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Hampson K. Good news for travellers, but what do rabies vaccines say about global health? THE LANCET. INFECTIOUS DISEASES 2024; 24:119-121. [PMID: 37802091 DOI: 10.1016/s1473-3099(23)00499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 10/08/2023]
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Ravinetto R, Henriquez R, Srinivas PN, Bradley H, Coetzee R, Ochoa TJ, Semuto Ngabonziza JC, Mazarati JB, Van Damme W, van de Pas R, Vandaele N, Torreele E. Shaping the future of global access to safe, effective, appropriate and quality health products. BMJ Glob Health 2024; 9:e014425. [PMID: 38195155 PMCID: PMC10807033 DOI: 10.1136/bmjgh-2023-014425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Rodrigo Henriquez
- Maestría de Epidemiología y Salud Colectiva, Universidad Andina Simón Bolívar, Quito, Ecuador
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Hazel Bradley
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Renier Coetzee
- School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Theresa J Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jean Claude Semuto Ngabonziza
- Research, Innovation and Data Science Division, Rwanda Biomedical Center, Kigali, Rwanda
- Department of Clinical Biology, University of Rwanda, Kigali, Rwanda
| | | | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Els Torreele
- , Institute for Innovation and Public Purpose, University College London, London, UK
- Independent Researcher and Advisor, Geneva, Switzerland
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Damanet B, Costescu Strachinaru DI, Levêque A. Single visit rabies pre-exposure prophylaxis: A literature review. Travel Med Infect Dis 2023; 54:102612. [PMID: 37394127 DOI: 10.1016/j.tmaid.2023.102612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/22/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The current WHO-recommended rabies pre-exposure prophylaxis (PrEP) are two-visit vaccination schedules, but there are studies suggesting that single visit schedules might be sufficient to prime the immunity. METHODS A literature review was conducted to retrieve and summarize published data on single visit rabies PrEP. PubMed database was screened for articles published between January 1st, 2003 and December 31st, 2022. The bibliographies of the articles chosen to undergo full text review and of the current major WHO publications on rabies were searched to find additional references, regardless of publication date. The primary outcome was the percentage of subjects having received rabies PrEP on single visit schedules who achieved antibody levels ≥0.5 IU/mL one week after post-exposure prophylaxis (PEP), regardless of the PEP regimen. RESULTS 11 studies were selected for inclusion, totalling 935 subjects, of which 696 received a simulated PEP schedule. Of these 696, a serological test result on day 7 was available for 408 of them, and 406 subjects (99.51%) seroconverted after PEP without any difference regarding time delay between PrEP and PEP or the vaccination schedule used for PEP. CONCLUSION Single visit PrEP schedules seem to confer sufficient protection in most healthy individuals without immunocompromised status if a booster PEP is administered after a suspected rabies exposure. Further studies in real-life settings and in different age categories are needed to confirm this finding, which may increase the availability of vaccines and thus the accessibility of PrEP for vulnerable populations.
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Affiliation(s)
- Benjamin Damanet
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium; National Institute for Health and Disability Insurance, Brussels, Belgium.
| | | | - Alain Levêque
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Saffar F, Heinemann M, Heitkamp C, Stelzl DR, Ramharter M, Schunk M, Rothe C, Bühler S. Rabies post-exposure prophylaxis of international travellers - Results from two major German travel clinics. Travel Med Infect Dis 2023; 53:102573. [PMID: 37087082 DOI: 10.1016/j.tmaid.2023.102573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Travel to regions with rabies risk has increased. However, data on adequate rabies post exposure prophylaxis (PEP) abroad is scarce. The aim of this study was to assess the appropriateness of medical management following suspected rabies exposure (SRE) in international travellers. METHOD A cross-sectional questionnaire-based study in returning travellers with reported SRE who sought post-exposure medical care was conducted in two large German travel clinics. RESULTS The 75 included SRE cases had a median age of 34 years (range 26-43) and showed a female predominance (59%, 44/75). Most participants returned from Asia (47%, 34/72). About 28% had received pre-exposure prophylaxis (PrEP, ≥2 vaccine doses) (20/71). In 51% the animal was actively approached (34/67). All patients had category II/III exposure according to the World Health Organization (65% category III, 49/75). With 78% (52/67), most patients cleaned the wound after SRE; 36% (24/67) used water and soap. Only 57% (41/72) of participants sought medical care during their trip. Overall, 45% (33/74) received rabies vaccination abroad which corresponds to 80% out of those who sought healthcare (33/41). CONCLUSIONS Awareness for appropriate first aid and the urgency of seeking timely professional treatment including PEP after an SRE seems to be insufficient in German travellers. Travel practitioners need to educate travellers about rabies risk, prevention measures and the correct behaviour after SRE including adequate wound treatment and seeking immediate medical help for PEP. PrEP should be offered generously especially to travellers with high rabies-exposure risk and those visiting areas with limited healthcare access.
