxoid/administration & dosage
- Diphtheria Toxoid/adverse effects
- Diphtheria Toxoid/immunology
- Female
- HIV Infections/immunology
- Humans
- Male
- Meningococcal Infections/prevention & control
- Meningococcal Vaccines/administration & dosage
- Meningococcal Vaccines/adverse effects
- Meningococcal Vaccines/immunology
- Neisseria meningitidis, Serogroup A/immunology
- Neisseria meningitidis, Serogroup C/immunology
- Neisseria meningitidis, Serogroup W-135/immunology
- Neisseria meningitidis, Serogroup Y/immunology
- Serotyping
- Serum Bactericidal Antibody Assay
- Treatment Outcome
- Vaccines, Conjugate/administration & dosage
- Vaccines, Conjugate/adverse effects
- Vaccines, Conjugate/immunology
Collapse
Affiliation(s)
- George K Siberry
- Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
In summary, immunizations in special populations require understanding the underlying disease and how it might affect the immune system's ability to mount an antibody response to vaccines or predispose certain patient populations to developing certain serious infections. There is still a great need for research on the optimal timing of vaccines after transplants, how to assess protection and development of a protective antibody response after immunization, and whether certain groups (eg, HIV) need to be revaccinated after a certain amount of time if their antibody levels decline. In addition, there are limited data on efficacy of the newer vaccines in these special patient populations, which also requires further investigation.
Collapse
Affiliation(s)
- Michael A Miller
- Department of Pediatric Infectious Diseases and Immunology, University of Florida, Jacksonville, 32209, USA
| | | |
Collapse
|
44
|
Abstract
Vaccinations are key to limiting the increased risk of severe infectious diseases in HIV-infected patients for whom the risk–benefit ratio has been re-evaluated. Vaccine safety and immunogenicity depend on both vaccine type and immune deficiency, while vaccine-induced immune activation promotes a transient increase in viral load. Vaccine immunogenicity is reduced and wanes more rapidly, strengthening the need for revaccination. While inactivated vaccines are safe, attenuated vaccines are theoretically contraindicated, but the risk of infectious diseases outweighs the risks of severe adverse events in endemic areas, where the majority of HIV-infected individuals live, thus allowing their use when immune deficiency is moderate. Immune reconstitution with HAART has improved vaccine immune response, highlighting the importance of global access to and early initiation of therapy.
Collapse
Affiliation(s)
- Nicole Le Corre
- INSERM, UMRS-945, Hôpital Pitié-Salpêtrière, Département d’Immunologie Cellulaire et Tissulaire F-75013, Paris, France
- UPMC Université Paris 06, UMRS-945, Hôpital Pitié Salpêtrière, Département d’Immunologie Cellulaire et Tissulaire F-75013, Paris, France
| | - Brigitte Autran
- Laboratoire d’immunologie cellulaire et tissulaire - INSERM U945, Batiment CERVI - 4ème étage, Groupe Hospitalier Pitié-Salpêtrière, 83, boulevard de l’hôpital, 75651 Paris Cedex 13, France
| |
Collapse
|
45
|
Abstract
To identify immunologic factors that modulate the risk of herpes zoster (HZ), we compared varicella-zoster virus (VZV)-specific and nonspecific T-cell subpopulations of 47 HIV-infected children before they developed HZ with those of 141 VZV-positive HZ-negative matched controls. Compared with controls, HZ cases had lower VZV-specific CD8(+) CD107a(+) cell percentages independently of CD4(+) percentages or HIV loads, suggesting that VZV-specific cytotoxic T cells are protective against HZ. In contrast, high nonspecific regulatory and activated T cells were associated with an increased risk of HZ.