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Affiliation(s)
- Farah Saffar
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melina Heinemann
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian Heitkamp
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Robert Stelzl
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the LMU Munich, Germany
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the LMU Munich, Germany
| | - Silja Bühler
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Hygiene and Infectious Diseases, Institute for Hygiene and Environment, Hamburg, Germany; Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
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Gan H, Hou X, Wang Y, Xu G, Huang Z, Zhang T, Lin R, Xue M, Hu H, Liu M, Cheng ZJ, Zhu Z, Sun B. Global burden of rabies in 204 countries and territories, from 1990 to 2019: results from the Global Burden of Disease Study 2019. Int J Infect Dis 2023; 126:136-144. [PMID: 36343866 DOI: 10.1016/j.ijid.2022.10.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Rabies is an acute lethal infectious disease caused by a lyssavirus infection. In 2018, the World Health Organization proposed a global strategic plan to end human rabies deaths by 2030. However, systematic studies on the global rabies disease burden and epidemiological trends are scarce. METHODS We extracted the disease burden and epidemiological data of rabies worldwide in the preceding 30 years from the Global Burden of Disease Study 2019 and performed a comprehensive analysis. RESULTS In 2019, the incident cases of rabies worldwide were 14,075.51 (95% uncertainty interval: 6124.33-21,618.11), and the number of deaths was 13,743.44 (95% uncertainty interval: 6019.13-17,938.53), both of which were lower than that in 1990. With the improvement of the sociodemographic index, the incident cases, the number of deaths, age-standardized incidence rate, age-standardized incidence death rate, and disability-adjusted life years of rabies all showed downward trends. Adolescents and adults aged <50 years represented the majority of rabies cases worldwide. CONCLUSION The global disease burden of rabies has declined over the past 30 years. Furthermore, the disease burden of rabies was closely related to the sociodemographic index level.
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Affiliation(s)
- Hui Gan
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xiangqing Hou
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Yiming Wang
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Gaofeng Xu
- School of Artificial Intelligence Application, Shanghai Urban Construction Vocational College, Shanghai, China
| | - Zhifeng Huang
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Teng Zhang
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Runpei Lin
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Mingshan Xue
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China; Guangzhou Eighth Peoples Hospital, Guangzhou Medical University, Guangzhou, China
| | - Haisheng Hu
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Mingtao Liu
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zhangkai J Cheng
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
| | - Zheng Zhu
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, Department of Laboratory, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
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Royal A, John D, Bharti O, Tanwar R, Bhagat DK, Padmawati RS, Chaudhary V, Umapathi R, Bhadola P, Utarini A. A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India. Vaccines (Basel) 2022; 11:vaccines11010088. [PMID: 36679933 PMCID: PMC9866950 DOI: 10.3390/vaccines11010088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
Children contribute to one-half of the total painful rabies mortalities in India. The state-of-the-art rabies mortality averting strategies need exploration for the effective implementation of pre-exposure prophylaxis (PrEP) in India. This study reports on the economic evaluation of various PrEP and post-exposure prophylaxis (PEP) strategies to avert rabies mortalities in school-aged children in India. A decision tree model has been developed for children in the age group of 5-15 years to evaluate various PrEP + PEP and PEP only regimens. The 2-site intradermal regimen administered on day zero and seven was chosen as the intervention [PrEP (I)]. ICER was calculated from the quasi-societal and quasi-health systems' perspectives for the base case analysis, along with one-way sensitivity, and scenario analyses for each regimen. The incremental DALYs averted per million population with the implementation of PrEP (I) ranged between 451 and 85,069 in 2020. The ICER was reported in the range of USD 384-352/DALY averted (non-dominant) in comparison to PEP regimens from a quasi-societal perspective. PrEP (I) is reported to be 'very cost effective' in comparison with PEP regimens from the quasi-societal and quasi-health systems' perspectives and reduce deaths by up to 89.9%. This study concludes that the PrEP (I) regimen is a cost-effective and life-saving strategy to avert painful mortalities due to rabies in school-aged children in India.
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Affiliation(s)
- Abhishek Royal
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Denny John
- Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bengaluru 560054, India
| | - Omesh Bharti
- State Institute of Health and Family Welfare, Department of Health & Family Welfare, Government of Himachal Pradesh, Shimla 171009, India
| | - Ritesh Tanwar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal 462002, India
| | - Deepak Kumar Bhagat
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi 110067, India
| | - Retna Siwi Padmawati
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Vishal Chaudhary
- Department of Physics, Bhagini Nivedita College, University of Delhi, Delhi 110021, India
| | - Reddicherla Umapathi
- Department of Biological Sciences and Bioengineering, Inha University, Incheon 22212, Republic of Korea
| | - Pradeep Bhadola
- Centre for Theoretical Physics and Natural Philosophy, Mahidol University, Nakhonsawan Campus, Phayuha Khiri, NakhonSawan 60130, Thailand
- Correspondence:
| | - Adi Utarini
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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Kisaka S, Makumbi FE, Majalija S, Muwanga M, Thumbi SM. The potential for the double risk of rabies and antimicrobial resistance in a high rabies endemic setting: detection of antibiotic resistance in bacterial isolates from infected dog bite wounds in Uganda. Antimicrob Resist Infect Control 2022; 11:142. [PMID: 36372895 PMCID: PMC9655799 DOI: 10.1186/s13756-022-01181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/02/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Post-exposure treatment for dog bites in humans aims at alleviating the risk of rabies and promoting wound healing. Wound healing may be complicated by bacteria. This study identified the different bacteria and their antibiotic susceptibilities in infected dog bite wounds (DBWs) in Uganda. METHODS A cross-sectional study was conducted among 376 dog bite patients. Wound swabs from patients with infected DBWs were collected and inoculated into recommended media. They were cultured for both aerobic and anaerobic bacteria. All isolated bacteria were identified based on colony characteristics, gram stain, and standard biochemical tests. Molecular identification was performed for strains that were resistant to three or more antibiotics. Antibiotic susceptibility testing was conducted using the disc diffusion method following the modified Kirby-Bauer method. The data were analysed using Stata version 15 software. RESULTS Approximately half of the patients (52.9%, 199/376) presented with infected wounds. Majority of the swabs (84.4%, 168/199) were culture positive, and yielded a total of 768 isolates where about half (52.9%, 406/768) were gram positive bacteria, and about two-thirds (64.6%, 496/768) were recovered from category II wounds. Among the gram positive bacteria, 339 (83.5%) were aerobes where Staphylococcus aureus (103, 30.4%), Coagulase-negative staphylococci (68, 20.1%), and Corynebacterium spp (33, 9.7%) had the highest prevalence. For the 362 Gram negative isolates, 217 (59.9%) were aerobes and the commonest isolates were P. maltocida (64, 29.5%), Capnocytophaga canimorsus (36, 16.6%) and P. canis (26, 12.0%). Gram-positive isolates were resistant to metronidazole (93.6%), oxacillin (68.5%), ceftriaxone (14.6%) and amoxicillin/clavulanic acid (14.0%). Gram negative isolates were resistant to metronidazole (100%), ampicillin (30.7%), oxacillin (29.3%), and doxycycline (22.9%). Multidrug resistance was in 105 (29.0%) and 121/406 (29.8%) of the gram-negative and gram-positive isolates, respectively. All gram-positive isolates were susceptible to vancomycin and ciprofloxacin. CONCLUSIONS Infection rates of DBWs in Uganda are high and the dominant bacterial isolates are Staphylococcus aureus, Pasteurella spps, and Capnocytophaga canimorsus. Multidrug resistance to commonly used antibiotics is high. The recommendation in the Uganda Clinical Guidelines to use metronidazole in the management of DBWs should be reviewed. DBWs should be enlisted for routine antimicrobial resistance surveillance and rational use of antimicrobial agents should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya.