Collapse
|
46
|
Frenck RW, Yeh S. The development of 13-valent pneumococcal conjugate vaccine and its possible use in adults. Expert Opin Biol Ther 2011; 12:63-77. [DOI: 10.1517/14712598.2012.636348] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
47
|
Thanee C, Pancharoen C, Likitnukul S, Luangwedchakarn V, Umrod P, Phasomsap C, Apornpong T, Chuanchareon T, Butterworth O, Puthanakit T. The immunogenicity and safety of pneumococcal conjugate vaccine in human immunodeficiency virus-infected Thai children. Vaccine 2011; 29:5886-91. [PMID: 21729732 DOI: 10.1016/j.vaccine.2011.06.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 06/16/2011] [Accepted: 06/18/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND HIV-infected children have high risk of invasive pneumococcal disease (IPD) despite receiving highly active antiretroviral therapy (HAART). This study aimed to determine the immunogenicity and safety of a 7-valent pneumococcal conjugate vaccine (PCV-7) in Thai HIV-infected children compared to HIV-exposed uninfected children. METHODS A prospective study was conducted among children 2 months to 9 years. The number of PCV-7 doses depended upon age and HIV status; 2-6 months of age: 3 doses; 7-23 months of age: 2 doses; HIV-infected child ≥24 months: 2 doses and HIV-exposed child ≥24 months: 1 dose. Serotype-specific pneumococcal IgG antibody concentrations were measured at baseline and 28 days after complete vaccination. The primary end point was the proportion of children who achieved serotype-specific IgG antibody concentration at a cut off level ≥0.35 μg/mL. Secondary end points were a 4-fold increase in serotype-specific IgG antibody, rates of adverse events and predictors for seroconversion among HIV-infected children. RESULTS Fifty-nine HIV-infected and 30 HIV-exposed children were enrolled. The median (IQR) age was 97 (67-111) and 61 months (51-73), respectively (p<0.001). Among HIV-infected children, current and nadir CD4 counts were 1,079 cell/mm(3) and 461 cell/mm(3), respectively. The proportion of children who achieved pneumococcal IgG ≥0.35 μg/mL was in the range of 85-98% in HIV-infected and 83-100% in HIV-exposed children depending on serotype. The lowest response was to serotype 6B in both groups. The 4-fold increase in serotype-specific IgG concentrations was similar between HIV-infected and HIV-exposed groups, except for serotype 9V (p=0.027). HIV-infected children who had a history of AIDS had a lower antibody response to serotype 23F (p=0.025). Seven (12%) HIV-infected children had a grade 3 local reaction. CONCLUSION PCV-7 is highly immunogenic and safe among HIV-infected children treated with HAART. The use of the pneumococcal conjugate vaccine among HIV-infected children is encouraged in order to prevent IPD.
Collapse
Affiliation(s)
- Chareeya Thanee
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Lazarus R, Clutterbuck E, Yu LM, Bowman J, Bateman EA, Diggle L, Angus B, Peto TE, Beverley PC, Mant D, Pollard AJ. A Randomized Study Comparing Combined Pneumococcal Conjugate and Polysaccharide Vaccination Schedules in Adults. Clin Infect Dis 2011; 52:736-42. [DOI: 10.1093/cid/cir003] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
49
|
Safety and immunogenicity of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine in HIV-infected children 7 to 12 years old. J Acquir Immune Defic Syndr 2010; 55:197-204. [PMID: 20574412 DOI: 10.1097/qai.0b013e3181de8d26] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quadrivalent human papillomavirus vaccine (QHPV) is > 95% effective in preventing infection with vaccine-type human papillomavirus. The safety and immunogenicity of QHPV are unknown in HIV-infected children. METHODS HIV-infected children (N = 126)-age > 7 to < 12 years, with a CD4% ≥ 15-and on stable antiretroviral therapy if CD4% was < 25-were blindly assigned to receive a dose of QHPV or placebo (3:1 ratio) at 0, 8, and 24 weeks. Adverse events were evaluated after each dose. Serum antibody against QHPV antigens was measured by a competitive Luminex immunoassay 1 month after the third QHPV dose. RESULTS The safety profile of QHPV was similar in the 2 study arms and to that previously reported for QHPV recipients. QHPV did not alter the CD4% or plasma HIV RNA. Seroconversion to all 4 antigens occurred in > 96% of QHPV recipients and in no placebo recipients. Geometric mean titer was > 27 to 262 times greater than the seropositivity cutoff value, depending on the antigen, but was 30%-50% lower against types 6 and 18 than those of age-similar historical controls. CONCLUSIONS QHPV was safe and immunogenic in this cohort of HIV-infected children. Efficacy trials are warranted.
Collapse
|
50
|
Sutcliffe CG, Moss WJ. Do children infected with HIV receiving HAART need to be revaccinated? THE LANCET. INFECTIOUS DISEASES 2010; 10:630-42. [DOI: 10.1016/s1473-3099(10)70116-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|