- School of Public Health, Makerere University, Kampala, Uganda.
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.
| | | | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Moses Muwanga
- Department of Medicine, Entebbe General Referral Hospital, Entebbe, Uganda
| | - S M Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- Rabies Free Africa, Washington State University, Pullman, USA
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, USA
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Jenkin D, Ritchie AJ, Aboagye J, Fedosyuk S, Thorley L, Provstgaad-Morys S, Sanders H, Bellamy D, Makinson R, Xiang ZQ, Bolam E, Tarrant R, Ramos Lopez F, Platt A, Poulton I, Green C, Ertl HCJ, Ewer KJ, Douglas AD. Safety and immunogenicity of a simian-adenovirus-vectored rabies vaccine: an open-label, non-randomised, dose-escalation, first-in-human, single-centre, phase 1 clinical trial. THE LANCET. MICROBE 2022; 3:e663-e671. [PMID: 35907430 PMCID: PMC7614839 DOI: 10.1016/s2666-5247(22)00126-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rabies kills around 60 000 people each year. ChAdOx2 RabG, a simian adenovirus-vectored rabies vaccine candidate, might have potential to provide low-cost single-dose pre-exposure rabies prophylaxis. This first-in-human study aimed to evaluate its safety and immunogenicity in healthy adults. METHODS We did a single-centre phase 1 study of ChAdOx2 RabG, administered as a single intramuscular dose, with non-randomised open-label dose escalation at the Centre for Clinical Vaccinology and Tropical Medicine, Oxford, UK. Healthy adults were sequentially allocated to groups receiving low (5 × 109 viral particles), middle (2·5 × 1010 viral particles), and high doses (5 x 1010 viral particles) of ChAdOx2 RabG and were followed up to day 56 after vaccination. The primary objective was to assess safety. The secondary objective was to assess immunogenicity with the internationally standardised rabies virus neutralising antibody assay. In an optional follow-up phase 1 year after enrolment, we measured antibody maintenance then administered a licensed rabies vaccine (to simulate post-exposure prophylaxis) and measured recall responses. The trial is registered with ClinicalTrials.gov, NCT04162600, and is now closed to new participants. FINDINGS Between Jan 2 and Oct 28, 2020, 12 adults received low (n=3), middle (n=3), and high doses (n=6) of ChAdOx2 RabG. Participants reported predominantly mild-to-moderate reactogenicity. There were no serious adverse events. Virus neutralising antibody concentrations exceeded the recognised correlate of protection (0·5 IU/mL) in three middle-dose recipients and six high-dose recipients within 56 days of vaccination (median 18·0 IU/mL). The median peak virus neutralising antibody concentrations within 56 days were 0·7 IU/mL (range 0·0-54·0 IU/mL) for the low-dose group, 18·0 IU/mL (0·7-18·0 IU/mL) for the middle-dose group, and 18·0 IU/mL (6·0-486·0 IU/mL) for the high-dose group. Nine participants returned for the additional follow-up after 1 year. Of these nine participants, virus neutralising antibody titres of more than 0·5 IU/mL were maintained in six of seven who had received middle-dose or high-dose ChAdOx2 RabG. Within 7 days of administration of the first dose of a licensed rabies vaccine, nine participants had virus neutralising antibody titres of more than 0·5 IU/mL. INTERPRETATION In this study, ChAdOx2 RabG showed an acceptable safety and tolerability profile and encouraging immunogenicity, supporting further clinical evaluation. FUNDING UK Medical Research Council and Engineering and Physical Sciences Research Council.
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Affiliation(s)
- Daniel Jenkin
- Jenner Institute, University of Oxford, Oxford, UK; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | | | | | | | - Luke Thorley
- Jenner Institute, University of Oxford, Oxford, UK
| | | | | | | | | | - Zhi Quan Xiang
- Wistar Institute of Anatomy & Biology, Philadelphia, PA, USA
| | - Emma Bolam
- Clinical Biomanufacturing Facility, University of Oxford, Oxford, UK
| | - Richard Tarrant
- Clinical Biomanufacturing Facility, University of Oxford, Oxford, UK
| | - Fernando Ramos Lopez
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Abigail Platt
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Ian Poulton
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Catherine Green
- Clinical Biomanufacturing Facility, University of Oxford, Oxford, UK
| | | | - Katie J Ewer
- Jenner Institute, University of Oxford, Oxford, UK
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One-week intramuscular or intradermal pre-exposure prophylaxis with human diploid cell vaccine or Vero cell rabies vaccine, followed by simulated post-exposure prophylaxis at one year: A phase III, open-label, randomized, controlled trial to assess immunogenicity and safety. Vaccine 2022; 40:5347-5355. [PMID: 35933278 DOI: 10.1016/j.vaccine.2022.07.037] [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: 03/23/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Shorter rabies pre-exposure prophylaxis (PrEP) regimens may offer improved convenience and feasibility over classic 3-week regimens, for example in regions with poor access to vaccines or for travelers to rabies-endemic regions. In this multicenter, open-label, controlled trial, 570 healthy participants aged 2-64 years were randomized to receive: 1-week PrEP (vaccination days [D]0 and 7; Group 1) or classic 3-week PrEP regimen (D0, D7, and D21; Group 2) with one 1.0 mL intramuscular [IM] dose of human diploid cell culture rabies vaccine (HDCV) at each visit; 1-week PrEP with two 0.1 mL intradermal (ID) HDCV doses at each visit (Group 3); or 1-week PrEP with one 0.5 mL IM dose (Group 4) or two 0.1 mL ID doses (Group 5) of Vero cell rabies vaccine (PVRV) at each visit. Participants received simulated post-exposure prophylactic (PEP) vaccination (two IM or ID doses of HDCV or PVRV three days apart) one year later. Rabies virus neutralizing antibody titers and seroconversion (titers ≥ 0.5 IU/mL) rates were assessed 14 days and up to 1 year post-PrEP, and pre- and post-PEP. Safety was assessed throughout the study. Seroconversion rates were high 14 days post-last PrEP injection (ranging from 96.7 % to 97.2 % across groups 1, 3-5; 1-week PrEP) and reached 100 % in Group 2 (3-week PrEP). Non-inferiority of Group 1 versus Group 2 in terms of seroconversion rates 14 days post-last PrEP injection (primary objective) was not demonstrated. After simulated PEP, all groups showed rapid and robust immune responses, with all but one participant achieving seroconversion (titers ≥ 0.5 IU/mL). There were no safety concerns, and the tolerability profiles of the vaccines were similar across the groups. A 1-week, IM or ID PrEP regimen with HDCV or PVRV provided efficacious priming, enabling rapid robust anamnestic responses to simulated PEP 1 year later across age groups. ClinicalTrials.gov number: NCT03700242. WHO Universal Trial Number (UTN): U1111-1183-5743.
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Van De Pas R, Widdowson MA, Ravinetto R, N Srinivas P, Ochoa TJ, Fofana TO, Van Damme W. COVID-19 vaccine equity: a health systems and policy perspective. Expert Rev Vaccines 2021; 21:25-36. [PMID: 34758678 PMCID: PMC8631691 DOI: 10.1080/14760584.2022.2004125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction The global COVID-19 vaccine rollout has highlighted inequities in the accessibility of countries to COVID-19 vaccines. Populations in low- and middle-income countries have found it difficult to have access to COVID-19 vaccines. Areas covered This perspective provides analyses on historical and contemporary policy trends of vaccine development and immunization programs, including the current COVID-19 vaccination drive, and governance challenges. Moreover, we also provide a comparative health system analysis of the COVID-19 vaccine deployment in some countries from different continents. It recommends that the international Access to COVID-19 Tools Accelerator (ACT-A) partnership requires a strong governance mechanism and urgent financial investment. Expert opinion All WHO member states should agree on technology transfer and voluntary license-sharing via a commonly governed technology access pool and supported by a just Intellectual Property regime. Contextualized, dynamic understandings and country-specific versions of health systems strengthening are needed to improve vaccine equity in a sustainable matter.
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Affiliation(s)
- Remco Van De Pas
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Theresa J Ochoa
- Instituto De Medicina Tropical Alexander Von Humboldt Universidad Peruana Cayetano Heredia (Upch) Av. Honorio Delgado 430, Perú
| | - Thierno Oumar Fofana
- African Center of Excellence for the Prevention and Control of Communicable Diseases (CEA-PCMT), University Gamal Abdel Nasser Dixinn, Conakry, Guinea
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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